Neck and back pain.

What are the underlying causes?

Left part of K

Find out more about neck or back pain and the underlying causes. 

Neck and back pain - Dr Alex Koefman, spinal surgeon Brisbane

Neurosurgeon Brisbane

Dr Alex Koefman about neck and back pain

Neck and back pain key points

  • In most cases (over 90%) neck or back pain is due to muscular spasms (often in younger people) and spinal arthritis (often in older people).
  • In some cases the pain is due to infection, a fractured bone, ruptured disc, or cancer.
  • The key to treatment is to work out what the underlying cause is.
  • When your pain is caused by infection, cancer, a fracture or ruptured disc, surgery is often required.
  • When you have a condition called spondylolisthesis, then surgery is an effective treatment.
  • In the majority of cases, however, surgery for neck or back pain is not required, nor recommended.

Neck and back pain Brisbane

What is it?

Over 90% of neck or back pain is due to either arthritis in the spine or muscular spasms and cramps. 

When someone describes their back “locking up” or feeling tight, this is usually a spasm of the deepest group of muscles in the back, which on average are about 5-7 cm under the skin. They are much deeper than you would imagine.

Arthritis is more common in older people and muscular pain is more common in younger people.

A lot of people get frustrated at this so-called ‘musculoskeletal” diagnosis. But it is not a ‘get-out-jail-card’ or ‘cop-out’ diagnosis for the surgeon making the assessment; it is a real phenomenon that is responsible for the majority of neck and back pain. And it can be difficult to get quick relief. 

Dr Alex Koefman | Brain and Spinal Surgeon Brisbane
Dr Alex Koefman

Spinal surgeon Brisbane

The key is not to have unnecessary surgery for this common condition. 

Neck pain symptoms | Back pain symptoms | Brisbane

What are the symptoms?

Typically neck pain is felt somewhere in the back of the neck and often felt radiating into the back of the head, or into the shoulders. 

Back pain can either be central in the lower back, or on either (or both sides) and often radiates into the buttock and hip region.

Neck pain causes | Back pain causes | Brisbane

What causes it? Did I do something to cause it?

The two most common causes are wear and tear changes (also called arthic changes) and trauma. The most common causes of trauma are work related incidents or road accidents. 

Neck pain treatment | Back pain treatment | Brisbane

How is it treated?

The key to treatment is to work out what the underlying cause is. This is actually much harder than it sounds. Even after a comprehensive discussion, examination, and review of all the scans it is sometimes not clear what exactly is causing the neck or back pain. We often suspect it’s a facet joint or disc or muscle, but finding which facet joint, disc or muscle is the challenge. 

This is very different to nerve pain down the arms or legs where it is often quite easy to work out exactly which nerve is causing the pain.

If the exact cause can’t be identified, the next best step is to rule out the nasty causes of back and neck pain. This can be fairly easily done with a series of questions, examination and modern scans. 

This way cancer, infection and fractures and ruptured discs can be ruled out. Once they have, and the spine has been deemed ‘safe to use’ then sending the patient down physiotherapy or pilates pathways is usually the best option.

Dr Alex Koefman | Brain and Spinal Surgeon Brisbane
Dr Alex Koefman

Spinal surgeon Brisbane


Neck and back pain surgery Brisbane

Do I need surgery?

Surgery for back or neck pain is rarely ever required. The only time it is required is if the pain is due to cancer, infection, a fracture or ruptured disc. There is one exception and that is the condition spondylolisthesis. If the surgeon can confirm that it is the cause of the pain, then this condition responds very well to surgery. 

Beyond this, the days of long-segment spinal fusions for back and neck pain are rapidly coming to an end on account of the severe side effects of these historical operations. It is not recommended by today’s more modern surgeons. A well-tailored pilates, physiotherapy or pharmacotherapy program are much more effective in the long run.

Dr Alex Koeman, Spinal surgeon Brisbane

Does the treatment work?

Surgery can be successful for the treatment of pain due to cancer, infection, fractures, ruptured discs or spondylolisthesis. 

For facet or muscular pain, or general arthritis surgery has a very low success rate.

Unfortunately this type of surgery still goes on, but you can almost understand why: a patient can be at their wit’s end with back or neck pain and desperate to try anything. Surgery makes the patient feel like they are being proactive when everything else has failed. This can be empowering. The effects of the anaesthetic will further heighten this optimism in the first few days to weeks and they will feel good.
Dr Alex Koefman | Brain and Spinal Surgeon Brisbane
Dr Alex Koefman

Spinal surgeon Brisbane

However, in 6-12 months down the track, there will be a very high likelihood that the symptoms will return to the same level, or worse, and the surgery will start to cause long-term complications. 

It is for this reason that a well-trained expert will not recommend surgery for your neck or back pain outside the reasons listed above. It generally does not work and will only make you worse in the long run.

As a patient with back or neck pain, this information is presented to refocus your sights on the long term management, not a short term fix with long term disastrous complications.

Neck and back pain specialist Brisbane

What should I do now?

Back or neck pain is incredibly complex. It requires a thorough assessment and examination of you and your symptoms, and review of all your scans. I am happy to organise all the necessary scans and full assessment of your pain. If you would like this assessment then please contact my team

Ready to make an appointment?

Alex consults at Queensland Neurosurgery & Spine Surgery (QNS).
Dr Alex Koefman

Ramsay Specialist Centre
Suite 325
Newdegate St
Greenslopes QLD 4120


(07) 3397 4185

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