Neck and back pain

Back and neck pain are common, especially in older people. Low back pain affects 50% of people over 60 years of age. Symptoms of back and neck pain may include simple local pain, sharp or dull, chronic or remittent, dependent on any cause and accompanied by muscle spasm. Reflex tension of paraspinal muscles in response to painful spinal lesions may be more painful than the underlying cause. If the spinal cord or spinal roots are affected, various neurological symptoms may occur, including sensory disturbances and muscle weakness. Back pain may radiate distally if the spinal roots are affected.

Main diseases that cause neck and back pain

Localization of pain	Diseases
Only neck pain	Atlantoaxial subluxation Referred pain during dissection of the vertebral and carotid arteries, angina, myocardial infarction, meningitis, esophageal diseases, thyroiditis Herpes zoster Temporomandibular joint diseases Spasmodic torticollis Subarachnoid hemorrhage
Just lower back pain	Lumbar spinal stenosis Sclerosing osteitis of the ilium Osteoporotic fractures (may also occur in the thoracic region and, rarely, in the cervical region) Reflected pain in diseases of the femur, gluteal region, and pelvic organs. Referred visceral pain in aortic dissection or aneurysm, renal colic, pancreatitis, retroperitoneal tumor, pleurisy, pyelonephritis Iliosacral osteoarthritis Sacroiliitis Spondylolisthesis
Pain in the neck and lower back	Ankylosing spondylitis (usually in the lower back and thoracic region) Arthritis (osteoarthritis, rheumatoid arthritis, rheumatoid arthritis rarely affects the lower back) Congenital anomalies (eg, spina bifida, lumbarization SI) Fibromyalgia Intervertebral disc diseases Infectious diseases (eg, osteomyelitis, discitis, spinal epidural abscess, infectious arthritis) Injuries (eg dislocations, subluxations, fractures) Stretching (overstraining) of muscles and ligaments Paget's disease Polymyalgia rheumatica Tumor (primary or metastatic) Spinal cord compression

All causes of back pain can be divided into three categories (the average frequency of occurrence is indicated in percentages):

1. Mechanical (97%)
2. Non-mechanical (~1%)
3. Visceral (~2%)

Mechanical back pain:

• Lumbar overload and tension - myogenic pain (70%)
• Degeneration of discs and facet joints (10%)
• Disc herniation (4%)
• Osteoporotic compression fractures (4%)
• Spinal stenosis (3%)
• Spondylolisthesis (2%)
• Traumatic fractures (<1%)
• Congenital diseases (<1%)
  • Severe kyphosis or scoliosis
  • Transitional vertebra
• Spondylolysis
• Internal disc rupture
• Anticipated instability

Non-mechanical back pain:

• Neoplasia (0.7%)
  • Multiple myeloma
  • Metastasis of carcinoma
  • Lymphoma and leukemia
  • Spinal cord tumors
  • Retroperitoneal tumors
  • Primary tumors of the vertebrae
• Infections (0.01%)
  • Osteomyelitis
  • Septic discitis
  • Paraspinal abscess
  • Epidural abscess
  • Shingles
• Inflammatory arthritis (0.3%)
  • Ankylosing spondylitis
  • Reiter's syndrome
  • Visceral inflammatory pathology
• Scheuermann's disease (osteochondrosis)
• Paget's disease

Visceral back pain:

• Diseases of the pelvic organs:
  • Prostatitis
  • Endometriosis
  • Chronic pelvic inflammatory disease
• Kidney diseases
  • Nephrolithiasis
  • Pyelonephritis
  • Perinephric abscess
• Aortic aneurysm
• Gastrointestinal diseases
  • Pancreatitis
  • Cholecystitis
  • Ulcer penetration

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