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Pathophysiology Back Pain: Daryo Soemitro
Pathophysiology Back Pain: Daryo Soemitro
Back Pain
Daryo Soemitro
Department of Neurosurgery
Medical Faculty – University of Indonesia
Definition
This is the area of the spine where the lordotic curve forms. The most
frequent site of low back pain is in the 4th and 5th lumbar segment .
Terminology
Localized.
In localized pain the patient will feel soreness or
discomfort when the doctor palpates, or presses on, a
specific surface area of the lower back.
Diffuse.
Diffuse pain is spread over a larger area and comes
from deep tissue layers.
Radicular.
The pain is caused by irritation of a nerve root. Sciatica
is an example of radicular pain.
Referred.
The pain is perceived in the lower back but is caused
by inflammation elsewhere-- often in the kidneys or
lower abdomen.
Terminology
1. Fascicular Pia-
Arachnoid
2. Intra- and Interfasicular
Arterial Coils
3. Major Radicular
Longitudinal artery
4. Radicular Vein
5. Arterio-Venous
Anastemoses
6. Collateral Radicular
Arteries
7. Radicular Pia-Arachnoid
Nerve Compression
Mechanical causes
98% of low back pain. Sitting produces the
highest load on the spine, typically worsens the
pain.
sprained / strained ligaments, tendons, and
muscles
Rheumatologic
Neoplastic Disease
Infections : acute or chronic
Vascular or Hematologic
Endocrine / Metabolic
Referred pain
Other non-mechanical causes
Psychological factors
Facet Joint Syndrome
A B
A is computerized picture of the lumbar spine showing
where the facet joints are located. B is radiographic
anatomy of a facet joint
First Stage :
Nerve Roots markedly
swollen
Second Stage :
Nerve Roots Atrophy
with Scar Proliferation
Final Stage :
Empty Cavity
Nerve Totally Enveloped
in Dense Scar
Cause of Adhesive Arachnoiditis
Chemically induced AA
This arises when chemicals are introduced into or around the
subarachnoid space.
Myelogram
Epidural / intrathecal steroid injection
Epidural anaesthetics
Chymopapain
Intraspinal chemotherapy agents
Chemical meningitis
Cause of Adhesive Arachnoiditis
Mechanically-induced AA
Spinal surgery : especially multiple surgeries.
Trauma
Multiple lumbar punctures
Spinal stenosis (when chronic)
Anatomical abnormalities : especially degenerative
conditions : e.g osteophytes (bony protuberances)
Chronic disc prolapse : including leaked disc
material, which is known to be highly irritant to
nerves.
Blood
Infection :
Meningitis
Tuberculosis
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