Back pain

The causes of back pain

Back or spinal pain can have many different causes. Pain can be caused by congenital or inflammatory conditions, accidents, degenerative changes or tumours. The pain can be localised in any section of the spine.

Spinal pain caused by degenerative diseases

Degenerative disc disease can cause significant pain in the spine: on the one hand, due to pressure from the bulging or prolapsed disc (disc prolapse) on the nerve structures in the immediate vicinity, and on the other hand, these degenerative processes (disc degeneration) trigger a cascade that leads to instability of the spine. This in turn initiates supportive bone growths, progressive loss of elasticity and loss of stability, which untrained muscles cannot compensate for. The pain continues to intensify. These bone growths on the vertebrae and vertebral joints can lead to spondylarthrosis, wear and tear of the vertebral joints (facet arthrosis) and narrowing of the spinal canal (spinal stenosis) with compression of the nerves and spinal cord.

Spinal pain caused by metabolic disorders and inflammatory processes

Osteoporosis is a primary metabolic bone disease that often occurs in women due to oestrogen deficiency during the menopause. It often occurs in advanced age or secondarily as a result of other diseases, e.g. chemotherapy or cortisone therapy. Due to severe bone loss or excessive breakdown of bone cells with insufficient bone formation, stability rapidly declines. The vertebrae become more fragile. This can cause severe pain in the spine. Inflammation of the vertebral bodies and intervertebral discs (spondylodiscitis) can also lead to severe spinal pain. However, these conditions are less common.

Spinal pain due to congenital or acquired causes

Other causes of back pain can include spondylolisthesis, in which two vertebrae slip out of alignment, vertebral fractures as a result of osteoporosis or an accident, rheumatic diseases or tumours/metastases.

Scoliosis is an abnormal curvature of the spine. It is often congenital (idiopathic) and occurs in children and adolescents either as a primary growth deformity or secondarily in older age as a result of instability caused by the above-mentioned degenerative diseases.
Pain often only occurs in the late stages of scoliosis. Early detection in children through regular check-ups is therefore very important, as is early treatment in specialised centres.

ISG arthrosis (wear and tear of the sacroiliac joint) causes deep back pain. Typical symptoms include pain when sitting and lying down, with pain radiating down the legs.

The term “failed back syndrome” refers to persistent pain in the lumbar spine following previous spinal surgery, which can have various causes, e.g. “post-nucleotomy syndrome” (painful condition following disc surgery), post-operative imbalance of the vertebrae or muscles, instability, scar fibrosis or even a renewed disc prolapse (recurrence).