Back/Spinal Pain

What conditions can cause back pain?  

Degenerative disc disease, cauda equina syndrome, herniation of lumbar disc, compression injury, injury to vertebral column (fracture, dislocation, and subluxation), spinal stenosis, osteoarthritis, and acute lumbosacral strain. 

Degenerative disc disease

Occurs when the cushioning discs between vertebrae in the spine begin to deteriorate. 

Cauda equina syndrome

Occurs when the bundle of nerves called the cauda equina, located at the lower end of the spinal cord, becomes compressed. These nerves control motor and sensory function in the legs, bladder, and bowel, and their compression can lead to severe neurological deficits if not treated promptly. 

Herniation of lumbar disc

Occurs when the soft center of a spinal disc pushes through a tear in the outer ring. 

Compression injury

Occurs when the vertebrae in the spine collapse or compress due to various factors such as trauma, tumors, or loss of bone density. 

Spinal stenosis

Happens when the space around your spinal cord becomes too narrow. This irritates your spinal cord and/or the nerves that branch off it. 

Acute lumbosacral strain

Occurs when the muscles or tendons in the lower back are overstretched or torn, often due to sudden lifting, twisting, or overexertion. 

Assessments for pts with back pain

Assess posture, position changes, gait, muscle strength, sensation, movement and effects on ADLs, spinal curvature and limb symmetry, pain assessment, physical exam, medical history. 

What diagnostics can be done for pts with back pain? 

X-ray of the spine, bone scan and blood studies, CT scan, MRI, EMG (electromyogram), nerve conduction study, myelogram, and ultrasound. 

X-ray of the spine

Will present a fracture, dislocation, infection, osteoarthritis, or scoliosis. 

CT scan

Useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral discs. 

MRI

Permits visualization of the nature and location of spinal pathology. 

EMG and nerve conduction studies

Used to evaluate spinal nerve root disorders (radiculopathies). 

Myelogram

Permits visualization of segments of the spinal cord that may have herniated or may be compressed (infrequently performed; indicated when MRI scan is contraindicated). 

Ultrasound

Useful in detecting tears in ligaments, muscles, tendons, and soft tissues in the back. 

Medical management (pharm)

Analgesics, tricyclic antidepressants and dual-action SNRI, atypical anticonvulsant medications, opioids, and corticosteroids. 

Medical management (non-pharm)

Thermal applications, spinal manipulation, CBT, exercise regimens, physical therapy, acupuncture, massage, and yoga. 

Discectomy with fusion

A surgical procedure that involves removing a damaged disc in the spine and fusing the adjacent vertebrae to stabilize the spine and relieve pain. 

Laminectomy

A surgical procedure aimed at relieving pressure on the spinal cord or nerves by removing part or all of the vertebral bone (lamina). 

Forminotomy

A surgical procedure designed to widen the foramen, the opening in the spine where nerve roots exit. This surgery is performed to relieve pressure on compressed nerves. 

What surgical management can be done for spinal pain?  

Microdiscectomy, laminectomy, hemilaminectomy, partial laminectomy or laminotomy, discectomy with fusion, and forminotomy. 

Nursing interventions

Pain management, exercise, body mechanics, work modifications, stress reduction, health promotion activities, and dietary plan to encourage weight reduction. 

Patient education topics

Restrictions, positioning, activity level, exercise, and prevention.