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Back injuries result from damage, wear, or trauma to the bones, muscles, or other tissues of the back. Common back injuries include
sprains and strains,
herniated discs, and
fractured vertebrae. The
lumbar spine is often the site of back pain. The area is susceptible because of its flexibility and the amount of body weight it regularly bears. It is estimated that low-back pain may affect as much as 80 to 90 percent of the general population in the United States.
[Putz-Anderson, Vern, Thomas Waters, and Arun Garg. (1994)]
Applications Manual for the Revised NIOSH Lifting Equation
National Institute for Occupational Safety and Health. NIOSH (DHHS) Publication 94–110.
Classification
Soft tissue graded system
Muscle and
soft tissue
Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth. Soft tissue connects, surrounds or supports internal organs and bones, and includes muscle, tendons, ...
injuries can be classified using a graded system.
* Grade 1 muscle strain is the least severe with damage to few muscle fibers and little if any loss of function.
* Grade 2 muscle strain indicates a mild to moderate injury with appreciable tissue damage and some loss of function or strength.
* Grade 3 muscle strain is the most severe injury grade with the muscle being either completely torn or experiencing complete loss of function.
AO spine injury classification system
Spinal column or vertebral injuries can be classified using the AO spine injury classification system.
The three categories - A, B, and C - are based on the location of damage on the
vertebra
The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...
(either on the anterior or posterior segment) and by the direction of the applied injurious force.
* Type A injuries are those associated with a
compression force with damage to the vertebral bodies.
* Type B injuries are those associated with a distraction force resulting in structural damage to the posterior components of the vertebral column.
* Type C injuries are those associated with damage to both anterior and posterior aspects of the vertebral column resulting in displacement of the disconnected segments in any direction.
This classification system can be used to classify injury to the
cervical
In anatomy, cervical is an adjective that has two meanings:
# of or pertaining to any neck.
# of or pertaining to the female cervix: i.e., the ''neck'' of the uterus.
*Commonly used medical phrases involving the neck are
**cervical collar
**cerv ...
,
thoracolumbar
The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordates ...
, and
sacral
Sacral may refer to:
*Sacred
Sacred describes something that is dedicated or set apart for the service or worship of a deity; is considered worthy of spiritual respect or devotion; or inspires awe or reverence among believers. The property ...
regions of the spinal column.
MSU classification for herniated discs
Herniated discs can be graded based on the size and location of the herniation as seen on an
MRI
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...
.
Size
The size of the herniation is the extent to which it protrudes into the
vertebral foramen
In a typical vertebra, the vertebral foramen is the foramen (opening) formed by the anterior segment (the body), and the posterior part, the vertebral arch.
The vertebral foramen begins at cervical vertebra #1 (C1 or atlas) and continues inferio ...
. The MSU Classification for herniated discs uses the proximity of the disc to the
facet joint when measuring the size of a herniated disc.
Using the MSU Classification, a grade of 1, 2 or 3 can be used to describe the size of a herniated disc with 1 being the least severe and 3 being the most severe.
Location
The location of the herniation can also be described using the MSU Classification for herniated discs. This classification describes how far away from mid-line a disc protrusion is using a grade of A, B, or C.
* Grade A describes a herniation at midline.
* Grade C herniations are the most lateral and protrude into the
intervertebral foramen
The intervertebral foramen (also called neural foramen, and often abbreviated as IV foramen or IVF) is a foramen between two spinal vertebrae. Cervical, thoracic, and lumbar vertebrae all have intervertebral foramina.
The foramina, or openi ...
(through which
spinal nerves travel).
* Grade B herniated discs are those located between grade A and C, using the facet joint as the landmark for the lateral border.
MSU Classification is primarily used for classifying herniated discs in the lumbar spine.
Causes
Many back injuries share similar causes. Strains and sprains to the back muscles can be caused by improper movements while lifting heavy loads, overuse of a muscle, sudden forceful movements, or direct trauma.
Herniated discs are associated with age-related degeneration, trauma such as a fall or car accident, and bending or twisting while lifting heavy weights.
Common causes of vertebral fractures include trauma from a direct blow, a compression force resulting in improper or excessive axial loading, and
hyper-flexion or
hyper-extension.
Vertebral fractures in children or elderly individuals can be related to the development or health of their spine. The most common vertebral fracture in children is
spondylolysis
Spondylolysis is a defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5), but spondylolysis may also occur in the cervical vertebrae.Dubousset, J. Trea ...
which can progress to
spondylolisthesis
Spondylolisthesis is the displacement of one spinal vertebra compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (or t ...
.
The immature skeleton contains
growth plates
The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with ...
which have not yet completely
ossified
Ossification (also called osteogenesis or bone mineralization) in bone remodeling is the process of laying down new bone material by cells named osteoblasts. It is synonymous with bone tissue formation. There are two processes resulting in t ...
into stronger mature bone.
Vertebral fractures in elderly individuals are exacerbated by weakening of the skeleton associated with
osteoporosis.
Diagnosis
Diagnosis of a back injury begins with a
physical examination
In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the pati ...
and thorough
medical history
The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...
by health-care personnel.
Some injuries, such as sprains and strains or herniated discs, can be diagnosed in this manner. To confirm these diagnoses, or to rule out other injuries or pathology, imaging of the injured region can be ordered.
X-ray
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...
s are often used to visualize pathology of bones and can be ordered when a vertebral fracture is suspected.
CT scans produce higher resolution images when compared to x-rays and can be used to view more subtle fractures which may otherwise go undetected on x-ray.
MRI is commonly referred to as the
gold standard
A gold standard is a monetary system in which the standard economic unit of account is based on a fixed quantity of gold. The gold standard was the basis for the international monetary system from the 1870s to the early 1920s, and from the l ...
for visualizing soft tissue and can be used to assist with diagnosing many back injuries, including herniated discs and
neurological disorders,
bleeding
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
, and
edema.
Prevention
Suggestions for preventing various back injuries primarily address the causes of those injuries. The risk for back sprains and strains may be reduced with lifestyle choices, including
smoking cessation
Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often m ...
, limiting alcohol, maintaining a healthy weight, and keeping bones and muscles strong with adequate
exercise and a
healthy diet.
The risk for disc herniations can be reduced by using proper techniques when lifting heavy loads, smoking cessation, and weight loss to reduce the load placed on the spine.
Vertebral fractures may be difficult to prevent since common causes are related to accidents or age-related degeneration associated with osteoporosis. Treating osteoporosis with
pharmacotherapy
Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement (physical therapy), or other modes. Among physicians, sometimes the term ''medical ther ...
, enrolling in a
fall prevention
Fall prevention includes any action taken to help reduce the number of accidental falls suffered by susceptible individuals, such as the elderly (idiopathic) and people with neurological (Parkinson's, Multiple sclerosis, stroke survivors, Guilla ...
program, strengthening muscles and bones with a weight-bearing exercise program, and adopting a nutritional program that promotes bone health are all options to reduce the risk of vertebral fractures associated with osteoporosis.
Treatment
Treatment for back injuries depends on the diagnosis, level of pain, and whether there is loss of function or quality of life.
Conservative
*
Cold therapy reduces
inflammation
Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
, edema,
pain, and
muscle spasms
A spasm is a sudden involuntary contraction of a muscle, a group of muscles, or a hollow organ such as the bladder.
A spasmodic muscle contraction may be caused by many medical conditions, including dystonia. Most commonly, it is a muscle c ...
associated with acute back injury.
*
Heat therapy
Heat therapy, also called thermotherapy, is the use of heat in therapy, such as for pain relief and health. It can take the form of a hot cloth, hot water bottle, ultrasound, heating pad, hydrocollator packs, whirlpool baths, cordless FIR h ...
is used to reduce pain and alleviate sore and stiff muscles.
Heat therapy is proposed to work by facilitating delivery of nutrients and oxygen to the site of injury to accommodate healing.
*
Medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and ...
: Non-steroidal anti-inflammatory drugs (
NSAIDs) or
acetaminophen can be taken to reduce mild to moderate pain associated with back injuries.
NSAIDs are suggested to be more effective for persistent pain than for acute pain. If pain remains intolerable while taking
over the counter medications, a stronger pain medication such as a
narcotic or a
muscle relaxant
A muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therap ...
can be prescribed at a physician's discretion.
* Therapy and alternative medicine: an active approach to recovery is recommended over
bed rest
Bed rest, also referred to as the rest-cure, is a medical treatment in which a person lies in bed for most of the time to try to cure an illness. Bed rest refers to voluntarily lying in bed as a treatment and not being confined to bed because of ...
for most cases of back injury.
Activity promotes strength and functional rehabilitation and counters
atrophy associated with disuse.
Physical therapy can help reduce pain and regain strength and function.
The gentle movement of
yoga
Yoga (; sa, योग, lit=yoke' or 'union ) is a group of physical, mental, and spiritual practices or disciplines which originated in ancient India and aim to control (yoke) and still the mind, recognizing a detached witness-consci ...
and
tai chi
Tai chi (), short for Tai chi ch'üan ( zh, s=太极拳, t=太極拳, first=t, p=Tàijíquán, labels=no), sometimes called " shadowboxing", is an internal Chinese martial art practiced for defense training, health benefits and meditation. ...
are suggested to improve function and to counter the negative
psychosocial
The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...
effects that can be secondary to injury.
Spinal manipulation,
massage
Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In E ...
, and
acupuncture
Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientif ...
have been used to treat the pain associated with various back injuries, but there is little consensus on their degree of effectiveness.
* Injections: Spinal
nerve block
Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block (sometimes referred to as simply "nerve block") is a short-term block, ...
s and
epidural
Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians an ...
injections are options available to alleviate pain and neurological symptoms.
Injections of
anesthetic
An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia — in other words, to result in a temporary loss of sensation or awareness. They may be divided into two ...
s alleviate pain while
steroid injections
A steroid is a biologically active organic compound with four rings arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter membrane fluidity; and ...
can be used to reduce the inflammation and swelling surrounding spinal nerves.
Non-Conservative
Surgery is considered when symptoms persist after attempting conservative treatment. It is estimated 10-20 percent of individuals with low back pain fail to improve with conservative measures.
* A
discectomy
A discectomy (also called open discectomy, if done through a 1/2 inch or larger skin opening) is the surgical removal of abnormal disc material that presses on a nerve root or the spinal cord. The procedure involves removing a portion of an int ...
is a common procedure used to alleviate the
radiating pain and
neurological symptoms
A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. Examples of symptoms include paralysis, muscle weaknes ...
associated with a herniated disc. There are multiple variations of a discectomy with differing approaches to access the herniated disc, but the goal of the procedure is to remove the portion of the intervertebral disc that is protruding into the vertebral foramen.
* A
total disc replacement can also be performed to address a herniated disc. Rather than removing only the portion of the disc that has
prolapsed as in a discectomy, this procedure involves removing the entire
vertebral disc
An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, to act as a ligament to hold t ...
and replacing it with an artificial one.
* Surgical remedies for vertebral fractures are found to be more effective than conservative treatment.
Vertebroplasty
Vertebral augmentation, including vertebroplasty and kyphoplasty, refers to similar percutaneous spinal procedures in which bone cement is injected through a small hole in the skin into a fractured vertebra in order to relieve back pain cause ...
and
kyphoplasty
Vertebral augmentation, including vertebroplasty and kyphoplasty, refers to similar percutaneous spinal procedures in which bone cement is injected through a small hole in the skin into a fractured vertebra in order to relieve back pain caused ...
are considered minimally invasive surgical procedures and are proposed to relieve pain and restore function of fractured vertebrae.
Epidemiology
* The two age groups with the highest rate of vertebral column injuries are ages 15–29 and 65 and older.
* An estimated 50 percent of spinal injuries are attributed to
motor vehicle accidents.
* Although the majority of vertebral fractures go undiagnosed, the annual cost related to treatment of vertebral fractures is estimated to be $1 billion in the U.S.
* Symptomatic disc herniations are most common between ages 30–50 years.
95 percent of herniated discs diagnosed in patients 25–55 years are located in the lumbar spine.
* By age 15 an estimated 26-50 percent of children have experienced acute or
chronic back pain.
References
{{DEFAULTSORT:Back Injury
Injuries of abdomen, lower back, lumbar spine and pelvis
Hazards of outdoor recreation