Back Pain or Back Ache
This is the pain felt in the back which stems from bones, joints, muscles, nerves and other structures. Back pain can be described as sharp or sudden, dull or aching, burning and shooting pain. Back pain often originates from the spine, in particular the lumbar area (lower back), and is the most common area affected. Episodes of back pain may be acute, lasting only a few weeks, to chronic lasting more than three months.
Other symptoms that may accompany back pain and relating to disease of the spine include weakness to one or both legs as a result of compression to motor nerve fibres, numbness or tingling which spread or radiate to feet as a result of compression to sensory nerve fibres and constipation or difficulty passing urine due to compression of nerve tracts that innervate rectum and bladder (lumbro-sacral radiculopathy or pinched nerve).
In order to properly diagnose you, if you are experiencing any of the above symptoms, your doctor will take a detailed history and do a thorough physical examination. Your doctor will also do investigations such as Blood test, X-rays, CT scan, MRI, etc. to confirm the diagnosis or underlying cause for your symptoms.
Common causes of back pain include:
1. Degenerative Disc disease or arthritis affecting the spine - this is usually seen in the middle aged or elderly
2. Trauma or injury to their back previously
3. History of a fracture or a break to the back bone
4. Herniated or slipped disc causing compression of nerve roots
5. Spondylolisthesis or loss of alignment of one vertebral body in relation to its adjacent vertebral body
6. Growth related disorders such as scoliosis (or lateral curvature of the spine) or kyphosis (or sagittal curvature of the spine).
7. Athletes and persons, whose job requires repeated heavy lifting (>25 pounds)
8. Operating vibrating equipment
There are numerous treatments for the above causes, however, surgery is recommended in persons who have backache or back pain that is not relieved by medications or physiotherapy, persons who are experiencing weakness, numbness and tingling and bowel and bladder symptoms and persons who have significant findings on imaging where the spine is deemed unstable and the risk of spinal cord compression is very high. It is important to note that the conditions listed above, if left untreated, will ultimately progress to spinal cord compression or cauda equine syndrome which may result in paralysis of the lower limbs and permanent bladder and bowel dysfunction.
Spine surgery can be minimally invasive vs open and fusion vs non fusion (motion preserving). Spine surgery usually involves the use of implants and bone allograft to give structural stability as well as promote healing. Fusion surgery includes Pedicle Screw Fusion (PSF) or Posterior-Lateral Fusion (PLF) of the back, and is one of the most common procedures done. Non-fusion spine surgery involves placement of an artificial disc prosthesis (Disc Replacement Surgery).
Complications in back surgery such as this are infrequent and usually minor. However, as with any spine surgery, there are risks, including the possibility of general complications of any surgery such as reaction to anesthesia, bleeding, infection and venothromboembolism (blood clot in the legs that can break-off and go to the lungs). Specific to PLF, patients may experience hoarseness or difficulty swallowing but this usually improves within hours to days after surgery, wound hematoma, failed fusion, CSF leak and adjacent vertebrae degeneration. You are advised to discuss the potential risks and complications with your surgeon prior to having PLF surgery. However, risks from any surgery can be reduced by following the surgeon's instructions before and after the neck surgery.