Backache is one of the commonest problem that one encounter in our day-to-day practice. One or more of several etiologies can cause pain in back. A thorough knowledge of the structure of the bony spine is essential to understand the cause of backache and hence successfully treat problem occurring in the back. 
Backache can be considered as a hypo kinetic disease—that means inactivity and sedentary lifestyle are major factors contributing to it.  
The parts of the back that posses the great freedoms of movement are the lumbar and cervical region and hence are most frequently subject to injury.  

Pain in back may arise from three causes: 
1. Lesion or disorder of bony spine 
2. Lesion of nerve root  
3. Referred pain from deeper structures.
  Lesion or disorder of bony spine
  Lesion or disorder of the spine can be categorized in to 10. They are as follows: 
1. Congenital abnormalities 
A) Lumbar or sacral variation
B) Hemi vertebra
C) Spina bifida 
2. Deformities 
A) Kyphosis
B) Lordosis
C) Scoliosis         1
3. Infections of the bone 
A) Tuberculosis of the thoracic or lumbar spine
B) Pyogenic infection of the thoracic or lumbar spine. 
4. Arthritis of the spinal joints 
A) Rheumatoid arthritis
B) Osteoarthritis
C) Ankylosing spondylitis 
5. Mechanical derangements 
A) Prolapsed lumbar disc
B) Acute lumbago
C) Spondylolysis
D) Spondylolisthesis
E) Spinal stenosis 
6. Tumors 
A) Tumors in relation to the spinal column (spinal cord)
B) Tumors in relation to the nerve root 
7. Chronic strains 
A) Coccydynia
B) Chronic lower lumbar ligamentous strain
8. Disorders of the sacro- iliac joints 
A) Tuberculosis of the sacro-iliac joints
B) Sacro iliac ligamentous strain
C) Ankylosing spondylitis of sacroiliac joints
D) Other forms of arthritis of sacro iliac joints
9. Miscellaneous 
A) Senile osteoporosis
10. Other local affections of bone 
A) Scheurmann’s kyphosis
B) Calve’s vertebral compression                       
Congenital abnormalities 
Lumbar or sacral variations: 
Minor variations of the bony anatomy are common in lumbar and sacral region.  
They include 
1. Deficient or rudimentary lowest ribs 
2. Complete or incomplete incorporation of the fifth lumbar vertebral body in sacrum (Sacralisation of fifth lumbar vertebra) 
3. Persistence of the first sacral segment as a separate vertebra
    (Lumbarisation of the first sacral vertebra) 
4. Over development of the fifth lumbar transverse process on one or both sides with a false joint between the hypertrophied process and ilium (false joint is the source of pain) 

Hemi vertebra: 
A vertebra is formed in one lateral half only [defect at any level]. The body of half vertebra is wedge shaped and the spine is angled laterally at the site of the defect. This anomaly is a cause of scoliosis. 
Spina bifida: 
This condition develops due to the failure of fusion of the posterior part of the spine resulting in a defect through which the membranes and even spinal cord may herniate. Usually it affects one vertebra, most commonly in the lumbosacral region. Different types are follows 
1.Spina bifida occulta 
Spina bifida occulta occurs due to failure of the neural arches to unite posteriorly. But no protrusion of the cord or membrane is noticed. Most common site for spina bifida occulta is in lumbosacral region. Spina bifida occulta can be suspected in presence of a cicatrical thickening or a dimple or tuft of hair or dilated vessels or a fibro fatty tumor or a naevo lipoma over the bony deficiency. Back ache, enuresis, foot drop, weakness of lower limb and paralysis may appear later.  
Diagnosis by X -ray (for some other reason) 
2. Meningocele 
When meninges protrude through the defect in the spine, this condition develops. It contains only CSF.  
3. Meningo- myelocele 
In addition to protrusion of the membrane, normally developed spinal cord and cauda equina may protrude and lie within the sac and may adherent to the posterior aspect of the sac.  
4. Syringo myelocele 
In this condition the central canal of the spinal cord becomes dilated and the cord lies within the sac and become adherent to posterior part of the sac.
5. Myelocele  
The commonest type of spina bifida but is incompatible with life. The central canal of the spinal cord opens out on the surface and discharges cerebro spinal fluid continuously. Paralytic deformities of the foot and incontinence of urine and faeces are almost always accompanied with these conditions.

Homoeopathic medicines for spina bifida 
Silicea
Calcarea carb,
Calcarea phos,
Calcarea sulph,
Psorinum.
Arnica Ars alb Asaf          Baryta carb Bryonia
Carbo veg Dulcamara Graphitis Hepar sulph Lachesis Lycopodium Merc sol Mezerium Nitric acid Phosphorus
Ruta Staphysgria Sulphur Syphilinum Tuberculinum 

  DEFORMITIES

1. Scoliosis  
Deviation of the spine to one side. [There may slight deviation after fracture or after infection like tuberculosis. But these are not considered in this section] 
Two types of scoliosis 
1. Mobile or transient scoliosis and
2. Structural or permanent scoliosis  
Mobile scoliosis: 
Never transformed in to fixed scoliosis [not associated with rotation of the spine]. There are three types of mobile scoliosis
a) Postural scoliosis
b) Compensatory scoliosis and
c)  Sciatic scoliosis 
A] Postural scoliosis  
Usually seen in adolescent girls and the curve is mild convexity to the left.
Diagnosis– when the patient bend forwards the spine straightens completely. 
B] Compensatory scoliosis
Seen in patient with unilateral short leg, ocular disorders, torticollis etc.
Diagnosis—Curve disappears when the patient sits.  
C] Sciatic scoliosis 
Usually accompanied by sciatica with prolapsed lumbar disc.
Structural scoliosis (permanent scoliosis) 
Always associated with rotation of vertebra [The bodies of vertebra rotate towards convexity of the curve and the spinous process towards the concavity.] Once the deformity develops, it liable to be increased due to greater pressure on the epiphysis on the concave side with retarded growth.
There are four types of structural scoliosis
A) Idiopathic
B) Congenital
C) Paralytic and
D) Scoliosis from multiple neurofibromatosis. 
A) Idiopathic: 
Idiopathic structural scoliosis is the commonest type. Primary curve is always thoracic. Mental defect always accompaniment of this condition. 
B) Congenital: 
Congenital structural scoliosis always associated with radiologicaly demonstrable anomalies, like hemi vertebra, fused vertebra, absent ribs or fused ribs absent disc etc. Some obvious congenital abnormalities may be found on the surface. E.g.: - Angioma, excess of hair, a dimple, and naevi or a pad of fat.  
C) Paralytic: 
Paralytic structural scoliosis due to paralysis from poliomyelitis, cerebral palsy,
muscular dystrophy etc, intercostals and lateral abdominal muscles is the cause of scoliosis.]
D) Scoliosis from multiple neurofibromatosis: 
One third of patient suffering multiple neurofibromatosis develops scoliosis. 
In all cases of scoliosis one must not forget to examine the heart and lung, as congenital heart disease may be associated with this condition and an increasing thoracic scoliosis may lead to gradual respiratory embarrassment.  
2. Kyphosis 
Excessive posterior convexity of the [thoracic spine] spinal column is called kyphosis. The deformity may take the form of a long rounded curve – “ round back” or there may be localized sharp posterior angulations –“ hump back”. 
There is normally a considerable posterior curvature in thoracic region. Thoracic kyphosis exists only if this curve is excessive. In cervical and lumbar region there is normally anterior curvature—lordosis. Any reversal of this constitutes cervical or lumbar kyphosis.  

Causes: 
1.Postural kyphosis – Seen in flat foot person, girls approaching puberty, women after childbirth or with obesity. 
2. Compensatory kyphosis –Seen in lumbar lordosis and congenital dislocation of hip. 
3. Ankylosing spondylitis 
4. Senile osteoporosis 
5. Destructive tumors of the spinal column 
6. Scheurmann’s disease –Osteochondritis affecting epiphyseal plate of the vertebra.
3. Lordosis  
Excessive anterior curvature of the spinal column –“hollow back” is called lordosis. In practice, lordosis is seen only in the lumbar region, where a slight anterior curvature is normal. [Spinal disorder always tends to cause kyphosis or scoliosis rather than lordosis] 
Causes: 
1. Tuberculosis of the hip
2. Malunited fracture of the femur
3. Last trimester of pregnancy, large uterine fibroid or a big fatty abdomen (Here lordosis develop to correct center of gravity of the body)
4. Postural as compensatory to fixed flexion deformity of hip or congenital dislocation of hip. 

Homoeopathic medicines 
Asafetida Calc flour Calc phos
Calc sulph Merc sol Phos acid
Phosphorus       Silicea Sulphur 
Baryta mur Conium mac Carbo veg
Lycopodium Pulsatilla 
 Aur met Baryta carb        Calc iod
Carb sulph Drosera Ferr Iod
Hecla lava Hepar sulph Opium
Psorinum Sulphur             Sepia
Tarentula Theridion Thuja

  INFECTIONS OF THE BONE  

1) Tuberculosis of the spine [Pott’s disease] 
Tuberculosis of the thoracic or lumbar vertebral bodies is one of the commonest forms of skeletal tuberculosis. It attacks more common in children and adolescents than adults.
Pathology:
The infection begins at the anterior margins of a vertebral body near the inter vertebral disc, which is soon destroyed. It may spread to adjacent vertebra, which collapse in front with consequent angular kyphosis. Commonly there is complete destruction of one intervertebral disc with partial destruction of two adjacent vertebras most marks anteriorly.  
Clinical features:
Great weakness, loss of weight and evening rise of temperature. Pains usually the main complaint, which is worse on walking or jolting. Rigidity is the next complaint- restricts all movements. 
On examination – localized tenderness, if pressed on affected spine.
Cold abscess formation and paraplegia are two complications. 
Investigations: -
X- ray will show destruction with diminution of the intervertebral space.
ESR increased in active stage.
Mantoux test positive.
Tubercle bacilli can sometimes be isolated from aspirated mucus. 
2) Pyogenic infections of the spine  
Pyogenic infections of the spine are common. Caused by infection with the staphylococcus, pneumococcus etc. 
Homoeopathic medicine 
Aurum met Calc phos Iodum       
Phosphoric acid Phosphorus Stanum met
Syphilinum Tuberculinum 

ARTHRITIS OF THE SPINAL JOINTS 
Arthritis of the spinal joint is a major cause of backache, cervical pain and occipital headache.
1) Osteoarthritis
Osteoarthritis found very commonly in those used to heavy work most prevalent in the cervical (cervical spondylosis) and lumbar region (lumbar spondylosis) 
Pre disposing factors: 
1. Previous injury to spinal joints
2. Previous disease involving the joints
3. Degenerative changes due to increasing age or wear and tear 
Pathology:
The changes affect the central intervertebral and posterior intervertebral joints. In central joints (affected first) there is degeneration with consequent narrowing of the intervertebral disc and hypertrophy of bone at the joint margins leads to formation osteophyts. In the posterior intervertebral joints the changes are attrition of the articular cartilage and osteophyte formation at the joint margins. 
(Rarely osteophytes encroach upon an intervertebral foramen sufficiently to interfere with the function of the issuing nerve. Thinning of the articular cartilage of the posterior intervertebral joints reduces the stability of the affected segment and predisposes to one type of spondylolisthesis.) 
Clinical features: 
Patient often complain of pain centered in the spine that is increased by motion, especially after stooping or lifting. Pain often worse in morning. There may be a feeling of stiffness when rising from sitting position. Lumbosacral pain with neurological symptoms on walking (numbness, paraesthesia or weakness in both leg) suggests syndrome of intermittent claudication of spinal cord due to spinal stenosis. 
Diagnosis: X-ray shows narrowing of the intervertebral space and osteophyte formation at the joint margin. Diagnosis confirmed by CT or MRI. 

Homoeopathic medicine: 
Calc carb Nat mur Phosphorus
Silicea Sticta Syphilinum  

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