This is a general overview of the issues involved in the evaluation and treatment of back pain. It is intended to help prepare you and your family to work with your doctor to make the best decisions in the event you suffer a work injury to your back.
WHAT CAUSES BACK PAIN AND RADIATING SYMPTOMS?
There are many conditions that cause back pain. Some of these are congenital. Most causes of back pain, however, result from injury or trauma. Common causes of back pain include muscle strain, bulging or herniated discs, degenerative disc disease, spinal stenosis, sciatica and joint inflammation.
The purpose of the spinal column is to support the muscles, discs, nerves and spine. The spine can be thought of as a stack of building blocks, with intervertebral discs in between each spine segment. The discs provide a cushion and permit flexibility in the spine, allowing room for the nerves to exit the spinal canal. The spinal cord branches into many nerves that go into the arms, hands, legs and feet. The spinal nerves exit the spinal cord very close to the intervertebral discs. This is why a herniated disc (i.e., a rupture of the jelly-like inner core of the disc) can cause a "pinched nerve" that produces symptoms in the arms, hands, legs and feet.
MEDICAL EVALUATION AND DIAGNOSTIC TESTS
Back injuries should be evaluated by a neurosurgeon or orthopedic surgeon. The initial visit will include a detailed history of prior back symptoms. If the back symptoms are due to trauma, it is important to tell the physician exactly how you injured your back. The examination will include a detailed musculoskeletal and neurosurgical evaluation to rule out soft tissue injury and arrive at a diagnosis and treatment plan. If pain persists, or radiating symptoms are present, it is particularly important to evaluate with diagnostic tests as follows:
- An x-ray is usually given to evaluate any boney abnormalities and degenerative lesions.
- A CT (or CAT scan) takes snap shots of cross sections of the spine.
- The mylegram, as opposed to an x-ray or CT, is an invasive test. A liquid dye is injected into the spinal canal, making internal structures visible on a fluoroscopic screen and x-ray film. The mylegram is used to diagnose disc problems.
- MRI gives an enhanced view of the discs in the back, as well as the nerves and other soft tissues. The MRI will identify bulging, herniated or ruptured discs, degenerative disc disease, tumors, fractures, and soft tissue lesions.
- The EMG/nerve conduction study is a noninvasive test used to determine whether you have a pinched nerve in your neck, back or extremities.
- Discography involves injecting dye into a spinal disc to determine whether there are any tears in the lining of the disc. This is done in a surgical center with x-ray guidance. Based on your symptoms, test results and MRI, your doctor will determine which disc(s) may be causing your back pain. In this manner, the physician uses discography for surgical planning.
In many instances back pain can be treated non-surgically. Non-surgical treatment includes rest, medications, physical therapy, exercise, weight loss and injections.
If a period of conservative therapy produces ineffective results and back pain interferes with day to day activities, then surgery may be an option. The type of operation a surgeon performs depends upon the nature of your back problems. Most procedures involve a laminectomy, which requires removal of the vertebral arch to gain access to the cause of the back pain. If the disc is ruptured, the surgeon will remove a portion of the degenerative disc material, especially those portions that press on a nerve root producing symptoms in the extremities. The surgeon may consider a second procedure - spinal fusion, if he or she feels that stabilization of the spine is necessary. Spinal fusion is performed by fusing the vertebrae together with bone grafts. Sometimes the bone grafts are combined with metal plates, or other types of instruments.
Certain herniated discs are suitable for treatment by microsurgery. Percutaneous discectomy involves repairing the disc through the skin without making a surgical incision.
If you are continuing to have back pain, it is important that you see a neurosurgeon or orthopedic surgeon for evaluation. Diagnostic testing can determine the cause of the back pain and can be used to plan treatment or surgery. There are many treatment options available to help you reduce your pain and be more functional.
Should you have any questions relative to this article, or if you sustained a work injury to your back, please call Hoey & Farina.