The intervertebral disc is the shock absorber that sits between the two adjacent vertebral bodies. Their other important function it to allow flexibility and maintain stability throughout the spine.
With age the disc loses water and becomes less flexible, and is therefore less able to provide shock absorption and more likely to sustain tears in the outer layer of the disc (annulus fibrosis). This can lead to disc prolapse, formation of bone spurs and the degeneration of other components of the spinal canal.
Because the disc is no longer able to provide the same level of support, there is more strain placed onto the facet joints at the back of the spine. They in turn can become arthritic, leading to pain as well as potentially enlargement of the joint (hypertrophy) which may lead to narrowing of the spinal canal, impingement of the nerve roots and spinal canal stenosis. If the disc does not wear equally, the spine can begin to curve towards one side. Once the alignment is no longer correct, this can lead to further deterioration and the development of degenerative scoliosis which can cause pain in the lower back and/or radiculopathy from nerve root compression.
Imaging is generally recommended only if there is no response to conservative treatment or if there are nerve symptoms such as pain, weakness and/or numbness in the legs. Imaging involves a combination of xray, CT scan, bone scan and MRI. These are all used for different reasons, and may only be required if considering specific treatments. If surgical treatment is being discussed, bone density testing is often also recommended before proceeding.
The treatment is typically non-surgical, and may involve lifestyle modification physical therapy, medications for pain relief and image guided injections.
For pain caused by compression of a nerve root that doesn’t respond to non-surgical treatment, the options include decompression alone, or decompression with fusion.
Back pain alone can be more challenging to manage. Typically, you will be treated by a variety of medical and allied health professionals to manage the symptoms and only if the symptoms remain, surgical treatment can be considered. The type of surgery depends on the area causing the pain, but includes spinal fusion, decompression and fusion, and artificial disc replacement.