Next Lesson - Conditions of the Back and Neck
Core
Want more information on anatomy before you begin looking at conditions? Head to our article on The Spine for more information!
Spondylosis is the term used to describe chronic degenerative changes of the spine, including degeneration of the intervertebral discs and osteoarthritis of the facet joints, most commonly affecting the lumbar or cervical spine. It is usually caused by disc degeneration and marginal osteophytosis (bony spurs developing adjacent to the end plates of the disc).
It can present with radiculopathy causing dermatome/myotome symptoms. X-ray, MRI, and CT scans can be used in diagnosis but are not definitive alone. Treatment is conservative in nature and focuses on lifestyle modifications, pain management and physiotherapy.
Image - An X-ray showing the lateral view of lumbar spine spondylosis
Creative commons source by Nevit Dilmen and annotated by Mikael Häggström, M.D [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Spondylolisthesis is the anterior displacement of the above vertebra on the below vertebra (commonly the 5th lumbar vertebra on the sacrum). Causes are divided into five categories: congenital/dysplastic, isthmic, degenerative, traumatic and pathological.
It can be asymptomatic, but may present with lower back pain, sciatica and/or neurogenic claudication (pain/paraesthesia in the legs when standing or walking that is relieved by rest). Diagnosis is usually confirmed with a standing X-ray, which demonstrates the vertebral displacement. Clinical examination may reveal signs of nerve root irritation if there is associated neural compression.
Treatment depends on severity, but often starts with rest, painkillers and physiotherapy. If very severe, surgery can be recommended to fuse the slipped vertebra to the adjacent vertebra using metal screws and rods.
Image - An X-ray of Spondylolisthesis
Creative commons source by Jojo [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Mechanical back pain is an extremely common condition, and the source may be in the spinal joints, the intervertebral discs, the vertebrae themselves or the surrounding soft tissues (like ligaments or muscles). It presents with back pain when the spine is loaded that worsens with activity and is relieved with rest. Risk factors for mechanical back pain include: poor posture, sedentary lifestyle, poor lifting technique and being overweight. Management involves lifestyle modifications and pain management, commonly with NSAIDs.
Sciatica is pain/paraesthesia caused by compression of the sciatic nerve or by one or more of the contributing spinal nerves (L4-S3). It presents with pain in the lower back and buttocks that radiates to one or more of the following dermatomes:
- L4: Anterior thigh and knee, and medial leg
- L5: Lateral thigh and leg, and dorsum of the foot
- S1: Posterior thigh and leg, and sole of the foot
Sciatica usually self resolves within 4-6 weeks. If symptoms are severe or persistent, the GP may suggest exercises and stretches, prescribe additional painkillers and refer to physiotherapy.
Image - The distribution of pain/paraesthesia in sciatica
Creative commons source by BruceBlaus [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
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