Back Pain Back pain is often a common symptom of many disease conditions and the back pain may range from simple or dull pain to sudden and sharp pain. If the pain persists for few days, it is acute pain whereas if continues for more than 3 months, it is considered as chronic pain. In most cases, back pain may resolve without any treatment however if persists for more than 3 days, medical intervention is necessary. Neck Pain The first 7 vertebral bones on the spinal column form the cervical spine and are located in the neck region. The neck bears the weight of the head, allows significant amount of movement, and also less protected than other parts of spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position. Spinal Deformity Surgery The Spine or backbone provides stability to the upper part of our body. It helps to hold the body upright. It consists of several irregularly shaped bones, called vertebrae appearing in a straight line. The spine has two gentle curves, when looked from the side and appears to be straight when viewed from the front. When these curves are exaggerated, pronounced problems can occur such as back pain, breathing difficulties and fatigue and the condition will be considered as deformity. Spine deformity can be defined as abnormality in the shape, curvature and flexibility of spine. Spine Injections Spine injection is a nonsurgical treatment modality recommended for treatment of chronic back pain. Injection of certain medicinal agents relieves the pain by blocking the nerve signals between specific areas of the body and the brain. The treatment approach involves injections of local anaesthetics, steroids, or narcotics into the affected soft tissues, joints, or nerve roots. It may also involve complex nerve blocks and spinal cord stimulation. Spine Trauma Spine trauma is damage to the spine caused from a sudden traumatic injury caused by an accidental fall or any other physical injury. Spinal injuries may occur while playing, performing normal activities, operating heavy machines, lifting heavy objects, driving automobiles, or when you suffer a fall. Injury to spine may cause various conditions including fractures, dislocation, partial misalignment (subluxation), disc compression (herniated disc), hematoma (accumulation of blood) and partial or complete tears of ligaments. Vertebral Fractures Vertebral compression fractures occur when the normal vertebral body of the spine is squeezed or compressed. The bone collapses when too much pressure is placed on the vertebrae, resulting in pain, limited mobility, loss of height, and spinal deformities. In severe compression fractures the vertebral body is pushed into the spinal canal which will apply pressure on the spinal cord and nerves.

1. Herniated Disk in the Lower Back:
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Sometimes called a slipped disc, a herniated disk most often occurs in your lower
back. It is one of the most common causes of low back pain, as well as leg pain
(sciatica).

2. Herniated Disc symptoms: sharp, burning or stabbing pain in back, may also run
down leg; onset is often sudden.
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Condition and Causes:
Between 60% and 80% of people will experience low back pain at some point in
their lives. A high percentage of people will have low back and leg pain caused by a
herniated disk.
Although a herniated disk can sometimes be very painful, most people feel much
betterment with just a few weeks or months of nonsurgical treatment.
Anatomy:
Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one
another. These bones connect to create a canal that protects the spinal cord.
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Five vertebrae make up the lower back. This area is called your lumbar spine.
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Other parts of your spine include:
Spinal cord and nerves.These "electrical cables" travel through the spinal canal
carrying messages between your brain and muscles.
Intervertebral disks. In between your vertebrae are flexible intervertebral disks.
They act as shock absorbers when your walk or run.
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Intervertebral disks are flat and round, and about a half inch thick. They are made
up of two components.

5. Healthy intervertebral disk (cross-section view).
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6. • Annulus fibrosus.This is the tough, flexible outer ring of the disk.
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• Nucleus pulposus.This is the soft, jelly-like center of the disk.
• In between the vertebrae of the spine are cushions called discs. Theses discs
contain an inner core, called the nucleus pulposus, and an outer wall, called
the annulus fibrosis. If the annulus degenerates or tears, the nucleus can
seep into the annulus and cause the disc to bulge and protrude. This bulging
disc may press against nerves and cause pain. When the inner core pushes
through the annulus fibrosis, it's called a herniated disc. The tear in the
annulus fibrosis created by this bulging of the inner core causes back pain.
That pain may spread to a different area of the body if the now protruding
disc is putting pressure on a spinal nerve.
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A disk begins to herniate when its jelly-like nucleus pushes against its outer ring
due to wear and tear or a sudden injury. This pressure against the outer ring may
cause lower back pain.
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If the disk is very worn or injured, the jelly-like center may squeeze all the way
through.
Once the nucleus breaks — or herniates — through the outer ring, pain in the lower
back may improve. Sciatic leg pain, however, increases. This is because the jelly-
like material inflames the spinal nerves. It may also put pressure on these sensitive
spinal nerves, causing pain, numbness, or weakness in one or both legs.
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Causes:
In many cases, a herniated disk is related to the natural aging of your spine.
In children and young adults, disks have a high water content. As we get older, our
disks begin to dry out and weaken. The disks begin to shrink and the spaces
between the vertebrae get narrower. This normal aging process is called disk
degeneration.
Risk Factors
In addition to the gradual wear and tear that comes with aging, other factors can
increase the likelihood of a herniated disk. Knowing what puts you at risk for a
herniated disk can help you prevent further problems.
Gender. Men between the ages of 30 and 50 are most likely to have a herniated
disk.
Improper lifting. Using your back muscles to lift heavy objects, instead of your
legs, can cause a herniated disk. Twisting while you lift can also make your back
vulnerable. Lifting with your legs, not your back, may protect your spine.

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Weight. Being overweight puts added stress on the disks in your lower back.
Repetitive activities that strain your spine. Many jobs are physically demanding.
Some require constant lifting, pulling, bending, or twisting. Using safe lifting and
movement techniques can help protect your back.
Frequent driving. Staying seated for long periods, plus the vibration from the car
engine, can put pressure on your spine and disks.
Sedentary lifestyle. Regular exercise is important in preventing many medical
conditions, including a herniated disk.
Smoking. It is believed that smoking lessens oxygen supply to the disk and causes
more rapid degeneration.
Symptoms and Diagnosis;
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The main symptom of a herniated disc is sharp and acute pain, often described as
a "deep pain," which increases in severity as it moves down the affected leg. Pain
onset may occur suddenly, or be preceded by a snapping or tearing sensation in
the spine. This sensation may be attributed to the annulus fibrosis suddenly tearing.

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There is often a limited range of motion present in patients with herniated discs,
and patients will often lean to one side when bending over. Walking will often be
painful, with patients attempting to alter their gait by straightening the affected leg to
avoid putting too much weight on it.
Magnetic Resonance Imaging (MRI) is often used to diagnose a herniated disc. CT
scans are also helpful for providing better images of the source of pressure if a
nerve root is being pressed upon by the herniated disc.
Symptoms may be one or all of the following:
• Back pain
• Leg and/or foot pain (sciatica)
• Numbness or a tingling sensation in the leg and/or foot
• Weakness in the leg and /or foot
• Loss of bladder or bowel control (extremely rare) This may indicate a more
serious problem called cauda equina syndrome. This condition is caused by
the spinal nerve roots being compressed. It requires immediate medical
attention.
Not all patients will experience pain as a disk degenerates. It remains a great
challenge for the doctor to determine whether a disk that is wearing out is the
source of a patient's pain.
Physical examination:
To determine whether you have a herniated lumbar disk, your doctor will ask you for
a complete medical history and conduct a physical examination. The diagnosis can
be confirmed by a magnetic resonance imaging (MRI) scan.

12. Medical History and Physical Examination
After discussing your symptoms and medical history, your doctor will examine your
spine. During the physical examination, your doctor may conduct the following tests
to help determine the cause of your low back pain.
Neurological examination. A physical examination should include a neurological
examination to detect weakness or sensory loss. To test muscle weakness, your
doctor will assess how you walk on your heels and toes. Your thigh, ankle, and toe
strength may also be tested. Your doctor can detect any loss of sensation by
checking whether you are numb to light touch in the leg and foot. In addition, your
reflexes at the knee and ankle will be tested, and sometimes may be absent.
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Straight leg raise (SLR) test.
This test is a very accurate predictor of a disk herniation in patients under the age
of 35. In this test, you lie on your back and your doctor lifts your affected leg. Your
knee stays straight. If you feel pain down your leg and below the knee, you test
positive for a herniated disk.
Imaging Tests:
To help confirm a diagnosis of herniated disk, your doctor may recommend a
magnetic resonance imaging (MRI) scan. This scan can create clear images of soft
tissues like intervertebral disks.
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13. Treatment :
In the majority of cases, a herniated lumbar disk will slowly improve over a period of
several days to weeks. Typically, most patients are free of symptoms by 3 to 4
months. However, some patients do experience episodes of pain during their
recovery.
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Rest, medication and physical therapy are usually successful when treating a
herniated disc. Medications like anti-inflammatory drugs, analgesics and muscle
relaxants may be prescribed to help with pressure and pain.
Surgery is not often needed for a herniated disc, but if a patient doesn't respond to
rest, physical therapy and medications over a long period of time, surgery may be
recommended.
Nonsurgical Treatment
Unless there are neurological deficits — muscle weakness, difficulty walking — or
cauda equina syndrome, conservative care is the first course of treatment. Because
it is not clear that nonsurgical care is any better than letting the condition resolve on
its own, the focus is on providing pain relief.
Common nonsurgical measures include:
Rest. Usually 1-2 days of bed rest will calm severe back pain. Do not stay off your
feet for longer, though. Take rest breaks throughout the day, but avoid sitting for
long periods of time. Make all your movements slow and controlled. Change your
daily activities so that you avoid movements that can cause further pain, especially
bending forward and lifting.
Anti-inflammatory medications. Medicines like ibuprofen or naproxen may relieve
pain.
Physical therapy. Specific exercises can strengthen your lower back and
abdominal muscles.
Epidural steroid injection. In this procedure, steroids are injected into your back
to reduce local inflammation.
Of the above measures, only epidural injections have been proven effective at
reducing symptoms. There is good evidence that epidural injections can be
successful in 42-56% of patients who have not been helped by 6 weeks or more of
other nonsurgical care.
Overall, the most effective nonsurgical care for lumbar herniated disk includes
observation and an epidural steroid injection for short-term pain relief.
Surgical Treatment

14. Only a small percentage of patients with lumbar disk herniations require surgery.
Spine surgery is
typically recommended
only after a period of
nonsurgical treatment
has not relieved painful
symptoms.
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Microdiskectomy. The most common surgical procedure for a herniated disk in the
lower back is a lumbar microdiskectomy. Microdisketomy involves removing the
herniated part of the disk and any fragments that are putting pressure on the spinal
nerve.
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Rehabilitation. Most patients do not require formal physical therapy after surgery.
After your surgeon evaluates you and confirms that your incision is healed, you
may begin a rehabilitation exercise program. A simple walking program 30 minutes
each day, along with flexibility exercises for the back and legs, can be done as a
home program. If needed, your surgeon will refer you to a physical therapist.
Considerations
Regardless of the kind of treatment prescribed, there is a 5% chance of the disk
herniating again.
The risk of nonsurgical treatment is that your symptoms may take a long time to
resolve.
The risk of surgical complications is exceptionally low. Possible complications
include:
• Infection
• Nerve damage
• Dural leak — An opening of the thin lining of the nerve root canal may cause
loss of the watery liquid (cerebrospinal fluid) that bathes the nerves roots.
When seen during surgery, the lining may be repaired. Sometimes
headaches occur afterward, but typically improve with time.
• Hematoma causing nerve compression — This is caused by blood collecting
around the nerve roots after the surgery.
• Recurrent disk herniation — another piece of disk material may break off at
the same site and cause the leg pain to return. This may be managed with
conservative treatment, but another surgery may be necessary.
• Outcomes:
The results of microdiskectomy surgery are generally very good. The outcome of
leg pain improvement is much more reliable than back pain and therefore this
surgery is rarey performed for back pain only.

17. Most patients notice improvement over the first several weeks following surgery, but
may also experience continued improvement over several months. Pain is typically
the first symptom to improve, followed by improvement in overall strength of the leg,
and then sensation. It is common for some patients to state that although pain
symptoms are better, they still have a numb spot on their leg or foot.
Most patients will slowly resume normal daily activities over the first several weeks
following surgery.
Over the last several years, there has been extensive research on lumbar disk
surgery and patient improvement. One of the most publicized research projects in
this area is the Spinal Patient Outcomes Research Trial (SPORT). The study
followed patients with herniated disk. Half were treated with conservative
measures, and half with surgery.
The initial outcomes for patients treated with surgery were much better than those
who followed conservative treatment, including improvement in pain relief and
function. At the 2-year follow-up, patients treated with surgery again showed
improvements over those treated conservatively. However, over the course of the
study, numerous patients did change their treatments. Your surgeon will be best
able to explain what the actual study results are with any recommended approach
for you.
All information provided here is for information purposes only. Please see a
healthcare professional for medical advice.

18. This information is provided as an educational service and is not intended to serve
as medical advice. Anyone seeking specific orthopaedic advice or assistance
should consult his or her orthopaedic surgeon.
Dr.Sandeep C Agrawal!
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Consultant Orthopaedic Surgeon!
Agrasen Hospital Gondia!
Vidarbha Maharashtra India!
www.drsandeepagrawal.com!
www.agrasenortho.com!
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