What is back pain?

The spine is made up of a group of bones in your back called vertebrae, which protect the spinal cord. Each vertebra has a large oval area facing the inside of the body (vertebral body), two bones coming out of the vertebral body on either side of the spine (pedicles), smaller bones attached to the inside of each pedicle to protect the back of the spine (lamina), a small bone at the back of the spine (spinous process), and two more bones on the outside of each lamina where muscles sit (transverse processes). On the inside of each transverse process is a structure called the facet joint that allows one vertebra to connect to another above or below it so the spine can move. The vertebrae have an opening in the center of the bones that surrounds and protects the spinal cord, called the spinal canal. This opening is made by the position of the vertebral body, the pedicles, and the lamina.

The vertebrae are named based on where they are located in the back. Cervical vertebrae are found in the neck, thoracic vertebrae in the upper back, and lumbar vertebrae in the lower back. The sacrum is below the lumbar vertebrae and is made up of 5 fused bones. Below that, your tailbone is made up of 3 fused bones called the coccyx. In between most of the vertebrae are gel-like shock absorbers called disks. Nerves that lead to the rest of the body pass through openings (foramina) in the bones.

Back pain may be caused by:

• Injuries or overuse, which most often affects muscles, joints and ligaments
• Poor posture
• Overweight
• Poor body mechanics when lifting
• Pressure on spine nerves, due to:
  • Changes with aging, such as disk thinning or rupture, narrowing of the spinal canal or osteoarthritis
  • Osteoporosis, when the bones get brittle from lost calcium
  • Any bone fracture in the back
  • Structure problems you were born with, such as scoliosis
  • Infection
  • Tumors

What can I expect in the hospital?

You may need to stay in the hospital because your back pain is not controlled with your current treatment or you need surgery to treat your back pain.

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• Your strength, range of motion, and ability to feel pain will be checked regularly.

Testing

Testing may include:

• Blood tests to check for infection or certain diseases that may be causing your back pain.
• Neurologic examination: Testing to check your strength, ability to feel, balance, and reflexes.
• Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin cross sections of the spine and spinal cord.
• Computed tomography (CT) scan: A series of X-rays taken from different angles and arranged by a computer to show thin cross sections of the spine if you are not able to have an MRI.
• X-rays: Pictures of the spine to check for abnormal areas.
• Discography: An X-ray taken after an injection of a special dye into a disk in your spine to check for the cause of back or neck pain.
• Myelography: A series of X-rays taken after injecting special dye into the fluid around your spinal cord to show the spinal cord, nerves, and blood vessels around the spinal cord.

Treatment

The treatment for back pain depends on its cause, your symptoms, how well you respond to treatment, your overall health, and any complications you may have.

Your chance of cure depends on the cause of your back pain and the treatments available. You may need to make lifestyle changes to get and stay healthy, manage your treatments, or adjust to any activity limits that you may have.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow for medicine to be given directly into your blood and to give you fluids, if needed.
• You may need an injection of medicine in the area around your spine to reduce swelling and back pain.
• You may need surgery to treat back pain. Surgery may include:
  • Facetectomy: Surgery to remove spine joints (facets) to reduce pressure on nerves. This procedure is often done with laminotomy.
  • Foraminotomy: Surgery to widen the opening (foramen) where the nerve leaves the vertebra. This surgery may be done with laminectomy or laminotomy.
  • Laminectomy: Surgery to remove a part of the lamina which may be pressing on the spinal cord. This surgery may be done with discectomy, foraminotomy, and spinal fusion.
  • Laminotomy: Surgery to widen the opening of the bones (lamina) that surround and protect the spinal cord. This procedure is often done with facetectomy.
  • Spinal fusion: Surgery to stabilize the bones in the spine with a piece of bone or ceramic, which is held in place with plates, screws, or rods. Spinal fusion may be done with:
    • Discectomy: Surgery to remove all or part of a disk which may be pressing on a nerve. This may be done with laminectomy or foraminotomy.
    • Corpectomy: Surgery to remove an entire vertebra that may be squeezing the disk. Your surgeon may replace this disk with an artificial disk.
• Your provider may prescribe medicine to:
  • Treat pain
  • Treat or prevent an infection
  • Reduce swelling
  • Prevent side effects, such as nausea or constipation, from other treatments
• You may need physical or occupational therapy to help you adjust to chronic (long-term) back pain, strengthen the back, or recover from back surgery. Most rehabilitation programs include:
  • Physical therapy to help you regain muscle strength and teach you ways to move safely
  • Occupational therapy to help you learn safe ways to do the tasks that you previously did
  • If your nerves are damaged and you have trouble with your bowel or bladder, therapy may include skin, bladder, and bowel care and training.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Back pain
  • Depression
  • Lightheadedness
  • Loss of balance or coordination
  • Loss of bladder control
  • Loss of bowel control
  • Numbness in your legs, feet, arms, or hands
  • If you had surgery, signs of infection around your surgical wound. These include:
    • The area around your wound is more red or painful.
    • The wound area is very warm to touch.
    • You have blood, pus, or other fluid coming from your wound area.
    • You have chills or muscle aches.
  • Swelling of your legs, ankles, or feet
  • Trouble with muscle movements, such as moving arms and legs
• Ask questions about any medicine, treatment, or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many factors. You may stay in the hospital for only a few hours, depending on your condition and the treatment you received. However, the average amount of time to stay in the hospital with back pain is 2 to 3 days. If your back pain was severe and you have surgery or complications, you may stay in the hospital longer. You may also need to go to a rehab facility to continue your rehab program before going home.