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Spine Problems Overview

The Spinal Column

The spinal column consists of 24 separate bones, called vertebrae, plus the fused bones of the sacrum and the coccyx. Your spinal column is the central support for the upper body, carrying most of the weight of your head, chest, and arms. Together with the muscles and ligaments of your back, your spinal column enables you to walk upright.

Vertebrae and Discs

The Cervical Vertebrae

The vertebrae in the cervical (or upper back) portion of your spine carry the weight of your head. The pressure from this weight along with the wear and tear associated with the constant turning and bending of your head and neck is what usually leads to problems associated with the cervical vertebrae.
The cervical region has seven vertebrae (C1 through C7), the thoracic region has 12 vertebrae (T1 through T12), and the lumbar region has five vertebrae (L1 through L5). The sacral region consists of five vertebrae, all fused together to form one continuous bone mass known as the sacrum. The coccygeal region consists of four vertebrae, all fused together to form the coccyx or tailbone.

The Lumbar Vertebrae

The vertebrae in the lumbar (or lower back) portion of your spine are under constant pressure from the weight of your upper body, even when you are simply sitting in a chair. The wear and tear of this pressure is what usually leads to problems associated with the lower back.

The Intervertebral Discs

The intervertebral discs are composed of a fiber-like outer lining (the annulus) and a gelatin-like inner core (the nucleus). These discs act as the spine’s shock absorbers, preventing vertebra from rubbing against one another and providing much of the flexibility found in your spine. Because they are under constant pressure, it is the intervertebral discs which first show signs of the wear and tear associated with the aging process.

The Spinal Nerves

Running through the center of the spinal column is the spinal cord, which ends in the lumbar spine in a bundle of nerves called the cauda equina. At each disc level, a pair of spinal nerve roots branch off from the spinal cord or cauda equina and pass through an opening called the foramen.

The Growth of Bone Spurs

As your spine ages, the gelatin-like centers of your discs begin to dry out, thereby reducing their effectiveness as shock absorbers. As this protection is lost, simple everyday activity can cause the bone matter of your vertebrae to develop jagged edges, called bone spurs. As these spurs develop and extend outward, they can cause both the spinal canal and the foramen to narrow. The result is often the pinching (compression) of the spinal cord and/or a spinal nerve root.

The “Slowly Closing Window”

As discs dry out, your vertebrae begin to settle. This settling causes the window-like openings of the foramen and the spinal canal to become smaller and smaller. Eventually, these openings can become so small that a spinal nerve(s) becomes pinched against a vertebra. It’s similar to slowly closing a window on your hand. There will be a point at which you begin to feel the pressure. The more the window is closed, the greater the pressure and pain.

Back Pain

Low back pain often has complex origins and symptoms, and it does not discriminate. It can originate from identified muscle trauma or an unknown, non-traumatic event. Low back pain can also begin in other regions of the body and eventually attack the muscles or other structures in the lower back. Sometimes low back pain can even begin in the nerves or nervous system. Other origins are postneural difficulties, congenital disorders, trauma, infections, degenerative disorders, inflammatory diseases, circulatory disorders, or any of 30 other additional causes.

It is often difficult for physicians to pinpoint the exact cause of a patient’s low back pain because of the complex composition of the human spine. Bone, discs, muscles, ligaments, tendons, and various tissues are arranged like a three-dimensional puzzle to make up the spine. The complex makeup can easily mask the exact cause of low back pain.

In addition, depression, anxiety, frustration, reinforcement, stress, anger, fear, and many other psychological states can cause the onset of back pain,be a reaction to prolonged pain, or exist concurrently with pain.

The emotional component can complicate the back pain diagnosis, sometimes resulting in needless surgery and disability and masking the underlying physical causes of pain.

Mechanical Disorders

As a result of the natural wear and tear that occurs with aging, certain parts of the spine start to degenerate as we grow older. This process makes some of the anatomic structures of the spine, bones, intervertebral discs, ligaments, and muscles less flexible and less resistant to injury.

Spondylolisthesis / Spondylolysis

Spondylolysis is a defect in the lamina of the vertebrae in the pars interarticularis, usually the fourth or the fifth lumbar vertebrae in the lower (lumbar) spine. Spondylolysis may occur as a congenital defect or the result of repetitive trauma. Some physicians believe spondylolysis may be genetic, and that someone born with thin vertebral bones could be vulnerable to the condition. Spondylolysis is common in teenage gymnasts and football players, and involves lower back pain that is worse with strenuous exercise or activity. Radiographic findings are subtle, but bone or CT scans will usually detect the lesion. Activity modification, bracing, or surgical treatment may be indicated for persistent symptoms.

Spondylolisthesis

Spondylolysis is a prerequisite for spondylolisthesis. Spondylolisthesis occurs when spondylolysis weakens one of the vertebrae so much that the bone slips out of place.

The condition can also be caused by degenerative disc disease. If the vertebrae slip too much and begin to press on nerves, surgery may become necessary. Spondylolisthesis may also be caused by degenerative conditions that affect the vertebral joints, such as cerebral palsy. Early treatment usually involves rest and medication. Progressive spondylolisthesis usually requires surgical treatment.

Sprains & Strains

Most acute pain in the back results from mild strain in the back or back musculature. Sprains and strains in your lower back usually happen during a sudden and stressful injury, causing stretching or tearing of the muscles, tendons, or ligaments. When you strain or sprain your lower back, it places stress on your spine, irritating it. If you have this condition, you may also suffer from painful muscle spasms which can occur during your daily activities or at night while you’re sleeping. The pain is usually limited to five or ten days.

Sciatica
Sciatica is the descriptive term for pain running from the back or buttocks down the leg and into the foot. It is caused by either compression or trauma of the sciatic nerve. Sciatica is made worse when you cough or if someone lifts your leg while you are lying down. Symptoms may begin abruptly or gradually, are usually irritated by movement, and often grow worse at night. Sciatica implies there is an irritation of your nerve root in the lower part of your spine. In some instances, this could be due to a ruptured or herniated disc in your lower back.
Herniated / Ruptured Discs

A herniated (“slipped”) or ruptured disc in your back can cause each of these pain patterns. The ways in which a slipped disc causes different pain patterns and problems with your back is related to the location of the slipped disc along your spine and to the anatomy of your spinal column.

Stenosis

Stenosis produces a dull, aching pain in the lower back when standing or walking. The pain usually radiates down into the buttocks and thighs, and can be relieved by stopping to rest, using a walker, or utilizing a shopping cart in the grocery store. These symptoms usually get worse over time, and people who suffer from spinal stenosis will notice a slow decrease in their ability to walk shorter and shorter distances.

Lumbar stenosis is a natural result of aging. As our bodies grow older, the ligaments and bones that make up the spine grow thicker and become stiffer. The spinal canal gradually narrows, and the spinal cord is slowly compressed. The lack of space interferes with normal spinal cord and body function.

Inflammatory & Infectious Disorders

Though infections and inflammation of the spine are rare, if they are neglected, or if there is a delay in diagnosis, they can become a significant source of pain and disability. Bone and joint infections anywhere in the body can be crippling and life-threatening.

Discitis

Discitis is a low-grade infection that affects the disc space between two vertebrae. Discitis is uncommon, usually affecting children under ten. It is the result of an inflammation caused by staphylococcus, viruses, or other inflammatory processes. Discitis is characterized by the slow onset of severe back pain and may or may not be associated with fever, chills, sweats, fatigue, loss of appetite, or other symptoms. The diagnosis is usually made by seeing narrowing of the disc space between two vertebrae and a bone scan that shows the disc and adjacent vertebrae are “hot.” This condition can be very painful and is often aggravated by any movement of the spine. The pain often travels to other parts of the body including the abdomen, hip, leg, or groin. It usually occurs in the lower (lumbar) and upper (thoracic) back.

Young children with this condition are usually irritable and uncomfortable and refuse to sit up, stand, or walk. The treatment of discitis generally involves antibiotics, rest, and a brace. Surgery is rarely needed.

Ankylosing Spondylitis

Ankylosing spondylitis is a rare condition that can cause back and neck pain. It is a rheumatic inflammatory disease that affects the spine and sacroiliac joints. Although it primarily attacks the spine (usually the low back first), this chronic and painful disease can also attack other joints, tendons, ligaments, and the chest wall.

Over time, this disease can cause the vertebral bodies in the spine to fuse together. When this happens, patients have difficulty moving freely. Common symptoms for ankylosing spondylitis are gradually occurring back pain and stiffness (usually over a period of weeks or months). Early morning stiffness is often helped with a warm shower or light exercise. Symptoms last longer than three months.

In particularly severe cases, patients may be unable to look above the level of the horizon, or they may develop a significant amount of pain from hunched-over posture. Ankylosing spondylitis is usually diagnosed using x-rays of the sacroiliac joints, looking for changes in the tissues caused by inflammation. However, tissue changes are not always visible.

Tumors

Tumors of the spine and spinal cord are relatively uncommon. The most common initial symptom is pain. As back pain is very common, it cannot be used to diagnose any one disease or medical condition. Spinal cord tumors can be either primary (originating in the spinal cord) or secondary (metastases of cancer that originated elsewhere in the body). Therefore, the challenge is to evaluate back pain with the goal of specifically excluding a tumor as the cause. Fortunately, most back pain is not due to a tumor. However, if cancer were discovered after a long period of “conservative” management of back pain, most patients would feel their problem should have been investigated more thoroughly in the beginning.

Benign Tumors

Doctors use the term “benign” to indicate that a particular tumor is unlikely to spread to other parts of the body. Benign tumors can still be a significant problem, however, depending upon their location, size, adjacent structures, blood supply, and other factors. Fortunately, most benign tumors can be treated successfully.

Malignant Lesions

Doctors use the term “malignant” to indicate that a particular tumor or cancer is likely to spread to other parts of the body, and can be difficult to cure or treat. This is very different from “benign” cancers, which are much less likely to spread, are easier to treat and control.

Trauma

It is impossible to predict how badly someone’s spine has been injured before medical evaluation. Therefore, anyone involved in an accident that could have damaged their back is treated as if they have a spinal injury. Most people are familiar with the “backboards” paramedics use to transport accident victims, but are unaware of how important these devices are in keeping the spine stable during transit to the hospital.

Paramedics and emergency response teams treat accident victims according to strict protocols developed in order to save lives. These protocols are designed to minimize the possibility of injury at the accident scene or en route to a hospital. They entail placing cervical collars on all accident victims, securing the victim on a backboard, and taking them to a hospital for further evaluation.

Spinal Cord Injuries

Each year in the United Sates, there are approximately 50,000 new spinal cord injuries caused by accidents. A spinal cord injury occurs when the cord itself is crushed, stretched, or torn by the accident.

Unfortunately, this is still an injury that can not be reversed or cured by modern medicine. More than half of these injuries involve the cervical spine, and most of them happen to young men. These injuries are incredibly devastating to the patients, their families, and their communities. There is currently much research being done on ways to minimize spine injuries by designing cars for better safety, improving protective gear like football helmets, and educating people about the dangers of certain activities.

Research is also being done on how to care for someone immediately after a spinal cord injury, and on which kind of rehabilitation is best for them.

Osteoporosis

Osteoporosis is caused by a decrease in the amount of calcium in your bones, which can cause the bones in your spine to break because they are too weak to support the weight of the body. When this happens, people usually suffer from sharp back pain and often become shorter or have a “hunched over” posture.

Osteoporosis affects more than eight million women and two million men. It is characterized by low bone mass and deterioration of bone tissue which can lead to fragile bones and increased risk in fractures of the spine, hip, and wrist. More than 700,000 vertebral fractures every year are caused by osteoporosis.

Osteoporosis is sometimes called the “silent disease” because bone loss has no symptoms, and the disease usually remains painless until a bone breaks. Although the disease can affect any bone, spinal or vertebral compression fractures can have serious consequences including loss of height, severe back pain, deformity, curving of the shoulders and back, and a thickening waistline. Women in particular reach their maximum bone mass at about age 20. After that, they will gradually lose bone mass. In the 5-7 years immediately following menopause, women will lose up to 20% of their bone mass. When osteoporosis affects the spine, there is a gradual collapse of the vertebrae, producing back pain, loss of overall height, and a stooped posture. The back pain at vertebral collapse may be severe at times.

Neck Pain

Neck pain and symptoms caused by a cervical (neck) spine disorder are a very common problem for many adult Americans. The cervical spine is composed of many different anatomical structures, including muscles, bones, ligaments, and joints. Each of these structures has nerve endings that register pain when problems occur. The different parts of the cervical spine are normally well balanced and able to handle all the movements, stresses, and strains of the body gracefully. However, when they are injured or start to wear out, your neck can be a significant source of pain and discomfort.

Studies show that approximately fifty percent of the population has evidence of degeneration of the cervical spine by age fifty. These changes happen because the discs that act as shock absorbers between the vertebral bodies of the cervical spine wear out as we grow older. As the intervertebral discs wear out, they begin to collapse, or herniate, and become less flexible. The common causes of neck pain and cervical disorders include arthritis, injuries, and trauma. In some situations neck pain can also be a warning sign of something more serious such as spinal cord compression, a tumor, or spinal infection.

Any patient suffering from neck, shoulder, head, or arm pain should be examined by a doctor in order to determine the origination and cause. The tissues involved in producing pain must also be identified, and how they are being irritated must be understood. The history of the pain and any activities that may have triggered it are also important factors in diagnosis and treatment. Impairment of movement in any part of the cervical spine can be responsible for pain, discomfort, and disability.

Mechanical Disorders
As a result of the natural wear and tear that occurs with aging, certain parts of the cervical spine start to degenerate and wear out as we grow older. This process makes some of the anatomical structures of the cervical spine, the bones, intervertebral discs, ligaments, and muscles less flexible and less resistant to injury.
Degenerative Disc

Degenerative disc disease (DDD) is part of the natural process of growing older. Unfortunately, as we age, our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The ligaments that surround the disc, called the annulus fibrosis, become brittle and are more easily torn. At the same time, the soft gel-like center of the disc, the nucleus pulposus, starts to dry out and shrink. Degenerative disc disease is as certain as death and taxes, and to a certain degree this process happens to everyone. However, not everyone who has degenerative change in the cervical spine has pain. Many people who have “normal” necks have MRI’s showing disc herniations, degenerative changes, and narrowed spinal canals. Every patient is different, and it is important to realize not everyone develops symptoms as a result of degenerative disc disease.

Herniated Disc

There are soft-tissue discs between the bony vertebral bodies in your cervical spine that are called intervertebral discs. These discs are composed of a soft gel-like center called the nucleus pulposus, and a tough outer lining that surrounds the disc called the annulus fibrosis. The intervertebral disc creates a joint between each of the vertebral bodies that allows them to flex and extend, rotate slightly, and move with respect to one another. When the outer lining surrounding the disc tears, the soft center squeezes through the opening, creating a “herniated,” “slipped,” or “ruptured” disc. Each of these terms describes the same process.

Myelopathy

Myelopathy is a term meaning there is something wrong with the spinal cord itself. This is usually a later stage of cervical spine disease, and is often first detected as difficulty walking due to generalized weakness or problems with balance and coordination. This type of process occurs most commonly in the elderly, who have many reasons for experiencing trouble walking or problems with gait and balance. However, one of the more worrisome reasons these symptoms are occurring is that bone spurs and other degenerative changes in the cervical spine are squeezing the spinal cord. Myelopathy affects the entire spinal cord, and is very different from isolated points of pressure on the individual nerve roots.

Radiculopathy

This term comes from a combination of the Latin words radix, meaning the roots of a tree, and pathos, meanging disease. This disease is often caused by direct pressure from a herniated disc or degenerative changes in the cervical spine that cause irritation and inflammation of the nerve roots. Doctors use the term radiculopathy to specifically describe pain and other symptoms like numbness, tingling, and weakness in your arms or legs caused by a problem with your nerve roots. The nerve roots are branches of the spinal cord that carry signals to the rest of the body at each level along the spine.

Spondylolysis

Cervical spondylolysis is a disorder that narrows the spinal canal in the neck, compressing the spinal cord or spinal nerve roots. It is a fracture or defect in the pars anticulars (a portion of the bone between each of the joints of the back), allowing one vertebral body to slide forward on the next. Spondylolyosis is sometimes referred to as pars interarticularis defect. It may be unilateral or bilateral and is usually due to a developmental defect but may be secondary to a fracture. Spondylolysis affects the area of the vertebra called the pedicle, part of the bony ring that protects the spinal nerves, and is the portion that connects the vertebral body to the facet joints. Spondylolysis often affects middle-aged and older adults who have degenerative discs and vertebrae in their necks. When a spondylolysis is present, the back part of the vertebra and the facet joints simply are not connected to the body except by soft tissue.

Stenosis

Stenosis is a term used to describe a narrowing of various parts of the body. Cervical stenosis is a degenerative disease where the spinal canal and neural foramina narrow and compress the spinal cord and nerve roots. Stenosis occurs when pressure increases, inflaming the facet joints, the overlapping arches that form the spinal canal. These joints are covered with cartilage and a membrane. Degenerative changes and wear and tear can cause their inflammation. This disorder is most common in people over 50 years of age. Genetics and congenital factors may predispose a person for stenosis.

Inflammatory and Infectious Disorders

Though infections and inflammation of the cervical spine are rare, they can become a significant source of pain and disability. If they are neglected for a period of time, or if there is a delay in diagnosis. Bone and joint infections anywhere in the body can be crippling and life threatening, and infections in the cervical spine are no exception.

Ankylosing Spondylitis

Ankylosing spondylitis is a rare condition that can cause back and neck pain. It is a rheumatic inflammatory disease that affects the spine and sacroiliac joints. This disease is three times more likely to develop in men than in women and it usually occurs between the ages of 20 and 40. Although it primarily attacks the spine (usually the low back first), this chronic and painful disease can also attack other joints, tendons and ligaments, and the chest wall. Though its cause is unknown, ankylosing spondylitis tends to run in families, suggesting a genetic role in its development. A patient is 10 to 20 times more likely to have ankylosing spondylitis if a parent or sibling also has the condition.

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis is a type of inflammatory arthritis that affects almost 200,000 children in the United States. JRA is a disease that causes painful, swollen, and stiff joints in children, most commonly in large joints like the knee. JRA has three well-defined subsets: a monoarticular form, where the disease affects only one joint; a polyarticular form, where it affects many joints, and a systemic form, where it affects other organs in the body besides the joints. The systemic form of the disease is most often associated with high fevers and rash in addition to arthritis. The polyarticular and systemic forms of the disease are the two types that commonly affect the cervical spine.

Rheumatoid Arthritis

Rheumatoid Arthritis is among the most debilitating forms of arthritis, causing joints to ache, throb, and even deform over time. The exact cause of this inflammatory condition is not known, but it is believed to be related to an attack on the synovium (tissue that lines the joints) by the body’s immune system. The upper cervical spine can be damaged by inflammation caused by rheumatoid arthritis. This disease is three times more common in women than in men and usually occurs between the ages of 20 and 50. Just like the gradual destruction of other joints in the body, several joints between the base of the skull and uppermost vertebral bodies in the cervical spine are very susceptible to damage from rheumatoid arthritis.

Tumors

Tumors of the spine and spinal cord are relatively uncommon. The most common initial symptom is pain. As neck pain is very common, it cannot be used to diagnose any one disease or medical condition. Spinal cord tumors can be either primary (originating in the spinal cord) or secondary (metastases of cancer that originated elsewhere in the body). Therefore, the challenge is to evaluate neck pain with the goal of specifically excluding a tumor as the cause. Fortunately, most neck pain is not due to a tumor. However, if cancer were discovered after a long period of “conservative” management of neck pain, most patients would feel their problem should have been investigated more thoroughly in the beginning.

Benign Tumors

Doctors use the term “benign” to indicate that a particular tumor is unlikely to spread to other parts of the body. Benign tumors can still be a significant problem, however, depending upon their location, size, adjacent structures, blood supply, and other factors. Fortunately, most benign tumors can be treated successfully.

Malignant Lesions

Doctors use the term “malignant” to indicate that a particular tumor or cancer is likely to spread to other parts of the body, and can be difficult to cure or treat. This is very different from “benign” cancers, which are much less likely to spread, are easier to treat and control.

Trauma

Cervical spine injuries can occur during motor vehicle accidents or in rough contact sports, after a fall, or from hitting your head against a hard surface (for instance, when diving into a pool that is too shallow). These accidents can cause injuries ranging from mild cases of neck pain (whiplash) to paralysis of the body below the level of injury.

Whiplash

Whiplash is the common term used for a hyperextension injury to the neck. Though the neck is a very flexible structure, it can be injured when the weight of the head exceeds the neck’s ability to control its motion. The injury usually happens when the head is suddenly jerked back and forth beyond its normal limits during a car accident, rough contact sports, or a fall. This jerking motion can cause over-stretching and tearing of the neck muscles and ligaments and can cause the discs between the neck vertebrae to bulge, tear, or rupture.

Disc Herniations

The discs that act as shock absorbers between the vertebral bodies of the cervical spine can be damaged during an accident. When this happens, the material in the center of the disk can be pushed out from where it normally is, a process called disk herniation. A herniated disk can put pressure on the spinal cord or nerves to the arms and legs. In situations when a disk ruptures very quickly, as in the case of an accident, then the nerve does not have any time to adjust to the increased pressure and it may stop working.

Fractures and Dislocations

Fractures and dislocations of the cervical spine demand early and accurate diagnosis so that treatment can quickly be introduced in order to produce a painless, stable neck and prevent pressure on the spinal cord and/or nerves. When the neck is injured in very violent accidents, the bones in the neck can be broken or pulled forcefully out of normal alignment. Fractures and dislocations of the cervical spine are very serious injuries because there is the potential for damage to the spinal cord if the patient is not taken care of very carefully.

Spinal Cord Injuries

Each year in the United Sates, there will be approximately 50,000 new spinal cord injuries caused by accidents. A spinal cord injury occurs when the cord itself is crushed, stretched, or torn by the accident. Unfortunately, this is still an injury that can not be reversed or cured by modern medicine. More than half of these injuries involves the cervical spine, and most of them happen to young men. These injuries are incredibly devastating to the patient, their families, and also to their communities. There is currently a lot of research being done on ways to minimize spine injuries by designing cars for better safety, improving protective gear like football helmets, and educating people about the dangers of certain activities. There is also a lot of research being done on how to care for someone immediately after they have had a spinal cord injury, and also what kind of rehabilitation is best for them.