Back injury

Muscle and soft tissue injuries can be classified using a graded system.[4]

• Grade 1 muscle strain is the least severe with damage to few muscle fibers and little if any loss of function.
• Grade 2 muscle strain indicates a mild to moderate injury with appreciable tissue damage and some loss of function or strength.
• Grade 3 muscle strain is the most severe injury grade with the muscle being either completely torn or experiencing complete loss of function.[4]

Spinal column or vertebral injuries can be classified using the AO spine injury classification system.[5] The three categories - A, B, and C - are based on the location of damage on the vertebra (either on the anterior or posterior segment) and by the direction of the applied injurious force.

• Type A injuries are those associated with a compression force with damage to the vertebral bodies.
• Type B injuries are those associated with a distraction force resulting in structural damage to the posterior components of the vertebral column.
• Type C injuries are those associated with damage to both anterior and posterior aspects of the vertebral column resulting in displacement of the disconnected segments in any direction.[5][6]

This classification system can be used to classify injury to the cervical, thoracolumbar, and sacral regions of the spinal column.

Herniated discs can be graded based on the size and location of the herniation as seen on an MRI.

The size of the herniation is the extent to which it protrudes into the vertebral foramen. The MSU Classification for herniated discs uses the proximity of the disc to the facet joint when measuring the size of a herniated disc.[7] Using the MSU Classification, a grade of 1, 2 or 3 can be used to describe the size of a herniated disc with 1 being the least severe and 3 being the most severe.

The location of the herniation can also be described using the MSU Classification for herniated discs. This classification describes how far away from mid-line a disc protrusion is using a grade of A, B, or C.[7]

• Grade A describes a herniation at midline.
• Grade C herniations are the most lateral and protrude into the intervertebral foramen (through which spinal nerves travel).
• Grade B herniated discs are those located between grade A and C, using the facet joint as the landmark for the lateral border.

MSU Classification is primarily used for classifying herniated discs in the lumbar spine.

• Cold therapy reduces inflammation, edema, pain, and muscle spasms associated with acute back injury.[19]
• Heat therapy is used to reduce pain and alleviate sore and stiff muscles.[19] Heat therapy is proposed to work by facilitating delivery of nutrients and oxygen to the site of injury to accommodate healing.[19]
• Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can be taken to reduce mild to moderate pain associated with back injuries.[8] NSAIDs are suggested to be more effective for persistent pain than for acute pain.[20] If pain remains intolerable while taking over the counter medications, a stronger pain medication such as a narcotic or a muscle relaxant can be prescribed at a physician's discretion.[14][12][9]
• Therapy and alternative medicine: an active approach to recovery is recommended over bed rest for most cases of back injury.[8] Activity promotes strength and functional rehabilitation and counters atrophy associated with disuse.[12] Physical therapy can help reduce pain and regain strength and function.[12] The gentle movement of yoga and tai chi are suggested to improve function and to counter the negative psychosocial effects that can be secondary to injury.[14][21] Spinal manipulation, massage, and acupuncture have been used to treat the pain associated with various back injuries, but there is little consensus on their degree of effectiveness.[21][14][9]
• Injections: Spinal nerve blocks and epidural injections are options available to alleviate pain and neurological symptoms.[12] Injections of anesthetics alleviate pain while steroid injections can be used to reduce the inflammation and swelling surrounding spinal nerves.[9]

Surgery is considered when symptoms persist after attempting conservative treatment. It is estimated 10-20 percent of individuals with low back pain fail to improve with conservative measures.[22]

• A discectomy is a common procedure used to alleviate the radiating pain and neurological symptoms associated with a herniated disc.[23] There are multiple variations of a discectomy with differing approaches to access the herniated disc, but the goal of the procedure is to remove the portion of the intervertebral disc that is protruding into the vertebral foramen.[22]
• A total disc replacement can also be performed to address a herniated disc. Rather than removing only the portion of the disc that has prolapsed as in a discectomy, this procedure involves removing the entire vertebral disc and replacing it with an artificial one.[24][9]
• Surgical remedies for vertebral fractures are found to be more effective than conservative treatment.[25] Vertebroplasty and kyphoplasty are considered minimally invasive surgical procedures and are proposed to relieve pain and restore function of fractured vertebrae.[25]