How Spine works

How Back Muscles Work

Back and Neck Pain Causes

Back Problems & Surgery

For you to fully understand any back or neck issues you may be having, it helps to know a little bit about how that complicated system of bones, vertebra, and muscles that makes up your neck and back work. Once you get a feel for that, you can better understand the different things that can cause you to suffer from back and neck pain. If your problems are severe enough to require surgery, then you can be mentally prepared for that possibility.

How Your Spine Works

The spine serves many purposes in the body and without it we would not be able to keep ourselves upright, let alone stand up. It gives the entire body support and structure and allows us to move, twist, and bend. It also has the very important job of protecting the spinal cord, the column of nerves that serves as the connector from the brain to the body, thus being in charge every move we make.

PARTS OF THE SPINE
The spine contains 24 small bones called vertebra that are the basis of the spinal column. All of these bones together are referred to as vertebrae. Not only do the vertebrae surround and protect the spinal cord, but they also support most of the weight that is put on the spine. Each vertebra has two parts – the body and lamina. Each lamina protrudes from the body of the vertebra and encircles the spinal cord. The lamina is made up of the spinous process and the transverse process. The spinous processes are the bumpy spots you can feel in the middle of the back, while the transverse processes are the places where the back muscles connect to the vertebrae.

A soft cushion called a disc is between each vertebra. This gel-like disc absorbs pressure put on the spine and prevents the individual bones from rubbing together. The vertebra are held to each other by the ligaments in the spine. The job of ligaments not matter where they are found in the body is to connect bones together. There are also tendons in the spine that connect the vertebra to the muscles in the back. The spinal column also has joints, called facet joints, which connect the vertebrae to each other and provide flexibility for movement.

The spinal cord, a bundled group of nerves, runs down through the tube that is formed by the holes in the vertebrae. Thirty-one groups of nerve roots branch off from the spinal cord and come out of the spine on each side through small spaces between each vertebra.

SEGMENTS OF THE SPINE
The spine is made of three separate segments:

· The cervical spine – This is the upper segment known as the neck and is made up of seven vertebrae.

· The thoracic spine – This is the center segment of the spine and has 12 vertebrae.

· The lumbar spine – This is the lower portion of the spine with 5 and sometimes 6 vertebrae.

Directly beneath the lumbar segment is the sacrum, which is technically a group of a different type of vertebrae whose purpose is to attach the spine to the pelvis. These vertebrae are different because they become fused together before we are born. The pelvis has two sacroiliac joints (SI) where the pelvis and ilium, the larger pelvic bone, attach.
How Back Muscles Work
That complex spine and is bordered by a an equally complex set of muscles.

1. The intertransversarii muscles help with the movement that occurs between each vertebra. They are located between the transverse processes and are the most developed in the cervical segment of the spine. In this segment, there are seven pairs of intertransversarii muscles. In the thoracic segment, they are also found between the transverse processes, but in the lumbar segment they are on each side of the vertebrae rather than between.

2. The multifidus muscle is a very thin muscle that is located deep in the spine, covering all three of the segments of the spinal column as well as the sacrum. Its job is to stabilize the joints, lowering the possibility of the joints degenerating.

3. The trapezius muscle extends from the occipital bone at the base of skull to the lower part of the thoracic vertebrae. It also extends across the back from the base of the skull to the shoulder blades. Its purpose is to support the arms.

4. The latissiumus dorsi, which means “broadest muscle of the back”. It forms a triangle that starts at the shoulders down extends down to the hip. Among it many other purposes, this muscle plays a role in the extension and flexibility of the lumbar portion of the spine. It also helps with the rotation of the shoulder joints.

Back and Neck Pain Causes

There are a lot of different conditions that can cause pain in the lower back and in the neck. Sometimes pain that you feel in your back may not even be caused by the muscles in the back or your spine, but by organs that are nowhere near your back. Pain like this is called referred pain and a good example of this is pain caused by a kidney infection or kidney stones.

The most common reasons for back and neck pain are:

1. A sprain or strain in your spine – These have to do with either ligaments or muscles. A sprain occurs when the ligaments in the spine are injured and a strain is an inured muscle or muscles.

Symptoms of a strain or sprain are things like spasms in the neck or back, tightness or stiffness, and pain. The pain is caused when the soft tissue in your neck or back has been stretched too far or has torn. If this occurs in the lower back, it is often the result of lifting something heavy. If you have consistently bad posture or are overweight, this can cause a strain or sprain as well. People who are at a higher risk for this type of injury are people whose work may expose them to constant vibrations, women who are pregnant, and older adults.

This type of neck or back injury usually goes away within a month with proper care.

2. Discogenic Pain – Another type of back or neck pain is discogenic pain and is a result of disc degeneration. As we age, we begin to lose the fluid that is in the outer portion of the discs. When this happens, they start to get dry and brittle and can crack more easily, allowing chemicals that cause pain to leak out from the discs into the spinal canal. These chemicals can irritate nerve endings, making the back or neck hurt, but the pain can even move down into the buttocks, thighs, and legs or up into the shoulders, hands, and arms.

3. Sciatica – This is the kind of pain that begins in the back and eventually is sent into the thigh and the outer part of the leg. Sciatica is caused when the sciatic nerve becomes irritated. This causes pain and often a tingling sensation down the leg. This irritation of the nerve typically occurs when a disc degenerates or becomes herniated.

4. Facet Joint Syndrome – Discs, facet joints, and ligaments are what link the vertebrae together. It is the facet joints that are the part of this system that allow us to move. All of the nerves that come out of the spine have tiny branches that go into the facet joints. These nerves can send pain signals when there is inflammation in the facet joint; joint stress, which means the bones of the joint or rubbing together; or both.

Pain from facet joint syndrome occurs only a few times a year. The pain or tenderness is at the point over the facet joint that is inflamed and may be accompanied by some loss of motion or flexibility. The pain will be more evident when leaning backwards.

These facet joint problems usually occur in the lower back and make it difficult to stand for long periods and sitting may be even more painful. If the problem is in the cervical facet joints, the pain is like a deep ache and occurs higher up in the back and into the neck.

5. Spinal Stenosis – This condition occurs when the spinal canal that contains the spinal cord narrows. This narrowing puts undue pressure on the nerves in the spinal canal, thus causing pain. The pain is usually described as more of an ache and sometimes as an electrical shock going down the arm or the leg. Spinal stenosis can also cause leg pain when walking.

There are two kinds of spinal stenosis. The more common is acquired stenosis, which is caused by aging. The facet joints get thicker because of conditions like disc degeneration. The other type of stenosis starts before birth and is quite rare.

Back Problems & Surgery

Almost everyone will suffer from some type of back problems in their life. Ninety percent of these problems will improve with no treatment or with some conservative form of therapy in 4 to 6 weeks. Surgery is usually not considered unless all conservative measures have proved unsuccessful. Back surgery is usually only considered to be an option when spinal nerves are being compressed as with sciatica.

Once sciatica has caused damage to the nerve, surgery may be required and some side effects like “foot drop”, leg weakness, or pain in the leg that is disabling and has not improved with other treatments.

With this type of surgery, the spinal canal is entered and the lamina, the bony roof area of the canal, is removed. Then either the disc that is causing the irritation is removed or the area between the disc and the nerve is made wider.

If conventional treatments for spinal stenosis have not solved the problem, a spinal decompression may be performed. The surgery is similar to that performed to relieve sciatica.

Some other back surgeries that may be considered include:

· Spinal fusion – This is done to connect two or more bones in the spine. It is sometimes performed to get rid of the pain that results from degenerated discs or discs that are otherwise injured.

· Artificial discs – Artificial disks can be inserted rather than using spinal fusion for degenerated or injured disks.

· Vertebroplasty – Occasionally, vertebrae can become compressed. This procedure is done to inject what is known as bone cement into this area.

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