Common Disorders of the Spine

What are Disorders of the Spine?

Spine disorders and injuries are serious because they affect the main support system of the body. The spine is made up of vertebrae (individual bones), facet joints (cartilage that connects the bones) and discs (spongy tissues that cushion the vertebrae). A problem in any of these parts can cause pain and restrict movement. Spine disorders are very common. In fact, low back pain affects approximately 80 percent of the U.S. population.

Please note that the information presented here is only for general informational purposes and may not be applicable to your health condition. The goal is to be able to have an informed discussion with the doctor and or surgeon. The surgeon’s role is to educate you and assist with the decision-making process – providing you with information about your full range of options, and describing what is technically possible, the difficulty and risk of the procedure and potential benefits.

 

Herniated/Bulging Disc

Herniated DiscWhat is a Herniated/Bulging Disc?

The disc is a jelly-like cushion between each bone of the spine which act like shock absorbers between the vertebrae and is made up of two parts, the center (nucleus) and the outside portion (annulus). A herniated/bulging disc presses against the nerve causing pain. A herniated disc may result from the stretching of or a tear in the annulus fibrosus. Disc material (annulus or the nucleus) then may enter the spinal canal or neuroforamen resulting in symptoms. Disc herniations occur in the cervical spine (neck), the thoracic spine, or in the lumbar spine (lower back).

What symptoms are characteristic of a herniated/bulging disc?

In cervical disc herniation, the spinal cord as well as the nerve roots may be compressed. The symptoms and signs produced are the result of nerve root compression, spinal cord compression, or both. The most common complaint is neck pain and limited neck motion. Pain also may radiate into the arm, in a pattern characteristic of the particular root involved; you may also have numbness in the shoulders, arms, or chest. In most cases, pain begins upon waking up.

Thoracic disc herniation presents most commonly as chest pain or spine pain, and occasionally in numbness, weakness, or spasticity you may also experience pain in the front of the thigh. Radicular symptoms occur but are more difficult to discern due to the overlapping dermatomal distribution of nerve roots. If the disc herniation compresses the spinal cord, may result.

In lower back (lumbar) disc herniation, pain and/or numbness follows the irritated nerve root, typically down the back of the leg, side of the calf, and possibly into the side of the foot. For this reason, a herniated lumbar disc characteristically produces sciatica but not back pain. Impairment of motor function of the root will cause weakness in raising and lowering the ankle or big toe, depending on the particular nerve root. Very large disc herniations may result in weakness in both legs as well as urinary difficulty and constipation (in this case contact a doctor immediately or call 911). This specific and severe type of nerve root compression is called cauda equina syndrome. This is a rare but serious problem, and a person with these symptoms should see a doctor immediately.

What treatment options are available for a herniated/bulging disc?

Due to the many possible causes of a herniated/bulging disc, each patient requires a different treatment plan. Typically, the first approach we take with all our patients is conservative, with treatment consisting of exercise, physical therapy or medication (or a combination thereof). The majority of back problems go away in four to six weeks with moderate medical attention and pain medication. For those who fail conservative treatment there are now new microsurgical techniques that can offer appreciable relief. If the symptoms continue past 6 weeks, however, you should consider undergoing an evaluation which includes MRI studies.

If symptoms continue and conservative management has not been helpful, surgical decompression of the disc (microdiscectomy) may be helpful in relieving the symptoms. The only absolute indications for surgery, however, are progressive neurological symptoms, bowel or bladder problems, and severe, unremitting pain.

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Degenerative Disc Disease (DDD)

What is a Degenerative Disc Disease?

Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs as you age. The disc is a jelly-like cushion between each bone of the spine which act like shock absorbers between each vertebrae. They are mostly made up of water, allowing them to be very elastic and absorb stress. However, age, repetitive strain, and (possibly) genetics can cause disc degeneration. Because there is little blood supply to the disc, it cannot repair itself if injured. As a worn disc becomes thin, the space between the vertebrae decreases. With less space available, nerves may become compressed, causing them to swell and signal pain. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).

What symptoms are characteristic of degenerative disc disease?

Degenerative disc may result in back or neck pain, but where the pain occurs depends on the location of the affected disc. An affected disc in the neck area may result in neck or arm pain, while an affected disc in the lower back may result in pain in the back, buttocks, or leg. The amount of pain from degenerative disc disease can vary from naggingly irritating to severely debilitating. Most patients have some underlying chronic low back pain with intermittent episodes of severe pain. Usually, sitting worsens the pain more than standing. Bending, twisting, and lifting generally worsen the pain and lying down reduces it by relieving the strain on the disc space. In addition to back pain, there may also be numbness, and tingling in the legs if the disc degeneration is located in the lower spine. Numbness and tingling in the shoulder and arms may be present for disc degeneration in the upper spine.

What treatment options are available for degenerative disc disease?

Treatment options for degenerative disc disease range from conservative (non-invasive) to invasive (surgery). Some problems need immediate attention - possibly surgery. However, the vast majority of back problems do not require surgery. A variety of treatment options exist for different types of back pain. In most cases, simple conservative therapies such as mild pain medications and rest are effective in relieving the immediate pain.

Surgery may be recommended if the conservative treatment options do not provide relief within 2 to 3 months. If leg or back pain limits normal activity, if there is weakness or numbness in the legs, if it is difficult to walk or stand, or if medication or physical therapy are ineffective, surgery may be necessary. There are many surgical options for the treatment of degenerative disc disease. The most common surgical treatment is:

The overall goal of treatment is: to make you comfortable as quickly as possible, to design a program to reduce further degeneration, and to get you back to normal activity in a timely manner.

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Spinal Stenosis

spinal stenosisWhat is Spinal Stenosis?

Spinal stenosis is a narrowing of the spinal canal. Degenerative or age-related changes in our bodies can lead to the compression of nerves (pressure on the nerves that may cause pain and/or damage). This crowding of nerve fibers results in pain and numbness in the back and legs when standing or walking. Some patients are born with this narrowing, but most often spinal stenosis is the result of a degenerative condition that develops in people over the age of 50. Younger people with a spine injury or a narrow spinal canal are also at risk.

What are the symptoms of spinal stenosis?

If you suffer from lumbar spinal stenosis you may feel various symptoms, including:

  • dull or aching back pain spreading to your legs
  • numbness and “pins and needles” in your legs, calves or buttocks
  • weakness, or a loss of balance, and
  • a decreased endurance for physical activities

Symptoms increase after walking a certain distance or standing for a time. Symptoms can improve when you:

  • sit
  • bend or lean forward (see Figure below)
  • lie down, or
  • put your foot on a raised rest

What treatment options are available for spinal stenosis?

Once a diagnosis of spinal stenosis is confirmed, the process of treating the condition usually begins with a regimen of non-invasive, “conservative” therapy. There are a number of to treat stenosis without surgery, including:

  • Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain, and analgesics to relieve pain.
  • Corticosteroid injections (epidural steroids) to reduce swelling and treat acute pain that radiates to the hips or down the leg. Pain relief from an epidural injection may be temporary and patients are usually advised to get no more than 3 injections per 6-month period.
  • Rest or restricted activity.
  • Physical therapy and/or exercises to help stabilize the spine, build endurance and increase flexibility.

While some patients obtain relief from symptoms with these treatments, others do not. Non-surgical treatments may temporarily relieve pain. More severe cases of stenosis may require surgery.

The most common surgical procedures for spinal stenosis are:

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Radiculopathy

What is Radiculopathy?

Radiculopathy is not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly (a neuropathy). The emphasis is on the nerve root (Radix = "root"). This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.

What are the symptoms of Radiculopathy?

In a radiculopathy, the problem is at or near the root of the nerve, along the spine. However, the pain or other symptoms may manifest in an extremity through a process called referred pain. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm.

What treatment options are available for Radiculopathy?

Ideally effective treatment resolves the underlying cause and restores the nerve root to normal function. Treatment options for this condition will often be different, depending upon the underlying cause of the symptoms.

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Sciatica

sciatica nerve painWhat is Sciatica?

The term sciatica refers to pain radiating down the sciatic nerve into the posterior thigh, leg, and little toe, mostly due to nerve root irritation in the spinal column. In addition to pain, there may be numbness and difficulty moving or controlling the leg. Typically, the symptoms are only felt on one side. The sciatic nerve exits the spinal column between the lowest lumbar vertebral body (L5) and first level of the sacrum (S1). It supplies sensation to the posterior thigh and buttock, knee flexors, and foot muscles. When this nerve is compressed, inflamed, or irritated anywhere along its length, pain may result.

What are the symptoms of Sciatica?

The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body and can be described as "shooting pain down the leg"..

What treatment options are available for Sciatic pain?

Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.

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Foraminal Stenosis

foraminal stenosisWhat is foraminal stenosis?

Foraminal Stenosis occurs when the foramen of the spine narrows and may pinch nerves as they leave the spinal cord. The foramen are the openings between vertebrae which allow the nerve roots to exit from the spinal column. These openings allow the various nerves to branch off from the spinal cord and serve the regional neurological requirements of the body. Therefore, stenosis of the foramen is the condition in which one or more foramen narrow, possibly impinging on a nerve root. This condition is commonly referred to as a pinched nerve.

Degenerative or age-related changes in our bodies can lead to the compression of nerves (pressure on the nerves that may cause pain and/or damage). This crowding of nerve fibers results in pain and numbness. Most often foraminal stenosis is the result of a degenerative condition that develops over time.

What are the symptoms of foraminal stenosis?

Generally the symptoms are exactly identical to any other pinched nerve condition. The most common physical symptoms are:

  • neck pain
  • stiffness
  • pain radiating into the shoulder, arm, and hand
  • numbness
  • tingling and/or weakness in the arm and hand
  • This condition is also a possible cause of chronic sciatica.

What treatment options are available for foraminal stenosis?

Once a diagnosis of foraminal stenosis is confirmed, the process of treating the condition usually begins with a regimen of non-invasive, “conservative” therapy. There are a number of to treat stenosis without surgery, including:

  • Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain, and analgesics to relieve pain.
  • Corticosteroid injections (epidural steroids) to reduce swelling and treat acute pain that radiates to the hips or down the leg. Pain relief from an epidural injection may be temporary and patients are usually advised to get no more than 3 injections per 6-month period.
  • Rest or restricted activity.
  • Physical therapy and/or exercises to help stabilize the spine, build endurance and increase flexibility.

While some patients obtain relief from symptoms with these treatments, others do not. Non-surgical treatments may temporarily relieve pain. More severe cases of stenosis may require surgery.

The most common surgical procedure for foraminal stenosis is:

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Spondylolisthesis

spondylolisthesisWhat is Spondylolisthesis?

Spondylolisthesis occurs one of the spine bones (vertebrae) slips forward over the one below it. Normally, the bones of the spine stand neatly stacked on top of one another. This slippage most often occurs in the lower spine (lumbosacral area). Spondylolisthesis alters the alignment of the spine. In this condition, as the bone slips forward, the nearby Ligaments, joints and nerves may become irritated and painful.

What are the symptoms of Spondylolisthesis?

An ache in the low back and buttock areas is the most common complaint in patients with spondylolisthesis. Symptoms of spondylolisthesis may include:

  • Numbness or weakness in one or both legs.
  • back, leg, or buttock pain that gets worse when you bend over or twist.
  • Difficulty walking (posture will typically give the appearance that the individual leans forward slightly).
  • Pain that runs from the lower back down one or both legs.
  • Loss of bladder or bowel control.

Sometimes spondylolisthesis causes no symptoms at all, but usually, a patient will typically experience generalized pain in the lower back, along with intermittent shocks of shooting pain beginning in the buttock traveling downward into the back of the thigh and/or lower leg (radicular pain). Nerve pressure on the cauda equina (a structure within the lower end of the spinal column that consists of nerve roots and rootlets), can affect the nerves that go to the bladder and rectum. When this happens, bowel and/or bladder function can be affected (a person with these symptoms should see a doctor immediately).

What treatment options are available for spondylolisthesis?

The treatment of spondylolisthesis is usually non-surgical. Physical therapy to strengthen the back and abdominal muscles is the primary mode of treatment. Surgery is used when the slip is severe and when symptoms are not relieved with nonsurgical treatments. Symptoms that cause an abnormal walking pattern, changes in bowel or bladder function, or steady worsening in nerve function require surgery. Deterioration of symptoms is common in patients with a history of significant neurologic symptoms who don't have surgery to correct the problem.

Surgical treatment becomes necessary when conservative management fails. Surgery is especially effective for patients with leg symptoms. If a reasonable trial of conservative care (three months or more) does not improve things and/or your quality of life is significantly reduced, then surgery may be the next best solution. The main types of surgery for spondylolisthesis include

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Scoliosis

scoliosisWhat is Scoliosis?

Scoliosis is a disorder that curves the spine into an S or a C shape when looking at the spine from the back. Some curves in your spine are normal. If this curve is severe, it can cause pain and make breathing difficult. It may occur in the thoracic or lumbar segment of the spine, and it may or may not include rotation or deformity of the vertebrae.

The good news is that most cases of scoliosis are mild. If found early, they can usually be prevented from getting worse.

What are the symptoms of scoliosis?

Scoliosis is most commonly seen in adolescents and adults. Adults can also develop scoliosis as a result of bone degeneration. Scoliosis most often causes no symptoms until the spinal curve becomes large. Scoliosis is often painless. People with scoliosis commonly see a spine specialist because they notice a problem with the way their back looks. If you have scoliosis, you may notice some of the following things about your body:

  • Uneven shoulders (one shoulder that looks higher than the other)
  • Head does not look centered over the body
  • One shoulder blade that appears more prominent than the other
  • Uneven waist (waistline is flat on one side)
  • One hip higher than the other
  • Leaning to one side
  • Limb length discrepancy
  • Back pain or difficulty breathing (only in rare cases of severe scoliosis)
  • In adults, scoliosis may cause back pain and trouble breathing

What treatment options are available for scoliosis?

The treatment of scoliosis is determined by the extent of the deformity and the stage of bone growth (how near the growth centers are to closure). Many scoliotic curves require no treatment (less than 30 degrees) but should be followed in 6-month intervals. More serious cases may require observation, exercise, a back brace, or surgery. The treatment is most successful when it is started early. In severe cases, or if bracing doesn't help, surgery may be necessary.


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