Back injury

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Back injury results from damage, wear, or trauma to bones, muscles, or other tissues in the back. Common back injuries include sprains and strains, herniated discs, and cracked spine. Lumbar spine is often the location of back pain. This area is vulnerable due to its flexibility and the amount of weight it normally wears. It is estimated that lower back pain can affect as much as 80 to 90 percent of the general population in the United States.

Video Back injury

Classification

Soft network gradation system

Muscle and soft tissue injuries can be classified using a multilevel system.

• Class 1 muscle disturbance is the most severe with damage to some muscle fibers and less if loss of function.
• Class 2 muscle strains show mild to moderate injuries with considerable tissue damage and some loss of function or strength.
• The degree of 3 muscle strains is the most severe level of injury to muscles that are completely torn or fully functional.

Spine injury classification system AO

Vertebral spine or injuries can be classified using AO's spinal injury classification system. Three categories - A, B, and C - are based on the location of damage to the vertebrae (either in the anterior or posterior segments) and by the adverse force direction applied.

• Type A injury is associated with compression style with damage to the vertebral body.
• Type B injuries are associated with interference styles that result in structural damage to the posterior components of the vertebral column.
• Type C injury is associated with damage to the anterior and posterior aspects of the vertebral column resulting in the removal of segments that are cut off in any direction.

This classification system can be used to classify injuries to the cervical, thoracolumbar, and sacral areas of the spine.

MSU classification for herniated discs

Herniated discs can be judged on the size and location of the herniation as seen on MRI.

Size

The size of the herniation is the extent to which it protrudes into the vertebral foramen. The MSU classification for herniated discs uses the proximity of the disk to the facet joint when measuring the size of the herniated disc. Using MSU Classification, values ​​of 1, 2 or 3 can be used to describe the herniated disk size with the 1 most severe and the 3 most severe.

Locations

The location of the herniation can also be explained using the MSU Classification for the herniated disc. This classification explains how far from the centerline of the disc bulge using values ​​of A, B, or C.

• The value A represents the herniation in the midline.
• The degree C is the most lateral and prominent to the intervertebral foramen (via the travel spinal cord).
• Grade B herniated discs are located between grade A and C, using a joint facet as a landmark for the lateral border.

MSU classification is mainly used to classify disc herniation on the lumbar spine.

Maps Back injury

Cause

Many back injuries have similar causes. Tension and sprain to the back muscles can be caused by improper movement when lifting heavy loads, overuse of muscles, sudden, forceful movements, or direct trauma. Herniated discs are associated with age-related degeneration, trauma such as falls or car accidents, and bending or twisting while lifting heavy loads. Common causes of vertebral fractures include trauma from direct blows, compression forces that result in improper or excessive axial loading, and hyper-flexion or hyper-extension.

Vertebral fractures in children or the elderly may be associated with the development or health of their spine. The most common vertebral fractures in children are spondylolysis that can develop into spondylolistesis. The immature skeleton contains a growth plate that has not yet fully hardened into a stronger mature bone. Vertebral fractures in elderly individuals are exacerbated by weakening of skeletons associated with osteoporosis.

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Diagnosis

The diagnosis of back injury begins with a physical examination and a thorough medical history by health care personnel. Some injuries, such as sprains and strains or disc herniation, can be diagnosed in this way. To confirm this diagnosis, or to rule out any other injury or pathology, imaging of the injured area may be ordered. X-rays are often used to visualize bone pathology and can be ordered when a spine fracture is suspected. CT scanning produces higher resolution images when compared with x-rays and can be used to view finer fractures that may not be detected on x-rays. MRI is often referred to as the gold standard for visualizing soft tissue and can be used to help diagnose many back injuries, including disc herniation and neurological disorders, bleeding, and edema.

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Treatment

Treatment for back injury depends on the diagnosis, level of pain, and whether there is loss of function or quality of life.

Conservative

• Cold therapy reduces inflammation, edema, pain, and muscle spasms associated with acute back injury.
• Hot therapy is used to relieve pain and relieve sore and stiff muscles. Hot therapy is proposed to work by facilitating the delivery of nutrients and oxygen to the site of injury to accommodate healing.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen may be taken to reduce mild to moderate pain associated with back injury. NSAIDs are recommended to be more effective for persistent pain than acute pain. If the pain remains unbearable while taking over the relieving drugs, stronger pain medications such as narcotics or muscle relaxants may be prescribed at the discretion of the physician.
• Alternative therapies and treatments: an active approach to recovery is recommended for bed rest for most cases of back injury. Activities promote strength and functional rehabilitation and counter atrophy associated with not being used. Physical therapy can help reduce pain and regain strength and function. The gentle movements of yoga and tai chi are advised to improve function and to counteract negative psychosocial effects that can become secondary to injury. Spinal manipulation, massage, and acupuncture have been used to treat pain associated with various back injuries, but there is little consensus on the level of effectiveness.
• Injections: Spinal cord block and epidural injection are the options available to reduce pain and neurological symptoms. Anesthetic injections relieve pain while steroid injections can be used to reduce inflammation and swelling of the surrounding spinal cord.

Non-Conservative

Surgery is considered when symptoms continue after attempting conservative treatment. It is estimated that 10-20 percent of individuals with low back pain fail to improve with conservative measures.

• Discectomy is a common procedure used to reduce the radiating pain and neurological symptoms associated with disc herniation. There are several variations of discectomy with different approaches to access the herniated disk, but the purpose of this procedure is to remove part of the prominent intervertebral disk into the vertebral foramen.
• Total disk replacement can also be done to solve the disc hernia. Rather than simply removing the prolapsed disc-like part of the discectomy, this procedure involves removing the entire vertebral disc and replacing it with an artificial one.
• Surgical solutions for vertebral fractures are found to be more effective than conservative treatment. Vertebroplasty and kyphoplasty are considered minimally invasive surgical procedures and are proposed to reduce pain and restore the function of the cracked bone.

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Prevention

Suggestions for preventing various back injuries primarily address the cause of the injury. Risks for back sprains and strains can be reduced by lifestyle choices, including quitting smoking, limiting alcohol, maintaining a healthy weight, and maintaining strong bones and muscles with adequate exercise and a healthy diet. The risk for disc herniation can be reduced by using appropriate techniques when lifting heavy loads, stopping smoking, and losing weight to reduce the burden placed in the spine. Vertebral fractures may be difficult to prevent because of common causes associated with accidents or age-related degeneration with osteoporosis. Treating osteoporosis with pharmacotherapy, enrolling in a fallout prevention program, strengthening muscles and bones with weight training programs, and adopting a nutrition program that improves bone health are all options to reduce the risk of vertebral fractures associated with osteoporosis.

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Epidemiology

• The two age groups with the highest rates of spinal cord injuries are aged 15-29 years and 65 years and over.
• An estimated 50 percent of spinal injuries are associated with motor vehicle accidents.
• Although most vertebral fractures are undiagnosed, the annual costs associated with the treatment of vertebral fractures are estimated at $ 1 billion in the US.
• Disk herniation is most common between the ages of 30-50 years. 95 percent of herniated discs diagnosed in patients 25-55 years are in the lumbar spine.
• At age 15, an estimated 26-50 percent of children have experienced acute or chronic back pain.

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References

Source of the article : Wikipedia