Back pain

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Back pain

• Back pain is a common problem that affects most
  people at some point in their life.
• It usually feels like an ache, tension or
  stiffness in the back.
• The pain can be triggered by
• bad posture while sitting or standing
• bending awkwardly
• lifting incorrectly

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Back pain

• is not generally caused by a serious condition
  and, in most cases, it gets better within few
  days or weeks
• is most common in the lower back, although it can
  be felt anywhere along your spine, from your neck
  down to your hips
• It can usually be successfully treated by taking
  keeping mobile, painkillers, physioterapy

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Back pain

• Dividing by its cause
• nonspecific back pain
• back pain with radiculopathy or spinal stenosis
  (disk herniation, spondylartritis)
• back pain associated with another specific cause
  (such as infection or cancer)

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Back pain

• Non specific pain indicates that the cause is not
  known precisely, but is believed to be due from
  the soft tissues such as muscles, fascia, and
  ligaments

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Back pain

• Other causes of back pain
• Postural abnormalities (scoliosis, kyphosis)
• Congenital malformations (spondylolistesis)
• Trauma

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Back pain

• The pain may radiate into the arms and hands as
  well as the legs or feet
• may include symptoms other than pain
• tingling, weakness or numbness.

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Back pain

• Back pain can be divided anatomically neck pain,
  middle back pain, lower back pain
• By its duration acute (up to 12 weeks), chronic
  (more than 12 weeks) and subacute (the second
  half of the acute period, 6 to12 weeks)

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Spinal anatomy
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Spinal anatomy
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Ligaments
Spinal Anatomy
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Spinal Anatomy
Spinal pathology
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The four stages to a herniated disc include
Disc Degeneration chemical changes associated
with aging causes discs to weaken, but without a
herniation. Prolapse the form or position of the
disc changes with some slight impingement into
the spinal canal. Also called a bulge or
protrusion. Extrusion the gel-like nucleus
pulposus breaks through the tire-like wall
(annulus fibrosus) but remains within the
disc. Sequestration or Sequestered Disc the
nucleus pulposus breaks through the annulus
fibrosus and lies outside the disc in the spinal
canal (HNP).
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Ligaments
Facet joints
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Osteophytes
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Cervical osteophytes
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Upper extremities dermatomes
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Normally, the cervical spine has a slight
anterior curvature (lordosis). The cervical
spine is straightened, which may be due to
paravertebral muscle spasm
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Cervical myelopathy

• Spastic paraparesis
• Quadriparesis
• Difficulties with balance
• Spasticity lower extremities
• Radicular symptoms upper extremities
• Incontinence uncommon, urinary frequency -
  common

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Diagnostics

• Plane X-ray
• MRI
• CT

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Fyziological diameters of spinal canal - L4
1. Interpedicular distance 2030 mm 2. výška
pedikla 35 mm 3. výška facety 58 mm 4. AP
sagital distance 1525 mm 5. interfacetarna
vzdialenost 1520 mm
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Spinal canal stenosis

• Borderline anterio-posterior diameter for spinal
  canal
• Cervical 11 mm
• Lumbar 11-13 mm

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Cervical myelopathy

• Cervical myelopathy refers to compression on the
  cervical spinal cord from either a disc
  herniation or cervical spinal stenosis.
• Generally, it is more common in the elderly
  population and is a slow process.

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Cervical myelopathyk

• Symptoms include
• incoordination in the hands
• a heavy feeling in the legs
• or numbness and tingling in the legs
• It is generally a slowly progressive condition.
  It is usually not painful as compression of the
  spinal cord does not cause pain.

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Cervical myelopathy
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Cervical myelopathy
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Lower extremities dermatomes
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Lumbar nerve root compression
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Lassegue root L5, S1
Opposite Lassegue root L4
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Lassegue maneuver
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Nerve root pain pattern
Radiculopathy C6
Radiculopathy S1
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Sign of toe
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Thomayer
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Location of Pain and Motor Deficits in
Association with Nerve Root Involvement at Each
Lumbar Disc Level Disc level
Location of pain
Motor deficit

T12-L1 Pain in inguinal region and
medial None
thigh L1-2
Pain in anterior and medial aspect
Slight weakness in quadriceps
of upper thigh
slightly diminished suprapatellar


reflex L2-3 Pain in anterolateral thigh
Weakened quadriceps
diminished
patellar or
suprapatellar reflex L3-4 Pain in
posterolateral thigh and
Weakened quadriceps anterior
tibial area diminished patellar
reflex L4-5 Pain in dorsum of foot
Extensor weakness of big toe

and foot
L5-S1 Pain in lateral aspect of foot
Diminished or absent Achilles reflex
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Cauda equina syndrome

• L1-5 a S1-5.
• Areflexic and flaccid paraparesis
• Back pain that radiates down posterior aspect of
  both legs
• Sensory loss in distribution of involved roots
  (saddle distribution)
• Urinary and fecal incontinence (loss of bladder
  and bowel function)

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Cauda equina syndrom
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Fyziological diameters of spinal canal - L4
1. Interpedicular distance 2030 mm 2. výška
pedikla 35 mm 3. výška facety 58 mm 4. AP
sagital distance 1525 mm 5. interfacetarna
vzdialenost 1520 mm
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Spinal canal stenosis

• Borderline anterio-posterior diameter for spinal
  canal
• Cervical 11 mm
• Lumbar 11-13 mm

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Spinal canal
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Lumbar stenosis

• medical condition in which the spinal canal
  narrows and compresses the spinal cord nerves at
  the level of the lumbar vertebra
• Leg pain (proximal to distal pain)
• Numbness
• Weakness exacerbated by standing or walking and
  relieved with lumbar flexion

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Lumbar stenosis
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Lumbar stenosis

• Narrowing of the spinal canal or neural foramina
  that produces root compression
• Most common L4-L5, L3-L4
• Congenitally or degenerative disease
• Usually after 60
• Single segment or multiple segments

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Plain X-ray
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L4/5 Spondylolisthesis
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MRI
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Prolapse of the disc - CT
Diffuse prolapse of the disc and osteophyte
Central prolapse of L4-L5 disc
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Dif. dg. radiculopathy

• Vertebrate MTS
• Boreliosis
• Pelvic tumors (LS), lungs (Th, C) and others
• Intraspinal tumors
• Inflammatory diseases

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Dif. dg. radiculopathy
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Therapy acute stage

• Rest
• Analgetics
• Non-steroid antiinflammatory drugs
• Myorelaxants
• Local anesthetics
• Epidural corticosteroides

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Therapy - later

• Analgetics
• Non-steroid antiinflammatory drugs
• Myorelxants
• Local anesthetics
• Physiotherapy, exercising

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Therapy

• Neuropathic pain anticonvulsants (pregabalin)
• Surgery
• Cauda equina syndrome
• Pain
• Peripheral paresis

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Therapy - surgery

• Cauda equina syndrome with urinary symptoms
• Marked muscular weakness pertaining to a nerve
  roots
• Progressive neurologic deficit
• Pain that exists more than 4 months