Spine and vertebrae

INTRODUCTION

Back pain was a medical catastrophe of the 20^th century and the legacy reverberates into the new millennium. Pain in the back has always been a common feature of human life. Low back pain takes the second place after the respiratory disease as a cause to visit a physiotherapist. (Waddell, 2004, 1) Back pain is a very common throughout the industrial world, with its high prevalence leading to social and socioeconomic consequences. For example, in Finland, 33% of women and 29% of men reported having had low back pain in the previous month, and 11% of women and 10% of men mentioned being diagnosed or treated by a physiotherapist for the low back pain in the last year. However, the situation with of lumbar pain has not changed over the last 30 years. (Paatelma & Kilpikoski, 2008, 858-63)

Low back pain effects on all human beings. A lot of work companies spend huge sums of money each year on low back pain, the most common cause of job-related disability and a leading reason of missed work. For example, back pain is the second most common musculoskeletal disease in the United States of America. (Website of National Institute of Neurological Disorders and Stroke, 2003) Pain in the back and mental depression are two most common reasons leading to work loss and early retirement. However, natural history of low back pain is often seems to be good, many patients suffer from repeated episodes with consequences for their well-being as well as for their quality of life. (Paatelma, 2011, 11) However, 85% of low back diseases have unknown etiology. (McGill 2002, 6)

ANATOMY OF LOW BACK

Spine and vertebrae

“The complex anatomy of the lumbar spine is a remarkable combination of these strong vertebrae, multiple bony elements linked by joint capsules, and flexible ligaments/tendons, large muscles, and highly sensitive nerves.” (Kishner, 2015)

Low back (lumber area) consists of five vertebrae (L1-L5), located between the rib cage and the pelvic. Fibrocartilaginous discs are located between L1-L5 vertebrae region. They protect spinal cord and prevent the vertebrae from rubbing together. L1-L5 are the biggest vertebrae in the spinal column. (Floyd, Thompson & Clem, 2008)

The term “lumbar” which comes originally from Latin word “lumbus” means lion, as it is both powerful and flexible area of the back. The lower the vertebra is located in spine the more it has to bear the weight. L4-L5 are mostly exposed to degradations and injuries. The lumbar vertebrae consist of different parts. Vertebrae body is the anterior part of lumbar vertebrae. It consists of big block of bone. Pedicle is projected from the back of the vertebral body and performs two stout pillars of bone. Lamina comes from each pedicle towards the midline. (Bogduk 2005, 3)

Spinous processes of lumbar vertebrae are short and blunt. Transverses processes are large and blunt. Sizes of intervertebral discs are the thickest (Figure 1). (Tortora & Derrickson 2011, 242)

Figure 1. A typical lumbar vertebrae. (Website of Spine Institute, 2015)