Back pain

23 December 2023

One in ten people in the world suffers from back pain. This condition leads to a decrease in the ability to work and greatly limits the usual way of life. In some cases, back pain can be a symptom of a serious illness, the treatment of which is more effective with early diagnosis. Therefore, if unpleasant symptoms appear in the back area, especially in the lower parts, it is recommended to consult a doctor. The specialist will establish an objective diagnosis and develop a specific treatment and rehabilitation plan.

Highly qualified doctors work in the modern clinic and care is provided in accordance with international standards. You can make an appointment by phone or online. Reception of specialists is organized at a time convenient for the patient.

About the disease

Back pain, and especially in the lower third, is one of the most common reasons why patients go to neurologists, surgeons, therapists and orthopedists. Job losses due to pathology of the musculoskeletal system occupy one of the main places, since, as a rule, the most active group of the population is affected - from 20 to 60 years old, and most often - from 25 to 45 years old.

The spinal column withstands a colossal mechanical load, but at the same time it is a complex anatomical formation in which the circulatory, supporting and spinal structures innervating the entire human body are closely intertwined. That is why changes in the spine, causing compression or irritation of the spinal elements, can manifest themselves as pathology of any internal organ (headache, vascular dystonia, hypertension, arrhythmia, sexual dysfunction, etc. ).

Types of back pain

Pain is an unpleasant sensory and emotional experience caused by existing or potential tissue damage. The duration of back pain can vary, so there are 3 types:

acute – lasts up to 6 weeks;
subacute – present for more than 6 weeks;
chronic - bothers a person for more than 3 months.

Taking into account the causes of pain in the back area, it can be specific or nonspecific. The most common pain encountered in clinical practice is nonspecific pain, which can occur at any age. This condition is characterized by the absence of a clear cause-and-effect relationship between the existing symptoms and the objective data of the examination (physical and instrumental). Prompt treatment can interrupt the painful impulse.

Doctors speak of specific back pain if one or more pathological processes are discovered during a comprehensive diagnostic search. In this case, the mechanisms leading to the development of pain syndrome can be:

compression of nervous structures;
inflammatory damage to the joints of the spine;
instability of different segments of the spine (the lumbar region suffers most often);
Damage to muscles and fascia.

Depending on the underlying cause, specific back pain is classified as follows:

discogenic – the cause lies in damage to the intervertebral disc;
radicular: caused by compression of the nerve roots emerging from the spinal cord through the intervertebral foramina;
myofascial: pain occurs due to damage to the muscles surrounding the spine and/or the connective tissue membranes that cover them;
articular: the pain is caused by facet-articular osteoarthritis.

Spontaneous back pain, which arises for no apparent reason, is a separate category.

Back pain symptoms

The disease can begin with acute pain in any part of the back, which intensifies with active movements and bending. But more often it all begins with a "tolerable" feeling of discomfort in the interscapular, lumbar and scapular zones. The discomfort intensifies at night, with weakness of the paravertebral muscles, or in the morning, as a result of poor sleeping conditions.

Depending on the mechanism of pain onset, it may be accompanied by other symptoms:

numbness in an arm or leg;
decreased muscle tone;
pathological sensitivity: tingling sensation, burning sensation, etc. ;
dysfunction of the pelvic organs: incontinence of urine, gas or stool, intimate disorders in men, etc.

Most common causes of back pain.

According to observations and retrospective studies, the most common causes of back pain in patients visiting a medical center are the following conditions:

herniated disc, stenosis (narrowing) of the spinal canal, various forms of osteochondrosis: degenerative damage to the intervertebral joints (spondyloarthrosis), increased mobility of the spinal segments (spinal instability) and slipping of the vertebrae (spondylolisthesis degenerative);
uncomplicated traumatic injuries of the spine;
pathological fractures of the vertebrae that occur against the background of osteoporosis (a minor external impact is enough to disrupt the integrity of the bone);
aggressive hemangioma: a tumor that originates in blood vessels and can compress nearby tissues;
Primary and metastatic tumors affecting the spine.

Diagnosis of back pain.

To identify possible causes of pain, doctors at the medical center conduct a complete examination of the patient. The diagnostic program is drawn up individually for each patient.

In addition to an objective neurological examination, the following diagnostic procedures may be prescribed:

Computed tomography of the spine. In the clinic, the examination is performed using a high-precision device that makes 128 sections of the anatomical area. This makes it possible to detect various anomalies in the structure of the spine, incl. in the initial stage of development. CT is informative in identifying developmental anomalies and degenerative-dystrophic lesions in the vertebrae, foci of inflammation, bone tumors, fractures and displacements of the vertebrae, narrowing of the spinal canal, hemorrhages in the spinal cord, which are associated with rupture of the system arteriovenous. malformation.
Computer densitometry of the spine. The study allows objective measurement of bone mineral density, which is important for the early diagnosis of latent osteoporosis. The sooner this condition is detected, the sooner your doctor can prescribe treatment to strengthen your bones.
MRI of the spine. Most professional centers have a modern tomograph that generates a magnetic field of 1. 5 Tesla, which allows obtaining detailed, high-precision images. MRI can detect not only bone pathologies, but also soft tissue injuries. The method is informative in detecting various forms of osteochondrosis (intervertebral hernias and protrusions, arthrosis of the joints), injuries and deformities of the spine, vascular anomalies, inflammatory diseases of the spinal cord, tumors of variable density, etc.
X-ray of the spine. A robotic 3D X-ray complex allows you to examine multiple parts of the spine in a single procedure, while computer software performs digital "stitching" of the images. This greatly increases the diagnostic value of the method. The clinic is equipped with computers and highly functional MRI scanners, which allow patients to be examined even with heavy weight (up to 200 kg).

The diagnostic program for patients with back pain also includes laboratory tests. They allow you to take a comprehensive approach to evaluating the clinical situation and selecting the most optimal solution to the problem.

Expert opinion

Back pain is common in people over 60 and many people attribute it to "age", deliberately depriving themselves of the pleasure of active movement. Meanwhile, the problem can arise at any age. Late diagnosis, as well as inadequate treatment, often prolong the disease for many months, forcing patients to be referred to establish a disability group, and premature surgical treatment often permanently disables patients. The number of people with disabilities due to the so-called spinal osteochondrosis has reached alarming proportions.

Which doctor should I go to if I have back pain?

General practitioners deal with general back pain problems. If highly specialized treatment is necessary, the patient is referred to a neurologist and, if there are indications for surgical treatment, to a neurosurgeon.

Back pain treatment

Conservative treatment

Nonsteroidal anti-inflammatory drugs, corticosteroid therapy, and local anesthetic blocks may be used to relieve pain. As part of a comprehensive treatment, physical exercise, massages, physiotherapy, reflexology, etc. are useful.

The further nature of conservative treatment is determined by the cause of the pain syndrome. Thus, anti-inflammatory drugs are used for osteoarthritis, drugs that block the activity of cells that destroy bone tissue are used for osteoporosis, etc. Some pathologies initially require surgical intervention, because. . . Conservative measures a priori are ineffective.

Surgery

Surgical treatment of patients with back pain in the clinic can be carried out using different methods. In some cases a minimally invasive intervention is performed, in others traditional surgery is required.

Depending on the cause of back pain, doctors use several surgical options.

The main types of surgical care are as follows:

Nucleoplasty. In case of intervertebral protrusion or hernia, a puncture is performed in the projection of the affected disc. Using an electrode (cold plasma or radiofrequency method), the deformed part of the nucleus is "evaporated", which reduces the pressure on the nerve root. As a result, the pain disappears. Rehabilitation is short: approximately 2 weeks.
Microdiscectomy. This microsurgical operation is performed for a fairly large intervertebral hernia. After removing the prolapsed part of the nucleus pulposus, the pain syndrome is eliminated.
Radiofrequency denervation of the facet joints. The operation is indicated for back pain of myofascial origin and severe spondyloarthrosis. Under the influence of a high-frequency current, thermocoagulation of nerve endings occurs, irritation of which causes pain. This is a one-day minimally invasive operation with a short rehabilitation period (1-2 days).
Spine stabilization. A stabilizing structure is installed in the problem area, which firmly fixes the position of the vertebrae. Transpedicular fixation systems with screws, interbody cages, systems with laminar hooks and ventral plates can be used as stabilizers.
Spinal canal decompression. The surgeon removes fragments and compressive structures. If there is increased mobility of individual segments of the spine, additional stabilizing surgery may be performed.
Vertebroplasty. Sterile medical bone cement is injected into the diseased vertebra through a special needle. As a result, the stability and functionality of the spine is restored.

Back pain prevention

Preventive measures are relevant both for those people who have never experienced pain and for those who have already experienced unpleasant symptoms. Neurologists and orthopedists recommend:

regularly perform exercises aimed at strengthening the back muscles;
avoid physical inactivity;
keep body weight under control;
avoid lifting weights or do it correctly, without putting stress on the spine;
quickly treat and correct postural disorders, bone and joint diseases;
undergo periodic examinations and follow all doctor's recommendations.

Rehabilitation

The duration and characteristics of the rehabilitation period depend on the type of surgical intervention. After minimally invasive operations, it is recommended that the patient start walking during the first day; After more extensive operations, the patient becomes more active within a few days. Physical activity restriction can also range from 1-2 days to 1. 5 months. Your treating doctor will inform you about the details of the rehabilitation period.

It is important, after relieving acute pain and restoring tissue, to pay due attention to strengthening the muscular corset of the back. This will stabilize the spine and reduce stress on the vertebrae. A specialist must develop a series of physical exercises, taking into account the initial state of the musculoskeletal system.

Questions and answers

Why does my back hurt?

The causes of pain can be varied. In some cases, compression of the nerve roots occurs, in others, the muscles and fascia are damaged, in others, the intervertebral joints suffer. Sometimes the cause of pain is related to functional conditions.

What to do when your back hurts?

First of all, go to the doctor. As first aid, creams or gels based on non-steroidal anti-inflammatory drugs can be applied to the painful area.

Does surgery help me return to my normal lifestyle?

Before surgery, the patient is examined in detail to select the optimal surgical technique that will help break the "vicious circle. "In most cases, surgical treatment reliably relieves pain and restores spinal mobility.