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South Texas’ Guide to Learning About Back Pain Conditions

At South Texas Bone & Joint, we understand that back pain conditions in South Texas are a common concern for people of all ages. In most cases, lower back pain results from tissue fatigue from a microscopic injury, which can cause short-lived stiffness, pain, and muscle spasm. However, other underlying conditions can be more significant and may contribute to back pain. Learn all about them here:

I. Severe Lumbar Sprains/Strains

Severe lumbar sprains and strains can occur in all age groups when muscle, ligament, or tendon insertions begin to fail, tear, or rip under unusual loads or forces. Symptoms include local pain radiating toward the tailbone, buttocks, and hips but usually not below the knees.
Treatment
Treatment includes rest, ice, over-the-counter analgesics such as Tylenol or NSAIDs, and potential treatment from a physical therapist or our chiropractic professionals if the symptoms become more protracted.
These problems are usually self-limiting, but caution is advised in older patients with osteoporosis who may have an underlying compression fracture. In that situation, a visit to their family doctor for an X-ray examination is warranted if the symptoms last for more than three days.

II. Degenerative Disc Disease & Herniated Lumbar Discs

The human disc is a complex hydrostatic support mechanism that absorbs and disperses stresses ongoing in the spine under a variety of conditions and postures. Young, healthy discs are succulent because of healthy cells maintaining a matrix that imbibes water, and this protects the outer edges of the disc. This annulus is a denser collagen ligamentous-type tissue.
Sometimes, under certain loads and stresses, the retaining disc annulus wall will thin, and nuclear material will begin to occupy the space and push outward. When this occurs in the direction of the nerves, it can cause intense back pain, especially with prolonged sitting, bending, and stooping.
Mediators of inflammation can irritate the nerves and cause radiating leg pain, typically burning or lancinating. There is frequent numbness or tingling and even weakness in certain leg muscle groups. This is a symptomatic disc herniation.
Disc Herniations
When a disc herniation becomes larger or extruded, the nuclear contents are released from the disc space, causing heightened nerve compression and irritation. This can result in severe sciatic leg pain that can be debilitating. While this condition is usually self-limiting, it is not always the case. 
Patients who are beginning to manifest these types of symptoms should consult their family doctor. They may benefit from certain exercises that can reduce the forces across the disc and alleviate symptoms. 
Treatment
Rest, avoiding repetitive bending and stooping, avoiding heavy lifting, and prolonged sitting in conjunction with using analgesic medications such as Tylenol and NSAIDs are appropriate. When symptoms become more severe or protracted, especially when accompanied by leg numbness and weakness, an MRI is recommended, and more aggressive treatment, such as lumbar epidural steroid injections, may be considered.
Patients who fail to respond or manifest progressive numbness or weakness in the legs or begin to manifest loss of bladder or bowel function require surgical evaluation by a spinal surgical specialist. Degenerative disc disease is ubiquitous in society and is not always symptomatic. 
Sometimes small fissures will present in the back or sides of the disc, which can cause local pain for which analgesic medications, muscle relaxers, and physical therapy are typically very helpful. In some individuals with more incapacitating attacks of back pain, there may be a place for epidural steroid injections or even spinal operative treatment.

III. Spondylolisthesis

Spondylolisthesis is a condition that can affect individuals of all ages. About 8% of the population has a bony defect called spondylolysis, which can eventually result in spondylolisthesis. Some people refer to this condition as a “slipped disc.”
Treatment
Treatment is usually non-operative with supportive medication and back-strengthening exercises. Some individuals with more severe or incapacitating pain or functional limitations require injection therapies, such as epidural steroid injections. When the condition results in concomitant nerve pain, sciatica with or without leg numbness or weakness, the condition is frequently treated by operative intervention by a spinal surgical specialist.

IV. Osteoporosis & Compression/Fragility Fractures

Compression fractures of the spine bones can occur after severe high-energy trauma, such as falls from heights, motor vehicle accidents, or other types of direct or indirect trauma. However, elderly individuals and even some younger individuals with metabolic disease or who are taking corticosteroids for chronic illness can develop vertebral body compression fractures under low-trauma conditions or even with virtually no trauma at all.
Patients who have already been diagnosed with osteoporosis should be highly suspected of having compression fractures. The diagnosis is typically made by X-ray examination in conjunction with a structural study such as an MRI.
Treatment
Treatment for this condition has become much more effective and satisfactory with vertebral augmentation procedures, such as kyphoplasty, which is typically offered.

V. Spinal Stenosis

Spinal stenosis is a condition where the space available in the spinal canal behind the vertebral bodies is gradually encroached upon by local anatomic structures, whether they be a bulging disc, enlarged arthritic facet joints, thickened ligamentum flavum, or lamina, and especially if there is a vertebral shift (spondylolisthesis or retrolisthesis). 
Patients typically complain of increased back pain, leg weakness, and fatigue with standing and walking. For instance, they typically do better leaning forward while walking behind a shopping cart.
Treatment
The treatment is initially with therapeutic exercise. Epidural steroid injections can favorably impact this problem. Some individuals have stenosis so severe that they require operative management. Options available for such management include the new X-STOP implant and more traditional and frequently necessary lumbar laminectomy (decompressive) spinal surgical procedures. X-rays and lumbar spine MRI examinations are frequently required to make the diagnosis.

VI. Non-Mechanical Pain

Back pain can be caused by various structures or conditions, some of which are not benign. One such condition is a tumor of one of the bones of the spine or one of the nerve structures. While some tumors are benign, most tumors of the spine result from metastases from breast cancer, prostatic cancer, and the like.
Individuals who are likely undergoing such treatment should have a high index of suspicion if they are experiencing severe pain, even at rest. Infections can also cause such intractable severe pain at rest, such as spondylodiscitis, which is frequently the result of urinary tract infections and other types of skin infections in individuals who have compromised immune status or have chronic corticosteroid therapies.
Other conditions that can potentially cause non-mechanical back pain include kidney-related conditions such as kidney stones, pancreatic conditions such as pancreatitis and pancreatic cancers, and even some vascular conditions such as a dissecting aortic aneurysm. It is important to differentiate between mechanical and non-mechanical back pain, as the latter requires urgent workup and appropriate and aggressive medical intervention.

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