Patients over 40 years old are most susceptible to diseases of the cardiovascular system and diseases of the musculoskeletal system. A common symptom of diseases of the musculoskeletal system is back pain. It affects a large number of the population every year, including young people. There are not many causes of back pain. In the presence of back pain, the patient should consult a doctor to find out the cause of back pain and the necessary examination. Consider the main causes of back pain in our article.
Pathological processes that are the causes of back pain
Often, an episode of mechanical pain in the elderly is observed in patients with musculo-ligamentous dysfunction, less often – with degenerative lesions of the spine (osteoarthritis of the facet joints, spondylosis), herniated disc, non-traumatic osteoporotic compression of the vertebrae, spondylolisthesis, spinal stenosis.
- Facet Syndrome
If in young people back pain often appears due to degenerative processes in the intervertebral disc (hernia, prolapse), then in elderly people, the cause of back pain is often the pathology of the facet joints.
It was found that in case of facet syndrome, the height of the disc between the vertebrae decreases, and the articular processes of the vertebrae are inclinated. This reduces and deforms the area of the intervertebral foramen. This is how osteoarthritis of the facet joints develops.
In facet syndrome, the cause of back pain can be a mechanical blockade of the joints, reactive synovitis, compression of the nerve root. In facet syndrome, back pain is typical with extension and rotational movements in the lower back. The pain radiates to the buttocks and is more intense when standing, decreases when leaning forward.
- Degenerative spondylolisthesis
Spondylolisthesis may be the cause of back pain. Pain, typical of degenerative spondylolisthesis, is characterized by localization along the back of the thigh, which appears after taking a sitting or lying position. Such pain is typical of L5-S1 spondylolisthesis, but can also be a symptom of segmental instability of the lumbar spine.
- Spinal stenosis
Often, stenosis of the spinal canal is formed against the background of the growth of the surface of the edges of the facet joints, hernias and protrusions of the intervertebral discs, posterior osteophytes, hypertrophy of the yellow ligament. Stenosis can occur after trauma as a result of an undiagnosed vertebral fracture, in which deformation and narrowing of the spinal canal occurs.
Stenosis of the lumbar spine is characterized by aching pain in the legs, which increases at the beginning of walking and is relieved by rest and sitting.
- Non-mechanical back pain
Non-mechanical spinal lesions are a common cause of back pain. This refers to infectious and neoplastic processes in the back. Non-mechanical back pain has the following symptoms:
- Pain appears at night (metastases, swelling).
- There is a decrease in body weight (malignant tumors).
- Fever (tumor, osteomyelitis, disc infection, tuberculosis, sepsis).
- The pain in the back is localized and intense (speaks of an erosive process).
- It is difficult for a person to find a comfortable body position for him (aortic aneurysm, urolithiasis, metastases).
- Ineffective pain therapy.
Most often, the thoracic spine is involved in the tumor process - 70%, the lumbar – 20%, cervical – ten%. Breast cancer, lung cancer, prostate cancer and thyroid cancer metastasize to the spine. When metastasizing, spongy tissue is first affected, then the longitudinal ligament and lateral sections. The anterior sections are the last to be affected.
Myeloma can cause back pain. Bone damage in multiple myeloma is one of the main clinical syndromes and is accompanied by the development of osteoporosis and osteodestruction. Characterized by constant intense pain in the back and chest, which subsides in the supine position (in contrast to the pain of lesions with metastases).
Vertebral osteomyelitis develops as a result of hematogenous spread of infection from foci in the body. Predisposing factors are long-term immunosuppression, diabetes mellitus, alcoholism.
The cause of back pain may be a tuberculous process in the lungs.
Why does osteoporosis of the bones cause back pain?
- Vertebral compression in case of bone osteoporosis (non-traumatic origin)
Compression fractures of the vertebrae are most common in the first 20 years of menopause in women (postmenopausal osteoporosis). Pain in osteoporosis of the bones has some features:
- Pain often radiates to the abdominal wall, chest cavity, while movements are sharply limited.
- Back pain appears with compression load (lifting weight, changing body position).
- The vertebrae that bear the greatest weight load (10-12 chest and 1-2 lumbar) are affected and suffer.
- Pain radiates to the iliac crests and femur with a fracture of 1st lumbar vertebra.
- Back pain in osteoporosis of the bones lasts for 1-2 weeks, then slowly decreases in intensity over 2-3 months.
In order to detect a vertebral fracture in osteoporosis in time, you need to know its signs:
- Increased thoracic kyphosis.
- Decrease in human height by 2-3 cm or more over 2-3 years of observation. When a person's height decreases by 4 cm from the height of 25 years, it is advisable to perform an x-ray of the spine for examination.
- In standing position, detection of the distance from the back of the head to the back.
- Reduction of the distance between the iliac crest and ribs.
- Reduction in the number of teeth less than 20 and weight loss less than 51 kg.
If osteoporosis of the bones is suspected, a differential diagnosis with metabolic diseases of the skeleton should be performed.
To do this, you need to take tests to determine the level of total phosphorus and calcium, the level of calcium in the morning portion of urine as a marker of bone resorption, the daily excretion of calcium in the urine to determine the absorption of calcium.
It is also necessary to determine the activity of alkaline phosphatase as a marker of osteoblastic function, creatinine clearance, the level of parathyroid hormone, TSH in women, testosterone in men.
In any case, if you experience back pain, you should not hope that it will pass. If such pains do not arise after physical overstrain and do not disappear within 4 days – this should alert the patient. Self-medication with anti-inflammatory ointments will only erase the clinical picture, which will make it much more difficult to diagnose the causes of back pain.
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