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 More about the cause of pain |
The spinal segment
The lumbar spine has mainly a mechanical function, by supporting and continuously mobilizing the body. The functional unit is the spinal segment: two adjacent vertebra, one intervertebral disc and two dorsal facet joints. The intervertebral disc functions as an aqueaous buffer, which ensures that movement is possible in all directions. The intradiscal pressure is equally divided over the end plates and to the dorsal facet joints. The condition of the disc is most responsible for the spinal segment functioning. The facet joints are playing a secondary role. |
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The discThe intervertebral disc is walled by a fibrous annulus and has a central nucleus. The pressurized central jelly nucleus is kept in shape by the tension of the annulus. The disc consists of radiolucent fabrics wich are complex and have a changing composition. Therefore it is very difficult to predict or measure the internal mechanical behaviour. It is even more difficult to design a `real`artificial disc. |
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Where does back pain come from?Mechanical lower back pain is caused by failure of these lumbar segments and is provoked by movements or strain. The real cause of the lower back pain has been already a point of discussion for centuries. Explanations which were found plausible in the early days, have appeared incorrect the more recent years. Actual new root irritation was always considered as the most important cause of back pain, although lumbar herniation with violent leg complaints frequently causes no back pain at all. New insights in anatomy, functioning and innervation of the discus make it plausible that internal annulus-ruptures are playing an important role as a source of lower back pain. Recent research shows that internal damages of the annulus (without herniation or other deformations of the back) are causing as frequently leg pain, in the same way as real dorsal protrusions, but annular degeneration (annular rupture) is much more accompanied with severe back pain. The physiological (by nature) degeneration of the spine mostly has no direct correlation with back pain.
Chronic back pain is a frequently occurring problem in the Western society which often leads to long-term illness with high indirect costs by unfitness for weeks and secundary production loss. Approximately 70% of all adults have at least once per year back complaints, 90% of all adults experience that at least once in their life time. Fortunately 90% of those people experience spontaneous recovery in three months. For the remaining 10% there is a continuing pain, they become chronically with many and long-term restrictions. |
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