Back pain has multiple causes

1. Simple causes of back pain – Lumbar spine
spondylogenic / Metabolic / Mechanical/ Muscular / Postural / visceral / Reffered.

Often related to life style , posture , lack of exercise , Vit deficiency , increasing weight and stress. Do not have associated nerve compression
RED FLAG signs absent usually
Investigations often not needed unless pain persists >3 weeks

Pain is typically localised , fatigue related , better with rest , and exercises help a lot , need life style modification. Pain management with simple measures – exercise , medicines and heat therapy , supervised physiotherapy help. Meet spine specialist for supervised care.

Usually improve without any active / aggressive intervention

Contact specialist if pain persists or progresses.

2. Disease related back pain

• Tuberculosis / Infection / Trauma / Instability / Tumor / inflammation / Nerve compression related causes.
• Symptoms often more with activity / affect mobility / increase with walking
• Symptoms often present at rest / night pain
• Radiation to leg with nerve paresthesiae present if nerve compression is present.
• Pain , Numbness , Heaviness weakness in leg – buttock and back of thigh and calf
• RED flag signs noted.
• Fever , Rest pain , Night pain , persistent pain , weakness leg , bowel bladder symptoms

May need investigations to detail to rule out exact cause , unsupervised pain management – self medication / self guided physiotherapy – not recommended and may not help.

Scoliosis
1. Bend +rotational twist in spine causing – Hump / deformity / Swelling On back with posture tilt

2. Etiology -Idiopathic scoliosis in Young Adolescent female ( 8-15 years) present with back Hump

3. Other causes
– Congenital scoliosis(bony malformation)
– Syndromic scoliosis
– Neuromuscular Scoliosis among kids
– degenrative scoliosis among adults.
Correct diagnosis & etiology shall be ascertained at earliest

4. Presence of Pain and motor or sensory weakness / difficulty walking in scoliosis patient warrants – detailed investigation to rule out Infection / tumor / TB or some secondary pathology.

5. Proper X ray and MRI are primary investigations in scoliosis patients

6. Investigations in Scoliosis involve
– X ray Full spine PA view standing (not AP view)
– X Ray Full spine standing Lateral View
– X ray full spine PA views Bending films left and right
– MRI screening whole spine with dedicated study of affected spine ( only if pain or sensorimotor involvement )

7. Bracing, Casting and Physio have limited role or NO ROLE in correction of Scoliosis(only for mild deformity in young kids ). In severe deformity in gown up kids is a wastage of time.

8. Early diagnosis is important to manage the child surgically in safest manner. Late diagnosis can lead to severe deformity requiring bigger surgery.

9. Scoliosis Surgery is extremely Safe and predictable efficient straightening of spine is possible safely and is reocmmended if defomrity is progressive ( > 50 degree) or has pain, neuro deficit. Fear of surgery can sometimes can delay the need for worse.

10. Scoliosis surgery is extremely safe with modern innovations – navigation, Neuromonitoring and modern implant and imaging techniques.

Early diagnosis and early management is the key!!

1. Pain around Neck / base of Head-Occiput/ trapezius to shoulders

2. common causes
“Posture / Muscle fatigue -constant dull aching pain/constant gaze in flexed position – advise – posture correction and supervised Physiotherapy”
“Degenerative ( wear n tear ) changes -neck spasm -common – omanaged by simple pain management and supervised physiotherapy”

3. NOT ALL NECK PAINS ARE ARE DUE TO SIMPLE CAUSES and need specialist opinion.
Neck pain ( seemingly subtle / simple neck pain ) can also be caused by problems requiring specific care

4. Causes of neck pain often requiring timely diagnosis and specialist opinion

• Slip Disc with nerve compression
• Cervical Myelopathy
• Facet arthritis progressive symptoms
• Cervical spine Tuberculosis
• cervical Spine Tumors
• cervical Spine metastasis
• cervical Spine pyogenic infection
• cervical Spine fracture or Whiplash
• Metabolic Causes
• cervical Spinal Deformity.

5. Early diagnosis is paramount and can have promising result timely intervention

6. Early Diagnosis can be established with detailed history taking to rule out any red flag signs – night Pain, Rest pain, Activity pains, 24 hours pain, Progressive symptoms, Neurological symptoms – paresthesiae, Numbness, Weakness of time movements of hands, Gait imbalance, Fever with pain

7. Any of these red flag signs shall raise suspicion and may need specialist opinion.

8. Cervical Spine Surgery has promising and predictable results and are routinely performed for Cervical slip disc, Cervical myelopathy, Cervical spine Tuberculosis, Cervical spine tumors, Cervical spine infections etc. All cervical spine surgeries are now performed under microscopic control with no risks.

9. Microendoscopic Spine Surgery, Minimal invasive spine surgery (Key hoke surgery technique) has promising results with added advantages in cervical spine surgery

Happy Spine – Spread smiles!!

Back pain has multiple causes: 

Simple causes of back pain – Lumbar spine spondylogenic / Metabolic / Mechanical/ Muscular / Postural / visceral / Reffered.

• Often related to life style, posture, lack of exercise, Vit. Deficiency, increasing weight and stress.
• Do not have associated nerve compression
• RED FLAG signs absent usually
• Investigations often not needed unless pain persists >3 weeks

Pain is typically localised, fatigue related, better with rest, and exercises help a lot, need life style modification. Pain management with simple measures – exercise, medicines and heat therapy, supervised physiotherapy help.

Meet spine specialist for supervised care.

Usually improve without any active / aggressive intervention

Contact specialist if pain persists or progresses.

Disease related back pain

• Tuberculosis / Infection / Trauma / Instability / Tumor / inflammation / Nerve compression related causes.
• Symptoms often more with activity / affect mobility / increase with walking
• Symptoms often present at rest / night pain
• Radiation to leg with nerve paresthesiae present if nerve compression is present. – Pain , Numbness , Heaviness weakness in leg – buttock and back of thigh and calf
• RED flag signs noted. – Fever, Rest pain, Night pain, persistent pain, weakness leg, bowel bladder symptoms

May need investigations to detail to rule out exact cause, unsupervised pain management – self medication / self guided physiotherapy – not recommended and may not help.