Spinal Pain

Spine pain, felt in the back or neck is common. Most pain is temporary, but it can reoccur. It’s often caused by a strained muscle or sprained ligament—perhaps from an activity you’re not used to, such as yard work, moving furniture, or sitting for a long time. Less often, pain comes from damage to part of your spine, or from a condition you were born with.

The pain may accompany other symptoms such as stiffness, numbness, or weakness in your arms and legs. Spine problems can even affect your bowels and bladder.

In addition to pain, symptoms of a spine condition may include:

• Numbness, tingling, “pins and needles”
• Bowel or bladder problems
• Stress or emotional issues
• Fever, chills, sweating
• Weakness, slow reflexes
• Dizziness, headaches
• Sexual dysfunction
• Unusual weight gain or loss

Your spine is made up of 33 vertebrae, discs, spinal cord and nerves, ligaments, and muscles. The spinal column is divided into four regions, and the vertebrae within each region are numbered.

The spinal column is divided into four regions:

• Cervical: Neck area
• Thoracic: Upper and mid back
• Lumbar: Lower back
• Sacral: Tailbone area

Spine pain can arise from several different conditions:

• Abnormal curvature. Your spine’s natural curves help balance your body. But if the curves become too pronounced—or if your spine develops a twist or an extra curve—it puts extra pressure on the vertebrae and discs.
• Fractures. Reasons for a spine fracture include an injury, repeated stress, or a condition like osteoporosis, which can make bones weak and brittle.
• Degenerated disc. Disc degeneration can result from normal aging or wear-and-tear, but it’s sometimes begun or sped up by injury, disease, or unusual stress. Degenerated discs can irritate the spinal nerves and cause instability. They can be painful.
• Bulging disc. If the outer wall of a spinal disc weakens, it may push out (bulge) toward the nerves. This can cause painful nerve irritation.
• Herniated disc. If the outer wall of a spinal disc tears (ruptures), the soft material inside the disc can squeeze out and press on nearby nerves. This can cause pain, numbness, or weakness in your legs or back.
• Instability. Spinal instability is when adjoining vertebrae slip back and forth, or have permanently shifted out of position.
• Stenosis. Stenosis is a narrowing of the spinal canal. Stenosis can press on the spinal cord and nerves and cause pain and other symptoms.
• Nerve Problems. This can cause pain, numbness, weakness, and other problems throughout your body.

If you experience any symptoms, mention them to your care team. Even if it seems unrelated to your spine or doesn’t bother you, it will help your providers get a more complete picture of your health.

Anyone can have back or neck pain. Still, some things increase your chance of having pain, for example:

• Getting older. The older you are, the more likely you are to have back or neck pain.
• Poor physical fitness. Lack of exercise and poor posture increase your risk of back pain.
• Being overweight. Extra weight puts extra stress on your spine.
• Your job or your hobby. A job or activity that requires you to lift, push, or pull can be risky. But desk work can also be hard on your back—especially if you don’t sit up straight or don’t get up very often.
• Smoking. Studies show that smokers have more back pain than non-smokers do.
• Previous injury. An injury you had months or years ago may put you at risk for back problems later on.
• Diseases. Arthritis, osteoporosis, and other diseases can increase your chance of having back pain.
• Family history and genetics. Some conditions run in families.

Your doctor may conduct a series of exams or test to understand your spine pain:

Physical exam

In a physical exam, your doctor will check your body and its movement. Below are some things your doctor may note.

• Weakness. Simple exercises can help test your strength.
• Range of motion. Your doctor may check your flexibility or watch you bend and twist.
• Tenderness. Your doctor may assess areas of soreness by touching parts of your body.
• Sensation and sensitivity. Your doctor may check to see that you can feel heat, cold, or a pin prick on parts of your body.
• Reflexes and motor skills. Your doctor may ask you to walk on your heels or toes, or do tests to check your body’s reactions.
• Shape, tone, and position of the spinal bones, muscles, and so on.

Lab tests

Sometimes back and neck symptoms can be caused—or made worse—by a systemic illness (an illness throughout your body, not just in your spine). To check for illness, your doctor may request a test of a sample of your blood or urine.

Imaging studies

There are several technologies that allow your spine team to take pictures of the inside of your body. Depending on what they need to see, they may suggest one of the imaging studies listed below.

• X-ray. Beams of low-dose radiation create pictures of tissues, bones, and organs on film.
• MRI. Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to create images. MRI is very useful for showing details of soft-tissue structures, like nerves, in and around your spine.
• CT scan. Computed tomography (CT) uses a computer and x-rays to create cross-section views (“slices”) of areas of the body. It’s especially useful for highlighting abnormal tissue and clearly showing bone detail.
• Bone density scan. This scan uses x-ray or ultrasound to measure the amount of bone in a particular area. It can detect and assess osteoporosis (thinning bones).
• Electrodiagnostic testing. The term “electrodiagnostic testing” covers a range of tests that measure electrical activity in nerves and muscles. Two common electrodiagnostic tests are the electromyogram (EMG) and the nerve conduction study (NCS). Results from these tests help your doctor assess nerve and muscle function and locate any damage.
• Other procedures. Other procedures—like spinal injections and discography—may also be useful in finding sources of back pain that may not show up in common imaging studies. Your care team will provide information on these procedures as needed.

Your care may include one or more of the treatments described below.

• Education and activity. Your care team can teach you what you can do on your own to relieve pain, regain strength, and increase flexibility. For example, they may advise you on proper body mechanics (how to sit, sleep, lift, and so on) or how to use ice and heat to ease inflammation. Much of this important education can help you prevent spine pain in the future—as well as treat it today.
• Oral medication (pills). Your doctor may prescribe medication to reduce inflammation, relax muscles, and ease pain. Take the medication exactly as your doctor or pharmacist advises—and let your doctor know about other medications, herbs, or supplements you take.
• Physical therapy. Physical therapy encompasses a variety of treatments to promote healing, relieve pain, build strength and flexibility, and help prevent future injuries. For example, your physical therapist may create and supervise a program of exercises and make suggestions to help improve body mechanics (how to sit, sleep, lift, and move). Other physical therapies include spinal manipulation (applying force to a spinal joint) and traction.
• Traction. Traction is a non-surgical method for decompressing the vertebrae. It’s done either manually by a specially trained provider, or mechanically with braces or devices that gently elongate the spine.
• Spinal injection. Your doctor may recommend a spinal injection to treat inflammation or ease pain. An injection can deliver medication directly to the source of your symptoms. Common injections include:
• Epidural steroid (cortisone) injections. Injections near specific nerves or directly into the epidural space (the area around the nerves within the spinal canal) can help diagnose and treat pain.
• Facet joint injections and nerve branch blocks. Injections in or near the facet joints can treat arthritic joint pain.
• Sacroiliac (SI) joint injections. Injections at the SI joint, where the spine and pelvis join, can diagnose and treat pain in that area.
• Trigger point injections. Injections into tight, irritated muscle areas (trigger points) may help the muscle relax and ease pain.
• Other non-surgical procedures. Other procedures—such as neurotomy and radiofrequency ablation—use heat, cold, chemicals, or radiofrequency energy to destroy nerves near a problem joint. This relieves symptoms by preventing pain signals from traveling to the brain. Additional treatments for chronic pain include spinal pumps and stimulators that are implanted under the skin. A pump can put medication directly into the spinal fluid at just the right place in your spine. A spinal stimulator delivers a small electric pulse on the surface of the spinal cord to help mask pain.
• Surgery. Most spine problems can be treated without surgery. In some cases, however, your spine care team may suggest surgery as a good option for relieving your symptoms. Surgical options include those listed below.
• Microdiscectomy. Removing part of a damaged spinal disc using microscopically enhanced techniques.
• Laminotomy, laminectomy (decompression). Cutting away part of a vertebra to open the spinal canal and relieve pressure on a nerve or the spinal cord.
• Spinal fusion. Joining (fusing) two vertebrae so that there’s no movement between them.
• Anterior Cervical Discectomy and Fusion (ACDF). Removing a disc in the neck (cervical) region of your spine and fusing the vertebrae above and below it.
• Vertebroplasty. Injecting special cement into a collapsed vertebra to stabilize and support the damaged bone.
• Kyphoplasty. Injecting a special balloon and cement into a collapsed vertebra. The balloon is inflated inside the vertebra to restore the original height of the bone, and the cement helps preserve this shape after the balloon is removed.
• Total disc replacement (arthroplasty). Removing an entire damaged spinal disc and replacing it with an artificial disc to help preserve motion between two vertebrae.