The Types of Lesions That Give You Neck or Back Pain

Lesion is a general term used in medicine to refer to a pathology of tissue. It indicates an area of tissue that has been injured, destroyed, altered (for the worse) or otherwise has a problem. Lesions exist in all medicinal specialties, with a wide variety of types that run the gamut from cancerous to non-cancerous, from large to small, serious or minor, as well as other criteria.

Lesions can also be classified according to their characteristics including pattern or location, or they may be named after the doctor or another person who first described it. In other words, when your doctor tells you that you have a lesion, it simply means "something's going on" that may form the basis for further exploration and/or treatment.

Neck and back lesions, along with those affecting the spinal cord can be categorized in 3 ways, according to spine experts Weisberg, Garcia, and Strub. These categories are also called clinical pictures or clinical syndromes. The 3 clinical pictures relating to the spine include back pain, or myofascial syndromes, nerve root symptoms, or radiculopathy, and spinal cord symptoms, called myelopathy. Each of these categories is further broken down.

Back pain, or myofascial syndrome, is by far and away the most common type of spinal lesion, making up about 80% of all cases, according to the authors. This type of lesion is also called "non-specific back pain," which means pinpointing the exact location or abnormality responsible for the pain is not possible.

With this type of back lesion, you'll likely not get nerve symptoms, i.e., weakness, numbness, tingling and/or electrical shock going down one leg or arm. The good news about non-specific low back pain is that it generally doesn't require imaging.

Goertz, and colleagues, in their guideline for spine physicians (entitled "Adult acute and subacute low back pain"), recommends that imaging for adults aged 18 or older with non-specific low back pain be "reduced or eliminated."

If you don't have nerve symptoms, and you suspect your doctor's recommendation to have films taken is not in line with evidence-based guidelines (as summarized above,) please speak up. 

Ask her why she thinks films are necessary, and also try to find out what if any, business or financial association she has with the facility that will do the tests. Then make your own decision. You might also consider getting a second opinion before giving the okay to the tests.

Generally speaking, about 20 percent of neck or back lesions can often be identified by your doctor on a film. These include root lesions and spinal cord type lesions. Root lesions include sciatica, conus medullaris syndrome (which is a termination of the spinal cord leading to numbness at the bottom of your feet, weakness of your gastric muscle, lack of ankle reflexes, and saddle amnesia,) lumbar spinal stenosis, and disc disease.

Spinal cord lesions mainly consist of congenital and acquired diseases or conditions such as spina bifida. Other types of spinal cord lesions include multiple sclerosis, infections, and chronic progressive myelopathy. Chronic progressive myelopathy often results from arthritis or degenerative disc disease.