PATHOPHYSIOLOGY OF LOW BACK PAIN

Dr. Rodrigo Rivera Sepúlveda Orthopedics and Traumatology Hospital Felix Bulnes
University Andrés Bello
Introduction
• • • • • • Pain Anatomy Embryology Epidemiology Classification Pathophysiology
Pain
Set by International Association for the Study of Pain: "an unpleasant experienc
e, sensory and emotional, associated with potential or actual damage, or describ
ed in terms of such damage."
IASP
Pain
• Help v / s Damage
- Serves as a sign of care useful in certain situations, avoiding further damage
, or help identify a disease - it loses its usefulness when it is severe, dispro
portionate, without regard to the cause or the result is deleterious to the pati
ent
Pain
Tissue Trauma Increased concentration of nociceptive substances (eg prostaglandi
ns, histamine, serotonin, substance P. ..)
Activation of CNS pain
Pain: The 5th Vital Sign
1. 2. 3. 4. 5. Blood Pressure Temperature Pulse Respiration Assessment of Pain (
recommended by the American Pain Society)
American Pain Society. 1998
Analog scale pain
Analog scale pain
Back pain. Biomechanical elements
• functional spinal unit: 2. Lig.Lon. Later. 3. Lig. Lon. above. 4. Vertebral bo
dy. 5. Intervertebral disc. 6. Hole conjugation and nerve root. 9. Intervertebra
l joint. 13. Vertebral canal.
Anatomy
Innervation of spinal structures
Primary Industry Previous: transverse processes and muscles paravert ant. Poster
ior primary ramus: branch medial post Musculat paravert deep neural arch periost
eum, joints zigoapofisiarias, ligamnto inter-and supraspinous and intertransvers
e, lig yellow skin. Lateral branch, musculature and skin deep axial paravert.
Innervation of spinal structures
Sinuvertebral recurrent nerve: Periosteum of posterior wall spinal cord and epid
ural venous plexus, epidural adipose tissue, fibrous anulus later LCVP, anterior
aspect of the dura. Sympathetic trunk and branch communicating gray: lateral an
d anterior aspect of the anulus fibrosus, LCVA, anterior and lateral periosteum
of the vertebral body.
Innervation of spinal structures
Cord and dorsal root ganglia: Your irritation and / or compression causes metame
ric commitment, with pain in a specific dermatome.
Back pain. Functional considerations.
• basic biomechanical functions: 2. Weight transfer static and dynamic axial and
appendicular skeleton. 3. Allow the support of physiological movements. 4. Prot
ect the structures of the spinal cord and nerve roots.
Physiology
Pressurized core axial load
stabilizing the anulus tight spinal unit allows full range of motion
Pathophysiology of DIV
Pathophysiology
• disc disease: normal disc degenerative process. • It affects their three eleme
nts: - Drying the kernel - the anulus fissure - sclerosis and osteophytes
Pathophysiology
Desiccation of the nucleus (Decreased proteoglycan) Low voltage drive anulus Una
ble to stabilize spinal segmental hypermobility and abnormal traction osteophyte
s fascetaria
Pathophysiology of DIV
Pathophysiology
• Events abnormal degenerative process: - Rupture of anulus fibrosus: acute or p
rogressive nuclear prolapse. - Symptomatic instability: For commitment to artic.
fascetarias - secondary Estenorraquis: osteophytes, bulging ring and soft tissu
e hypertrophy.
Slipped disc
• Rupture disc material bulging anulus. According severity can be: - Bulging dis
c - disc extrusion (HNP)
Slipped disc
• Mechanical Compression: Deficit compromised root
HNP L3-L4: 10% HNP L4-L5 and L5-S1: 90%
Slipped disc
• CK: autocrine and paracrine mechanisms: - Estimation. Nerve endings - Sensitiz
ation of nociceptors - Promotes loss of proteoglycans (alters balance EZS / inhi
bitors) - Neovascularization
Back pain. Kinematic Bases
• RISK FACTORS:
2. Age (20-60 years). 3. Static spinal posture. 4. Occupation and dynamic postur
e. 5. Body vibration exposure prolonged. 6. Fitness and sports. 7. Psychological
aspects.
• • •
Mobility KINEMATICS functional unit. Mobility of the spine.
REPRESENTATIVE VALUES OF THE MOVEMENT KINEMATICS OF THE SPINE
Pathophysiology
• 2. 3. 4. 5. Vertebral body: intervertebral disc. Vertebral ligaments. Spinal a
nd abdominal muscles. Core and root structures.
Cinematic Bases
Key Concepts
• Clinical diagnosis and imaging • The vast majority is due to mechanical causes
postural-tension of less significance. • The physician must recognize the warni
ng symptom patterns: pain at rest and / or night pain.€Fever weight loss and mor
ning stiffness polyarthralgia acute pain, persistent, refractory to symptomatic
treatment.
Diagnostic sequence
Syndromatic
1.-Sd.de pure back pain sciatic pain Sd.de 2.-3.-Root Esclerotógeno Sd.de neural
claudication pain lumbar pain lumbar Sd.de 4.-Atypical
International Association LUMBAR PAIN OF PAIN FOR ESTUDY
I. Agree to the compromised system and its etiology. System: Musculoskeletal. Ne
urologic. Visceral or vascular disease. Psychological. Idiopathic
2. • • • • •
2. Etiology: • Degenerative. • Inflammatory. • Metabolic. • Neoplasm. • Trauma.
• Congenita. • Infectious.
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