SPINAL CONDITIONS

Your spine will become stiffer and lose its flexibility as you age. By the time you are 20, your discs may begin to show signs of deterioration. They begin to lose their water content, becoming flatter and more brittle as they dry out. Sometimes the disc will swell and bulge out, without actually releasing any of its center fluids. These changes are part of the aging process and account for most episodes of low back pain, though they also can occur without pain.

The tough, fibrous outer covering of the disc is more likely to develop tiny tears as part of this degeneration. Eventually, the soft, compressible substance in the center of the disc (which, in surgery, looks and feels like crab meat) can come out through the tears, resulting in a herniation or rupture. If the substance pokes out far enough to irritate a nerve, it can cause pain in your back and/or down your leg. This typically is called a slipped disc (aka herniated disc, bulging disc, or protrusion), though the disc is attached firmly between the vertebrae.

Often, before a disc ruptures, you will experience a single occurrence of low back pain or a history of occasional low back pain. But once the disc actually ruptures, the most common complaint is pain that is usually sharp or throbbing and can cause mild to severe discomfort in your back and shooting pain down your leg. If the damaged disc is in the middle or lower part of your back, you also may experience numbness, tingling or weakness in the buttocks, legs, or feet. Other symptoms include a shooting pain that occurs if you cough, sneeze, or strain, and pain that may become worse after prolonged sitting or standing. Usually only one leg is affected.

Herniated discs occur most frequently in the lumbar spine – between the bottom of your ribs and your hips – and are most common in people in their 30s and 40s.

Spinal stenosis refers to the shrinking or narrowing of the spinal canal. The reduction in the size of the spinal canal can be congenital (present at birth) but is more common as a developmental problem (meaning it occurs as we grow older.) As the spinal canal narrows, there is less room for the nerves to branch out and move freely. As a result, they may become swollen and inflamed, which can cause pain. Spinal stenosis can be caused by degenerative changes, injury or surgery.

Who is Affected?

Symptoms may start slowly or occur as a sudden onset of pain. The condition affects both males and females and is most common between the ages of 50 and 70. Individuals with spinal stenosis may experience vague pain in the low back and legs when walking or standing. As the disease progresses, some patients may feel a sharp, jabbing pain that shoots down the leg with each step.

Treatments:

Nonsurgical treatment for stenosis can include the use of nonsteroidal anti-inflammatory medications and physical therapy. Rest, analgesics, muscle relaxants and application of ice may be helpful in the acute stages.

Common conservative treatment for pain relief is epidural steroid injections. This procedure involves the injection of steroids and an analgesic numbing agent into the epidural space of the spine to reduce the swelling and inflammation of the nerves. Injections often provide temporary relief that can last from a few days to several months.

Spinal stenosis can be difficult to treat definitively without surgery. Depending on the location of the stenosis, one of two surgical options is available.

• One option is to make an entrance through the lamina, or bony arched portion of the vertebra, to give the nerves more space.
• Another option can be considered when spinal stenosis has constricted the foraminal openings in the vertebra that provide a passageway for the nerves. This procedure, called a foraminotomy, enlarges the foramen to free up space for the nerves and decrease compression, and thereby reduce inflammation of the nerve.

Following surgery to treat spinal stenosis, most patients stay in the hospital for two or three days and are back to full activity in about six weeks.

Spondylolysis and spondylolisthesis (also “spondylosis”) are conditions that affect the articulating joint (pars interarticularis) of the spine’s facet joint. Treatment options include physical therapy to strengthen the muscles surrounding the area. In severe cases, surgery is also an option.

What is it?

Spondylolysis refers to a defect in a specific part of the spine’s facet joint called the pars interarticularis. This defect can cause instability in the vertebra, much like a loose hinge on a door. Over time, with ongoing stresses, the ligaments and muscles that help hold the vertebral body in place may become overworked and strained.

As a result, the entire vertebral body can slide forward, which can cause nerves to be pinched, causing pain. This sliding of the vertebral body is called spondylolisthesis. Both spondylolysis and spondylolisthesis can be present at birth or occur through injury.

Mild cases of spondylolysis and spondylolisthesis usually cause minimal pain. Indeed, the conditions are often discovered incidentally when a person has an examination or X-rays of the back for an unrelated reason.

Treatments:

When spondylolysis and spondylolisthesis do cause pain, you may experience back pain and stiffness, muscle spasms, sciatica, or numbness. The pain is usually treated by strengthening back muscles and avoiding heavy lifting. If that treatment is unsuccessful, a spine surgeon can use a very successful surgical treatment method that maintains the correct alignment of the spine with excellent results, if done properly.

Spondylosis (Spinal Osteoarthritis) is defined as arthritis that affects the spine. Symptoms may range from mild to severe. Spondylosis may affect the Cervica (neck), thoracic (mid-back) or lumbar (low back) regions of the spine. Structural components of the spine affected by spondylosis include intervertebral discs, facet joints and ligaments.

Degenerative changes in the spine can cause a cascade of problems. Discs may become thin, weak, and at risk of herniating or bulging. These thin or damaged discs decrease the space between the vertebral bodies. The facet joints are also affected, which can lead to irritation and inflammation of nerve roots, and ultimately to pain. Sometimes the body’s response to an ill-functioning facet joint is to produce bone spurs also called osteophytes. These spurs can also cause further pain and problems.

Many cases of spondylosis are mild and require minimal treatment. Non-surgical treatments include: NSAIDS (Non-Steroidal Ant-inflammatory drugs ie. Motrin, Advil), Narcotics (opiod pain medications used for short term pain), Muscle relaxants, Physical Therapy, Spinal Injections (such as epidural steroid injections or facet injections) and Acupuncture.

Surgical treatment for Spondylosis alone is seldom needed unless evidence of neurological deficit exists. This may include compression of spinal cord or nerves which may result in weakness or bowel or bladder incontinence.

Does your back feel old?

Spondylosis is arthritis that affects the spine. It is sometimes called spinal osteoarthritis. Spondylosis is a degenerative spinal disorder that commonly develops in people over age 40. It can affect any region of the spine—the cervical region (neck), thoracic region (mid-back), or lumbar region (low back).
Symptoms range from mild to severe and may become chronic or even disabling. They may include:

Cervical (Neck): Cervical Spondylosis

• Pain that comes and goes
• Pain spreads into your shoulders, arms, hands, fingers
• Morning neck or shoulder stiffness or a limited range of motion after getting out of bed
• Neck or shoulder tenderness or numbness
• Weakness or tingling in your neck, shoulders, arms, hands, or fingers
• Headache pain in the back of your head
• Loss of balance
• Difficulty swallowing (This is rare, but it may occur if the spinal cord is compressed.)

Thoracic (Mid-back): Thoracic Spondylosis

• Pain in the upper and mid sections of the back
• Bending and extending your body triggers pain
• Morning stiffness

Lumbar (Low back): Lumbar Spondylosis

• Back pain that comes and goes
• Morning low back stiffness after getting out of bed
• Pain that decreases with rest or after exercise
• Area tenderness or numbness
• Sciatica (mild to intense leg pain)
• Weakness, numbness, or tingling in the low back, legs, or feet
• Difficulty walking
• Bowel or bladder problems (This is rare, but it may occur if the spinal cord is compressed.)

To get the best treatment, you first need to know the origin of the problem. This article will help you understand
spondylosis and some of its causes. You will read about treatment options and discover prevention tips to help you avoid injury.