Orthopaedic and Spine Institute
Texas Center for Athletes
21 Spurs Lane Suite 245
San Antonio, Tx.78240
210.48.SPINE
(210.487.7463)
Fax: 210.487.7468
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Orthopaedic Conditions
CONDITIONS OF THE SPINE
- Where Back Pain Begins
Back pain is a very common complaint. 80% of adults will experience back pain at least once during their lifetime. It occurs most commonly in the lower back (lumbar spine). Most back pain results from sprains and strains caused by stressful movements. If your back pain is caused by a muscle sprain or strain, it will typically heal over time with over-the-counter or prescription medications, heat, ice, massage, or rest. Sometimes, though, back pain is caused by a more severe spinal condition, such as a herniated disc or spinal instability. Depending on the severity of your pain and its cause, you may require more involved treatment, such as physical therapy, injections, or even surgery. As we age, our discs may become arthritic. This is known as degenerative disc disease. It may not cause severe pain or other symptoms, but when the degeneration becomes advanced, low back pain may occur.
Typically, discogenic pain (pain from the spinal discs) is associated with activities that increase the pressure within the intervertebral disc. Sitting, bending forward, coughing and sneezing can increase low back discogenic pain. Leg pain caused by pinching of the nerves in the low back (called radiculopathy) may also accompany low back discogenic pain; especially while sitting, standing or walking. Discogenic low back pain typically affects people in their 30's-50's and can severely impair their ability to function or work. Just like other parts of the body, each intervertebral disc has a nerve supply. Discs are comprised of two parts; the annulus fibrosus (outer ring-like structure) and nucleus pulposus (gel-like interior). The nucleus pulposus has no nerve endings. However, the outer third of the annulus fibrosus contains nerve fibers. One type of discogenic disorder is called Internal Disc Disruption (IDD). IDD occurs when the disc tears. This allows the chemicals within the nucleus to cause inflammation and pain of the annular nerves. Inflammatory factors become deposited in the tears/fissures in some patients while in others, this deposition is minimal or non-existant.
Some studies have shown that in those with the most severe pain, there are a host of inflammatory factors in the painful discs. Whereas others may have degenerative/arthritic changes of the discs but little to no inflammatory factors within the tears, and thus, no pain. In those with debilitating and life-altering pain that has failed conservative treatment, the doctor may order a provocative discogram or discography. During this sterile procedure, the suspect discs are injected with a contrast dye to make each disc visible under fluoroscopy. Provocative discography helps the doctor to see the shape and size of the intervertebral disc, but more importantly, to help locate the source of the patient's pain. The injection of the contrast dye alters the pressure within the disc and may 'provoke' or reproduce the patient's pain pattern; thereby helping to isolate a particular disc as a pain generator. If conservative measures fail to address pain and dysfunction, your doctor may discuss surgical alternatives to help alleviate your pain.
