Pain from spine conditions for those suffering neck pain and/or back pain usually fit into two major categories; acute pain, and chronic pain. Radiculopathy can occur with both of these conditions and may also be either acute or chronic. Those who develop a sudden pain in the back or neck may have experienced direct trauma, injury, have slept awkwardly, or have had an acute exacerbation of a more minor or asymptomatic pathology such as a bulging disc having suddenly herniated. For others, the pain and suffering may have been a constant companion over many months with little relief found by using conservative treatment methods for their back or neck pain. Chronic back pain can be both sharp and severe, or a dull ache, with some sufferers only experiencing the pain and discomfort upon certain movements and others in constant pain with no relief from lying down or bending forward or to the side.
Acute Back and Neck Pain
More acute pain can be caused by a sudden disc herniation, by traumatic spondylolisthesis, whiplash and associated cervical facet joint disorder, spinal fracture following an accident or unsuccessful spinal fusion surgery, or pain after a contact sports injury which caused trauma to the spine and bruising of the ligaments, nerves, and muscles. Acute pain may be relieved by simple rest and the prodigious use of ice to reduce inflammation; heat should never be applied to inflamed tissues as this can exacerbate the condition and worsen recovery. In some cases acute pain in the back or neck may signal a significant worsening of an existing condition to the point where back surgery becomes necessary. Where a herniated disc is causing severe nerve impingement and looks unlikely to heal itself, a discectomy may be required, with or without spinal fusion before the nerve damage becomes permanent. Most disc herniations do heal themselves without the need for surgery but symptoms such as bowel or bladder incontinence, or the development of numbness and weakness in the lower limbs can indicate a need for back surgery.
Conditions Causing Acute Pain in the Back and Neck
Acute pain in the back may also be due to muscle fatigue due to tension. Thermotherapy can be helpful in reducing back pain due to muscular problems, along with acupuncture, massage, and acupressure. Where acute pain in the back or neck persists the condition may not be a simple strain or stress-related issue and could be a sign of the development of fibromyalgia, spinal stenosis, multiple sclerosis, ankylosing spondylitis, or spondylolysis (spinal osteoarthritis) amongst other things. These conditions can affect the way nerve signals are transmitted to and from the spinal tissues, including the muscles and those conditions which affect the spinal structures themselves may cause the spinal nerves or cord to become compressed or the bones to begin to rub together causing chronic pain.
Spinal Stenosis and Sciatica
Thoracic spinal stenosis is relatively rare compared to lumbar spinal stenosis, and cervical spinal stenosis, and accounts for only 1% or so of cases. This is due to the relative rigidity of the thoracic spine compared to the cervical spine and sections of the lower back. Surgery on the cervical spine is, therefore more common, but lumbar back surgery accounts for a major proportion of all surgeries carried out in the US each year. Sufferers of spinal stenosis or degenerative disc disease in the lumbar spine are often referred to as having sciatica, although this is not a condition as such, but rather a set of symptoms. Sciatic nerve pain can be due to compression of the sciatic nerve and other nerves in the lumbar spine but may also be due to piriformis syndrome or muscular problems in the thighs and buttocks themselves. Many of those who experience failed back surgery syndrome do so because their diagnosis was simply inaccurate and the surgery failed to actually address the site and origin of their pain.
Spinal Fusion and Scoliosis
Back and neck pain due to degenerative disc disease may be connected to spinal stenosis and to alterations in the intervertebral height and curvature of the spine. As the spine begins to tilt forward or backward abnormally, the discs in other segments may become damaged, and the spinal nerve roots and spinal cord can become compressed. Back surgery to restore intervertebral height and correct alignment are beneficial for some patients, including the X-Stop operation, spinal fusion, and artificial disc replacement. Spinal fusion and realignment may also help alleviate symptoms resulting from scoliosis which is the development of abnormal sideways curvature in the spine. This condition may remain asymptomatic in many and back surgery is unlikely to be carried out for any reason other than for cosmetic purposes. For others, the scoliotic curve may become problematic as it can lead to spinal stenosis and radiculopathy. Bracing and surgery are then likely to be of benefit.
The Risks and Benefits of Back Surgery
Back and neck pain can be extremely debilitating with sufferers often finding that their ability to concentrate is affected, energy levels become poor, they feel more depressed and find little enjoyment in previously exciting activities, and that they have problems maintaining steady employment due to the need for regular breaks or sick days. Conservative treatment may address some of these issues and allow patients to improve their quality of life, but back surgery may be necessary for some in order to prevent a condition from becoming any worse or to provide relief where conservative treatment has failed. Back surgery is risky with the possibility of spinal nerve trauma in many procedures, infection, anaesthetic problems, and protracted recovery times. However, on occasion the risks of not undergoing back surgery are considerably higher than those involved in the operations themselves, with paralysis a possibility where severe spinal cord compression is present.
Rheumatoid Arthritis and the Need for Urgent Surgery
Patients with rheumatoid arthritis and facet joint degeneration may develop basilar invagination which can cause extreme cord compression and often requires the bones at the base of the skull and top of the neck to be fused. Cervical spinal stenosis may also occur from spondylosis, ankylosing spondylitis, or other degenerative disease where the discs and bones become dysfunctional. Other conditions such as lumbar spinal stenosis or a ruptured disc in the lumbar spine may cause cauda equina syndrome and necessitate urgent back surgery to prevent long-term damage to the nerves.
If a patient suffers acute bowel or bladder incontinence or paralysis they should seek immediate medical attention as this could indicate severe cord compression which may have long term negative consequences. Even if a patient suffers from chronic back or neck pain, new symptoms should always be reported as they may necessitate different treatment from the therapies already being used.
Ensuring a Correct Diagnosis and Appropriate Treatment
Referred pain is a common symptoms of back and neck problems and this can make it extremely difficult to ascertain the cause of the pain. Selective nerve root blocks can be extremely helpful in isolating the problem nerve in order to ensure that any therapy, including back surgery, addresses the true cause of the condition. In some cases a problem with the thoracic spine may cause neck pain, or lumbar pain and vice versa as the stresses and strains of the spine become abnormally distributed. The use of pain maps can help with diagnosis as can imaging techniques such as MRI and CT scans, along with X-Rays and electromyelograms to test nerve function. Back surgery may not always be necessary or desirable, but in some cases it is the only way myelopathy and other symptoms can be relieved.