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Damage or wear to bones, muscles or other tissues of the back From Wikipedia, the free encyclopedia
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.[1] 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.[2] It is estimated that low-back pain may affect as much as 80 to 90 percent of the general population in the United States.[3]
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Muscle and soft tissue injuries can be classified using a graded system.[4]
Spinal column or vertebral injuries can be classified using the AO spine injury classification system.[5] The three categories - A, B, and C - are based on the location of damage on the vertebra (either on the anterior or posterior segment) and by the direction of the applied injurious force.
This classification system can be used to classify injury to the cervical, thoracolumbar, and sacral regions of the spinal column.
Herniated discs can be graded based on the size and location of the herniation as seen on an MRI.
The size of the herniation is the extent to which it protrudes into the vertebral foramen. The MSU Classification for herniated discs uses the proximity of the disc to the facet joint when measuring the size of a herniated disc.[7] 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.
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.[7]
MSU Classification is primarily used for classifying herniated discs in the lumbar spine.
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.[8] Herniated discs are associated with age-related degeneration, trauma such as a fall or car accident, and bending or twisting while lifting heavy weights.[9] 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.[10]
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 which can progress to spondylolisthesis.[11] The immature skeleton contains growth plates which have not yet completely ossified into stronger mature bone.[11] Vertebral fractures in elderly individuals are exacerbated by weakening of the skeleton associated with osteoporosis.[12][13]
Diagnosis of a back injury begins with a physical examination and thorough medical history by health-care personnel.[8][14] 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-rays are often used to visualize pathology of bones and can be ordered when a vertebral fracture is suspected.[15][8] 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.[16] MRI is commonly referred to as the gold standard for visualizing soft tissue and can be used to assist with diagnosing many back injuries, including herniated discs and neurological disorders, bleeding, and edema.[16][17]
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, limiting alcohol, maintaining a healthy weight, and keeping bones and muscles strong with adequate exercise and a healthy diet.[8] 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.[8][9][18] 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, enrolling in a fall prevention 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.[13][12]
Treatment for back injuries depends on the diagnosis, level of pain, and whether there is loss of function or quality of life.
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.[22]
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