Skip to main content
SpringerLink
Log in
Book cover

Fundamentals of Family Medicine pp 337–369Cite as

Disorders of the Back and Neck

  • Chapter

  • 234 Accesses

Abstract

Low back pain is a common and costly medical problem. The lifetime prevalence of low back pain is estimated to be 70% to 85%, while the point prevalence is approximately 30%.1 Each year, 2% of all American workers have a compensable back injury, and 14% lose at least one workday due to low back pain.2 Among chronic conditions, back problems are the most frequent cause for limitation of activity (work, housekeeping, school) among patients under 45 years of age.3 Acute low back pain is the fifth most common reason for a visit to the physician, accounting for 2.8% of all physician visits .4 And nonsurgical low back pain is the fourth most common admission diagnosis for patients over 65.5 Although difficult to estimate, the direct medical costs due to back pain totaled $33.6 billion in 1994. Indirect costs (i.e., lost productivity and compensation) are estimated to be as high as $43 billion.6 In most cases, low back pain is treated successfully with a conservative regimen, supplemented by selective use of neuroradiologic imaging, and appropriate surgical intervention for a small minority of patients.7

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Anderson GBJ. The epidemiology of spinal disorders. In Frymoyer JW, ed. The adult spine: principles and practice, 2nd ed. Philadelphia: Lippincott-Raven, 1997; 93–141.

    Google Scholar 

  2. Loeser JD, Volinn E. Epidemiology of low back pain. Neurosurg Clin North Am 1991; 2: 713–18.

    CAS  Google Scholar 

  3. Deyo RA. Conservative therapy for low back pain. JAMA 1983; 250 (8): 1057–62.

    Article  PubMed  CAS  Google Scholar 

  4. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain: frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine 1995; 20: 11–19.

    Article  PubMed  CAS  Google Scholar 

  5. Deyo RA, Loeser JD, Bigos SJ. Herniated lumbar inter-vertebral disc. Ann Intern Med 1990; 112: 598–603.

    PubMed  CAS  Google Scholar 

  6. Frymoyer JW, Durett CL. The economics of spinal disorders. In: Frymoyer JW, ed. The adult spine: principles and practice, 2nd ed. Philadelphia: Lippincott-Raven, 1997; 143–50.

    Google Scholar 

  7. Frymoyer JW. Back pain and sciatica. N Engl J Med 1988; 318 (5): 291–300.

    Article  PubMed  CAS  Google Scholar 

  8. Anderson GBJ. Epidemiologic features of chronic low back pain. Lancet 1999; 354: 581–5.

    Article  Google Scholar 

  9. Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low back pain and its related medical care in the United States. Spine 1987; 12: 264–8.

    Article  PubMed  CAS  Google Scholar 

  10. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992; 268 (6): 760–5.

    Article  PubMed  CAS  Google Scholar 

  11. Weber H. Lumbar disc herniation: a controlled prospective study with ten years of observation. Spine 1983; 8 (2): 131–40.

    Article  PubMed  CAS  Google Scholar 

  12. Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am 1991; 22 (2): 263–71.

    PubMed  CAS  Google Scholar 

  13. National Center for Health Statistics. Prevalence of selected impairments. U.S., 1977, series 10, number 132. Hyattsville, MD. DHHS publication (PHS) 81–1562, 1981.

    Google Scholar 

  14. Deyo RA, Weinstein JN. Primary care: low back pain. N Engl J Med 2001; 344 (5): 363–70.

    Article  PubMed  CAS  Google Scholar 

  15. Wipf JE, Deyo RA. Low back pain. Med Clin North Am 1995; 79 (2): 231–46.

    CAS  Google Scholar 

  16. Mixter WJ, Barr JS. Rupture of inter-vertebral disc with involvement of the spinal canal. N Engl J Med 1934; 211 (5): 210–5.

    Article  Google Scholar 

  17. Spitzer WO, LeBlanc FE, Dupuis M, et al. Scientific approach to the assessment and management of activity related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine 1987; 12 (suppl 1): S1–59.

    Article  Google Scholar 

  18. Frymoyer JW, Nachemson A. Natural history of low back disorders. In: Frymoyer JW, ed. In: The adult spine: principles and practice. New York: Raven Press, 1991; 1537–50.

    Google Scholar 

  19. Modic MT, Ross JS. Magnetic resonance imaging in the evaluation of low back pain. Orthop Clin North Am 1991; 22 (2): 283–301.

    PubMed  CAS  Google Scholar 

  20. Deyo RA, Diehl AK. Lumbar spine films in primary care: current use and effects of selective ordering criteria. J Gen Intern Med 1986; 1: 20–5.

    Article  PubMed  CAS  Google Scholar 

  21. Hensinger RN. Spondylolysis and spondylolisthesis in children and adolescents. J Bone Joint Surg 1989; 71A (7): 1098–107.

    PubMed  CAS  Google Scholar 

  22. Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults. Clinical practice guideline no. 14. Rockville, MD: Agency for Health Care Policy and Research, December 1994. (AHCPR publication no. 95–0642.)

    Google Scholar 

  23. Frymoyer JW, Newberg A, Pope MH, Wilder DG, Clements J, MacPherson B. Spine radiographs in patients with low back pain: an epidemiological study in men. J Bone Joint Surg 1984; 66A (7): 1048–55.

    PubMed  CAS  Google Scholar 

  24. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging in people without back pain. N Engl J Med 1994; 331 (2): 69–73.

    Article  PubMed  Google Scholar 

  25. Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med 1988; 3: 230–8.

    Article  PubMed  CAS  Google Scholar 

  26. Garfin SR, Herkowitz HN, Mirkovic S. Spinal stenosis. Inst Course Lect 2000; 49: 361–74.

    CAS  Google Scholar 

  27. Hilibrand AS, Rand N. Degenerative lumbar stenosis: diagnosis and management. J Am Acad Orthop Surg 1999; 7: 239–49.

    PubMed  CAS  Google Scholar 

  28. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine Lumbar Spine Study. Spine 2000; 25 (5): 556–62.

    Article  PubMed  CAS  Google Scholar 

  29. McCowin PR, Borenstein D, Wiesel SW. The current approach to the medical diagnosis of low back pain. Orthop Clin North Am 1991; 22 (2): 315–25.

    PubMed  CAS  Google Scholar 

  30. Barth RW, Lane JM. Osteoporosis. Orthop Clin North Am 1988; 19 (4): 845–58.

    CAS  Google Scholar 

  31. Bates DW, Reuler JB. Back pain and epidural spinal cord compression. J Gen Intern Med 1988; 3: 191–7.

    Article  PubMed  CAS  Google Scholar 

  32. Joines JD, McNutt RA, Carey TS, Deyo RA, Rouhani R. Finding cancer in primary care outpatients with low back pain: a comparison of diagnostic strategies. J Gen Intern Med 2001; 16 (1): 14–23.

    Article  PubMed  CAS  Google Scholar 

  33. Perrin RG. Symptomatic spinal metastases. Am Fam Physician 1989; 39 (5): 165–72.

    PubMed  CAS  Google Scholar 

  34. Jackson RP. The facet syndrome: myth or reality? Clin Orthop 1992; 279: 110–21.

    PubMed  Google Scholar 

  35. Carette S, Marcoux S, Truchon R, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med 1991; 325 (14): 1002–7.

    Article  PubMed  CAS  Google Scholar 

  36. Lilius G, Laasonen EM, Myllynen P, Harilainen A, Gronlund G. Lumbar facet joint syndrome: a randomized clinical trial. J Bone Joint Surg 1989; 71B (4): 681–4.

    CAS  Google Scholar 

  37. Revel M, Poiraudeau S, Auleley GR, et al. Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints. Spine 1998; 23 (18): 1972–7.

    Article  PubMed  CAS  Google Scholar 

  38. Nelemans PJ, deBie RA, deVet HC, Sturmans F Injection therapy for subacute and chronic benign low back pain. Spine 2001; 26 (5): 501–15.

    Article  PubMed  CAS  Google Scholar 

  39. Gran JT. An epidemiological survey of the signs and symptoms of ankylosing spondylitis. Clin Rheumatol 1985; 4: 161–9.

    Article  PubMed  CAS  Google Scholar 

  40. Frymoyer JW, Rosen JC, Clements J, Pope MH. Psychologic factors in low back pain disability. Clin Orthop 1985; 195: 178–84.

    PubMed  Google Scholar 

  41. Wheeler AH. Diagnosis and management of low back pain and sciatica. Am Fam Physician 1995; 52 (5): 1333–41.

    PubMed  CAS  Google Scholar 

  42. Waddell G, Feder G, Lewis M. Systematic reviews of bedrest and advice to stay active for acute low back pain. Br J Gen Pract 1997; 47: 647–52.

    PubMed  CAS  Google Scholar 

  43. Malmivaara A, Hakkinen U, Aro T et al. The treatment of acute low back painbedrest, exercises, or ordinary activity? N Engl J Med 1995; 332: 351–5.

    Article  PubMed  CAS  Google Scholar 

  44. van Tulder MW, Scholten RJ, Koes BW, Deyo RA. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review with the framework of the Cochrane Collaboration Back Review Group. Spine 2000; 25 (19): 2501–13.

    Article  PubMed  Google Scholar 

  45. Beurskens AJ, de Vet HC, Koke AJ, et al. Efficacy of traction for nonspecific low back pain: 12-week and 16-month results of a randomized clinical trial. Spine 1997; 22: 2756–62.

    Article  PubMed  CAS  Google Scholar 

  46. Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. N Engl J Med 1990; 322 (23): 1627–34.

    Article  PubMed  CAS  Google Scholar 

  47. van Tulder M, Malmivaara A, Esmail R, Koes B. Exercise therapy for low back pain: a systematic review with the framework of the Cochrane Collaboration Back Review Group. Spine 2000; 25 (21): 2784–96.

    Article  PubMed  Google Scholar 

  48. Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med 1998; 339: 1021–9.

    Article  PubMed  CAS  Google Scholar 

  49. Anderson GBJ, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans S. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med 1999; 341: 1426–31.

    Article  Google Scholar 

  50. van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for nonspecific low back pain (Cochrane Reivew). In: The Cochrane Library; issue 3. Oxford: Update Software, 1999.

    Google Scholar 

  51. van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain. Spine 1999; 24 (11): 1113–23.

    Article  PubMed  Google Scholar 

  52. Carette S, Leclaire R, Marcoux S. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997; 336: 1634–40.

    Article  PubMed  CAS  Google Scholar 

  53. Cherkin DC, Deyo RA, Loeser JD, Bush T, Waddell G. An international comparison of back surgery rates. Spine 1994; 19 (11): 1201–6.

    PubMed  CAS  Google Scholar 

  54. Taylor VM, Deyo RA, Cherkin DC, Kreuter W. Low back pain hospitalization: recent U.S. trends and regional variations. Spine 1994; 19 (11): 1207–13.

    PubMed  CAS  Google Scholar 

  55. Hurme M, Alaranta H. Factors predicting the results of surgery for lumbar inter-vertebral disc herniation. Spine 1987; 12 (9): 933–8.

    Article  PubMed  CAS  Google Scholar 

  56. Gibson JNA, Grant IC, Waddell G. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine 1999; 24 (17): 1820–32.

    Article  PubMed  CAS  Google Scholar 

  57. Abramovitz JN, Neff SR. Lumbar disc surgery: results of the prospective lumbar discectomy study. Neurosurgery 1991; 29 (2): 301–8.

    Article  PubMed  CAS  Google Scholar 

  58. Hoffman RM, Wheeler KJ, Deyo RA. Surgery for herniated lumbar discs: a literature synthesis. J Gen Intern Med 1993; 8: 487–96.

    Article  PubMed  CAS  Google Scholar 

  59. Atlas SJ, Chang Y, Kamann E, Keller RB, Deyo RA, Singer DE. Long-term disability and return to work among patients who have a herniated disc: the effect of disability compensation. J Bone Joint Surg 2000; 82A (1): 4–15.

    PubMed  CAS  Google Scholar 

  60. Chatterjee S, Foy PM, Findaly GF. Report of a controlled clinical trial comparing automated percutaneous lumbar discectomy and microdiscectomy in the treatment of contained lumbar disc herniation. Spine 1995; 20: 734–8.

    Article  PubMed  CAS  Google Scholar 

  61. Revel M, Payan C, Vallee C, et al. Automated percutaneous lumbar discectomy vs. chemonucleolysis in the treatment of sciatica. Spine 1993; 18 (1): 1–7.

    Article  PubMed  CAS  Google Scholar 

  62. Hermantin FU, Peters T, Quartararo L, Kambin P. A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg 1999; 81A: 958–65.

    PubMed  CAS  Google Scholar 

  63. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine: the influence of age, diagnosis, and procedure. J Bone Joint Surg 1992; 74A (4): 536–43.

    PubMed  CAS  Google Scholar 

  64. Turner JA, Denny MC. Do antidepressant medications relieve chronic low back pain? J Fam Pract 1993; 37 (6): 545–53.

    PubMed  CAS  Google Scholar 

  65. Atkinson JH, Slater MA, Wahlgren DR, et al. Pain 1999; 83: 137–45.

    Article  PubMed  CAS  Google Scholar 

  66. Lahad A, Malter AD, Berg AO, Deyo RA. The effectiveness of four interventions for the prevention of low back pain. JAMA 1994; 272 (16): 1286–91.

    Article  PubMed  CAS  Google Scholar 

  67. Von Poppel MN, Koes BW, van der Ploeg T, Smid T, Bouter LM. Lumbar supports and education for the prevention of low back pain in industry. JAMA 1998; 279: 1789–94.

    Article  PubMed  Google Scholar 

  68. Daltroy LH, Iversen MD, Larson MG, et al. A controlled trial of an educational program to prevent low back injuries. N Engl J Med 1997; 337: 322–8.

    Article  PubMed  CAS  Google Scholar 

  69. Loisel P, Abenhaim L, Durand P, et al. A population-based, randomized clinical trial on back pain management. Spine 1997; 22 (24): 2911–18.

    Article  PubMed  CAS  Google Scholar 

  70. Kelsey JL, Githens PB, Walter SD, et al. An epidemiological study of acute prolapsed cervical intervertebral disc. J Bone Joint Surg 1984; 66A: 907–14.

    PubMed  CAS  Google Scholar 

  71. Clark CR. Degenerative conditions of the spine. In: Frymoyer JW, ed. The adult spine: principles and practice. New York: Raven Press, 1991; 1145–64.

    Google Scholar 

  72. Lestini WF, Wiesel SW. The pathogenesis of cervical spondylosis. Clin Orthop 1989; 239: 69–93.

    PubMed  Google Scholar 

  73. Jahnke RW, Hart BL. Cervical stenosis, spondylosis, and herniated disc disease. Radiol Clin North Am 1991; 29 (4): 777–91.

    PubMed  CAS  Google Scholar 

  74. Russell EJ. Cervical disc disease. Radiology 1990; 177 (2): 313–25.

    PubMed  CAS  Google Scholar 

  75. Dillin W, Booth R, Cuclder J, Balderston R, Simeone F, Rothman R. Cervical radiculopathy: a review. Spine 1986; 11 (10): 988–91.

    Article  PubMed  CAS  Google Scholar 

  76. Murphy MJ, Lieponis JV. Non-operative treatment of cervical spine pain. In: Sherk HH, ed. The cervical spine. Philadelphia: Lippincott, 1989; 670–7.

    Google Scholar 

  77. Sampath P, Bendebba M, Davis JD, Ducker TB. Outcome of patients treated for cervical myelopathy. Spine 2000; 25 (6): 670–6.

    Article  PubMed  CAS  Google Scholar 

  78. La Rocca H. Cervical spondylotic myelopathy: natural history. Spine 1988; 13 (7): 854–5.

    Article  Google Scholar 

  79. White AA 3rd, Panjabi MM. Biomechanical considerations in the surgical management of cervical spondylotic myelopathy. Spine 1988; 13 (7): 856–69.

    Article  PubMed  Google Scholar 

  80. Hirsch SA, Hirsch PJ, Hiramoto H, Weiss A. Whiplash syndrome: fact or fiction? Orthop Clin North Am 1988; 19 (4): 791–5.

    PubMed  CAS  Google Scholar 

  81. Carette S. Whiplash injury and chronic neck pain. N Engl J Med 1994; 330 (15): 1083–4.

    Article  PubMed  CAS  Google Scholar 

  82. Eck JC, Hodges SD, Humphreys SC. Whiplash: a review of a commonly misunderstood injury. Am J Med 2001; 110 (8): 651–6.

    Article  PubMed  CAS  Google Scholar 

  83. Bogduk N, Teasell R. Whiplash: the evidence for an organic etiology. Arch Neurol 2000; 57 (4): 590–1.

    Article  PubMed  CAS  Google Scholar 

  84. Borchgrevink G, Smevik O, Haave I, et al. MRI of cerebrum and spinal column within 2 days after whiplash neck sprain injury. Injury 1997; 28: 331–5.

    Article  PubMed  CAS  Google Scholar 

  85. Borchgrevink GE, Kaasa A, McDonagh D, et al. Acute treatment of whiplash neck sprain injuries. Spine 1998; 23: 25–31.

    Article  PubMed  CAS  Google Scholar 

  86. Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash-associated disorders. A comparison of two treatment protocols. Spine 2000; 25: 1782–7.

    Article  PubMed  CAS  Google Scholar 

  87. Barnsley L, Lord SM, Wallis BJ, Bogduk N. Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med 1994; 330 (15): 1047–50.

    Article  PubMed  CAS  Google Scholar 

  88. Radanov BP, Sturzenegger M, DiStefano G. Long-term outcome after whiplash injury: a 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings. Medicine 1995; 74 (5): 281–97.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Walter L. Calmbach
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Oregon Health & Science University School of Medicine, Portland, Oregon, USA

    Robert B. Taylor M.D. (Professor of Family Medicine) (Professor of Family Medicine)

  2. Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Alan K. David M.D. (Professor and Chairman) (Professor and Chairman)

  3. Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA

    Scott A. Fields M.D. (Professor and Vice Chairman) (Professor and Vice Chairman)

  4. Department of Family Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA

    D. Melessa Phillips M.D. (Professor and Chairman) (Professor and Chairman)

  5. College of Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA

    Joseph E. Scherger M.D., M.P.H. (Dean) (Dean)

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer Science+Business Media New York

About this chapter

Cite this chapter

Calmbach, W.L. (2003). Disorders of the Back and Neck. In: Taylor, R.B., David, A.K., Fields, S.A., Phillips, D.M., Scherger, J.E. (eds) Fundamentals of Family Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-21745-1_17

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-21745-1_17

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-95479-0

  • Online ISBN: 978-0-387-21745-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation