Causes of Back Pain 

Most annular disc tears are caused by the natural aging process. Since the neck and back are responsible for bearing most of a person’s body weight, they are susceptible to a great deal of wear over time. In many patients with an annular tear, they experience acute back pain. Some symptoms may even extend into the legs. The pain is often worse when sitting compared to standing, and positions that load pressure on the disc (coughing, sneezing, forward bending, and lifting) tend to aggravate the symptoms. When noninvasive treatments fail to provide relief, lower back surgery can be considered. 

Many people with arthritis describe stiffness or localized aching at the involved area. People may have difficulty turning or bending their necks. In severe cases, arthritic changes may place pressure on a nerve root, pinching it and causing pain, sensation changes, or weakness.

With arthritis in the cervical spine (neck), conservative treatment is typically first-line care. Many modalities may be used to promote optimal spine health, improve mobility and strength and reduce pain. If conservative treatment isn’t enough to improve symptoms, back surgery may be suggested.

Bertolotti’s syndrome is an uncommon cause of low back pain, particularly focused along the waistline and slightly off to the side. It is often confused with sacroiliitis. Bertolotti’s syndrome is a diagnosis given to someone with symptomatic pain due to an inflamed transitional vertebra. Although it is a very rare cause of back pain, Bertolotti’s syndrome is a very treatable diagnosis. Back fusion surgery is often used to improve the symptoms of Bertolotti’s syndrome when conservative treatments don’t provide relief. 

Bone spurs in the back are an indication of increased forces on the joints of the spine. In response to this over time, the body remodels the bone. In many cases, bone spurs and other degenerative changes may be considered a normal process of aging. The presence of bone spurs alone does not necessarily mean that they are the actual cause of pain. The diagnosis of bone spurs can be easily made with X-rays.

If treatment is needed, it usually begins with conservative measures. If those don’t work and the bone spurs are significantly impacting your life, back surgery to remove the spurs is often necessary. 

Bursitis is a painful condition that affects small fluid-filled pads called bursae that act as cushions between bony projections and nearby tendons and muscles. Bursitis is inflammation of the bursa and can be acute or chronic.

Bursitis often occurs near joints that perform frequent repetitive motions, most commonly in the shoulders, hips, elbows, and knees. Bursitis can also occur in the back due to overuse or trauma. 

Degenerative disc disease in the back is a condition that involves the weakening of one or more vertebral discs, which normally act as a cushion between the vertebrae. The condition can develop as a natural part of the aging process but may also result from an injury to the back. When the disc degenerates, it begins to lose many of the properties that make it a good shock absorber. For some people, these tears can cause considerable pain and spasms.

Treatment usually begins with noninvasive options. If those don’t provide significant relief, back fusion surgery usually provides relief. 

A herniated disc in the back may occur when too much force is exerted on an otherwise healthy intervertebral disc. Heavy forces on the back may simply be too much for even a healthy disc to absorb.

A disc herniation, by definition, is the displacement of disc material beyond the normal confines of the disc space. The terms disc protrusion, disc bulge, disc herniation, ruptured disc, and slipped disc all mean the same thing and imply that disc material has left the normal disc space.

Treatment of a herniated disc depends on the severity of symptoms and if nerve damage is present. Most disc herniations improve in six weeks to three months from the initial injury.

If symptoms don’t improve, back surgery for the herniated disk is usually the next step.

Pain stemming from the facet joints is termed “facet syndrome.” This condition causes the facet joints to become inflamed and may cause pain, soreness, and stiffness. Patients often report increased pain with extension or after prolonged periods of inactivity like sitting or standing too long. Changing positions often improves the pain.

Facet syndrome pain may feel worse in the morning and improve after moving around as the day progresses. However, for those who work sitting all day with poor posture, they may experience pain throughout the day.

The lumbar spine has considerable motion and high compressive forces. Therefore, facet pain in these joints is quite common. Pain is usually felt directly over the affected joints, but it may also be felt in the buttocks, hips, groin, and back of the thighs, depending on which facet joint is injured.

Treatment usually begins with noninvasive and conservative options, but if those modalities don’t provide relief, lower back surgery is sometimes recommended. 

Myofascial pain syndrome in the neck and back is thought to be a form of muscle pain that may result from a single trauma to a muscle or from repetitive minor trauma over time. These painful trigger points in your low back develop in susceptible muscle tissues that are overworked for long periods.

Stress, poor sleep, and physical deconditioning have a significant effect on the worsening of symptoms. With spine-specialized physical therapy, symptoms of myofascial pain syndrome typically resolve.

Pain from inflammation of the sacroiliac joint is commonly called sacroiliitis. It is often felt as pain on one side of the lower back to the right or left of the midline where the joint is located. The inflamed joint often becomes dislocated.

When SI joint dysfunction is severe, pain can refer to the hip, groin, buttocks, and even down the back of the thigh. The pain may be worse with movements that stress that joint, such as standing up from a seated position, walking up an incline, elliptical exercise, prolonged sitting or walking, or twisting when rolling in bed at night.

Sacroiliac joint (SI) dysfunction or inflammation can mimic pain similar to degenerative hip disease, hip bursitis, lumbar disc herniation, or pinched nerves.

Treatments for SI joint dysfunction range from nonsurgical options to surgical solutions such as back fusion surgery.

Segmental spinal instability is a term used to describe a greater than normal range of motion ( hypermobility) between two vertebral segments. The condition often develops when a particular disc or facet joint degenerates to the point that it can no longer support the weight of the body through that segment of the spine.

Segmental instability in the spine presents as significant back pain or spasms caused by nerve irritation as a result of the irregular micro-movements. In addition, this pain may be accompanied by a “catch” or locking feeling of and sudden sharp pain. Most often, this happens mid-way through standing upright from a seated position.

After a consultation at Virginia Spine Institute, our providers might suggest back fusion surgery. 

A spinal fracture caused by trauma is a serious orthopedic injury. Fractures that occur as a result of a high-velocity accident most commonly injure the mid to low back. These injuries are most often due to motor vehicle accidents, a fall from height, or sporting accidents.

People can also develop spinal fractures unrelated to trauma. These fractures are usually due to weakened bones from osteoporosis, tumors, or other medical conditions. For people with low-energy fractures due to osteoporosis, the injuries are often called compression fractures.

Spinal fractures usually require back surgery, including back fusion surgery. 

Lumbar Spinal Stenosis refers to a narrowing of the spinal canal to a degree where the spinal cord or nerve roots may be compromised. Spinal stenosis may occur throughout the spine but is most common in the low back and the neck.

Symptoms depend on whether narrowing affects the spinal nerve roots, the spinal cord, or both. Spinal stenosis can cause patients to have symptoms in the arms or legs as well.

When spinal stenosis impacts the lumbar region and causes significant symptoms such as nerve damage or incontinence, lower back surgery is often necessary. 

Spondylolisthesis means that one lumbar vertebra slipped forward in relation to the vertebra below. Spondylolisthesis can be caused by several mechanisms. The two main causes are due to either a stress fracture in the vertebra or acquired degenerative changes in the facet joints. The condition is most commonly found in the lumbar spine.

If conservative treatments don’t provide relief, lower back surgery is a treatment option. 

Spondylolysis is a stress fracture or defect in the pars area of the spine, typically in the lumbar spine. It is a common reason for back pain for young athletes. It is important to diagnose in a young patient, so it can be treated appropriately for symptoms to resolve.

Spondylosis is a general term for degenerative arthritic changes of the cervical spine, or more simply, arthritis. While we generally think of arthritis as age-related, it can occur at any age. Heavy labor jobs, high-impact sports, and previous neck injuries may all contribute to accelerated arthritis.

There also appears to be a strong genetic component to arthritis, and we know that smoking quickly accelerates the degenerative process in the spine. Specific movements, including physical activity or prolonged positioning, may exacerbate the pain. Headaches may originate in the neck. Crepitus, or a grinding noise, may be heard with movement. Symptoms tend to improve with rest and are worst in the morning and at the end of the day.

Treatment options vary depending on the severity of your symptoms. Conservative options are usually first-line treatments. But if your symptoms don’t improve, back surgery may be suggested.