by Paul Saiz, M.D.
Back pain is as common as it is enigmatic. An estimated 90% of the population will experience at least one episode of back pain with the vast majority of symptoms resolving within one month. However, for certain people, back pain can become chronic and disabling.
There are multiple causes of back pain. These include the muscles of the back, ligaments, nerves and the bony architechture of the spine to name a few. Unfortunately, the normal process of aging is responsible for the majority of changes in our spinal anatomy, some of which can cause pain. However, degenerative change is commonplace. In fact, a study was done on asymptomatic patients in their twenties and 30% were found to have some changes found by MRI. By the time people are fifty approximately 97% of the population will have degenerative changes found on MRI. While the process of aging cannot be stopped, its effects can be minimized.
Symptoms from degeneration manifest themselves usually as back pain and/or leg pain. These symptoms come from nerves that are being irritated as they exit the spine or spine anatomy that is wearing out and becomes painful when stressed.
The spine is very similar to a car. An automobile is a series of moving parts that allow the vehicle to move in space. The more miles you put on the car, the more likely the vehicle will have some component wear out (tires, shocks, etc.). Our spine is the same way. As we get older, the various moving parts of our anatomy degenerate (discs, facet joints). One of the first areas to begin to degenerate is the discs. The disc serves two functions: motion and shock absorption. As we get older, the disc will lose this ability and shrink in height and distribute more stress to other areas (bone and joints). This change in stress distribution will cause arthritic change to occur in our surrounding anatomy. This degenerative cascade will manifest itself as increased back pain and stiffness.
Nerve “pinching” or stenosis follows the same degenerative cascade. Nerves exit the central canal through holes in the spine called foramen. The foramen are bordered by disc, facet joints and ligaments. As the disc loses height and bulges, our facet joints are simultaneously becoming arthritic (enlarged from bone rubbing bone), the foramen becomes smaller and the exiting nerve becomes “pinched.” We notice this as leg pain.
Another common manifestation of age is the fact our bones lose their mineral content over time (osteoporosis). This is more commonly seen in post menopausal women but occurs in men with increasing age. Our vertebra (spine bones) are unique in that they are designed to absorb stress. The bony architecture is similar to the Greek Pantheon. The bone has columns which support the roof and floor. With time, as we lose mineral, our vertebra lose columns and the roof is more at risk of collapse. If the spine sees a significant stress, you are at risk of sustaining a compression fracture. These injuries are extremely painful and may take weeks to months to heal.
Patients with back pain secondary to degeneration usually respond to conservative treatments which include physical therapy (P.T.), anti-inflammatories (Ibuprofen) and steroid shots. P.T. is important to strengthen our trunk, neck and shoulder girdle musculature, which helps to minimize the wear and tear to which our spine is exposed. The increase in muscular endurance and strength from P.T. is similar to getting new shocks on the car. The speed bumps you encounter in life are not as significant. Anti-inflammatory medication helps break the pain cycle and minimizes the effects of the arthritic change. Steroid shots are used to decrease the irritability of the nerve roots.
If symptoms do not improve with conservative management then a surgical consultation may be needed. Surgical intervention should be viewed as a last resort and usually involves “altering” your anatomy to alleviate the pain source. This can be anywhere from a decompression (making the foramen bigger and relieving the “pinching” the nerve is experiencing) to a fusion (stopping moving parts which are causing pain from moving). There are new techniques which focus on minimizing the physical insult of surgery by using smaller incisions (minimally invasive surgery) to “Kyphoplasty.” Kyphoplasty involves using a balloon to expand a compression fracture and fill the bone with bone cement to stabilize the fracture. All these techniques involve fewer days in the hospital and more rapid recovery.
To conclude, conservative measures and surgery do not “turn back the odometer.” These treatments are attempting to improve quality of life and increase function. Everybody has some back discomfort and degeneration of the spine is a fact of life. Our goal at Las Cruces Orthopaedic Associates is to do whatever is needed to get your “car” running as efficiently as possible for the rest of your life.