Back wear

'I have a worn back or a worn-out vertebra and then there is nothing left to do', I hear several people say. Then I become curious and ask what exactly is meant by wear and tear. Because it depends on whether there is indeed nothing to do about it. There are different forms of wear, each with its own characteristics. A brief explanation.

What is wear?

I have already listed the most important issues for wear and osteoarthritis in the hip and knee. Something similar applies to the back. Also with the back, wear and tear often means that certain 'deviations' can be seen on X-rays or CT or MRI scans. Vertebrae are closer together than expected, there is extra bone growth at the intervertebral joints or at the edges of the vertebrae. I deliberately put 'wear' in quotation marks, because it usually concerns 'deviations' that are increasingly seen when we get older. Real wear and tear involves the breakdown or destruction of structures, such as the cartilage of joints, loss of quality of bone with all its consequences. Perhaps we should distinguish between the term wear as a normal aging phenomenon and osteoarthritis as the destructive form. The term degeneration is also used. Just as with the term wear, it is unclear what exactly is meant by this: is this normal or deviant?

Complaints with wear and osteoarthritis

In case of wear and tear as an aging phenomenon, there are no pain complaints. Slowly movement limitation can occur, causing a bit of suppleness to disappear. In osteoarthritis, the destructive form, there can also be stiffness, especially when starting a movement (in the morning when standing up or getting up after a while). And now there can also be pain in the back and sometimes radiating to one or both legs. The complaints can increase annoyingly, particularly in the case of overload (dislocation, translation, moving). These extra symptoms can disappear after weeks. It is not easy to predict whether osteoarthritis and complaints increase over time. Sometimes there seems to change nothing, and sometimes it can increase rapidly.

Vertebral canal stenosis

Bone growth at the intervertebral joints and vertebrae can cause narrowing of the spinal canal. As a result, the circulation in that channel is no longer sufficient to keep the nerves and cells in optimal condition. There may be complaints in the legs: pain and fatigue. It is striking that these complaints come with standing and walking, and relieve when sitting and lying down. In physical examination, the back bending of the back is often very limited. A number of these people can be helped with exercises, sometimes combined with treatments.

References
Tulder MW van, Assendelft WJ, Koes BW, Bouter LM. Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine. 1997;22(4):427-34.

Brinjikji XW et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015 Apr;36(4):811-6.