Back pain

The causes of back pain

Back or spine pain can have very different causes. It can be either congenital or inflammatory, and an accident, degenerative changes or a tumour can cause pain. The pain may be located in all sections of the spine.

Pain in the spine due to degenerative diseases

Degenerative disc disease can cause significant pain in the spine: on the one hand from the pressure exerted on the nerve structures by a bulging or herniated disc (herniated disc) which has slipped into the spinal canal at that point, and on the other hand this disc degeneration process sets off a cascade which leads to instability of the spine. This in turn initiates supporting bone growth, a progressive lack of elasticity and loss of stability, which untrained muscles cannot compensate.  Increasingly, the pain intensifies. These bony growths on the vertebrae and facet joints can lead to so-called spondylarthritis, wear of the vertebral joints (facet arthrosis) and a narrowing of the spinal canal (spinal stenosis), with compression of nerves and the spinal cord.

Pain in the spine caused by metabolic disorders and inflammatory processes

Osteoporosis is a primary metabolic bone disease which can often occur in menopausal women due to estrogen deficiency.  It often occurs at an advanced age or secondarily as a consequence of other diseases, such as with chemotherapy or cortisone therapy. Through a decrease in bone mass or an excessive loss of bone cells, with too little regeneration, stability diminishes rapidly. The vertebrae become more brittle. This can cause severe pain in the spine. Inflammation of the vertebrae and the intervertebral discs (spondylodiscitis) can lead to severe back pain. However, these diseases are rarer.

Pain in the spine due to congenital or acquired causes

Other causes of back pain can be a spondylolisthesis, in which two vertebrae shift against each other; further vertebral fractures due to osteoporosis or an accident, rheumatic diseases or tumor / metastases.

Scoliosis is a defective curvature of the spine. This is often congenital (idiopathic) and occurs in children and adolescents either as a primary growth deformity or secondarily in later years, as a result of instabilities from the wear disorders mentioned above. Pain as a result of scoliosis often only occurs in the late stage. Therefore, early detection in children is very important, through regular checkups and early treatment in specialized centres.

SI-joint arthrosis (wear of the sacroiliac joint) triggers severe back pain. Pain when sitting or lying down, with radiating leg pain, is a typical symptom.

Persistent pain in the lumbar spine after previous spine surgery, or so-called “failed back syndrome” , can have different causes, eg the “post-nucleotomy syndrome” (post-operative pain after disc surgery), post-operative dysbalance of the vertebra or the muscles, instability, scar fibrosis or even a re-herniated disc (relapse).