Pain in scoliosis

B A C K  P A I N  AND  P A I N  IN  S C O L I O S I S   

A reduction of movement in the spine can cause the spinal joints to "lock up". This lack of mobility has the potential to affect the movement of the nerves and tissues around spine. Our daily activities mostly involve us moving our spines in one main direction, which over time can cause repetitive strains to the muscles and tissues. The discs between the vertebrae act as shock absorbers and are affected by movement. As we bend forward or backwards the disc is easily pushed around. The uneven pressure throughout the disc can send warning messages to the brain which are equated as pain. By correcting posture and movement patterns the disc pressure remains more evenly distributed and the risk of bulging or slipping is minimized. Pain is a warning sign that things need to change. 


Back pain should be investigated promptly to exclude inflammatory processes, such as discitis, and the occasional primary bone neoplasm, such as an osteoid osteoma.


Low back pain which affects nearly every one of us at some stage of our active adult life often starts without warning and for no obvious reason. 


Common causes of back pain


  • Spondylolisthesis - is characterized by a forward subluxation of the involved vertebra. Because of the orientation of the facet joints, the spondylolytic vertebra displaces anteriorly in relation to the vertebra directly below. Sign and symptoms associated with spondylolisthesis are centralized low back pain, muscle spasm and a straightening of the lordotic curve.
  • Facet syndrome - refers to an inflammation (spondylitis) of the facet joint and its surrounding capsule. Facet syndrome can result from acute trauma or chronic repetitive insult. Extension overload of the facet joint, particularly when combined with rotation, can compress and irritate the joint. Consequently, patients with scoliosis are more susceptible than others to facet joint pain and dysfunction. Inflammation of the facet joint may also irritate the nearby nerve root as it exits through the intervertebral foramen. Sign and symptoms include considerable pain, paraspinal muscle spasm and tenderness upon palpation and movement of the facet joint.
  • SI joint dysfunction - low back pain can be referred from a sprain or dysfunction of the sacroiliac (SI) joint. Sign and symptoms associated with sacroiliac sprains include pain, swelling and tenderness over the affected joint and ligaments. Pain may be localized to the involved area, but may also be felt as a deep ache or radiating pain into buttock and thigh.
  • Osteoporosis - is a disease in which bones become fragile and more likely to fracture due to a loss of calcium and other mineral components. This condition is often called the "silent disease" because bone loss may occur without symptoms.
  • Osteoarthritis - arthritis is a term most people recognize but different mechanisms cause the painful and disabling joint pain. Osteoarthritis is a degenerative joint disease and the result of "wear and tear". Such wear and tear in the spine is part of the aging process and is often an incidental finding. 
  • Sitting for prolonged periods - most people sitting for prolonged periods will adopt a poor posture. Sitting in a bad position causes the muscles that support the low back become tired and relaxed. This results in the slouched sitting posture. This position will cause overstretching of ligaments. Once the slouched sitting posture has become a habit and is maintained most of the time, it may also cause distortion of the discs contained in the vertebral joints. Once this occurs movements as well as positions will produce pain. Sedentary lifestyles contributes to a loss of lumbar lordosis and loss of lumbar lordosis correlates with the incidence of chronic low back pain. 
  • Lifting objects with the back rounded has been found to raise the pressure in the discs to a much higher level than that existing when the weight is held with the body upright and the lordosis present. If you use an incorrect lifting technique while lifting heavy objects, you may cause damage and of course sudden severe pain. In order to minimize the risks involved in lifting you should always use the correct lifting technique.

Types of pain


1. Acute pain - occurs as a result of injury to the body and generally disappears when the physical injury heals. Acute pain is linked to tissue injury. 

2. Chronic pain - lasts beyond the normal healing period - usually at least 3 months. There may be no signs on x-rays or scans to indicate the source of the pain since some pain may be generated by tissue injury. Depression is common with chronic pain. 

3. Neuropathic chronic pain - is a type of pain that is caused by injury to a nerve. Patients describe the pain as having tingling, numbness or burning sensation. Neuropathic pain is difficult to treat.

Symptoms: 

  • painful itching
  • strange sensation
  • extreme sensitivity to normal touch and temperature
  • burning
  • electric - like sensation
  • painful numbness
  • pins and needles

4. Non-neuropathic chronic pain - this type of pain is not caused by injury to the nerve. The most common types include: 

  • low back pain - pain in the lower back from muscles, ligaments, tendons, arthritis or damaged discs
  • osteoarthritis - arthritis resulting from wear and tear of the joints and with normal aging
  • rheumatoid arthritis - an autoimmune disorder resulting in pain, stiffness and inflammation of the joint 

Symptoms:

  • gnawing
  • pounding



Pain in scoliosis


Scoliotic adults suffer from spinal pain much more frequently than non-scoliotic adults. Back pain is already noted in people between 20 and 30 years old. Scheuermann's disease can be one of the predictors of developing chronic low back pain in adulthood.

Back pain and scoliosis in children

Persistent back pain and progressive scoliosis should always be taken seriously in children and require careful assessment of signs and symptoms. Clinical evaluation of back pain in children is important in order to provide appropriate management, prognosis and reduce complications.

The clinical history should detail the location, duration and frequency, the area to which the pain may radiate, quality of the pain and mechanism.

Pain that occurs at night and awakens the child may be associated with tumours infection. Acute onset of back pain may be secondary to trauma.

The increasing number of adolescents presenting with back pain is related to static physical action such as sitting, lifting weights and long-standing.

Intraspinal neoplasms and bone tumours may be present with back pain and associated scoliosis.


Common causes of back pain in children:

A/ Spondylolysis - Lumbar spondylolysis is the most common cause of low back pain in children older than 10 years Spondylolysis is a stress injury/fracture of the pars interarticularis and is characterized by reproducible point tenderness. 

B/ Inflammatory diseases and infectious - Back pain in children can be caused by inflammatory and infectious disorders of the spine, spinal cord, nerve roots, vertebrae and discs. 

- Infectious discitis and vertebral osteomyelitis are common in children between the ages of 2 and 12 years. They often result from lymphatic spread. Discitis occurs when bacteria directly invade the disc from other part of the body.

- Acute transverse myelitis is an inflammatory condition associated with rapidly developing progressive motor and sensory dysfunction can affect children between 10 and 19 years of age. 

- Spinal tuberculosis is another important cause of back pain and possible subsequent scoliosis or kyphotic deformity. Symptoms of infection include: back pain, fewer and local tenderness.

C/ Vertebral and spinal cord neoplasms can affect children at the end of the first decade and at the beginning of the second decade of life.

Clinical features include:
persistent and localized back pain that is worse at night

motor weakness

gait disturbance

muscle rigidity with paraspinal muscle spasm

progressive scoliosis

Benign neoplasms of the vertebrae include: osteoid osteoma, osteoblastoma
Malignant neoplasms include: Ewing sarcoma, lymphoma, neuroblastoma and osteosarcoma. Osteosarcoma commonly involves the posterior elements of the spine. 

Spinal cord tumours present with pain and progressive motor dysfunction followed by scoliosis and gait disturbance. 


Consultations are by appointment only.


Joanna Slup scoliosis expert


Britannia House, 1-11 Glenthorne Road, Hammersmith, London UK

W6 0LH


Phone: +44 77 1999 7920


Email:

enquiries@scoliosis-treatment.co.uk

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