Spinal disc problems and back pain: all you need to know

Are disc problems the reason for all types of back pain? What are the other causes of back pain?

The spine is made of muscles, ligaments, tendons and cartilage-like cushions called discs. Damage to any of these components can cause back pain. But, the spinal discs as such are not organs that transmit pain. The pain maybe caused by strained muscles or ligaments or a compressed nerve. Disc prolapse, also known as ‘herniated’ or ‘slip disc’, can cause a sharp and shooting pain that travels through the buttock and down the back of the leg. Around 95% cases where patients complain of a pain radiating down their legs is caused by a damaged disc. But the rest of the 5% back pain can have other reasons as well.

When back pain alone is the symptom, disc problems are not the cause in 95% of the cases. Muscle spasms, problems with internal organs in the stomach can result in back pain (referred pain). For example, pelvic inflammatory disease, bladder, or kidney infections may also lead to back pain.

What is the spinal disc? What is its function?

Normally, there are 33 vertebrae in a human vertebral column with 23 discs. The number of discs can slightly vary in people, 22 or 24 being totally normal. The bones in the spinal column are divided into 7 in the cervical region (neck), 12 in the thoracic region (upper), 5 in the lumbar region (lower), 5 in the sacral region and 4 additional bones in the coccygeal (tail bone) region .

Other than the first two cervical vertebrae, each of the vertebral bones is separated from its neighbour by a disc. The two bones, and the disc together, make one motion segment.

As a bipedal animal, the lumbar and thoracic curves in human beings bring the body’s centre of gravity directly over the feet. The vertebral column of humans takes a forward bend in the lumbar (lower) region and a backward bend in the thoracic (upper) region.

Now imagine your spine as an erect pole with neither the curves nor the cushion of the discs that make movements possible. What would it be like? You wouldn’t be able to bend or balance your body. People do go through this nightmare when affected by the condition called Ankylosing spondylitis, a type of arthritis that affects the spine. The symptoms include pain and stiffness from the neck down to the lower back. The spine's bones (vertebrae) fuse together, resulting in a rigid spine.

What are the conditions related to spinal discs that require immediate medical intervention?

At the base of the spinal column, near the first lumbar vertebra, is a collection of nerves called the cauda equina. They are called so because they resemble a horse's tail. Damage to these bundle of nerves, resulting in compression of the spinal nerve roots, is called cauda equina syndrome. It is a rare disorder that is usually a surgical emergency.

When the nucleus pulposus (the soft centre of the spinal disc) breaches the annulus fibrosus (the tough exterior), this is known as a herniated disc. It can cause a variety of nerve-related symptoms, including pain, numbness and muscle weakness. In the most severe cases, a herniated disk can compress nerves that control the bowel and bladder, causing urinary incontinence and loss of bowel control. This condition also requires immediate medical intervention.

What are the tests that can diagnose a disc problem?

An X-ray of the neck and back (AP view, Lateral view) can help detect problems with the bones. Magnetic Resonance Imaging (MRI) will provide a sensitive and accurate assessment of the spinal nerves and anatomy, including disc alignment, height, hydration, and configuration.

The diagnostic process will include inferences drawn from physical examination and the test findings. All types of back pain may not be caused by disc-related problems. To rule out such possibilities, your doctor might prescribe tests like ESR, NCS (Nerve Conduction Study) and EMG (Electromyography) based on the symptoms.

To detect changes in bone structure resulting from injury, disease or ageing, dynamic and fuctional MRIs can be done. MRI is considered as one of the main diagnostic tools for the assessment of spinal pathologies.

How effective is artificial disc replacement?

Artificial disc surgery is usually performed on the lower back (lumbar spine) or the neck (cervical spine). In this procedure, degenerated intervertebral discs in the spinal column are replaced with artificial devices. Though this treatment is emerging as an option in cases where conservative treatments have failed to resolve pain, disc replacement procedure still has many hurdles to overcome. Potential risks include a worsening or continuation of the symptoms after the procedure, loss of motion or fusion at the treated cervical level etc. The procedure can also be fatal in worst cases. Stem cell injection is emerging as a viable option for treating degenerative disc disease. Research in this area is giving new hope to patients suffering from back pain.

Can exercise help relieve the pain related to disc problems?

Regular exercise has important role in maintaining the health of your spine. People with disc problems should choose the right kind of exercise. Core muscle strengthening exercises are good for those who have difficulty in walking.

In the case of slip disc or herniated disc, the patient can begin a healthy exercise programme after the pain has settled. Physical activity and exercise will reduce pain and ensure long-term healing of the back. Patients should resist the temptation to lie down as this will not aid in rehabilitation. However, it is important to check with your doctor and get consent before beginning to exercise.

How can we avoid back pain through lifestyle changes?

Bad posture is the most common cause that gives you a bad back. Sitting in the same posture for a long time can result in back pain. If you are forced to sit for long hours due to office work, make sure that you use a lumbar support.

If you are someone who lifts heavy objects repeatedly, you are likely to develop a bad back overtime. Injuries during weight training at gym can also cause lumbar problems. You should never lift an item heavier than yourself – always call for help.

What should be the preferred sleep positions for people with disc problems?

The sleep positions should support the spinal curves. Choose a hard-surfaced bed with cotton mattress. Use a soft pillow to support the neck while lying on your back. If you usually sleep on your side, then cushion yourself with pillows supporting the part from shoulder to head.

Can pregnancy worsen back pain?

The posture of a pregnant woman changes as the pregnancy progresses. With the back flexing forward as her centre of gravity shifts, it causes low back pain in some women. This is a common condition that affects over half of pregnant women. In most cases, exercising, both before and during pregnancy, will strengthen the abdominal muscles and back muscles decreasing the risk of back pain.

For those women who have suffered back pain prior to becoming pregnant, particularly those with a history of herniated discs, there is an increased risk of significant pain. It is best to discuss treatment of such pain with your doctor. Ample bed rest and judicious exercise will help relieve the pain. It is not advisable to take medicines to reduce back pain while pregnant.

Courtesy: Manorama Arogyam