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Most cases of spinal pain are the result of the wear-and-tear changes described above, but there can be other causes. Doctors use the term differential diagnosis to refer to the various disorders which may cause a particular symptom to occur.

Internal organs
Disorders of internal organs can generate referred spinal pain usually lower back pain. Ulcers, gall stones, kidney disease and disorders of the uterus (womb) can all produce such pain. Sometimes disease of the major blood vessels can cause back pain. It is rare for internal organs to cause neck pain.

Nerves
Very occasionally, certain tumours, tumour-like structures or cysts may develop in the spinal canal and compress the nerves within the canal. They may also generate local spinal pain.

Bones and joints
Apart from degenerative changes, other conditions can affect the bones and joints of the spine and are capable of producing back pain or neck pain.

• A person may be born with a structural abnormality of the bones or joints, referred to as a congenital defect.
• A variety of arthritic conditions can affect the joints of the spine.
• The vertebrae can become infected by bacteria. This is rare.
• Tumours sometimes grow in the bones of the spine, a problem usually seen in patients already known to have certain forms of cancer.
• In older people the vertebrae can be affected by osteoporosis, which weakens the bones.