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Accidental Injury pp 581–609Cite as

Thoracolumbar Pain: Neural Mechanisms and Biomechanics

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Abstract

Based on extensive research the anatomic components that have been considered to cause back pain include the intervertebral disks, paraspinal muscles, spinal ligaments, facet joint capsules, dorsal roots and dorsal root ganglia. While mechanical strain is an important causative factor in the initiation of spinal pain, biochemical irritation plays an important role in sensitizing nerve endings in the injured tissue. In addition, central sensitization at the spinal cord level can be an important contributor to persistent spinal pain. The mechanical input that results in back pain includes both acute mechanical loading and repetitive cyclic loading. The latter is particularly important in disc injury and degeneration and in muscle fatigue to the lumbar spine. In this chapter the biomechanics and neural mechanisms of thoracolumbar pain are described in the following order: (1) mechanisms of pain initiation and maintenance (nociceptive pain vs. neuropathic pain, acute vs. chronic pain, peripheral sensitization, central sensitization), (2) biomechanics of noxious loading of the thoraco-lumbar spine, (3) joint, ligament and skeletal pain (involving intervertebral disc, anterior and posterior longitudinal ligaments, ligamentum flavum, dura, facet joints, bone and periosteum), (4) neuropathic pain (involving nerve roots and dorsal root ganglia) and (5) muscle pain. Further research is required to better characterize the relationship between measured mechanical input to tissues of the spine and the molecular, histological and neurophysiologic outcomes that result in spinal pain. This understanding can help in the development of preventive strategies to reduce the risk of spinal injury and pain.

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Acknowledgements

The authors thank Preston Lemanski for his significant efforts in the organization of references and figures in this chapter.

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  1. Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA

    John M. Cavanaugh M.D., Chaoyang Chen M.D. & Srinivasu Kallakuri Ph.D.

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Correspondence to John M. Cavanaugh M.D. .

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  1. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Narayan Yoganandan

  2. School of Medicine, University of California at San Diego, San Diego, USA

    Alan M. Nahum

  3. Tandelta Inc., Ann Arbor, USA

    John W. Melvin

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Cavanaugh, J.M., Chen, C., Kallakuri, S. (2015). Thoracolumbar Pain: Neural Mechanisms and Biomechanics. In: Yoganandan, N., Nahum, A., Melvin, J. (eds) Accidental Injury. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1732-7_20

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