Back pain is a problem that many people in our country have now, regardless of age, right? We usually think that back pain is caused by a slipped disc or arthritis. But sometimes, no matter how much medication or physical therapy you take, there are back pains that do not subside. The cause may not be what we think. Today, we are talking about a special type of back pain that has recently been identified by medical science, namely `` vertebral pain ''.
Simply put, what is Vertebrogenic pain?
To understand this, let's first think about our spine. Our spine is made up of a stack of small bones (vertebrae) stacked on top of each other, like bricks stacked on top of each other. Between these "bricks" is the disc we all know.
But the most important part of this story is the special protective layer that sits above and below each vertebra. This is a thin layer made of cartilage and bone. In medical terms, this is called the vertebral endplate . In the past, doctors thought that disc problems were the main cause of back pain. But new research has found that when these endplates are damaged, the nerves that run through them can become compressed, causing severe, long-lasting pain.
Simply put, ``Vertebrogenic pain '' is back pain that is caused not by the disc, but by damage to the endplates at the top and bottom of the vertebrae.
This could also be related to disc problems. Researchers have found that where a disc has worn away, changes occur in the spinal cord above and below it. There are also more nerve fibers that carry pain in those areas. But they're still figuring out exactly how that happens.
What are the reasons that cause this situation?
There are many reasons why our endplates can become damaged. This can be caused by natural wear and tear that comes with age, as well as an accident.
This doesn't happen to everyone, but some people are at a slightly higher risk of developing this condition.
- Being over 40 years of age: This risk increases with other natural changes in the body as we age.
- Height: Tall people may experience relatively greater pressure on their spine.
- Obesity: As body weight increases, the load on the spine increases, making the facet joints more susceptible to damage.
- Smoking: Smoking causes blood vessels to narrow, reducing blood flow to parts of the spine. This hinders the healing process.
- Heavy physical labor: People who engage in jobs that involve lifting heavy objects or straining their backs, such as construction, are at higher risk.
- Family history : If someone in your family has had chronic back pain, you may also develop it due to genetic influences.
How to recognize the symptoms?
This pain is a little different from other back pains. See if you have these symptoms too.
| Symptom | Description |
|---|---|
| Times when the pain increases | The pain increases when bending forward, sitting for long periods of time, and during active activities such as exercising. |
| Nature of pain | It can feel like a deep ache, burning, or burning pain coming from within. |
| The place where the pain is felt | The pain is often in the lower, middle part of the back. |
| The most important difference | Numbness and tingling in the legs, as seen with disc problems, are not often seen in this condition. However, if you have both problems, these symptoms may also occur. |
How do you find this, Doctor?
If you have had back pain for more than 6 months and it hasn't improved with standard treatments, your doctor may suspect this condition (Vertebrogenic pain). The following steps will be taken to make a diagnosis:
1. Asking you about your background: Does anyone in your family have back problems like this and what the pain feels like?
2. Physical examination: You will be asked to bend forward and to the sides, and to check when the pain increases.
3. Excluding other diseases: Other tests are done to see if there are other causes, such as a disc problem or a tumor.
4. MRI scan: The final and most definitive answer comes from an MRI (Magnetic Resonance Imaging) scan. This can take very clear pictures of the spine.
On an MRI, your doctor can see specific changes in the endplates that are causing the pain. These are called Modic changes . They come in two main types:
- Modic type 1: There is swelling and inflammation in the bone marrow.
- Modic type 2: Instead of healthy red bone marrow, fatty yellow bone marrow is seen.
How is it treated?
First, your doctor will recommend standard treatments such as painkillers (NSAIDs), muscle relaxants, and physical therapy.
However, if there is no improvement after about 6 months of this treatment, a special treatment method can be considered. It is called Basivertebral Nerve Ablation .
What is Basivertebral Nerve Ablation?
Simply put, the main nerve that carries pain signals to our extremities is the ``basivertebral nerve.`` This treatment involves damaging this nerve at the point where it enters the vertebrae where the pain is coming from, stopping the pain signals from going to the brain.
This is not a major operation. You will be given anesthesia, so you will not feel any pain. The surgeon will make a small incision in the skin where you have back pain and insert a small instrument through it into the spine. Then, they will use heat to damage the nerve.
You can usually go home the same day. The recovery time is shorter than with other back surgeries. Research has found that this treatment can help you stay pain-free for 5 years or more.
When should I see a doctor?
If your back pain has lasted for more than a few weeks, if the pain is getting worse, or if treatment is not helping, be sure to see a doctor .
Seek immediate medical advice , especially if you have the following red flag signs :
- Numbness or weakness in the legs
- Difficulty standing or walking
- Involuntary leakage of urine or stool (this is a very serious emergency, go to a hospital emergency room (ETU) immediately)
- Sudden weight loss
- Fever
Take-Home Message
- Vertebrogenic pain is a specific type of back pain that is caused not by a disc problem, but by damage to the endplates of the spine.
- This pain increases when bending forward or sitting, and symptoms such as leg numbness are usually less common.
- An MRI scan may be necessary to accurately diagnose the disease.
- If conventional treatments do not provide relief, modern, successful treatments such as ``Basivertebral nerve ablation'' are now available.
- Never ignore back pain. If it persists or has severe symptoms, be sure to see your doctor.
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