Spine Pathologies

Overview

The spine is divided into three parts cervical, dorsal, and lumbar. Each component has unique features that are influenced by its everyday use and wear. Each of these regions of the spine will have its own pathophysiology and therapy.

The most common conditions that can affect the spine in its many parts are degenerative, traumatic, and scoliosis diseases.

 

What are the Most Common Spine Pathologies?

Spinal osteoarthritis

 

What is Osteoarthritis of the Spine?

The breakdown of the cartilage in the joints and discs of the neck and lower back is known as osteoarthritis of the spine.

Osteoarthritis can cause spurs that put pressure on nerves exiting the spinal column. This might result in arm or leg weakness and discomfort.

 

What are the Symptoms of Osteoarthritis of the Spine?

Spine osteoarthritis can cause stiffness or discomfort in the neck or back. If it is severe enough to harm spinal nerves or the spinal cord itself, it may also cause weakness or numbness in the legs or arms. When a person lies down, the back pain usually goes away.

Some people have little interruption with their daily routines. Others become permanently crippled.

A person with osteoarthritis may have social and emotional challenges in addition to the physical symptoms. For example, a person suffering from osteoarthritis that interferes with everyday activities and work performance may feel depressed or helpless.

 

How is Osteoarthritis of the Spine Diagnosed?

An X-ray is the best technique to confirm an osteoarthritis diagnosis. The doctor will conduct a medical history and perform a physical exam to determine whether the patient has pain, discomfort, or loss of mobility in the neck or lower back, or whether symptoms indicative of nerve involvement, such as weakness, reflex abnormalities, or loss of feeling.

Certain tests may be ordered by the doctor to help in the diagnosis of spine osteoarthritis. Among these tests are:

• X-rays to look for bone damage, bone spurs, and loss of cartilage or disc; however, X-rays are not able to show early damage to cartilage.
• Blood tests to exclude other diseases
• Magnetic resonance imaging (MRI) to show possible damage to discs or narrowing of areas where spinal nerves exit

 

Treatment of Spine Osteoarthritis

There is no treatment for osteoarthritis of the spine, neither is it reversible. The therapy objective is to alleviate discomfort and increase mobility in the affected joint. Your doctor can go over treatment choices with you. Mild instances of spine OA may react to over-the-counter drugs like acetaminophen (Tylenol). To avoid liver damage, use this drug exactly as advised. Ibuprofen (Advil) and naproxen sodium can also be used to treat pain and inflammation (EC-Naprosyn). These drugs' side effects include upset stomach, blood issues, and organ damage, therefore it's critical to take them exactly as prescribed.

If over-the-counter medications do not relieve your symptoms, your doctor may recommend antidepressants used to treat chronic pain. Another alternative is to inject corticosteroids directly into the afflicted joints. Surgery is not a typical therapy for OA of the spine, but your doctor may consider it in severe instances to replace damaged discs in your spine.

Other methods for treating and managing with spine osteoarthritis include:

• gentle exercises to reduce pain and improve range of motion in the remaining cartilage.
• heat or cold therapy.
• occupational and physical therapy.
  
  

Spinal canal stenosis

Spinal stenosis occurs when the space within the backbone becomes too tiny. This can put stress on the spinal cord and nerves that go through it. Spinal stenosis most commonly affects the lower back and neck.

 

Spinal canal stenosis Symptoms

Spinal stenosis frequently has no symptoms. When symptoms do appear, they appear gradually and worsen over time. The symptoms differ depending on which part of the spine is affected.

In the lower back: Spinal stenosis in the lower back can cause pain or cramping in one or both legs. This happens when you stand for a long time or when you walk. Symptoms get better when you bend forward or sit. Some people also have back pain.

In the neck: Spinal stenosis in the neck can cause:

• Numbness.
• Tingling or weakness in a hand, leg, foot or arm.
• Problems with walking and balance.
• Neck pain.
• Problems with the bowel or bladder.

 

What Causes Spinal canal stenosis? 

From the skull to the tailbone, the spinal bones are piled in a column. They protect the spinal cord, which flows via a passage known as the spinal canal Some individuals are born with a narrow spinal canal. However, most cases of spinal stenosis arise when something reduces the amount of free space within the spine. 

• Bone spurs. They are one of the causes of spinal stenosis. Arthritic wear and strain can cause additional bone to form on the spine. These are known as bone spurs. They have the ability to push into the spinal canal. Paget's disease can also result in the formation of additional bone on the spine.
• Herniated disks. Disks are the soft cushions that act as shock absorbers between your spinal bones. If part of the disk's soft inner material leaks out, it can press on the spinal cord or nerves.
• Thick ligaments. The strong cords that help hold the bones of your spine together can become stiff and thick over time. Thick ligaments can push into the spinal canal.
• Tumors. Rarely, tumors can form inside the spinal canal.
• Spinal injuries. Car accidents and other trauma can cause spinal bones to break or move out of place. Swelling of nearby tissue right after back surgery also can put pressure on the spinal cord or nerves.

 

Diagnosis of Spinal canal stenosis

Your healthcare provider may ask about your symptoms and medical history. You may have a physical exam. You also may need an imaging test to help find the problem.

These tests may include:

• X-rays. An X-ray of the back can show bone changes that may be making the space within the spinal canal smaller. Each X-ray involves a small dose of radiation.
• Magnetic resonance imaging (MRI). An MRI creates comprehensive pictures of hard and soft tissue by using a strong magnet and radio waves. The exam can detect disk and ligament damage. It can also reveal any malignancies that are present.
• Computerized tomography (CT). If you are unable to get an MRI, you may require a CT scan. This examination includes X-ray pictures acquired from several angles. A contrast dye is injected into the spinal cord and nerves during a CT myelogram to define the spinal cord and nerves. This may reveal herniated disks, bone spurs, or malignancies.

 

Treatment of Spinal canal stenosis

Treatment for spinal stenosis depends on how severe your symptoms are.

 

Medications

Your health care provider might prescribe:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). If common pain relievers don't provide enough relief, prescription NSAIDs might be helpful.
• Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
• Anti-seizure drugs. Some anti-seizure drugs, such as gabapentin are used to reduce pain caused by damaged nerves.
• Opioids. Medications such as oxycodone and hydrocodone can be habit-forming.

 

Physical therapy

A physical therapist can teach you exercises that may help:

• Build up your strength and endurance
• Maintain the flexibility and stability of your spine
• Improve your balance

 

Steroid shots

Where your nerve roots are squeezed, they may become inflamed and swollen. Injecting a steroid drug into the area surrounding the pinched nerve may help decrease inflammation and alleviate discomfort.

Steroid injections, on the other hand, may not be the ideal option for spinal stenosis. According to some research, combination injections of steroids and a numbing drug treat back pain no better than numbing medicine shots alone.

This is significant because steroids can have severe side effects. Steroid injections can damage adjacent bones, tendons, and ligaments over time. As a result, a person must frequently wait many months before receiving another steroid injection.

 

Needle procedure for thickened ligaments

The ligament at the back of the lumbar spine might become too thick at times. Some ligament can be removed with needle-like equipment put through the skin. This can increase spinal canal space and relieve strain on nerve roots. You can be offered medication to help you relax during the surgery. Many folks can return home on the same day.

 

Surgery

Surgeries to create more space within the spinal canal may include:

• Laminectomy. The damaged spinal bone's rear section (lamina) is removed during this procedure. This relieves nerve strain by creating greater space surrounding them. In some situations, metal hardware and a bone transplant may be required to connect that bone to neighboring spinal bones.
• Laminotomy. This operation merely removes a portion of the lamina. The surgeon carves a small enough hole to alleviate pressure in a specified location.
• Laminoplasty. This surgery is exclusively performed on the spinal bones in the neck. It expands the space within the spinal canal by forming a hinge on the lamina. Metal hardware spans the gap in the spine's opening part.

Herniated disc or Herniated nucleus pulposus

Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber).

Herniated Disc Symptoms

The discomfort is usually felt on one side of the body. Depending on the place of damage, symptoms may include the following:

• With a slipped disk in your lower back, you may have severe pain in one leg, hip, or buttocks and numbness in others. You may also have discomfort or numbness on the back of your leg or the sole of your foot. The same leg may feel weak as well.
• You may have discomfort while moving your neck, deep ache around or over the shoulder blade, or pain that spreads to your upper arm, forearm, and fingers if you have a slipped disk in your neck. Numbness might also occur along your shoulder, elbow, forearm, and fingers.
• The pain often starts slowly. It may get worse:
• After standing or sitting.
• At night.
• When sneezing, coughing, or laughing.
• When bending backward or walking more than a few yards or meters.
• When straining or holding your breath, such as when having a bowel movement.
• You may also have weakness in certain muscles. Sometimes, you may not notice it until your health care provider examines you. In other cases, you will notice that you have a hard time lifting your leg or arm, standing on your toes on one side, squeezing tightly with one of your hands, or other problems. Your bladder control may be lost. The pain, numbness, or weakness often goes away or improves a lot over weeks to months.

 

How Disc Herniation is Diagnosed?

 Tests done may include: 

• Spine MRI or spine CT may be done to show where the herniated disk is pressing on the spinal canal.
• Electromyography (EMG) may be done to determine the exact nerve root that is involved.
• Myelogram may be done to determine the size and location of disk herniation.
• Nerve conduction velocity test may also be done.
• Spine x-ray may be done to rule out other causes of back or neck pain. It can look at how healthy your bone is and also look for how much room there is for your spinal nerves to travel out of the spinal cord. However, it is not possible to diagnose a herniated disk by a spine x-ray alone. 

 

How Disc Herniation is Treated?

The initial therapy for a slipped disk is a brief time of rest and pain medication. Physical treatment is then administered. Most persons who get these therapies recover and resume their usual lives. Some folks will require further therapy. Steroid injections or surgery may be used.

 

Medications

Medicines can help with your pain. Your provider may prescribe any of the following:

• NSAIDs for long-term pain control
• Narcotics if the pain is severe and does not respond to NSAIDs
• Medicines to calm the nerves
• Muscle relaxants to relieve back spasms

 

Lifestyle Changes

If you are overweight, diet and exercise are critical for reducing back discomfort.

Physical treatment is essential for almost everyone who has disk disease. Therapists will teach you correct lifting, dressing, walking, and other tasks. They show you how to strengthen the muscles that support your spine. 

Take care of your back at home:

• Reduce activity for the first few days. Slowly restart your usual activities.
• Avoid heavy lifting or twisting your back for the first 6 weeks after the pain starts.
• After 2 to 3 weeks, gradually start exercising again.

 

Surgery

Surgery may be an option if your symptoms do not go away with other treatments and time. One such surgery is discectomy, which removes all or part of a disk.

 

Spine curvature disorders

The spine should run straight down the center of the back when viewed from behind. When there are spinal anomalies, the natural curvatures of the spine are misplaced or exacerbated in some locations, as in lordosis, kyphosis, and scoliosis.

 

What are the Types of Spine Curvature Disorders?

Spine curvature problems are classified into three types:

1. Lordosis. The spine of a person with lordosis curves strongly inward in the lower back, often known as swayback.
2. Kyphosis. The upper back of a person with kyphosis is abnormally rounded (more than 50 degrees of curvature).
3. Scoliosis. Scoliosis is characterized by a lateral curvature in the spine. The curve is frequently S- or C-shaped.

 

Lordosis

What Can Cause Lordosis?

• Achondroplasia. A disorder in which bones do not grow normally, resulting in the short stature associated with dwarfism
• Spondylolisthesis. A condition in which a vertebra, usually in the lower back, slips forward
• Osteoporosis. A condition in which vertebrae become fragile and can be easily broken (compression fractures)
• Kyphosis. A condition marked by an abnormally rounded upper back
• Discitis. Inflammation of the disc space between the bones of the spine most often caused by infection

 

What are the Symptoms of Lordosis?

Symptoms of lordosis may include:

• Appearing swayback, with the buttocks being more pronounced.
• Having a large gap between the lower back and the floor when lying on your back on a hard surface that does not change when you bend forward.
• Back pain and discomfort.
• Problems moving certain ways.

 

Lordosis Management

Treatment for lordosis may include:

• Medication to relieve pain and swelling.
• Exercise and physical therapy to increase muscle strength and flexibility.
• Wearing a back brace.
• Weight loss.
• Surgery.

 

Kyphosis

What Can Cause Kyphosis?

• Abnormal vertebrae development in utero (congenital kyphosis)
• Poor posture or slouching (postural kyphosis)
• Scheuermann’s disease, a condition that causes vertebrae to be misshaped (Scheuermann’s kyphosis)
• Arthritis
• Osteoporosis
• Spina bifida, a birth defect in which the spinal column of the fetus does not close completely during development inside the womb
• Spine infections
• Spine tumors

 

Kyphosis Symptoms

Symptoms of kyphosis are usually visible in nature and include:

• Bending forward of the head compared to the rest of the body.
• Hump or curve to the upper back.
• Fatigue in back or legs.
• Postural kyphosis does not typically cause back pain; however, physical activity and long periods of standing and sitting can cause discomfort for people with Scheuermann’s kyphosis.

 

Treatment of kyphosis

• Exercise and anti-inflammatory medication to ease pain or discomfort.
• Wearing a back brace.
• Surgery to correct severe spine curvature and congenital kyphosis.
• Exercises and physical therapy to increase muscle strength.

 

Scoliosis

• Symptoms of scoliosis.

Symptoms of scoliosis may include having:

• Uneven shoulder blades with one being higher than the other.
• An uneven waist or hip.
• Leaning toward one side.

 

How are Scoliosis Treated?

In general, treatment is determined based on the severity and type of spinal curvature disorder you have. Mild spinal curvature, as occurs with postural kyphosis, may not be treated at all. More severe spinal curvature may require the use of a back brace or surgery.

Treatment for scoliosis may include:

• Observation. If there is a slight curve your doctor may choose to check your back every four to six months to see if the curve gets worse.
• Bracing. Depending on the degree of the curve, a back brace is sometimes prescribed for kids and adolescents who are still growing. Bracing can help prevent the curve from getting worse.
• Surgery. If the curve is severe and is getting worse, surgery is sometimes needed.
• Body casting. A cast is placed from the shoulders to the lower trunk while the child is under anesthesia. It is replaced every few months for up to 3 years. This is usually reserved for young children when a scoliosis curve looks like it will get worse as they grow.
• Exercise programs, chiropractic treatment, electrical stimulation, and nutritional supplements have not been proven to prevent the worsening of scoliosis. It is still ideal to keep as much as strength and flexibility to maintain normal function. This may require more effort and attention in someone with scoliosis.

 

Conclusion

Your spine is made up of 26 bone discs known as vertebrae. The vertebrae are the bones that protect your spinal cord and allow you to stand and bend. A variety of issues can alter the anatomy of the spine or cause harm to the vertebrae and surrounding tissue such as infections, injuries, tumors, conditions such as ankylosing spondylitis and scoliosis, and age-related bone changes such as spinal stenosis and ruptured disks are among them.

When bone abnormalities impose strain on the spinal cord or nerves, spinal diseases frequently cause pain. They can also be used to restrict mobility. Treatments vary depending on the condition, however they might involve back braces and surgery.