SPINAL DISORDERS

The spine is made up of a column of small bones called vertebrae that surround and protect the spinal cord and nerves that branch out from the spinal cord. Each bone or vertebra is separated from the other by a spongy tissue called an intervertebral disc, which acts as a cushion and prevents the bones from rubbing against each other during movement. Based on their position, the vertebral column is categorized into 7 cervical vertebrae in the neck, 12 thoracic vertebrae in the chest region, 5 lumbar vertebrae in the lower back, and 5 fused bones of the sacrum and 3 fused bones that form the coccyx in the pelvic region. Some of the common spinal disorders include:

Degenerative disc disease (DDD): Degenerative disc disease refers to the gradual deterioration of the intervertebral discs that cushion the vertebrae. DDD affects the strength, resiliency and structural integrity of the intervertebral discs due to advancing age, trauma, injury, repetitive heavy lifting, smoking and obesity.

Herniated disc: Herniated disc is a condition in which the outer fibrous annulus of the intervertebral disc is damaged, causing the nucleus to protrude through the ruptured annulus and compress the adjacent nerve root and/or spinal canal. Herniated disc is also known as a slipped disc or ruptured disc. 

Stenosis: Spinal stenosis is a condition caused when the vertebral column constricts and exerts pressure on the spinal cord or neural foramen (a bony tunnel through which a nerve exits the spinal cord). It usually affects the cervical and lumbar spine. If the spinal canal is narrowed, the disorder is called cervical/lumbar central stenosis. If the foramen is narrowed, it is referred to as cervical/lumbar foramina stenosis.

Spondylolisthesis: Spondylolisthesis is a condition in which the breakdown of the cartilage between the vertebrae of the spine causes one vertebra to slip out of place on top of the one below it. This causes misalignment and narrowing of the spinal column, a condition called spinal stenosis, which can put pressure on the nerves, resulting in pain in the buttocks or legs with walking or standing.

Scoliosis: Scoliosis is a condition where the spine or back bone is curved sideways instead of appearing in a straight line. It can occur in all ages, but commonly occurs in children before puberty, during their growth spurt.

Osteoporosis: Osteoporosis is a bone disease characterized by a decrease in bone mass and density resulting in brittle, fragile bones that are more susceptible to fractures. The condition most commonly affects elderly women. Osteoporosis-related fractures are more common at the vertebral bodies of the spine. Osteoporosis is called a "silent disease," as most the patients may be unaware of their condition until they develop a bone fracture.

Fractures: Vertebral compression fractures occur when the normal vertebral body of the spine collapses when too much pressure is placed on the vertebrae, resulting in pain, limited mobility, loss of height and spinal deformities. Fragile and weak bones in the elderly, and those suffering from osteoporosis and cancer can develop compression fractures with little or no force.

Tumors: Spinal tumors are abnormal growth of tissues or cells in and around the spinal cord or vertebral bones. Tumors can either be cancerous (malignant) or non-cancerous (benign). Tumors from other parts of the body can also spread and affect the spinal column.

Infections: The spinal cord and its surrounding structures can become infected by bacteria or fungal organisms. Certain risk factors that can make you more susceptible to these infections include obesity, malnutrition, weakened immune system, infection with HIV virus, diabetes and cancer.

 

 

CERVICAL STENOSIS

Cervical spine refers to neck portion of spine, and cervical spine conditions may result from overuse injuries, trauma and certain diseases. Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands, numbness or weakness in the legs. This condition causes cervical myelopathy and cervical radiculopathy. The abnormal pressure placed on the spinal cord causes damage and results in spinal cord dysfunction. This condition is known as myelopathy. Cervical radiculopathy occurs when the nerve roots connecting the spinal cord are injured or pinched as they exit the spinal canal. Myeloradiculopathy occurs when there is damage to the spinal cord and nerve roots.

  • Causes:

Cervical stenosis;-It develops after age 50, because of aging and spinal wear and tear. Some patients have a history of back injury or trauma. Different disorders can cause nerve compression, such as:

  • Thickening of spinal ligaments

  • Osteophytes (bony overgrowths)

  • Bulging or herniated discs

  • Degenerative disc disease

  • Symptoms:

Some people have no symptoms; they are asymptomatic. However, the symptoms may gradually develop and worsen over time. The common symptom of cervical stenosis is mild to intense neck pain. Other symptoms include:

  • Problems with gait and balance

  • Clumsy hand coordination

  • Upper extremity pain and weakness

  • Numbness, tingling, pins and needles sensation

  • Bladder and bowel problems

  • Rarely, loss of function (paraplegia)

Cervical spinal stenosis is usually diagnosed based on your medical history, physical and neurological examination, and diagnostic tests such as x-rays, CT or MRI scans, or myelography.

Cervical stenosis may be treated with conservative treatment approaches such as use of pain medications, physical therapy, steroid injections, or acupuncture. In chronic cases, surgery may be required to treat the condition. Surgery is considered for patients in whom the pain is not responding to conservative treatment.

 

 

COMPRESSION FRACTURES

A compression fracture of the vertebra occurs when the bones of the spine (vertebrae) collapse. Most commonly, these fractures occur in the thoracic or the middle portion of the spine.

  • Causes:

A common cause of compression fracture in the spine is osteoporosis. This is a condition which makes the bones weak and unable to sustain normal pressure. Traumatic injury to the spine such as from a fall or motor vehicle accident can also cause fractures. Metastatic spread of cancer to the bones of the spine is another cause of vertebral fractures. The cancer leads to destruction of part of the vertebra thus weakening the spine.

  • Symptoms:

The symptoms of a compression fracture include severe pain in the back, arms, and legs. If the spinal nerves have been injured, there may be associated numbness and a feeling of weakness. The pain will be milder in cases of osteoporotic fractures.

  • Diagnosis:

Your doctor will make a diagnosis and determine the cause of pain based on your complete medical history and physical examination. Some of the diagnostic tests that may be recommended include:

  • X-ray of the spine: X-ray helps to locate the site where the vertebra is broken.

  • CT and MRI scan: These are done to confirm that there is no nerve injury.

  • Bone scan: Bone scan helps to estimate the age of fracture. If a bone scan shows older fractures that have healed, it indicates the possibility of osteoporosis.

  • Neurological examination: It involves checking for reflexes, muscle strength, and sensory perception. Any abnormality indicates damage to the nerves.

  • Treatment Options:

Conservative Treatment

The conservative treatment modalities for compression fractures include pain medications, rest, and use of braces or back support.

Minimally Invasive Procedures

  • Vertebroplasty and Kyphoplasty are the minimally invasive procedures performed to treat compression fractures.

  • Vertebroplasty involves insertion of special cement into the broken vertebral body. It reduces pain and improves the strength of the vertebral body.

  • Kyphoplasty involves sliding a tube with a deflated balloon at its end   into the broken bone. The balloon is then   inflated to increase the height of the broken vertebra. Bone cement is injected into the space created by the balloon to hold the vertebra in its restored height.

Surgical Treatment

Spinal surgery is considered as an option in severe compression fractures where more than half of the vertebral body height is lost. Surgery becomes necessary to prevent bone from impinging on to the spinal nerves. Internal fixation may be done to support the vertebra in proper position during healing.

 

 

DEGENERATIVE DISC DISEASE

Degenerative disc disease is a condition where the intervertebral disc, the gel-like material between the vertebrae, has begun to wear out due to aging, repetitive stress, smoking, injury, formation of bone spurs or obesity.

Symptoms vary from person to person. Some patients have no pain while others may experience severe pain. Depending upon the location of the affected disc the condition may cause:

  • Neck or arm pain

  • Back pain

  • Numbness or tingling in the arms or legs

  • Pain in the thighs and buttocks

The pain is aggravated by movements such as bending, lifting or twisting.

Degenerative disc disease is usually diagnosed based on medical history, physical examination and neurological examinations. Diagnostic imaging techniques such as X-rays, CT scan or MRI scans, may be employed to confirm the diagnosis.

Nonsurgical treatment options such as medications (pain medication, narcotic medication, NSAIDs, muscle relaxants, antidepressants), rest, exercise, a spinal block and physical therapy may be recommended when there is no evidence of nerve root compression or muscle weakness. Surgery is considered when conservative treatment options fail to relieve the symptoms over a period. Spinal decompression along with a discectomy and fusion is usually performed to remove the affected disc and fuse the adjoining vertebrae to stabilize the spine.

 

 

HERNIATED DISC

The bones in the spinal column called vertebrae surround the spinal cord and other nerves, and are cushioned by soft intervertebral discs that act as shock absorbers for the spine. The intervertebral discs are composed of a jelly-like nucleus pulposus at the center, surrounded by a fibrous ring called the annulus fibrosus. A herniated disc is a condition in which the outer fibrous annulus of the intervertebral disc is damaged, causing the nucleus to protrude through the ruptured annulus and compress the adjacent nerve root and/or spinal canal. Herniated discs are also known as a slipped disc or ruptured disc. Wear and tear due to aging, repetitive strenuous movements, smoking, improper lifting and being overweight may alter the structure and function of these discs.

The predominant symptom of a herniated disc is pain, which can range from mild to severe and is usually aggravated by movement. The most common signs and symptoms of a herniated disc are as follows:

  • Herniated disc in the lower back causes back pain that radiates to the buttocks and legs

  • Herniated disc in the neck causes neck pain that radiates to the shoulders and upper arms

  • Numbness or tingling sensation

  • Muscle weakness

  • Rarely, bowel and bladder dysfunction

An accurate diagnosis and an effective treatment plan are important for a successful outcome. Your doctor will usually diagnose a herniated disc based on your history of symptoms along with a physical examination, where your sensations, reflexes and the strength of the muscles are evaluated. Imaging tests such as X-rays, MRI or CT scans or electromyography (measures nerve signals to muscles) may be ordered to confirm the diagnosis of a herniated disc.

Treatment comprises of conservative and surgical options. Conservative treatment may include rest, anti-inflammatory and pain medications, muscle relaxants, cold or hot compresses, activity and posture modifications, physical therapy, spinal injections, electrical stimulation, traction or braces. You doctor may recommend a combination of two or more treatment modalities to enhance the potential of success of the treatment.

Surgery is not always indicated for herniated disc. It is considered if you have an unstable spine, neurological dysfunction or persistent pain that does not respond to conservative treatment. A minimally invasive spine surgery may be performed to remove the protruding portion of the disc. In rare cases, the entire disc is removed, and the adjacent vertebrae are fused or an artificial disc is inserted.

Your surgeon will discuss surgical options and recommend the most appropriate treatment plan for you.

 

 

SCOLIOSIS

Scoliosis is a condition where the spine or back bone is curved sideways instead of appearing in a straight line. It can occur in all ages, but commonly occurs in children before puberty, during their growth spurt.

Most often the cause of scoliosis is unknown and is termed idiopathic scoliosis. Scoliosis can be categorized into two groups:

  • Non-structural scoliosis: This type of scoliosis presents as a structurally normal spine with a temporary or changing curve. Causes include:

  • Differences in leg lengths

  • Muscle spasms

  • Inflammatory conditions such as appendicitis

Structural scoliosis: This type of scoliosis presents with a fixed curve in the spine. Causes include:

  • Birth defects

  • Injury to the spine

  • Infections

  • Neuromuscular diseases such as cerebral palsy, polio and muscular dystrophy

  • Tumors

  • Connective tissue disorders

  • Rheumatic diseases

Scoliosis is diagnosed by reviewing your child’s medical and family history, and performing a thorough physical examination. X-rays further aid in confirming the diagnosis.

Treatment of scoliosis is based on the cause, age of the patient, and how much your child must grow. Treatment options include:

  • Observation: Your child’s physician may follow-up every few months to monitor the curve if the scoliosis is mild.

  • Bracing: Your child’s physician may recommend wearing a brace to prevent the curve from worsening if your child is still growing.

  • Surgery: If your child is still growing, the curve is over 40° or is worsening, surgery may be recommended. The most common surgical procedure for scoliosis is correction, stabilization and fusion of the curve.

 

 

SPINAL TUMORS

The spinal cord is a long bundle of nerves that extends from the brain along the length of the spinal column. The spinal cord is protected by three membranes called meninges and the vertebrae. Spinal tumors are abnormal uncontrolled growth of tissues or cells in the spinal cord. Tumors can either be cancerous (malignant) or non-cancerous (benign). Those that begin in the spine are called primary spinal tumors. Tumors that spread to the spine from other parts such as the breasts, prostate and lungs are called secondary spinal tumors. There are two types of tumors:

  • Intramedullary tumors: starts in cells within the spinal cord

  • Extramedullary tumors: develops from the network of cells that support the spinal cord (outer meninges). These are usually benign, but affect the functioning of the spinal cord by compressing the nerves.

The cause of primary spinal tumors is not known, but may occur from genetic defects, exposure to radiation and chemicals, or hereditary disorders such as neurofibromatosis and von Hippel-Lindau disease that interfere with the growth of cells.

Spine tumors may cause persistent and chronic back pain, numbness, burning and tingling sensations, bladder or bowel control problems, loss of sensation in the legs and arms, reduced sensitivity to heat, cold and pain, progressive muscle weakness, paralysis and difficulty balancing and walking.

Spine cancer can be diagnosed by reviewing your history and symptoms, and performing a thorough physical and neurological examination. Imaging tests such as biopsy (sample of the spinal tissue is removed for examination), myelogram (CT scan performed with a contrast dye), spine CT scan, spine MRI scan, and spine X-rays are usually ordered to confirm the presence of a spinal tumor.

Medications such as corticosteroids are prescribed to reduce inflammation and swelling around the spinal cord. Small benign tumors that do not compress surrounding nerves and show symptoms are closely monitored. Surgery is most often recommended to remove the tumor without affecting other important nerves. To minimize nerve damage, electrodes are used during the surgery to test the functioning of different nerves. In some cases, sound waves are used to break up the tumor, making it easier to remove the fragments.

When the tumor cannot be removed whole, and in cases of metastatic tumors or tumors that cannot be easily accessed, radiation therapy is performed to destroy the cancer cells. To avoid the ill effects of radiation on normal cells, your surgeon may perform stereotactic radiosurgery (SRS), where the radiation is targeted precisely on the tumor cells alone. Chemotherapy can be provided either alone or in combination with surgery and radiotherapy.

 

 

SPONDYLOLISTHESIS

Spondylolisthesis is the displacement of vertebral disc from the spinal column. Outward (forward) displacement is termed as anterolisthesis and inward (backward) displacement is termed as retrolisthesis. This condition is often preceded by spondylolysis, a degenerative condition of the vertebra.

Based on the cause of displacement, five subtypes of spondylolisthesis are identified, they are

  • Dysplastic spondylolisthesis

  • Isthmic spondylolisthesis

  • Degenerative spondylolisthesis

  • Traumatic spondylolisthesis

  • Pathologic spondylolisthesis

Among the various subtypes of spondylolisthesis, the two most common forms commonly observed are dysplastic spondylolisthesis and isthmic spondylolisthesis

Dysplastic spondylolisthesis – This subtype is a congenital condition, present at birth, and is caused because of abnormal bone formation of the facet part of the vertebra resulting in spondylolisthesis.

Isthmic spondylolisthesis – This type of spondylolisthesis occurs because of a defect in the pars interarticularis part of the vertebra.  This is more common in athletes and gymnasts as they often suffer from overuse injuries.

Signs and symptoms that suggest the spondylolisthesis in patients include:

  • Lower back pain

  • Stiffness in the back and tightening of the hamstring muscles from spasms

  • Pain in the thighs and buttocks

  • Decreased range of motion of the lower back

  • Pain and weakness of the legs or numbness because of nerve compression

  • Loss of control on bowel or bladder function by severe nerve compression

  • Increase in lordosis curve, also called swayback

  • Kyphosis (round back)

The cause for spondylolisthesis is multifactorial; the common causes are overuse injuries of spine, congenital abnormalities, trauma, bone disorders, and fractures.

Treatment for spondylolisthesis is based on the diagnosis made by collecting medical & family history, physical examination, and radiographic scans. During the diagnosis, also the severity of displacement is assessed which is expressed as grade I to IV. In mild conditions and for symptomatic relief, conservative treatments including medications, bracing and physical therapy are recommended. In severe cases, surgical correction with decompression laminectomy followed by spinal fusion is recommended. The procedure involves removal of a portion of vertebra compressing the nerves and other vertebra followed by removal of disc between the vertebrae and fusion of adjacent vertebrae. Fusion surgery is performed to confer stability to the spine. Following the surgery, your surgeon recommends physical therapy and rehabilitation programs to regain strength to the surrounding bones & muscles as well as to make you active soon.

 

 

ANKYLOSING SPONDYLITIS

The term ankylosis stands for loss of mobility of the spine, whereas spondylitis means inflammation of the spine. Therefore, ankylosing spondylitis is a condition where chronic inflammation of spine and sacroiliac joint, results in complete fusion of the vertebrae leading to pain and stiffness in the spine. Sacroiliac joints are present in the lower back where the sacrum part of the vertebrae joins the iliac bones.

Ankylosing Spondylitis is a systemic disease affecting other tissues and organs throughout the body. It can cause inflammation of faraway joints and organs such as the eyes, heart, lungs and kidneys.

Ankylosing spondylitis is 3 times more common in men than in women and affects people of all age groups including children which are referred to as juvenile ankylosing spondylitis.

  • Causes:

The development of ankylosing spondylitis is believed to be genetically inherited as most patients suffering from this condition are found to be born with a gene known as HLA-B27 gene. Other factors involved are family history, gender and certain environmental factors which can trigger immune system problems leading to chronic tissue inflammation.

  • Symptoms:

The starting symptom of ankylosing spondylitis is pain and stiffness in the lower back which may get worse in the night or early morning. Back pain may be felt in the sacroiliac joint between the spine and pelvis. Progression of the disease can affect all or part of the spine resulting in decreased mobility of the lower spine and fatigue. Other symptoms which are rarely seen are fever, loss of appetite, eye inflammation, and pain in heel, hip and other joints of the shoulder, knee, and ankles.

  • Diagnosis:

The diagnosis of ankylosing spondylitis condition involves physical examination to evaluate the patient’s symptoms, X-rays and blood tests. Physical examination helps the physician assess stiffness and range of motion of the spine and other related joints. X-rays are ordered for a clear diagnosis of sacroiliac joints, vertebrae, and other related bones. Certain blood tests are employed such as HLA-B27 antigen, and sedimentation rate which is a marker of inflammation throughout the body.

  • Treatment:

The treatment of ankylosing spondylitis involves the use of certain medications to help reduce inflammation, suppress immunity, and prevent progression of the disease. Different classes of medication available for treatment are NSAIDs, corticosteroids, or other new classes having anti-inflammatory and pain relieving effect including biologics such as anti-TNF agents. Other treatment options are physical therapy and exercise. These are very effective measures and helps alleviate many symptoms. One should eat a healthy whole food diet and should avoid drinking alcohol and smoking cigarettes.

 

 

ADULT KYPHOSIS

The spine has natural curves that alternate from top to bottom to better absorb the various pressures applied to it. The thoracic region of the spine has a “C”-shaped convexity; an exaggeration of which results in a condition called kyphosis. Kyphosis is characterized by an abnormal spinal curvature, which causes a physical deformity of the upper back commonly known as hunchback. Kyphosis mainly affects the thoracic spine, but sometimes the cervical and lumbar spine may also be affected as the curvature reverses from concavity to convexity.

Kyphosis may develop because of degenerative diseases such as traumatic injuries, osteoporotic fractures, arthritis, disc degeneration and slipped-disc. It can also be caused by malignancies or infections of the spine, poor posture, structural deformities such as scoliosis (abnormal sideward bending of the spine) and abnormal development of the spinal column before birth. If you have undergone radiation and chemo therapy for management of malignancies, you may have a risk of developing kyphosis.

Kyphosis can lead to back pain, weakness, fatigue, stiffness, tenderness and in severe cases, difficulty in breathing. When you present to the clinic with these symptoms, your doctor will take a thorough family and medical history, and perform a physical examination to evaluate the shape of the spine, strength of the muscles and neurological function to arrive at an accurate diagnosis. Various diagnostic tests such as X-rays, MRI and CT scans may also be performed to view the structures of the spine and evaluate the curve.

The treatment options for kyphosis can include conservative and surgical methods. Conservative treatment is the initial choice and includes pain and anti-inflammatory medications, exercises and supportive braces (in children) to support curves of more than 45°. If osteoporosis is the primary cause of kyphosis, slowing the progression of osteoporosis is recommended through the intake of vitamin D and calcium supplements, hormone replacement therapy and regular exercise.

Spinal surgery is considered for congenital kyphosis and kyphosis greater than 75° that is not relieved with non-surgical methods. The goal of surgery is to re-align the spine and fuse the vertebrae to form a solid bone and reduce the deformity. Metal screws, plates or rods are employed to hold the vertebrae in place during fusion.

  • Adult Kyphosis-Types and Causes:

Adult kyphosis, the condition of curve in spine is categorized into the following major types:

  • Postural Kyphosis

  • Scheuermann's Kyphosis

  • Congenital Kyphosis

  • Paralytic Disorders

  • Post-Traumatic Kyphosis

  • Post-Surgical Kyphosis

  • Degenerative Kyphosis

  • Postural Kyphosis:

Postural kyphosis is the result of poor posture and is common in adolescents and younger adults. Slouching posture when sitting or standing tends to cause the spine to curve forward. It is often associated with hyper lordosis of the lumbar portion of the spine. The lumbar spine normally has an inward curve. Hyperlordosis means the lumbar spine curves too far in the opposite direction. Postural kyphosis can be rectified by adopting correct posture while sitting and standing along with strengthening exercises for back muscles.

  • Scheuermann's Kyphosis:

Scheuermann's kyphosis is a condition in which the thoracic curve is between 45 and 75 degrees. Vertebral wedging of more than 5 degrees can be seen in three or more adjacent vertebrae. In these cases, the vertebrae appear triangular shaped. At the ends of the wedged vertebrae, Schmorl’s nodes (small herniation’s of the intervertebral disc) are formed. Exact cause for Scheuermann’s Kyphosis remains unknown and the probable causes may be avascular necrosis of the cartilage ring of vertebral body, vertebral disorders, or mild osteoporosis.

  • Congenital Kyphosis:

Congenital kyphosis is an inherited condition of spine caused because of abnormal development of spine in womb. There may be incomplete formation of the spine present at birth, which later can lead to a severe abnormal kyphosis. It may also cause paralysis of the lower part of the body. Congenital abnormalities in the urinary collecting system may also be associated with this type of kyphosis.

Surgery is considered successful in treating severe congenital kyphosis. Generally, early surgical intervention is said to provide good results and halt the progression of the curve further. However, non-surgical means are less suitable for this type of kyphosis.

  • Paralytic Disorders:

Kyphosis may gradually develop in certain paralytic disorders such as poliomyelitis, spinal muscle atrophy, and cerebral palsy.

  • Post-Traumatic Kyphosis:

Spinal injuries can lead to kyphosis and nerve problems in the spine. Most of the times, when there is vertebral fracture in the thoracic or lumbar spine some degree of kyphosis may result. Post-traumatic kyphosis can be treated with bracing or surgery depending on the severity of the condition.

  • Post-Surgical Kyphosis:

Post-surgical Kyphosis is the development of kyphosis following the spine surgery to correct other defects. This occurs when the healing is improper after surgery. A spinal fusion may not heal completely leading to unstable fusion which may cause the spine to collapse. The ligaments of the spine may not heal in an adequate manner to support the vertebrae and a kyphosis may develop. These problems need to be corrected with a second operation.

  • Degenerative Kyphosis:

Degenerative kyphosis may be caused by wear and tear of the lumbar portion of the spine. The degenerative process results in collapse of the intervertebral disc, changes in the shape of the vertebrae, and weakening of the ligaments that support the spine. This can cause kyphosis over a long period.

  • Other Causes:

Systemic diseases also can cause kyphosis over time. These conditions include infection in the spine, cancer or tumors of the spine, and certain types of systemic arthritis. Kyphosis can also develop in people who have   had radiation treatment   for malignant cancers in their childhood.

 

 

SCHEUERMANN'S KYPHOSIS

Scheuermann’s kyphosis is a deformity of the spine that develops during growth. It can be considered as increased kyphosis. Kyphosis is the C-shaped curving of the spine and is also known as hunchback. This deformity occurs in the junction between thoracic region and lumbar sections of the spine or in the chest region. However, it does not affect the spinal cord or nerve roots. It is commonly observed in males in their adolescence.

  • Causes:

The exact cause of Scheuermann’s kyphosis is not known, but it is caused due to the abnormal growth of the spine.  The front of the spine stops growing, while the back of the spine continues to grow, forming a wedge-shaped vertebra. This condition may be congenital, or may be developed because of osteoporosis at younger age, due to heavy lifting, and posture problems.

  • Symptoms:

Most commonly occurring symptoms include pain and the characteristic C-back. In some cases, no significant symptoms will be evident. Symptomatic pain can be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen but will not help to bring back the correct posture of the spine. This condition can lead to herniated thoracic disc, a condition in which the contents of the disc material leaks out.

  • Diagnosis:

Your doctor will conduct a detailed physical examination which includes range of motion tests, palpitation, and Adam’s forward bending tests. After the physical examination is complete, further imaging tests include X-ray, myelography (to check if the spinal cord is affected), magnetic resonance imaging (MRI) scan. Additionally, X-ray of the pelvis and wrist are taken to identify the bone age to know skeletal maturity.

  • Treatment:

Treatment for Scheuermann’s kyphosis based on the patient’s age, severity of the curve, and any associated neurological problems.

Nonsurgical treatmentYour doctor suggests physical therapy that includes strengthening exercises and postural training which helps to strengthen the spinal muscles and to improve the posture. Braces can be recommended if the results from physical therapy are not satisfactory. The commonly used brace is ‘Milwaukee brace’. This brace is made up of plastic which attaches itself to the waist. Pressure exerted by the upright bars present in the brace helps to straighten the spine.

Surgical treatment: Surgery is ideal for patients if the nonsurgical treatment does not bring back the correct posture of the spine. Surgery is performed to straighten the spine and relieve pain. It is done in two procedures; posterior fusion and combined fusion. In posterior fusion, two or more bones are fused together to form one bone. Combined fusion is the fusion of two surgeries; anterior and posterior of the spine. In the first part, the ligaments of the spine are cut, the problematic disc is removed, and filled with bone grafts which help in the bone growth. In the second part, spine muscles are cut and spread apart, the metal rods with hooks are inserted along the side of spine and bone grafts are inserted. The rods hold the spine such that the bone grafts help in healing.

After the surgery, rehabilitation program is suggested, that includes strengthening and stretching exercises which help to release the tension of the spine muscles and improve blood circulation. These exercises must be performed regularly to obtain better outcomes.

 

 

SACROILIAC JOINT DYSFUNCTION

The sacroiliac joint is one of the large joints in the body and is formed by the connection of the sacrum and the right and left iliac (pelvic) bones. The sacroiliac joints have small amount of movement and transmits all the forces of the upper body to the lower body. The sacrum is the triangular-shaped bone at the bottom of the spine, below the lumbar spine. The sacroiliac joint acts as a shock-absorbing structure. Sacroiliac joint dysfunction or sacroiliac joint pain is one of the common causes of the lower back pain.

Causes of sacroiliac joint dysfunction include:

  • Traumatic injuries caused when there is a sudden impact to the body

  • Biomechanical problems such as twisted pelvis, leg length discrepancies or muscle imbalances

  • Hormonal changes during pregnancy

  • Inflammatory joint conditions such as arthritis and ankylosing spondylitis

The most common symptom of sacroiliac joint dysfunction is pain. The patient often experiences pain in the lower back, thigh, groin or buttocks that radiates down the leg. The pain is typically worse with standing and walking and is relieved on resting. Other symptoms include limping, fever, psoriasis, eye inflammation and limited range of motion. Proper diagnosis is essential because the symptoms mimic other common conditions, including sciatica, herniated disks or other lower back pain problems. Sacroiliac joint pain is diagnosed by taking the patient’s medical history and by performing physical examination. Other imaging studies such as MRI, CT scan, bone scan and X-rays may be needed to know the extent of joint damage. Treatment options include adequate rest, use of pain medications, wearing a sacroiliac belt to stabilize the joint and physical therapy. Corticosteroid injections may be given to reduce the pain and inflammation. Surgery may be considered in patients not responding to conservative line of management. For severe cases of pain, one or a combination of the above treatments, may be effective.

 

 

SPINE TRAUMA

Spine trauma is damage to the spine caused from a sudden traumatic injury such as a fall, motor vehicle accident or sports injury. Trauma can cause damage to the vertebrae, spinal cord and/or nearby nerves. Injury to the spine may cause various conditions including fractures, dislocation, partial misalignment (subluxation), disc compression (herniated disc), hematoma (accumulation of blood), crushing, bruising, tearing or penetration of spinal cord tissue, brain stem stroke and partial or complete tearing of ligaments.

The most common symptom of a spinal injury is pain. Spinal injuries cause weakness and sensory loss and may proceed to paralysis with loss of all sensation and reflexes if the spinal nerves are damaged. It may also affect breathing and blood pressure, and lead to arrhythmias (irregular heartbeat), pneumonia, bowel, bladder or erectile dysfunction. Spinal injuries are diagnosed using X-rays, computed tomography (CT) scan or magnetic resonance imaging (MRI) of the spine.

Spinal trauma is an emergency condition and should be treated immediately to avoid further injury to the spinal cord. Immobilization of the head, neck and back is often the initial intervention. You may be treated with medications and epidural injections (injecting into spine) to alleviate pain. Surgery is recommended when other treatments are unsuccessful or inappropriate, and involves stabilization of any fractures and release of pressure from the compressed nerves and spinal cord. Completely damaged nerve tissue cannot be regenerated, but can be managed over time to restore some amount of feeling and function.

Long-term recovery from a traumatic spinal injury is based on physical therapy to prevent muscle wasting and development of contractures, occupational therapy to learn alternative methods of performing daily activities, and speech therapy to improve communication if needed.

 

 

SPINAL INJURIES AT WORK

Injuries at work place are very common and may be debilitating. Global statistics report that around 260 million non-fatal injuries occur every year around the world of which 350,000 cases may suffer death. Workplace injuries often occur because of high-risk jobs, lack of or scarcity in safety devices, lack of training and higher numbers of manual workers.

Spinal injuries are the most common workplace injuries that may occur while operating heavy machines, lifting heavy objects, driving automobiles or when you suffer a fall at the workplace.

Common spinal injuries you may suffer at the workplace include:

  • Fractures

  • Dislocation of adjacent bones

  • Partial misalignment (subluxation) of adjacent bones

  • Disc compression (herniated disc)

  • Hematoma (accumulation of blood)

  • Partial or complete tears of ligaments

The most common symptom of spinal injuries is pain. Some injuries may damage spinal nerves that may cause inflammation, loss of muscle control and loss of sensation. It may result in paralysis, limited movement and immobility. Workplace injuries are diagnosed using X-rays, computed tomography (CT) scans and magnetic-resonance imaging (MRI) scans.

Depending on the type and severity of injury, you may be treated with pain medications, epidural injections (injecting into spine), physiotherapy and surgery. Surgery is recommended when other treatments are a failure or inappropriate. Your spine surgeon may recommend rehabilitation that includes both physiotherapy and occupational therapy to promote complete and faster healing.

 

 

SPINAL FRACTURES

Vertebral compression fractures occur when the normal vertebral body of the spine is squeezed or compressed. The bone collapses when too much pressure is placed on the vertebrae, resulting in pain, limited mobility, loss of height, and spinal deformities. In severe compression fractures the vertebral body is pushed into the spinal canal which will apply pressure on the spinal cord and nerves.

Vertebral fractures result from weakened spine caused by osteogenesis imperfecta, osteoporosis, tumor and trauma. Osteogenesis imperfecta is a hereditary disease resulting in bone fragility. It is an autosomal dominant disorder of connective tissue that is characterized by easily fractured bones.

You may experience severe pain in the back which worsens on standing or walking and decreases when resting. Other symptoms include weakness and numbness in the affected areas, disability, limited spinal mobility and loss of overall height. The symptoms which indicate multiple fractures in the spine are hunch back, bulging stomach, shortness of breath, hip fracture and gastrointestinal problems.

Your doctor may require diagnostic tests such as X-ray, MRI scan and bone scan which help to determine and confirm the fracture.

  • Treatment:

The treatment for vertebral compression fractures aims at reducing the pain, stabilizing and repairing the fracture. The non-surgical measures include medications, back braces, bed rest and certain exercises. Non-steroidal anti-inflammatory drugs may be prescribed to relieve bone, muscle and nerve pain. A back brace may be suggested to support the back and immobilize the movements. Surgery may be needed if the pain persists despite non-surgical treatment. The two minimally invasive surgical procedures for treating vertebral compression fractures are:

  • Kyphoplasty: In this procedure, a deflated balloon called as bone tamp is injected into the spine. The balloon is inflated until it expands to a desired height. The created space is then filled with orthopedic cement called polymethylmethacrylate. This procedure helps to restore the height of the vertebrae and reduces the deformity.

  • Vertebroplasty: This technique involves injecting a cement material called polymethylmethacrylate into the collapsed vertebra. The injected cement hardens quickly, stabilizing the fracture, relieves pressure and prevents further collapse.

The following measures may be practiced to decrease the risk of developing vertebral fractures:

  • Learn some good techniques for standing, sitting, lifting and housework activities.

  • Avoid lifting heavy things, jumping, diving, horse riding, sliding and amusement rides

  • Ensure that you wear seat belts in cars

  • Exercise regularly. Swimming provides movement of joints without being stressed and is also good for the back muscles.

 

 

SPONDYLOARTHROPATHIES

Spondyloarthropathies are a group of chronic inflammatory diseases of the spine and joints. The most common spondyloarthropathies include ankylosing spondylitis, reactive arthritis, psoriatic arthritis and arthritis secondary to inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease. Spondyloarthropathies can occur at any age, however, they occur more often in young males.  A positive family history increases the risk of spondyloarthropathies.

The exact cause of spondyloarthropathies is not yet known. Infections with Chlamydia and other bacteria that cause dysentery have been found to activate reactive arthritis, a type of spondyloarthropathy.

  • Symptoms:

Although the different spondyloarthropathies have their own specific symptoms, some of the common symptoms include fatigue, lower back pain which may spread to the buttocks and early morning stiffness. Patients may also notice skin rashes, inflammatory eye diseases such as uveitis and intestinal disturbances. In severe cases, the spinal vertebrae fuse together, resulting in pain and stiffness of the spine. A few of the symptoms of spondyloarthropathies are very similar to that of rheumatoid arthritis.

  • Diagnosis: 

Diagnosis of Spondyloarthropathies includes a detailed medical history, physical examination and laboratory investigations. Imaging tests such as X-ray of the sacroiliac joint and spine may be useful in detecting spondylitis (inflammation of the spine). Some patients may also be tested for the presence of HLA-B27 gene.

  • Treatment:

Treatment of spondyloarthropathies is aimed at relieving pain and stiffness and prevention of any deformity. Regular physical exercise can control the progression of the disease and improve the functional ability of the joints. Medications such as non-steroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs and corticosteroids can provide symptomatic relief. For severe pain, corticosteroids can be directly injected into the joints or tendons. Antibiotics are prescribed for management of reactive arthritis. TNF alpha blocker injections have been found to be quite effective in managing the symptoms. Individuals prone to vertebral fracture are advised to wear a halo vest to stabilize the spine.

Surgical intervention is indicated in severe cases and may involve spinal fusion, osteotomy or total hip replacement. Complications such as osteoporosis, uveitis, inflammation of aortic valve in the heart, psoriasis and intestinal inflammation may occur in some patients and may require appropriate treatment by a physician, ophthalmologist, dermatologist or gastroenterologist.

 

 

SPONDYLOLYSIS

Spondylolysis is a stress fracture of vertebra that may progress into spondylolisthesis, a condition of displacement of vertebrae from the spinal column.  Spondylolysis is the cause for frequent low back pain in children. It is more common among children and teenagers who participate actively in sports such as football, weightlifting and gymnastics.

  • Causes:

Spondylolysis occurs because of a defect or stress fracture in the pars interarticularis, the part of the lumbar spine joining the upper and lower joints. Genetic factors may have a role. Children born with thin vertebra are prone to vertebral stress fractures. Also, repetitive trauma to the lower back area that occurs during sports and other activities can cause weakness of the pars interarticularis, resulting in spondylolysis.

  • Symptoms:

Although initially the patient may not have any symptoms, lower back pain is apparent during the teenage growth spurt period. The pain worsens with vigorous physical activities and exercises. At times, the pain may feel like a muscle strain.

  • Risk Factors:

Risk factors for developing spondylolysis include:

  • Family history of back problems

  • Repetitive trauma to the lower back

  • Increased lordosis (swayback)

  • Incomplete development of spinal cord (spina bifida occulta)

  • Participation in sports such as football, gymnastics and weight lifting that require constant overstretching of the spine

  • Complications:

Untreated spondylolysis may lead to further complications including:

  • Spondylolisthesis, a condition where one or more vertebrae slips out of place

  • Limited mobility and inactivity

  • Weight gain because of inactivity

  • Loss of bone density

  • Loss of muscle strength

  • Loss of flexibility

  • Permanent nerve damage

  • Chronic back pain

  • Numbness, tingling or weakness in the legs

  • Nerve compression causing problems with bowel or bladder control

  • Diagnosis:

Your surgeon diagnoses spondylolysis by asking several questions and performing several tests that include:

  • Family history

  • Medical history

  • Physical examination

  • X-ray

  • CT scan or MRI scan

  • Treatment:

Primary treatment for spondylolysis is always conservative. The goal of the conservative treatment is to reduce the pain, allow the fracture to heal and improve the function.

Conservative treatment options include:

  • Rest: Adequate rest should be taken and strenuous exercises should be avoided until the symptoms subside

  • Medications: Non-steroidal anti-inflammatory drugs (NSAID’s) may be prescribed to reduce the pain and inflammation. If NSAID’s do not provide relief, epidural steroid injections may be administered to the spine to reduce pain, numbness and tingling in the legs

  • Physical therapy: An exercise program helps to strengthen the abdominal and back muscles, improve flexibility and increase range of motion of the lower back.

  • Use of braces: In severe cases of spondylolysis, a brace or back support may be used to stabilize the lower back during fracture healing.

  • Surgical Treatment:

Surgery is usually required if spondylolysis has progressed into spondylolisthesis. The goal of the surgery is to remove any abnormal bone compressing a nerve and to stabilize the spine.

Decompressive Laminectomy & Spinal Fusion: In this procedure, a portion of the bone or lamina imparting pressure on the nerves is removed. A surgical incision is made in the back, then part of the bone and thickened tissue pressing on the spinal nerves is removed. This allows more space for the nerves, thus relieving pain and pressure. This procedure makes the spine unstable and therefore spinal fusion will be performed to stabilize the spine.

Spinal fusion is the procedure of joining two adjacent vertebrae. During the procedure, a piece of bone, taken from elsewhere in the body or donated from a bone bank, is transplanted between the adjacent vertebrae. As healing occurs, the transplanted bone fuses with the spine. This stimulates growth of a solid mass of bone which helps to stabilize the spine. In some cases, metal implants such as rods, hooks, wires, plates or screws are used to hold the vertebrae firm until the new bone grows between them.

  • Prevention:

Although spondylolysis is not completely preventable, certain factors can reduce the risk of developing the condition:

  • Maintaining a healthy weight to reduce stress on the lower back

  • Core exercises to keep the abdominal and back muscles strong will help to support the lower back

  • Eating a well-balanced diet to keep your bones strong

 

 

FACET JOINT ARTHRITIS

Facet joints, also called zygapophyseal joints, are located at the back of the spine which connects the vertebrae together. There are two joints between each pair of vertebrae located on either side of the spine. The facet joints provide stability for the spine.

Facet joint arthritis also known as facet joint syndrome is a form of arthritis that affects the facet joints of the spine. This condition is related to the ageing process. Facet joints are synovial joints. Normally the facet joints are lined by a cartilage and a membrane of synovium.

Loss of cartilage and synovial fluid in these joints causes friction due to contact between the bones. This results in development of osteophytes or bone spurs on or around the facet joints. Bone spurs are the bony growth formed along the edges of the bones.

Classical symptoms are pain and swelling around the joint. If a cervical joint is affected, the pain is usually felt over the neck radiating to the shoulder. If the joint is in the back, the pain is felt in the lower back that radiates to the buttocks and upper thigh area.

A diagnosis of facet joint arthritis is confirmed by injecting a small amount of a combination of x-ray contrast material, local anesthesia and corticosteroid into the joint. Relief of pain after the injection confirms the diagnosis of facet joint arthritis.

In most cases, symptoms can be (managed)? controlled by using conservative (line of management)?? treatment such as pain medication, use of braces, exercise, and corticosteroid injections. Surgery may be considered if conservative therapy does not show positive results.

 

 

PIRIFORMIS SYNDROME

Piriformis Syndrome is an uncommon, rare neuromuscular condition caused by the compression of the sciatic nerve by the piriformis muscle. The sciatic nerve is a thick and long nerve that passes below or through the piriformis muscle and goes down the back of the leg and finally ends in the feet in the form of smaller nerves.

  • Symptoms:

Piriformis Syndrome is characterized by pain, tingling and numbness in the buttocks. The pain may also extend down along the nerve and involve the leg as well (extraspinal sciatica).

Pain is usually exaggerated by activities which exert pressure over the piriformis muscle such as sitting for long hours, running or climbing stairs.

  • Diagnosis:

The diagnosis of piriformis syndrome involves a combination of physical examination employing different movements of the hip and the leg which may trigger characteristic pain in the buttock and leg. Imaging studies such as MRI may be useful in ruling out other causes of sciatic nerve compression such as degenerative disc disease, spondylolisthesis, spinal stenosis or arthritis of the spine.

  • Treatment:

Initially a conservative approach is used for the management of piriformis syndrome. This approach includes:

  • Lifestyle changes to avoid activities that trigger pain

  • Rest, ice and heat packs

  • Physical therapy comprising of stretching exercises to relieve compression of the sciatic nerve

  • Oral anti-inflammatory medications

  • Muscle relaxants

In patients with severe pain, corticosteroid or anesthetic injections can also be used.

In a few cases, botulism toxin injections and electrotherapy can also be considered. This help reduces the muscle tightness. In patients not responding to the conservative approach, surgery may be considered. This involves the surgical release of the piriformis muscle and decompression of the sciatic nerve.

 

 

WHIPLASH

Whiplash is a soft tissue injury to the neck, usually caused by sudden forceful jerk commonly occurring because of an automobile accident, sports injuries, or an accidental fall. Sometimes whiplash may also be referred to as neck strain, neck sprain or hyperextension injury.

Neck pain, stiffness in the neck and headache are the most common symptoms of whiplash. Headache may develop immediately after the injury or after a short period. Other symptoms include dizziness, tingling or pricking sensation in the upper extremities, shoulder pain, stiffness and psychological conditions such as memory loss, anxiety, depression and sleep disturbances.

Diagnosis depends on the history of the injury and the symptoms. X-ray of the neck may be taken to make sure there are no fractures or dislocation of the cervical spine. Pain medications, muscle relaxants, bed rest, cervical collar, neck exercises, ice therapy, heat therapy and physical therapy have been used in the management of symptoms. Bed rest and use of a soft cervical collar to immobilize the neck, usually results in minimal benefit, and hence early initiation of simple exercises is advised to restore flexibility. Physical therapy can be useful to help strengthen muscles and reduce pain. To avoid this injury, always wear your seat belt and adjust your headrest to a proper height while driving.

 

 

DISH (DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS)

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition commonly affecting the spine characterized by calcification (bony hardening) of ligaments, tendons and joint capsule insertions. Usually the upper portion of the back (thoracic spine) is affected, but it may also involve the neck (cervical spine) and lower back (lumbar spine). In a few cases, the elbow, patella, calcaneus and hip and knee joints may also be affected. The etiology remains unknown.

Diffuse idiopathic skeletal hyperostosis is more common among individuals older than 50 years of age with a male predominance. Diffuse idiopathic skeletal hyperostosis is often asymptomatic and is detected on unsuspected X-rays or CT/MRI scans. Some patients may complain of pain, stiffness and loss of range of motion. DISH is usually associated with osteoarthritis. Individuals with diffuse idiopathic skeletal hyperostosis tend to have a higher body mass index, elevated uric acid levels and a higher tendency to develop diabetes mellitus.

A doctor may recommend imaging tests such as X-rays, CT and MRI scans for the diagnosis of DISH.  The calcification of ligaments, particularly of the anterior longitudinal ligament, has a distinct appearance of candle wax dripping down your spine.

You may be prescribed non-steroidal anti-inflammatory drugs for pain relief. Chiropractic manipulation may also be beneficial. Arthroplasty surgery may be considered in patients with ossification around hip and knee joints.

A few patients with DISH may develop the following complications:

  • Myelopathy (spinal cord compression)

  • Rarely, dysphagia may result from the pressure of the overgrown ligamentous calcification on the esophagus

  • Cervical compression due to formation of osteophytes in the cervical spine

  • Rarely, osteophytes in the thoracic spine can compress bronchi, the larynx and trachea and the inferior vena cava.

  • Vertebral fractures may result from reduced flexibility of the vertebral column

 

 

BURNERS AND STINGERS

Burners and stingers are common neck or shoulder injuries characterized by intense burning or stinging pain which can radiate from the neck to the hand. They are caused by sudden movement or a direct blow to the neck resulting in an injury to the brachial plexus. This injury is commonly seen in contact sports such as football, ice hockey, wrestling and rugby. The brachial plexus is a group of nerves which pass from the neck to the arm that transmit the sensory and motor sensations of the arm. The compression or pinching of the brachial plexus results in pain. It usually lasts for a short period after which the symptoms resolve.  It may also be associated with numbness or weakness of the affected arm. In a few cases, it may last for a longer duration of time. People with a narrow spinal canal (spinal stenosis) are at an increased risk of recurrent burners and stingers.

The diagnosis of burners and stingers is usually made based on symptoms and the nature of injury; imaging studies are usually not required. Most of these resolves without any treatment. However, in a few patients the symptoms may persist longer. In such cases as well as in those with recurrent burners and stingers, immediate medical attention is required to check for any other significant injury. Physical therapy can also be considered for these patients.

Athletes should ensure complete recovery from burners and stingers before they return to active sports, as the risk of re-injury is very high. Athletes with recurrent burners and stingers are advised to wear a special neck roll or elevated shoulder pads while playing. Spider pads or cowboy collar may also be recommended in a few cases. Correct use of protective gear and proper sports technique help prevent such injuries.

 

 

MYELOPATHY

Myelopathy is a term used to refer to diseases that affect the spinal canal. Some of the common myelopathy diseases include carcinomatous myelopathy (degeneration of spinal cord associated with cancer), compressive myelopathy (changes in the spine because of pressure from hematomas or masses) and radiation myelopathy (spine destruction because of X-ray therapy).

The most common causes of myelopathy are trauma to the spinal cord because of vertebral fracture or dislocation, herniated disc, osteoarthritis of the spine and tumors. Other causes include viral infections, immune reactions and inadequate flow of blood through vessels of the spinal cord. It can occur at any age.

Cervical spondylotic myelopathy (CSM) is the most common disorder and it occurs in individuals aged above 55 years. Repeated trauma from activities such as carrying heavy loads or sports (gymnastics) increases the risk of CSM. The gradual wear and tear because of aging causes narrowing of the spinal canal that leads to compression of the spinal cord. This may cause symptoms such as:

  • Pain and stiffness in the neck

  • Loss of balance and coordination – difficulty in walking and performing simple tasks

  • Tingling sensation and numbness

  • Weakness

  • Diagnosis:

Your doctor may ask about your symptoms and examine your neck to look for any abnormal reflexes, numbness and atrophy of muscles. Some of the diagnostic tests such as X-rays, magnetic resonance imaging and myelogram may be done to confirm the diagnosis. Myelogram is a special type of computed tomography (CT) scan in which a dye is injected prior to the scan to get a clearer outline of the spinal cord.

  • Treatment Options:

Nonsurgical methods provide sufficient relief from the symptoms in most cases. These options include:

  • Soft Collars: Soft collars can be worn to allow the neck muscles to rest and restrict neck movements. This also helps in decreasing the pinching of nerve roots during movement.

  • Exercise: Simple exercises help to improve the strength and flexibility of your neck.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as aspirin and ibuprofen can be taken to reduce swelling and pain.

  • Epidural steroid injections: Cortisone injections are given directly into the epidural space to decrease swelling as well as pain.

  • Surgical Treatment:

Surgery of the spine is considered in case your symptoms do not alleviate with the conservative treatment methods. Spinal surgery involves anterior decompression (relieving pressure) of the spinal cord and nerve roots. During the procedure, certain plates and screws may be inserted to give internal support to the cervical spine and promote healing of the bone graft.

 

 

DEGENERATIVE SPINE

Degenerative spinal conditions are a group of disorders that causes loss of normal structure and function of the spine. These disorders may be caused due to ageing, infection, tumors, muscle strains or arthritis. Degenerative joint disease is commonly known as arthritis that affects feet, fingers, hands, spine and weight-bearing joints. It is caused due to the inflammation of joints because the articular cartilage covering the bones may be damaged or worn out. 

Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae.

  • Causes:

As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics. Annulus fibrosis, outer fibers surrounding the disc, become brittle and are more easily torn.  At the same time, nucleus pulposus, the soft gel-like substance located in the center of the disc, starts to dry out and shrink.

  • Symptoms:

Every patient is different and it is important to realize that not everyone develops symptoms because of degenerative disc disease. When the condition becomes painful or symptomatic, it can cause several different symptoms due to the compression of the nerve roots. Depending on the location of degenerative disc, it could cause back pain, radiating leg pain, neck pain, and radiating arm pain.

As the discs between the intervertebral bodies start to wear out, the entire lumbar spine becomes less flexible resulting in back pain and stiffness.

  • Diagnosis:

The diagnosis of degenerative disc disease begins with the patient’s history and a complete physical examination.  Examination of the back for flexibility, range of motion and the presence of certain signs that suggest nerve roots are being affected by degenerative changes in your back. This is done by testing the strength of your muscles and your reflexes to make sure that they are still working normally.

A series of X-rays is also usually ordered and if degenerative disc disease is present, the X-rays will often show a narrowing of the spaces between the vertebral bodies, which indicates the disc has become very thin or has collapsed. Bone spurs formed around the edges of the vertebral bodies and around the edges of the facet joints in the spine can be seen on an X-ray. Thus, the space available for the nerve roots starts to shrink. The nerve roots exit the spinal canal through a bony tunnel called the neural foramen and it is at this point the nerve roots are especially vulnerable to compression.

In most cases a MRI or a CT scan may be ordered to evaluate the degenerative changes, determine disc herniation and nerve root compression. A CT scan is often used to evaluate the anatomy in the spine which can show how much space is available for the nerve roots and within the neural foramina and spinal canal.

  • Treatment:

Both surgical and nonsurgical treatment options are available for degenerative conditions and the choice depends on various factors such as the age of the patient and severity of the disease.

Nonsurgical treatment – For people with no evidence of nerve root compression or muscle weakness, conservative treatment such as medication, rest, exercise and physical therapy are typically recommended.

Surgical treatment – Surgery is offered only after conservative treatment options have failed to adequately relieve the symptoms of pain, numbness and weakness over a significant period. Decompression of the spinal cord accompanied by a discectomy or an anterior cervical discectomy and fusion will be performed to remove the affected disc and fuse the associated vertebrae to stabilize the spine in that area.

 

 

OSTEOPOROSIS OF THE SPINE

Osteoporosis is a bone disease characterized by a decrease in bone mass and density resulting in brittle, fragile bones that are more susceptible to fractures. The condition most commonly affects elderly women. Osteoporosis-related fractures are more common at the vertebral bodies of the spine. Osteoporosis is called a "silent disease," as most the patients may be unaware of their condition until they develop a bone fracture.

The factors that increase the risk of developing osteoporosis include:

  • Women are at a higher risk than men

  • Family history of osteoporosis

  • Aging

  • Thin and small body frame

  • Low levels of estrogen and post menopause

  • Certain endocrine disorders such as diabetes

  • Medical conditions such as rheumatoid arthritis, cancer, and malabsorption syndromes or malnutrition

  • Some medications such as steroids, immunosuppressant, anticoagulants, antiepileptic and thyroid suppressive therapy

Osteoporosis in the spine can weaken bones and result in compression fractures, where the front of the bone collapses causing the spine to curve into a hunchback with loss of height. It may also cause pain, gastrointestinal and breathing problems, and disturbed sleep.

An accurate diagnosis of osteoporosis is essential to prevent future spinal compression fractures and to maintain a healthy spine. Your doctor will arrive at the diagnosis of osteoporosis based on the medical history, physical examination and neurological examination to evaluate your muscle strength, reflexes and sensations. X-rays, MRI, CT and bone scans of the spine may show fracture of the vertebrae. Your doctor may also order a bone densitometry scan, also called dual energy X-ray absorptiometry (DEXA) to measure bone density using a very low dose of X-ray.

Osteoporosis cannot be cured, but can be managed. Treatment is based on the patient’s age, gender, fracture risk and bone status. There are different treatment options available for the management of osteoporosis including lifestyle changes, weight bearing exercises, calcium and vitamin D supplements, hormone replacement therapy, and medications to stop bone loss and strengthen bones. Pain medications and spinal bracing are often recommended. When these methods fail to relieve symptoms, your surgeon may perform kyphoplasty, where a small deflated balloon is inserted into the fractured vertebra and inflated to restore its height, or vertebroplasty, where cement is injected into the narrowed vertebra.

Osteoporosis can be controlled and the complications can be prevented if detected early. Some of the preventive measures that can help reduce the risk of developing osteoporosis include:

  • Consume a healthy well balanced diet

  • Get adequate amounts of calcium and vitamin D

  • Avoid excessive alcohol intake and smoking

  • Exercise regularly