CATEGORY A: MUSCULOSKELETAL AND RELATED DISORDERS

1. Disc Disease (often with numbness/tingling and/or weakness of the affected leg or arm).

Disc Herniation, Disc Protrusion, Disk Extrustion.

Degenerative Disc Disease.

Failed Back Surgery Syndrome (Failed Back Syndrome, Post-Laminectomy Syndrome).

Annular Tear of the Disc Capsule.

2. Rheumatic Diseases

Ankylosing Spondylitis: Pain and swelling in other joints. Morning stiffness. Fatigue.

Psoriatic Arthritis: Pain and swelling in other joints. Morning stiffness. Fatigue. Skin disease (psoriasis).

Rheumatoid Arthritis: Pain and swelling in other joints. Morning stiffness. Fatigue.

Osteoarthritis.

3. Other Musculoskeletal Disorders

Back Strain (Muscular-Ligamentous)

Fibromyalgia

Spinal Stenosis

Foraminal Stenosis

Paget's Disease of Bone

Vertebral Compression Fracture

Osteoporosis

CATEGORY B: OTHER MEDICAL CAUSES OF BACK PAIN

Diseases of the Urinary Tract

Pyelonephritis: Dysuria (Burning on Urination), Fever, Hematuria (Blood in Urine)

Kidney Stones: Acute severe pain; Hematuria; Family History

Diseases of the Gastrointestinal Tract

Peptic Ulcer: Pain relieved by food; heartburn.

Gall Bladder Disease: Pain after fatty meal. Nausea

Infectious Disease

Osteomyelitis: Fever, night sweats.

Epidural Abscess

Tuberculosis

Cardiovascular Disease

Angina.

Dissecting Aneurysm of the Aorta.

Cancer

Metastatic Cancer: Breast, Prostate, Ovary, Lung: Previous history of cancer. Weight loss, loss of appetite.

Multiple Myeloma.

Leukemia.

Sciatica is pain which is due to inflammation of the sciatic nerve or its branches. The sciatic nerve is composed of nerves which originate from the lumbar nerve roots, usually L3, L4, and L5. Sciatica usually results from disc disease involving a disc in the L3-4, L4-5, or L5-S1 interspace. Sciatica, denoting the pain experienced, is usually experienced as pain which originates in the low back and then radiates through the buttock on one side, down the corresponding thigh and continues below the knee, often into the calf or the foot.

Sciatica is often accompanied by other symptoms of lumbar radiculopathy, those being numbness, tingling, and weakness in the same distribution. Radiculopathy denotes neurological symptoms corresponding to a nerve root, in this case one or more of the lumbar(lower back) nerve roots.

Cervical Radiculopathy

Similar symptoms are seen in cases of cervical radiculopathy, except in these cases the neurological symptoms are experienced in an upper limb due to disc disease in the neck. These patients often experience pain and numbness/tingling down an arm into the fingers of one hand. More extreme cases produce weakness of the involved hand.

Localized Chronic Back, Neck, or Leg Pain

Some patients experience pain that does not radiate down a limb, but instead is localized to the neck, upper, mid, or lower back, or is limited to the leg without a component of back pain. All of these patients may have pain which is caused by disk disease.

Forms of Disc Disease

The types of disc disease responsible can vary. There are several common forms: degenerative disc disease, usually seen in middle-aged or older adults, but occasionally seen in younger adults, usually in those who have been competitive athletes; traumatic disc disease, frequently seen after automobile accidents; and familial disc disease, with disc disorders being reported in many family members. MRI scans of these patients will usually show disc protrusion, disc bulge, disc extrusion, or disc herniation at one or more spinal levels which correlate with the patient's symptoms.

Annular Tears

The intervertebral disc is composed of an outer capsule, the annulus fibrosis, which surrounds the inner nucleus pulposus. A tear of this capsule, called an annular tear, allows the nucleus pulposus to escape, in some cases producing a visible bulge. This can usually be seen on the MRI with careful inspection. Some patients, however, on routine MRI exam appear to have normal discs but continue to experience severe symptoms which duplicate the normal symptoms reported with disc protrusion. It is now known that these symptoms can be due to an annular tear which allows the inflammatory contents of the disc to escape, even without an obvious disc bulge. Annular tears such as this can be diagnosed with enhanced MRI scans or with a technique called discography. Discography involves injecting the disc with dye; patients with an annular tear will demonstrate leakage of the dye through the tear. Patients with annular tears are frequently not diagnosed properly for years. This is somewhat understandable because often their routine MRIs are read as normal and a discogram, which is not a comfortable procedure, has not been done.