[The spine in adulthood].

Back pain and low back pain can be caused by extravertebral diseases, functional disorders or morphologic changes of the spine. Diagnosis of back pain is mainly done by clinical examination. The examination of segmental mobility is necessary to make the diagnosis of functional disorders. X-ray and laboratory are mainly used to exclude morphologic changes of the spine. Functional disorders are best treated by chirotherapy completed by rehabilitation of the active motion apparatus. The most important morphologic diseases of the spine causing back pains are deformities, especially lumbar scoliosis, infectious diseases as pyogenous or specific spondylitis, rheumatic diseases as rheumatoid arthritis, mostly at the occipitocervical region, and Bechterew's disease, furthermore instability caused by spondylolisthesis or iatrogenic low back pain as the failed-backsyndrome and tumors, which are in the majority metastases. The role of degenerative changes as a cause of back pain is difficult to estimate. The operative treatment of spinal instability, which has changed in the last years is described, as modern treatment facilities of lumbar disc herniation as chemonucleolysis or percutaneous nucleotomy.