Vertebrogenic Low Back Pain
Have you heard of vertebrogenic low back pain, or VLBP? This type of back pain results from damage to the spine’s vertebral endplates, which act as an interface between the vertebrae and intervertebral discs. As a significant cause of chronic lower back pain, VLBP requires prompt treatment to prevent lost mobility.
Keep reading to learn all about vertebrogenic low back pain and how it can be treated to restore your quality of life.
What is Vertebrogenic Low Back Pain?
Vertebrogenic low back pain is a type of chronic spinal pain that stems from damage to the vertebral endplates, usually due to gradual wear and tear.
A vertebral endplate is a thin layer of bone and cartilage tissue that sits between a vertebra and spinal discs. Endplates protect the spinal discs from the bony vertebrae, as the discs are softer, more pliable, and more prone to damage. They also take stress off of the spinal discs, absorb some impact from your day-to-day movements, and serve as the passageway for blood to flow to the discs.
In people with vertebrogenic low back pain, these endplates have degenerated and no longer function properly. This leads to an achy, deep, or burning pain in the lower back that worsens when you exercise, sit for prolonged periods, or bend forward.
How Do You Diagnose Vertebrogenic Low Back Pain?
You diagnose vertebrogenic low back pain with a family history, physical exam, and imaging tests (i.e. MRI).
- A complete family history is an important step in the process of diagnosing vertebrogenic low back pain, as it can be genetic.
- During your physical exam, a physician will have you bend and twist in certain ways to better understand your pain. They’ll probably also feel your spine to identify any abnormalities.
- Imaging tests are required to definitively diagnose vertebrogenic low back pain. Physicians generally use magnetic resonance imaging, or MRI, for this condition.
- MRI scans use radio waves and magnetic fields to create detailed images of the spine. This type of scan displays the spinal endplates and allows your doctor to identify damage.
Is Vertebrogenic Low Back Pain a Disability?
Vertebrogenic low back pain can be a disability, especially in the advanced stages.
With VLBP, you may experience pain when you’re physically active, bend forward, or sit for extended periods. You may also get referred pain, which is pain in a different area of the body from where the pain originates.
Over time, if the damage worsens, VLBP can make it difficult to complete your day-to-day activities. You may also experience back pain that makes it hard to move freely. If the pain persists for longer than three months, it’s typically considered chronic.
When vertebrogenic low back pain causes chronic pain, it can be used to apply for Social Security Disability Insurance, or SSDI. SSDI gives financial support through monthly payments to individuals with a disability that keeps them from working.
Can Spondylolisthesis Cause Low Back Pain?
Spondylolisthesis can cause low back pain.
While spondylolisthesis is a spinal condition, it’s different from vertebrogenic low back pain. Spondylolisthesis affects the vertebra itself, not the endplates. It occurs when a vertebra slips out of its normal position, falling onto the vertebra beneath it.
With spondylolisthesis, the misaligned vertebra may compress spinal nerves, triggering back pain and neurological symptoms. This condition most often affects the L4-L5 and L5-S1 spinal levels, so it typically affects the lower back.
How Do You Treat Vertebrogenic Pain Syndrome?
You can treat vertebrogenic pain syndrome with physical therapy, NSAIDs, muscle relaxants, and a procedure known as basivertebral nerve ablation.
Vertebrogenic Low Back Pain Treatments
Vertebrogenic low back treatments include:
- Physical therapy
- NSAIDs
- Muscle relaxants
- Basivertebral nerve ablation
Physical Therapy for Vertebrogenic Low Back Pain
Physical therapy for VLBP involves therapeutic exercises, stretches, and complementary therapies. These exercises are intended to strengthen the muscle groups that protect the spine, like your core, and improve spinal alignment. Over time, this helps balance the impact on your spine, leading to less pain and inflammation.
Many PTs offer complementary therapies like electromagnetic stimulation, massage, and acupuncture. These methods can provide an even greater improvement in pain and inflammation.
NSAIDs for Vertebrogenic Low Back Pain
NSAIDs are non-steroidal anti-inflammatory drugs. Examples include ibuprofen, aspirin, and naproxen. These medications reduce inflammation and curb pain signals, making them a good short-term remedy for vertebrogenic low back pain.
Physicians generally start by recommending over-the-counter NSAIDs for individuals with VLBP. However, if these medications don’t improve your symptoms, you may be a candidate for prescription NSAIDs, which contain higher doses of medication.
NSAIDs are generally paired with physical therapy and lifestyle adjustments, among other treatments, to create a well-rounded VLBP treatment strategy. It’s essential to consider the risk of side effects, complications, and reliance before starting any new medication.
Muscle Relaxants for Vertebrogenic Low Back Pain
Muscle relaxants are prescription medications used to treat muscle spasms and tension. Your physician may recommend this type of medication if you’re struggling with lower back spasms from VLBP, or if tight muscles are worsening your pain.
There are two major types of muscle relaxants: antispastic and antispasmodic. Antispastic drugs work in the brain and muscle tissue to reduce tension. Antispasmodic drugs prevent the involuntary muscle contractions that lead to spasms.
Note that muscle relaxants are only recommended for use in the short term. They’re not a long-term solution for vertebrogenic low back pain, although they may help you manage pain while you recover.
Basivertebral Nerve Ablation for Vertebrogenic Low Back Pain
Basivertebral nerve ablation is a widely used treatment for moderate to severe vertebrogenic low back pain. It’s a minimally invasive treatment that targets the basivertebral nerve – the nerve that begins in the vertebra and extends into the vertebral endplates.
During this procedure, the physician inserts a radiofrequency probe into the affected vertebra to reach the basivertebral nerve where it starts to brand into the endplate. The probe heats the nerve with radiofrequency energy, creating a controlled injury and blocking nerve signals to the brain. Basivertebral nerve ablation is often recommended if medication and physical therapy don’t alleviate VLBP. As a minimally invasive procedure, it presents fewer risks and a shorter recovery period than conventional spinal surgery. It also provides long-lasting results, with patients experiencing improved pain and function for several years.
Can I Prevent Vertebrogenic Low Back Pain?
Vertebrogenic low back pain can be caused by genetics and age-related spinal degeneration, so it’s not preventable in every case. However, you can lower your risk for this and other spinal conditions with a handful of lifestyle adjustments, including:
- Reaching (and maintaining) a healthy weight to prevent excess impact on the spinal end plates
- Sticking to a consistent, low-impact exercise routine to preserve your mobility, retain muscle strength, and improve circulation
- Stretching regularly to prevent muscle tension and declining flexibility
- Eating a nutrient-rich diet and limiting processed foods, added sugars, and alcohol
- Quitting smoking, which can weaken your spine and compromise the body’s ability to regenerate damaged tissue
Additionally, you may be able to prevent disability from vertebrogenic low back pain by seeing a doctor as soon as you start to have symptoms. Like most conditions, VLBP is easier to treat in its early stages, and early intervention may prevent the need for surgery.
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Causes of Vertebrogenic Low Back Pain
Possible causes of vertebrogenic low back pain include age-related degeneration, consistently overusing the back, an injury to the spine, and being overweight or obese.
- Age-related degeneration
The effects of normal aging and daily wear and tear can eventually lead to vertebrogenic low back pain. Day-to-day movements, exercise, and even sitting for prolonged periods impart stress on the vertebral endplates, causing them to thin and weaken over time. Also, aging naturally undermines the resilience of bone and cartilage tissue, making it more prone to injury.
- Back and spine overuse
Certain professions and forms of exercise place excessive impact on the spinal tissues, including the vertebral endplates. This applies to athletes, construction workers, manual laborers, farmers, cleaners, warehouse workers, and auto mechanics. Some professions that aren’t considered physically demanding, like dentistry and nursing, also place considerable impact on the spine, as they involve frequently bending forward and keeping the spine in a curved position for extended periods.
Forms of exercise that can increase the risk of vertebrogenic low back pain over time include weightlifting, gymnastics, and contact sports. If you partake in these activities, it’s crucial to prioritize proper posture, safe techniques, and adequate rest.
- Spinal injuries
Spinal injuries like vertebral fractures can compromise the vertebral endplates, leading to lower back pain. Fractures can result from sudden traumatic events, like a fall, major blow to the spine, auto accident, or sports injury. They can also occur as compression fractures from osteoporosis, a disease that causes weak, brittle bones.
- Obesity
Being overweight or obese can significantly elevate your risk of vertebrogenic low back pain by imparting significant pressure on the vertebrae and spinal discs. Over time, this triggers degeneration and damage, which may affect the vertebral endplates. Thankfully, with support from a physician, you can work toward sustainable weight loss and leave this risk factor behind you.
How Does Vertebrogenic Lower Back Pain Relate to Other Types of Lower Back Pain?
Vertebrogenic lower back pain relates to other types of lower back pain in its symptoms, many of which overlap with those of herniated disc, spinal stenosis, spondylolisthesis, and degenerative disc disease.
Along with deep, achy, or burning pain in the lower back, vertebrogenic lower back pain can cause neurological symptoms like tingling, numbness, and weakness. This occurs if the damaged endplates are accompanied by spinal disc degeneration. Since these symptoms also occur with herniated disc, spinal stenosis, spondylolisthesis, and degenerative disc disease, vertebrogenic lower back pain may be difficult to diagnose.
While there is some symptom overlap, it’s important to note that vertebrogenic lower back pain differs from other forms of lower back pain in its origin. While other lower back pain conditions stem from the spinal discs, spinal cord, nerves, or facet joints, vertebrogenic back pain is caused by vertebrogenic endplate damage.
Diagnosis of Vertebrogenic Low Back Pain
Diagnosing vertebrogenic low back pain typically involves a physical exam, medical and family history, and imaging tests.
Physical Exam
If you visit your doctor for low back pain, they’ll likely begin with a physical exam. They’ll feel along the vertebrae and may ask you to complete certain movements. This can help them identify if specific movements spike your pain.
Your doctor may also ask questions about your symptoms and when you first noticed the pain.
Medical and Family Histories
Doctor’s offices usually gather a complete medical and family history at the start of your appointment. This can help your provider diagnose low back pain by identifying risk factors, including underlying medical conditions and a family history of chronic back pain. It’s important to fill out your medical and family histories as accurately as possible to help your doctor make a correct diagnosis.
Imaging Tests
If your doctor suspects a spinal issue after conducting a physical exam, you may need to undergo imaging tests. The first recommendation is usually a spinal X-ray, which displays bone fractures, bone spurs, and bone deformities. X-rays can also display vertebral endplates, although your doctor may order a CT scan or MRI to see them in greater detail.
When examining your imaging results, your doctor will look for abnormalities in the vertebral endplates, like bone marrow inflammation and fat in the endplates.
Treatment Options for Vertebrogenic Low Back Pain
Treatment options for vertebrogenic low back pain include physical therapy, medications, and basivertebral nerve ablation (BVNA).
Physical Therapy for Vertebrogenic Low Back Pain
Physical therapy is a conservative treatment option for vertebrogenic low back pain. Under the advisement of a trained physical therapist, you’ll complete stretching and strengthening exercises designed to reduce muscle tension, strengthen muscles that support the spine, and lessen impact on the vertebral endplates.
Many PTs also provide alternative therapies, like massage, dry needling, and electrical stimulation to provide complementary benefits. These methods help reduce inflammation, improve blood flow to the spine, and stimulate your body’s natural healing process.
Medications for Vertebrogenic Low Back Pain
Doctors commonly recommend NSAIDs (non-steroidal anti-inflammatory drugs) and/or muscle relaxants to help treat vertebrogenic low back pain.
- NSAIDs like ibuprofen and naproxen target both pain and inflammation to help manage various conditions, including lower back pain. They’re widely available over the counter, but if you need a stronger formulation, your doctor may provide a prescription-strength alternative.
- Muscle relaxants are available with a prescription and may help with vertebrogenic low back pain by calming muscle tension and spasms.
Medications to reduce back pain are only recommended for short-term use, as they pose the risk of side effects and complications. Your doctor can offer insights into how to incorporate medications into a well-rounded back pain treatment plan.
BNVA for Vertebrogenic Low Back Pain
Basivertebral nerve ablation, or BVNA, may be implemented for vertebrogenic back pain that doesn’t improve with physical therapy or medications. It’s a minimally invasive procedure that destroys the basivertebral nerve that supplies sensation to the affected vertebral endplates. This curbs pain signals sent from the basivertebral nerve to the brain, leading to vertebrogenic pain relief.
If you’re experiencing symptoms of vertebrogenic lower back pain, talk to your doctor about the treatment options available to you.
Can I Prevent Vertebrogenic Low Back Pain?
Vertebrogenic low back pain can be caused by genetics and age-related spinal degeneration, so it’s not preventable in every case. However, you can lower your risk for this and other spinal conditions with a handful of lifestyle adjustments, including:
- Reaching (and maintaining) a healthy weight to prevent excess impact on the spinal end plates
- Sticking to a consistent, low-impact exercise routine to preserve your mobility, retain muscle strength, and improve circulation
- Stretching regularly to prevent muscle tension and declining flexibility
- Eating a nutrient-rich diet and limiting processed foods, added sugars, and alcohol
- Quitting smoking, which can weaken your spine and compromise the body’s ability to regenerate damaged tissue
Additionally, you may be able to prevent disability from vertebrogenic low back pain by seeing a doctor as soon as you start to have symptoms. Like most conditions, VLBP is easier to treat in its early stages, and early intervention may prevent the need for surgery.
