To whom it may concern.
One of the best ways to find out info on back related problems
is to search the MEDLINE web site. You can view abstracts from medical
journals there. PUBMED is the public access version. Notable researchers
are: Adams MA, Bogduk N, Nachemson AL. Schellhas KP, Videman T,
Kelsey JL. Type these names into the PUBMED search engine and their
scientific papers will be listed along with other related links.
Things to remember are; the sources of back pain are hard to identify.
Not all disc prolapses are painful. Some people have wider vertebral
canals that others so they escape nerve root compression. (Boos
et al.1995 Spine ;20:2613-25). Nerve root compression is the only
clear guide that medics can use to identify disc prolapse.
Degenerated discs are not a clear indication of pain.
Anular tears often do not impose on nerve roots, but the outer
third of the anulus has a nerve supply so it is very feasible that
they can be painful. Medics, however, are unable to diagnose this
because of the lack of nerve root compression. Painful anular tears
can show up on MRI scans as High Intensity Zone lesions. (ScHellhas
et al). But not all HIZ lesions are painful. Also, it is quite common
for these type of lesions to go unnoticed or their relevance misunderstood
"It is our view that some of the unsuccessful laminectomies an
dorsal fusions in our series could have been avoided had the HIZ
lesions, that in retrospect, were present on preoperative imaging
studies been recognized and understood initially." (Schellhas KP
et al. 1996. Spine volume 21, number 1, page 85, Third paragraph).
Possibly the most chronically painful and clinically undetectable
pain source is the endplate fracture or Schmorl's node. (Painful
lumbar disc derangement: relevance of endplate abnormalities at
MR Imaging. Weishaupt D, Zanetti M, Hodler J, Min K, Fuchs B, Pfirrmann
C, Boos N. Radiology 2001 Feb;218(2):420-7).
The weakest part of the spine is the vertebral endplate and adjacent
trabeculae bone. Some of the more accessible book authors comment
on how the intervertebral disc is stronger than bone in compression.
They then go on to discount high compressive forces existing in
life - BUT THEY DO!
In a heavy lift the back muscles can exert a force on the spine
of some 4 kiloNewton's. This is comparable to 400kg (the weight
of a horse). This type of activity, along with epileptic seizures,
electric shocks and possibly even child birth (although the latter
is speculation on my part whereas the three formers have been proven
- Vascancelos D. Compression fractures of the vertebra during major
epileptic seizures. 1973 Epilepsia 14:323-8), has the potential
to crack bone. (Bogduk N, Adams MA, Nachemson AL).
Spinal pathology is far from easy to understand and the subject
should be approached carefully and with humility. Getting angry
with the medical profession for failing to provide answers will
not help anyone. The better you can understand your own individual
condition the more chance you have of managing it. Things do tend
to get better naturally but it can take a long time. If your occupation
has played a part in your pathology then you may find yourself in
something of a vicious circle. Disc tissue does not knit itself
back together. Anular tears do not heal and the threat of acute
prolapse is very real. Speak to a health and safety consultant.
Some medics believe that disc degeneration has to occur before
a disc will prolapse. This is not necessarily true. My own L5/S1
disc has prolapsed but the MRI scan shows that it is well hydrated
(and has a HIZ lesion). My L4/5 disc has also prolapsed and is degenerative
but this may be due to the endplate fracture in the L4 vertebral
body. (Adams MA, et al. 2000. Spine vol 25 number13: 1625-36).
"It is no longer valid to claim that a disc must be degenerated
before it will prolapse." (Adams MA).
I found this book of value to me and I would recommend it as a
way of getting to know your own back. I got my copy from Foyles
in Charring Cross road London. £21.00. Clinical Anatomy of the Lumbar
Spine and Sacrum. Bogduk N. Third edition 1997. Churchill Livingstone
I am not a medic. I have suffered chronic pain for over three years.
I have studied my own condition at the British Library where medical
journals are accessible to the public.
All the best