Back & Leg Pain

Back pain affects millions of Americans every year and has a negative impact on their lifestyles, jobs, relationships, and mental wellbeing. It occurs most often due to the aging process, as well as from traumatic injuries or repetitive physical activity.

Fortunately, most occurrences of lower back pain only last a few days or a few weeks. This type of pain is commonly referred to as acute back pain. However, some people suffer from back pain that lasts more than 3 months. Chronic back pain is often progressive, and it can be quite difficult to determine the root cause of this pain.

Back pain is usually caused by degeneration of the spine as we age. Severe cases of chronic back pain can cause weakness or instability in certain areas of the spine, which can lead to debilitating pain in the lower back. This can also extend into your legs or feet.

Spinal degeneration can cause an existing nerve root to become compressed or pinched, and this can lead to leg symptoms such as pain, numbness, or tingling.

Symptoms

While back and/or leg pain are extremely common, the symptoms and severity of the pain vary greatly. The pain may be dull or sharp. It may be in one small area or cover a broad area.

Identifying the symptoms, along with accurate diagnosis of the underlying cause of the pain, is the first step in obtaining effective pain relief.  For simplicity, the symptoms can be divided into 2 categories: those related to degeneration of the spine, and those related to nerve impingement.

Symptoms of Spinal Degeneration

  • Back pain that worsens during prolonged sitting or standing.
  • Pain during certain types of activity—such as bending, lifting, or twisting.
  • Intermittent episodes of acute (sudden) pain.
  • Symptoms may reduce when lying down, as this takes pressure off the spine.

Symptoms of Nerve Impingement

  • Lower back pain.
  • Shooting pain, numbness, tingling, and muscle weakness in the leg.
  • Limitations in walking.
  • Symptoms may worsen while sleeping.
  • Recur when back is in an upright position.

Spinal Conditions

There are a number of spinal conditions that can lead to back and/or leg pain in the lumbar spine. A few of the most common spinal conditions that are responsible for back or leg pain are as follows.

Degenerative Disc Disease—our spinal discs begin to degenerate as we age. These discs can become thinner and less flexible due to a loss of fluid or they can develop tiny tears and cracks that cause the disc to bulge, break open, or fragment. This decreases the disc’s ability to cushion the vertebrae.1

Spondylolisthesis—condition in which one vertebra slips forward over another vertebra. In some cases this may lead to impingement of your spinal cord or nerve roots. There are multiple causes of spondylolisthesis. This condition may be congenital (present at birth); or it may be caused by active engagement in sports such as gymnastics, weightlifting, or soccer; or simply by the aging process of the spine.2

Lumbar Stenosis—spinal stenosis is the narrowing of the spinal canal most often caused by arthritis (the degeneration of any joint in the body). As a result of arthritis, bone spurs and thickened ligaments may pinch the spinal nerve roots. They may also cause painful burning, numbness, and/or a tingling sensation from your lower back down to your legs.3

Vertebral Fracture—the most common vertebral fractures occur in the thoracic (upper back) and lumbar spine and are usually caused by high-impact trauma, such as an automobile accident or a sports injury. Fractures of the spine can also be caused by underlying conditions such as osteoporosis or tumors.4

  1. WebMD. Degenerative Disc Disease-Topic Overview, via http://www.webmd.com/back-pain/tc/degenerative-disc-disease-topic-overview 1
  2. WebMD. Spondylolisthesis-Topic Overview, via http://www.webmd.com/back-pain/tc/spondylolisthesis-topic-overview
  3. AAOS. Lumbar Spinal Stenosis, via http://orthoinfo.aaos.org/topic.cfm?topic=a00329
  4. AAOS, Fracture of the Thoracic and Lumbar Spine, via http://orthoinfo.aaos.org/topic.cfm?topic=a00368

Definitions

ACDF – Anterior Cervical Discectomy and Fusion.

ALIF – Anterior Lumbar Interbody Fusion. Technique for fusing the lumbar spine from an anterior approach.

Allograft –Sterile bone tissue derived from another human which is used for grafting procedures.

Annulus Fibrosus – The outer layer of the intervertebral disc, which is located between the vertebral bodies. The annulus is made of collagen fibers.

Anterior – A term which describes the front of an object.

Anterior Cervical Plate – Plate and screw system than can be affixed to the anterior portion of the cervical spine.

Anterior longitudinal ligament (ALL) – composed of thick, longitudinally oriented fibers extending from the axis (C2) anteriorly to the sacrum.

Arthritis – Inflammation of a joint usually characterized by swelling, pain, and restriction of motion.

Autograft – Bone which is taken usually from the patient’s pelvis in order to fuse the spine.

Bone – The hard tissue that provides structural support to the body. It is primarily composed of hydroxyapatite crystals and collagen. Individual bones may be classified as long, short, or flat.

Bone spurs – Occur commonly in the spine due to the natural aging process (osteoarthritis). Bone spurs can occasionally push on nerves causing arm and leg pain.

Bone graft – Pieces of bone which are placed between the vertebrae that eventually grow together forming a spinal fusion.

Calcification – A process which occurs during aging where normal tissues become harder, due to increased calcium content.

Cauda equina – A group of spinal nerve roots located below the spinal cord in the vertebral canal. Usually starts at L1 and projects caudally.

Cervical – Refers to the neck. There are 7 cervical vertebrae in the neck.

Coccyx – The lowest tip of the spine, also known as the tailbone.

Collagen – A fibrous protein which is a major constituent of connective tissue, such as skin, tendons, ligaments, cartilage, and bones.

Congenital – Present at and existing from the time of birth.

Coronal – Refers to a section that divides the body into anterior and posterior portions.

Corpectomy – A term which describes the removal of the vertebral body, frequently performed to remove pressure from the spinal cord.

Cortical bone – The dense outer surface of bone that forms a protective layer around the internal cavity.

Decompression – Surgical removal of bone, disc, or calcified ligaments to relieve pressure on pinched nerves.

Degenerative disc disease – Gradual degeneration of the discs that reside between the vertebrae in the spine.

Disc bulge – A small disc herniation that can irritate a nerve, but usually does not require surgery.

Disc – The cushion between each of the vertebral bodies.

Disc protrusion – A larger disc herniation that frequently impinges on spinal nerves causing pain in the arms and legs.

Disc herniation – As a disc degenerates and breaks down, the inner core can leak out through the outer portion of the disc. This may impinge on the nerve, resulting in pain.

Discectomy – Removal of a portion of the disc.

Distal – Situated away from the center of the body.

Discography – An injection of contrast material into the central region of the disc. This is often followed by an x-ray or CT scan.

DLIF – Direct Lateral Interbody Fusion. Technique for fusing the lumbar spine from a lateral approach.

Dura matter – The membrane that forms the outer covering of the central nervous system.

Epidural – Situated outside the thin, tough dural membrane that surrounds the brain and spinal cord.

Facet – A posterior structure of the vertebra which articulates with a facet of an adjacent vertebra to form a facet joint that allows motion in the spinal column. Each vertebra has 2 superior and 2 inferior facets.

Facet joint – The joint on the back of the spine between two adjacent vertebrae.

Foramina – The space between vertebrae where nerve roots exit to travel down the arms or legs.

Fusion – Occurs when a bone graft is placed between 2 vertebrae or long bones and the bones grow together. After fusion is complete, there is no motion between these vertebral bodies or bony segments.

Herniated disc – Extrusion of part of the nucleus pulposus material through a defect in the annulus fibrosus.

Hydroxyapatite (HA) – The lattice-like structure of bone composed of calcium and phosphorous crystals which deposits on collagen to provide the rigid structure of bone.

Idiopathic – Used to describe a disease or disorder that has no known cause.

Iatrogenic – Occurring without known cause. Self-originated.

Iliac bone – A part of the pelvic bone that is above the hip joint where autogenous bone grafts are frequently obtained.

Iliac crest – The large, prominent portion of the pelvic bone at the belt line of the body.

Instrumented – The placement of metal, screws, plates and rods in the spine.

Intervertebral – The space between 2 vertebrae.

Kyphosis – A curvature in the sagittal plane with anterior concavity (concavity towards the front). The spine has a thoracic kyphosis and sacral kyphosis.

Lamina – The bony arch of the posterior aspect of a vertebra that surrounds the spinal cord, also referred to as the vertebral arch.

Laminectomy – The removal of the lamina, frequently done to relieve pressure on the nerves.

Laminotomy – A removal of a small portion of the lamina, frequently done to remove a portion of the disc.

Lateral – Situated away from the midline of the body, or from the side.

Load Sharing – Structural support grafts and/or implants.

Lordosis – A curvature in the sagittal plane with posterior concavity (concavity towards the back). The spine has a cervical lordosis and a lumbar lordosis.

Lumbar – The lower portion of the spine. There are 5 lumbar vertebrae in the low back.

Medial – Situated closer to the midline of the body.

Minimally invasive surgery – Surgery requiring small incision(s), usually performed with endoscopic or fluoroscopic visualization.

Microdiscectomy – The removal of a ruptured disc through a small incision with the aid of a microscope.

Motion segment – The functional unit of the spinal column. Motion is achieved through the intervertebral disc and the two facet joints.

Mylopathic – Resulting from abnormality of the spinal cord or the bone marrow.

Nucleus pulposus – The inner portion of the intervertebral disc. It is surrounded by and contained by the annulus fibrosus which prevents this material from protruding outside the disc space.

Ossification – The process of forming bone in the body.

Osteoporosis – A progressive disease that is age-related and is distinguished by a decrease in skeletal bone mass.

Osteoarthritis – A normal aging process where spurs develop in the spine. The discs lose water content and become narrowed.

Osteopenia – Reduction in bone volume to below normal levels, especially due to inadequate replacement of bone loss to normal lysis.

Pedicle – The portion of the vertebrae which connects the lamina to the vertebral body. Frequent site of screw placement.

Periosteum – A fibrous membrane that covers the surface of bone except at the end of the bones where it is covered with cartilage as part of a joint.

PLIF – Posterior Lumbar Interbody Fusion. Technique for fusing the lumbar spine from a posterior approach.

Prone – Position of the body in which the patient lies flat with the chest down and back up.

Proximal – Nearest to the center of the body.

Pseudoarthrosis (also Pseudarthrosis) – A form of a non-union in which there is the formation of a false joint with some cartilage covering the ends of the bones and a cavity containing fluid that resembles a normal joint.

Radiculopathy – Any pathological condition of the nerve root.
Sacrum – The base of the lumbar spine, which connects the spine to the pelvis. Has 5 fused vertebrae.

Sciatica – Irritation of the sciatic nerve, which is the largest nerve in the body and travels down the legs.

Scoliosis – A curvature of the spine which occurs most frequently in young adolescent females.

Sequestered disc fragment – Occurs when a portion of the disc breaks off completely and pushes on the nerves to the arms or legs.

Spinal fluid – The clear fluid which surrounds the spinal cord and nerves in the spine.

Spinal fusion – During this surgical procedure, the degenerative disc is removed and replaced with a bone graft, allowing the 2 vertebrae to fuse together.

Spinal canal – Bony channel formed by the intervertebral foramen of the vertebrae. It contains the spinal cord and nerve roots.

Spinal cord – The connection between the brain stem and the nerves which allows motion and sensation.

Spinous process – The bone along the back of your spine, furthest away from the delicate nerve roots.

Spondylolisthesis – A forward slippage of one vertebra onto another. There are 5 grades of spondylolisthesis.

Spondylolysis – A stress fracture of the back of the spine. Occurs in the portion of the lamina known as the “pars interarticularis.”

Stenosis – An abnormal narrowing or contraction of a duct or canal.
Sterilization – The method used to render a material free from living organisms. Usual methods include steam under pressure, gas, and ionizing radiation.

Supine – When the patient is lying on their back, facing upward.

Thoracic – The middle portion of the spine; there are 12 thoracic vertebrae.

TLIF –Transforaminal Lumbar Interbody Fusion. Technique used for fusing the lumbar spine from a minimally invasive unilateral approach.

Transverse process – The “wings” of the spine which are located posteriorly and lateral to the spinal cord.

Tumor – Abnormal mass of tissue within or surrounding the spinal cord  or spinal column.

Vertebra – One of the 33 bones of the spinal column. A cervical, thoracic, or lumbar vertebra has a cylindrically-shaped body anteriorly and a neural arch posteriorly that protects the spinal cord. The plural of vertebra is vertebrae.

Vertebral end-plates – The superior and inferior plates of cortical bone of the vertebral body adjacent to the intervertebral disc.

Wolff’s Law – Bones respond to stress by making more bone. Bone grows and remodels in response to the forces that are placed upon it.


Axial plane – Divides the body into upper and lower parts.

Sagittal plane – Divides the body into left and right parts.

Coronal plane – Divides the body into front and back parts.

Medial – Closer to (or towards) the midline of the body, or a specific reference point.

Lateral – Away from the midline of the body, or a specific reference point.

Proximal – Toward a point of reference, generally applied to an extremity.

Distal – Away from a point of reference, generally applied to an extremity.

Inferior – To the lower part of a structure or below a specific location.

Superior – The upper part of a structure or above a specific location.

Cranial – The head (or head end) of the body, organ, or other structure.

Anterior – Toward the front (or in the front part) of the body, organ, or other structure.

Posterior – Toward the back (or the back part) of the body, organ, or other structure.

Dorsal – The posterior (or back) of a structure.

Ventral – The anterior surface (or front) of a structure.

Caudal – Near (or toward) the tail end of the body.

Cephalad – Near (or toward) the head of the body.