Spinal pain accounts for about 20% of a Rheumatologist's workload. As many as 80% of the population will experience significant spinal pain at some point during their lifetime. In younger groups, it tends to be due to poor posture, especially at the desk or computer. A small number, usually males, may have an inflammatory arthritis called ankylosing spondylitis (see under section on 'Arthritis'). In middle age, we see more patients with degenerative disease of the intervertebral discs. Herniation of the central core of the disc, the nucleus pulposus, through the outer disc perimeter may result in compression of a nerve as it leaves the spine causing arm pain (brachalgia) or leg pain (sciatica). This may sometimes be referred to as a "slipped disc", a bit of a misnomer as the whole disc doesn't slip, just a small part. In later life, patients may have wear and tear arthritis of the spinal facet joints as well as disc disease. This may present in different ways - localised back pain, referred pain to the buttock or leg, or pain and sensory symptoms in both legs that commences after walking a certain distance (canal stenosis). Osteoporotic fracture of a vertebra can cause severe weightbearing pain that may last up to 3 months before settling. Treatments can help prevent further fractures, height loss and stooped posture.
All of these conditions require careful assessment and this may include an MRI scan, a safe imaging tool that uses magnets rather than X-Ray. An open MRI can be used for those patients who tend to claustrophobia.
Most spinal conditions can be managed using a combination of manipulation (chiropracty, osteopathy), acupuncture, analgesics and patient specific exercise programmes. Supervised exercise programmes are undoubtedly the single most important method of managing long-term spinal pain. These are best initiated by a physiotherapist who has specialist interest in spinal disorders.
Epidurals and imaging guided steroid injections, which target specific spinal joints, can be useful for those patients with unremitting back, leg or arm pain. Surgery may be the right approach for patients with specific conditions and for whom other treatment programmes have failed. Only a small percentage of patients with spinal pain require surgery.