Advanced Orthopedic Surgical Specialists. P.C.

Back Pain

Back Pain- How a surgeon can help :: Causes of back pain

Causes of back pain

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:: Degenerative Disc Disease
:: Canal Stenosis
:: Scoliosis
:: Herniation of Nucleus Pulposus
:: Spondylolisthesis
:: Sciatica
:: Internal Disruption of the Disc

Degenerative disc disease (DDD)

Is a generic description of many symptoms and diagnosis

This is a common finding in adults over 50. The cause can be biochemical or biomechanical in nature. It usually present as a gradual on set of lower back pain although DDD is a common finding in conjunction with a diagnosis of an acute disc herniation. Degenerative changes to the disc leads to water loss with in the nucleus pulposus as well as generalised wearing of the annulus fibrosus. As a result of the degeneration, the mechanics of the disc change, and over time a narrowing of the disc space may result in canal stenosis or segmental instability.

Degenerative Disc Disease

Canal Stenosis

Canal stenosis is a narrowing of the foramen through which the nerves pass. The narrowing of the lateral or side foramina can result in a single nerve root becoming entrapped and compressed. If the narrowing is in the central spinal canal many nerve roots can be affected causing pain.


  • pain in the back
  • pain in the buttock
  • numb / pins and needles down the leg
  • heavy tired feeling in the leg
  • weakness in the effected leg



Scoliosis is a lateral S shape or C shape deviation from the normal vertical line of the spine. There are two major classifications for scoliosis. The first is postural scoliosis where there is no permanent deformity. This can be seen as a mild curvature with or with out the prominence of one hip and humping of the shoulders. This type can be corrected with core stabilizing exercise and postural conditioning. The second and more serious form is structural scoliosis. This involves a fixed rotation of the vertebrae with compensatory changes such as asymmetry of hip and shoulder height as well as asymmetry of muscle mass and strength.


  • Shoulders are Asymmetrical ( one higher than the other )
  • Hips Asymmetrical ( one higher than the other )
  • Shoulders can humped
  • Shoulder blades can be very prominent
  • Visible listing to one side
  • Angled waist line


Herniation of nucleus pulposus

Herniation of the nucleus pulposus also referred to as a slipped disc, involves both a rupture or tear in the annulus (the outer fibrous rings of the disc), and the protrusion

of nuclear material through the tear beyond the outer limits of the disc. Pain is produced first by the annular nerve fibres recognising structural damage as for IDD. Then, depending on the severity of the herniation, nuclear material may also exert pressure on one or multiple nerve roots causing a heightened pain response.


  • Lower back pain can be sharp / burning / ache
  • Numbness and tingling down the back or side of the leg sometimes into the foot
  • In acute cases, the inner thigh (uppermost) can become numb along with loss of bladder control.


Spondylolisthesis means a forward displacement of one vertebra in relation to another. This type of pathology can be categorised as congenital, Isthmic, degenerative, traumatic and pathologic. The most common types are spondylitic (Isthmic) spondylolisthesis, where the pars interarticularis has a defect which allows the body of the L5 vertebra to slip forward. Another common form is the degenerative spondylolisthesis. This does not involve a pars defect but occurs as a result of long standing segmental instability and degeneration of the vertebra's facet joints. 



Sciatica is in actual fact a symptom, also called lumbar radiculopathy. It is a nerve pain and as the name suggests it is the sciatic nerve that is receiving pain signals from irritated nerve roots higher up in the lumbar spine. The cause of the pain can originate from internal disruption of the disc, disc herniation or degeneration disc disease.


  • A dull ache in your lower back
  • Radiating pain into your buttock and down the back of your leg.

Internal disruption of the disc

Internal disruption of the disc (IDD) indicates a change in the integrity of the annulus. Often, a tear in the annulus may result following trauma to the region. The nucleus it's self does not contain pain receptors and therefore does not recognise injury. It is the annulus that recognises the structural inconsistency and alerts us to the fact through pain. IDD can, but does not always in involve herniation of the nucleus pulposus. To fit the category of IDD the herniation must remain inside the outer limits of the disc.


  • Aching pain in the back usually lower
  • Aching pain in the buttock
  • Aching / pins and needles / numb sensation down one leg

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