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Cardiff Centre of Excellence for Spinal Care

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Common causes of neck and back pain

  • Although most people will experience back pain during their life time, many cases will resolve themselves with little or no intervention.

    Some, however, will require more specialist intervention. Here is some information which will provide you with a basic understanding of some of the more common conditions associated with neck and back pain.

    Degenerative Disc Disease

    More commonly known as wear and tear in the back, this affects between 12% - 35% of the population, with around10% of people becoming chronically disabled.

    Around 20% of people in their teens have discs which show mild degeneration. With age, the spine's flexibility decreases and studies show that around 60% of those in their 70s, have discs with severe degeneration.

    Disc degeneration is often associated with back pain but in some cases it can be attributed to disc herniations, leading to pains in the arms or legs or a loss of bladder and bowel control. It can also be associated with facet joint degeneration.

    The causes for disc degeneration are several. In 70% of cases the cause is genetic. Although this may not mean that another family member suffers to the same degree.

    Other associated causes are:

    • heavy physical work
    • lifting
    • obesity
    • smoking – a major risk factor

    Treatment options will depend on the severity of the problem and can be either a few days’ bed rest with analgesia or injections and manipulative treatment. Therapy includes strengthening the muscles around the disc, to help support it.

    Surgical options for discogenic back pain range from disc replacement through to fusion.

    Degenerative Disc Disease
  • Disc Herniation

    Disc herniation results from a prolapse of the intervertebral disc, causing bulges or ruptures. These bulges will press on a nerve causing nerve pain in the arm, if the affected disc is in the neck, or pain in the leg, if the herniation is in the lower back.

    If a nerve is irritated by a disc prolapse then the symptoms may be pain in the extremities, weakness or altered feeling, i.e. pins and needles, or numbness. A larger disc prolapse in the lumbar area can affect the nerves to your bladder and bowel causing loss of control.

    Nerve pain in 75% of people settles down within four to six weeks and in 90% of people settles down within three months.Initially the treatment of choice are pain killers and therapy, if appropriate, however, should an investigation be necessary, an MRI scan would be the preferred choice. Other treatment options are a nerve root block where local anaesthetic and steroid is placed around the nerve under X-ray guidance. If this is unsuccessful, then a discectomy/decompression may be considered which can assist in leg or arm pain relief.

    In the lumbar spine most of these operations involve keyhole surgery with an incision in the lower back. In the cervical area this tends to be done through the throat.

    Disc Herniation
  • Spinal Stenosis

    In most instances, this condition results from degeneration of the back, although a few people are born with a narrow spinal canal.

    With a bulging of the disc, the facet joints grow a little larger and the ligament around the nerves becomes thickened, resulting in less room for the nerves within the spinal canal.  Symptoms will be a degree of back pain but, predominantly, there tends to be aching in the buttocks and legs and walking longer distances can be difficult. This more commonly, affects those over 50.

    Treatment is often non-surgical in the first instance with lifestyle modification, physical therapy and epidural injections. If symptoms persist, decompressive surgery, with or without stabilisation, is an option. Sometimes interspinous process spacers can be used to increase the space for the nerve. This option can be assessed by viewing images from an MRI scan.

    Spinal Stenosis
  • Spondylolysis

    Spondylosis occurs when there are stress fractures in the bony architecture at the back of the spine. It affects approximately 5-6% of people, usually those who have a sporty lifestyle. It is often seen in the younger age group, i.e. early teenagers, but also in sporting people later in life.

    Initial investigation is carried out with an MRI scan and a CT scan may also help show the bony fracture.

    Treatment options include rest and therapy, however, if these are unsuccessful then consideration may be made for injections into the fractured area to assist in pain management. For some patients a period of rest post injections will allow things to settle down and heal but if this does not happen then surgery can be performed to assist in bony healing.


    Spondylolisthesis is the forward slippage of one vertebra on another, affecting just above 6% of people. This condition can result from a spondylolysis, as mentioned above, where two stress fractures occur at the back of the spine and it is often the result of an acute traumatic event. It may also occur degeneratively, as the spine ages. Patients tend to experience back pain and some leg pain, which may be more severe when the patient is on their feet. This can be the cause of sciatica.

    This condition is usually investigated using an MRI scan and standing X-rays.

    Initially, treatment involves therapy and analgesia, coupled with activity limitation. If this is unsuccessful, leg symptoms can be assisted with nerve root blocks, and the use of facet injections for back pain. If symptoms continue, surgery is an option with the intention of stabilising the spine and decompressing the nerve.

    Spondylolysis and Spondylolisthesis
  • Lower Back Pain

    Lower or lumbar back pain may have a number of root causes:

    Sacro-iliac Joint Dysfunction

    The sacro-iliac joint is the joint with the spine and the pelvis on either side.  The sacrum is a segment of the spine between the lumbar spine and the tail bone (coccyx).  It is a triangular piece of bone formed of fused vertebrae.  The sacrum forms the joint with the iliac part of the pelvis and it is named as the sacro-iliac joint.  The stability of the joint is aided by the way the two bones articulate and it is aided by strong ligaments which stabilise the joint along with several muscles which influence the stability of the joint itself. 

    The sacro-iliac joint has very minimal movement but it helps to transmit body weight from the spine onto the pelvis down to the lower limbs. 

    Sacro-iliac pain can present in isolation, i.e. leg/buttock pain but that is not always the case and the symptoms would be more part of the lower back pain complex which need specific assessment to assess and gauge if the pain is actually arising from the sacro-iliac joint and there are different clinical tests utilised to assess this. 

    From an investigation point of view, various investigations i.e. X-rays, MRI scan, CT scan or bone scan could be utilised but many of these could be negative without any specific abnormality on these investigations. 

    There are various conditions which can cause sacro-iliac joint pain but for most of the cases the cause usually is mechanical in nature.  Although there could be injury to the sacro-iliac joint which causes sacro-iliac joint pain and dysfunction.  It could also present following pregnancy and delivery, giving rise to pain which could be a part of the symphysis pubic dysfunction syndrome (SPD).  It could also be caused due to arthritic conditions, e.g. osteo-arthritis, rheumatoid arthritis and rheumatoid arthritis like conditions, which can affect the joint leading to pain.  One of the mechanical causes for sacro-iliac joint dysfunction could be following fusion/stabilisation of the lower lumbar segments which causes adjacent level problems affecting the sacaro-iliac joint due to mechanical issues. 

    An important aspect in management of sacro-iliac joint pain is the assessment and appropriate diagnosis.

    Most sacro-iliac joint dysfunction could be treated with non-operative and conservative methods, i.e. physiotherapy, osteopathy or chiropractic manipulation, which help improve the symptoms as the majority of sacro-iliac joint dysfunction is usually mechanical in nature.  

    Sacro-iliac belts could be an option to help with the symptoms and this should be discussed with your practitioner, physiotherapist, osteopath or chiropractor, to the efficacy and the duration of usage. 

    If non-operative methods fail then you would need an assessment from a clinician who would possibly decide to proceed with selective injections, i.e. targeted injections to the sacro-iliac joint under X-ray or CT guidance using local anaesthetic and steroid. 

    If non-operative methods and injection therapy fail then surgery would be an option, i.e. stabilising the sacro-iliac joint and this is usually achieved via a percutaneous approach in most situations and this should be discussed further in detail with your clinician about the procedure, outcome, risks and complications, and the rehabilitation following the procedure.  The procedure is usually successful in the majority of individuals and they undergo post-operative rehabilitation.


    Sciatica can occur with or without back pain and is caused when a nerve root in the spine is compressed. Your symptoms will be dictated by the position along the spine of the compressed nerve root.

    Sacro-iliac Joint Dysfunction and Sciatica

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