Watch Sciatica Causes and Symptoms Video. Symptoms of a lumbar herniated disc vary widely. Watch: Lumbar Herniated Disc Video. Repetitive motions and overuse injuries, especially for athletes, can lead to spinal osteoarthritis —or the mechanical breakdown of the cartilage between your aligning facet joints in the back portion of the spine.
See Causes of Osteoarthritis and Spinal Arthritis. When this happens, the facet joints become inflamed, and progressive joint degeneration creates more frictional pain. As your back pain progresses, the motion and flexibility of the spine decreases. While overuse and injuries can potentially accelerate the development of osteoarthritis later in life, it is important to remember that staying active is a key part of a healthy lifestyle.
Check with your doctor as to which exercises are appropriate for you, and how to perform exercises safely. Excessive motion in the spine can lead to cartilage breakdown. Watch: Lumbar Osteoarthritis Video. Disc degeneration in your spine can create excessive micro-motion at a vertebral level and lead to lower back pain, a condition termed lumbar degenerative disc disease. Common symptoms of degenerative disc disease include:. Potential pain relief may be experience when changing positions frequently, and lying day may be most comfortable.
Micro-motion from disc degeneration can lead to lower back pain. Over time, excessive motion in your spine can lead to inflammation and enlarged spinal joints. When this happens, bone spurs—or small, irregular growths on the bone—typically form on your facet joints in response to joint instability from the degeneration.
The bony overgrowths can eventually become big enough to reduce joint motion and cause more swelling and stiffness. See Diagnosis of Bone Spurs. Alternatively, even these types of cases can be performed from the front of the neck and the surgery is called a corpectomy, with instrumented or metallic cage fusion. Figure 5: Left side Pre-op lumbar disc herniation; Right side Post-op lumbar microdiscectomy.
Patients with lumbar disc herniation as shown in Figure 1 that require surgery are most commonly treated with micro-discectomy or other minimally invasive techniques to simply remove the herniated disc without destabilizing the spine.
The indications to perform this procedure or others can be confusing and requires clear communication between patient and surgeon. Second opinions can be helpful but can also add to the confusion if first and second opinions conflict with each other. Figure 5 on the left shows axial views of before left side and after microdiscectomy right side. Another surgeon might have performed a total disc replacement which could have been as equally appropriate and effective.
Surgical removal of most of the bony arch, or lamina of a vertebra for general decompression of neural elements with or without discectomy. An opening made in a lamina, to allow surgical access to relieve pressure on the neural elements such as nerve roots by removal of bone spurs and disc herniations as in Figure 5 above.
Often after decompression of the neural elements the spinal stability needs to be improved. This is particularly so in certain spinal diseases that imply spinal instability even before surgical treatment is provided; i. Stabilizing surgical procedures are commonly referred to as spinal fusion and can be performed in many ways.
Generally, bone is grafted onto or into the spine, creating a solid union between two or more vertebrae; and in which metallic usually titanium instrumentation such as plates, screws and rods may be used to provide additional spinal support. Such internal support can be thought of as an internal brace to support the spine while the natural fusion takes place and matures. In order to improve the probability of successful fusion, the surgeon might use bone harvested from the patient, allograft processed cadaveric bone made safe for surgical use and biochemical fusion enhancing substances for example: demineralized bone matrix and human bone morphogenic protein or BMP.
A successful fusion usually takes a minimum of three months and can take as long as a year or more to mature. Figure 7: Showing lateral left side and anterior-posterior views right side of lumbar 5 compression fracture due to osteoporosis.
Patients with decreased calcium content can sustain vertebral body collapse with normal activities of daily living see Figure 4. This usually causes the acute onset of moderate to severe spinal pain and can be treated with a back brace and pain medication, injection of the collapsed vertebrae with plastic vertebroplasty and kyphoplasty or open surgery, in selective cases see Figure 7 on the left.
The surgeon will give the patient specific instructions following surgery and usually will prescribe pain medication. Sometimes a spinal brace will be applied for weeks to months depending on the specific postsurgical needs. The surgeon will help determine when normal activities such as returning to work, driving and exercising may resume.
Some patients may benefit from supervised rehabilitation or physical therapy after surgery. Such treatment will usually require a referral. Discomfort is expected while the patient gradually return to normal activity, but pain is a warning signal that the patient might need to slow down.
In general, continued gradual improvement is the expected trend over the first three or more months following surgery. The surgeon will provide prognostic information and give an idea of how to determine what adverse post-operative trends necessitates scheduling an unplanned re-evaluation.
Such adverse trends would include fever, chills, wound drainage, new weakness, sensory or pain symptoms. Finally, a patient needs to know beforehand that there usually are no absolutes regarding medical or surgical treatment of spinal conditions. Every patient is unique. It can be confusing which treatment or which elective operation is best in each situation. That is why patients have to rely on choosing a physician carefully. This applies to non-surgeons as well as surgeons.
Pick a doctor that the patient feels comfortable with regardless of ultimate outcome. The best physicians are the ones that a patient can trust to tough it out with them when the treatment outcome fails to be ideal. The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets.
This information is provided as an educational service and is not intended to serve as medical advice. Joint Providership. Nausea or vomiting. Pain, pressure, or a strange feeling in your back, neck, jaw, upper belly, or one or both shoulders or arms. See a picture of areas where symptoms may be felt. Feeling dizzy or lightheaded. A fast or uneven heartbeat.
A person has signs of damage to the spine after an injury such as a car accident, fall, or direct blow to the spine. Signs may include: Being unable to move part of the body. Severe back or neck pain. Weakness, tingling, or numbness in the arms, legs, chest, or belly. Call your doctor now if: You have a new loss of bowel or bladder control.
You have new numbness in your legs or numbness in your legs that is getting worse. You have new weakness in your legs or weakness in your legs that is getting worse.
This could make it hard to stand up. You have new or increased back pain with fever, painful urination, or other signs of a urinary tract infection.
Watchful waiting Watchful waiting is a wait-and-see approach. Be sure to call your doctor right away if you start to have other symptoms or you have: Numbness. Urinary symptoms, such as pain when you urinate. Pain that is getting worse. Pain that you can't manage at home. Who to see Health care professionals who often diagnose the cause of back pain include: Primary care providers.
This includes: Family doctors. Osteopathic physicians. Physical therapists. Nurse practitioners. Physician assistants. Emergency doctors. If your back pain is severe or long-lasting, health professionals who can treat you include: Orthopedists. You can also get care from: Acupuncturists. Certified massage therapists. Exams and Tests Your doctor will first ask you about your past health, your symptoms, and your work and physical activities. You may have one or more tests, such as: An X-ray to look for injuries or diseases that affect the discs and joints of the spine.
An MRI to look for injuries and diseases that affect the discs and nerves of the spine, such as a herniated disc , a pinched nerve, or a tumor. It can also show whether any part of the spinal canal has narrowed. A CT scan to look for a tumor, a fracture, a herniated disc, narrowing of the spinal canal, or an infection. It can also show whether osteoporosis is the cause of a compression fracture. A bone scan to look for damage to the bones, a tumor, or infection, or to find the cause of unexplained back pain.
An electromyogram and nerve conduction study to check how well the spinal cord, nerve roots , and nerves and muscles that control your arms and legs are working. It can help find out what is causing pain, numbness, or weakness in the arms or legs. More tests may be done to check for other possible causes for your pain. Treatment Overview There are many treatments for upper and middle back pain. Treatment for upper and middle back pain is based on: How bad your symptoms are.
How much your symptoms prevent you from doing your daily tasks. How well other treatments have worked. Treatment for mild to moderate pain In most cases, people with mild to moderate upper and middle back pain can manage their symptoms with: Over-the-counter pain medicines , such as acetaminophen for example, Tylenol and nonsteroidal anti-inflammatory drugs for example, Advil, Aleve, aspirin, and Motrin , to reduce pain.
But if these don't get rid of your pain, you may need a prescription pain medicine that is stronger. Heat or ice to reduce pain and stiffness. Exercise to stretch and strengthen the muscles of your back, shoulders, and stomach.
Physical therapy to help increase your flexibility, strength, and balance. Your physical therapist may teach you an exercise program so you can do it at home. Massage to help reduce muscle tension and pain for a short time and to improve blood flow. Spinal manipulation to help relieve pain and improve function. It can range from massage and slow pressing to a quick thrust.
It involves putting tiny needles into your skin at certain points on the body to promote healing and pain relief. Capsaicin cream may help relieve pain. Capsaicin cream is applied directly to the skin over the painful area. Treatment if back pain gets worse If your back pain doesn't get better or it gets worse, your doctor may recommend: Prescription medicines , such as opioids, to help reduce pain.
Muscle relaxants to help reduce pain and muscle tension and improve mobility. These can help with severe muscle spasms that happen when the back pain starts acute phase. Antidepressants , such duloxetine, to help treat long-lasting chronic back pain. Steroid shots to help reduce swelling and relieve pressure on nerves and nerve roots.
But there is little evidence showing that these shots can help control back pain. In some cases, a back brace may be used to support the bones in the spine after a fracture. Surgery choices may include: Kyphoplasty or vertebroplasty. Bone cement is injected through a needle into the broken vertebrae to try to stabilize the bone.
These surgeries are not done very often, because most fractures heal on their own. And there is no evidence that kyphoplasty or vertebroplasty are better than nonsurgical treatment. It removes the portion of the disc that is herniated and pushing into the spinal canal. In most cases, herniated discs that occur in the upper and middle back are small and don't need surgery. But you may need surgery for a large herniated disc that presses on the spinal cord.
Spinal decompression for stenosis. It widens the spinal canal that has narrowed, and it relieves pressure on the spinal cord or nerves. This procedure is not done very often, because spinal stenosis in the upper and middle back is rare. Home Treatment There are several things you can do at home to help reduce your pain. Instead, return to your activities slowly, and avoid things that make your pain worse.
Studies show that bed rest doesn't relieve back pain better than staying active. And bed rest of more than a couple of days can make your back pain worse and lead to other problems, such as stiff joints and muscle weakness. You might want to switch back and forth between heat and cold until you find what helps you the most. Ask your doctor or a physical therapist about what kinds of exercises you can do to stretch and strengthen the muscles in your back, shoulders, and stomach.
These muscles help support your spine. Strong muscles can help improve your posture, keep your body in better balance, decrease your chance of injury, and reduce pain. Poor posture puts stress on your back.
Be sure to stand or sit tall, with your shoulders and your stomach pulled in to support your back. Here are some other things you can do to feel better: See a counselor. Cognitive-behavioral therapy can show you how to change certain thoughts and behaviors to control your pain.
Stress can make your pain feel worse. Getting plenty of calcium and vitamin D may help prevent osteoporosis, which can lead to compression fractures and back pain. For more information, see the topic Healthy Eating. Don't smoke.
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