To whom it may concern.

One of the best ways to find out info on back related problems is to search the MEDLINE web site. You can view abstracts from medical journals there. PUBMED is the public access version. Notable researchers are: Adams MA, Bogduk N, Nachemson AL. Schellhas KP, Videman T, Kelsey JL. Type these names into the PUBMED search engine and their scientific papers will be listed along with other related links.

Things to remember are; the sources of back pain are hard to identify. Not all disc prolapses are painful. Some people have wider vertebral canals that others so they escape nerve root compression. (Boos et al.1995 Spine ;20:2613-25). Nerve root compression is the only clear guide that medics can use to identify disc prolapse.

Degenerated discs are not a clear indication of pain.

Anular tears often do not impose on nerve roots, but the outer third of the anulus has a nerve supply so it is very feasible that they can be painful. Medics, however, are unable to diagnose this because of the lack of nerve root compression. Painful anular tears can show up on MRI scans as High Intensity Zone lesions. (ScHellhas et al). But not all HIZ lesions are painful. Also, it is quite common for these type of lesions to go unnoticed or their relevance misunderstood by medics.

"It is our view that some of the unsuccessful laminectomies an dorsal fusions in our series could have been avoided had the HIZ lesions, that in retrospect, were present on preoperative imaging studies been recognized and understood initially." (Schellhas KP et al. 1996. Spine volume 21, number 1, page 85, Third paragraph).

Possibly the most chronically painful and clinically undetectable pain source is the endplate fracture or Schmorl's node. (Painful lumbar disc derangement: relevance of endplate abnormalities at MR Imaging. Weishaupt D, Zanetti M, Hodler J, Min K, Fuchs B, Pfirrmann C, Boos N. Radiology 2001 Feb;218(2):420-7).

The weakest part of the spine is the vertebral endplate and adjacent trabeculae bone. Some of the more accessible book authors comment on how the intervertebral disc is stronger than bone in compression. They then go on to discount high compressive forces existing in life - BUT THEY DO!

In a heavy lift the back muscles can exert a force on the spine of some 4 kiloNewton's. This is comparable to 400kg (the weight of a horse). This type of activity, along with epileptic seizures, electric shocks and possibly even child birth (although the latter is speculation on my part whereas the three formers have been proven - Vascancelos D. Compression fractures of the vertebra during major epileptic seizures. 1973 Epilepsia 14:323-8), has the potential to crack bone. (Bogduk N, Adams MA, Nachemson AL).

Spinal pathology is far from easy to understand and the subject should be approached carefully and with humility. Getting angry with the medical profession for failing to provide answers will not help anyone. The better you can understand your own individual condition the more chance you have of managing it. Things do tend to get better naturally but it can take a long time. If your occupation has played a part in your pathology then you may find yourself in something of a vicious circle. Disc tissue does not knit itself back together. Anular tears do not heal and the threat of acute prolapse is very real. Speak to a health and safety consultant.

Some medics believe that disc degeneration has to occur before a disc will prolapse. This is not necessarily true. My own L5/S1 disc has prolapsed but the MRI scan shows that it is well hydrated (and has a HIZ lesion). My L4/5 disc has also prolapsed and is degenerative but this may be due to the endplate fracture in the L4 vertebral body. (Adams MA, et al. 2000. Spine vol 25 number13: 1625-36).

"It is no longer valid to claim that a disc must be degenerated before it will prolapse." (Adams MA).

I found this book of value to me and I would recommend it as a way of getting to know your own back. I got my copy from Foyles in Charring Cross road London. £21.00. Clinical Anatomy of the Lumbar Spine and Sacrum. Bogduk N. Third edition 1997. Churchill Livingstone ISBN 0-443-06014-2.

I am not a medic. I have suffered chronic pain for over three years. I have studied my own condition at the British Library where medical journals are accessible to the public.

All the best

Trevor Baylis.