Back & Neck Pain

About ¾ of all people experience back pain at some point in their lives. It is one of the biggest reasons for disability and sick leave.

Low back and neck pains are very common. They have numerous causes, including compressed nerves; ruptured disks; back strain; injured muscles, joints, ligaments or bones; degenerative diseases and changes in the shape of the spine.

Other causes include osteoporosis, arthritis, scoliosis, repetitive motion, obesity, injury and stress.

Most problems are solved without surgery. Only 2 to 3 percent of all back pain is caused by a herniated disk, and only 1 percent of back pain is caused by a compressed nerve.

Influenza, sleeping habits, arthritis, a pinched nerve, an infection or, rarely, cancer, as well as other factors can also cause neck pain.

Symptoms

The symptoms vary depending on the source, with the following listed as some of the most common:

• Back strain – This is also known as mechanical or musculoskeletal pain. The pain could be caused by strain of the muscles or ligaments of the spine or by a degenerative disease of the joints between the bones of the spine or from another cause.
• Herniated disk – This means that a disk has bulged out from its proper place at the shock absorber between the vertebrae or bones of the spine. A herniated or ruptured disk may press on nearby nerves, causing severe pain.
• Sciatica – This is pain that travels into the buttocks, the back of the thigh and sometimes further down into the lower leg and foot. The nerve root of the sciatic nerve usually is irritated, often by degenerative disease or compression of a disk.
• Spinal stenosis – This means that the spinal canal has narrowed, typically in the lower back or neck. Pressure on the back nerves causes pain. It can cause numbness, pain and weakness in the legs, as well. The pain is worse when walking.
• Radiculopathy – This involves problems with nerve roots. Weakness may be a symptom or pain, numbness or tingling or a combination of those.

Other back pain symptoms may include swelling, stiffness and limited motion.

Diagnosis

Evaluation of back pain begins with a patient history and examinations that include motor and sensory function.

X-rays may be required and further studies, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, electromyography, myleography or diskography.

Treatment

Most people with back pain can recover without surgery. Treatment includes pain medications, anti-inflammatory drugs, steroid injections, applied heat or cold, rest, traction, support, massage and physical therapy.

Exercises to stretch and strengthen muscles can help prevent further problems. Walking and swimming are both good exercises for strengthening and protecting the spine. Losing weight and good posture also help.

If surgery is necessary, the disk may be removed or part of the spine may be fused. In addition, hardware may be used, such as rods, plates or screws. One procedure is a diskectomy, the removal of a herniated disk to relieve pressure on a nerve root.

Another procedure is called a laminectomy and is performed when the major problem appears to be spinal stenosis. Basically it involves the removal of the lamina to make more room for the nerves and allows the surgeon to remove bone spurs, as well.

If mechanical back pain is the problem, the solution may involve a spinal fusion – placing a bone graft between 2 or more vertebrae, causing the vertebrae to grow together, or fuse. Fusing them together reduces the mechanical back pain and pressure on the nerve root.

Research

A lot of research is focusing on degenerative disks because they are such a major problem, including the development of technology like artificial disks and fusions.

In addition, new surgical interventions are constantly developing with advances in techniques and materials. Researchers also are looking at symptom management and for alternatives to painkillers that may be addictive or have negative side effects. Certain antidepressants and anti-epileptic drugs have been found to help with pain.

Other alternatives that are being studied include relaxation training, hypnosis, biofeedback and behavior modification.

WFUBMC Approach

The Medical Center has a long and well-established multi-disciplinary program for diagnosing and treating back and neck problems.

Surgery is only one of many components that include extensive physical and occupational therapies, as well as a functional spine restoration program and a pain control program.

Departments that contribute to the multi-disciplinary program include Neurology, Neurosurgery, Anesthesiology, Physical and Occupational therapy and Psychology. Every component of spine-care management is available at the Medical Center.

Diagnostic tools include X-rays, computed tomography (CT) or magnetic resonance imaging (MRI) scans, electromyography, myleography or discography.

Medical Center research includes evaluation of instrumentations used in fusions, substances to spark fusions and development of artificial disks, as well as medication studies.

A very current topic in the research is the development of bone morphogenetic proteins (BMPs) that can create fusions. 

Request an appointment online today to receive more information about your personal health and learn how Wake Forest can help.