common spinal problems

Neck and back pain can be debilitating; fortunately, most spinal pathology is self limiting [ie, the pain and problems resolve with time, exercises and at times injections.

Below is a list of the most common issues we see in our clinics.

 

Cervical Disc Herniation [Neck and arm pain]

Pure disc herniations causing symptoms in the neck [cervical spine] is not common. The most common cause of neck and arm pain is the presence of a combination of disc material with bony arthritic ridges which develop overtime.

Disc herniations in association with arthritic spurs [ridges] cause compression on the nerve roots which leads to inflammation and pain. Some numbness and weakness may also be present. The pain usually worsens with activities and neck motion.

The MRI above shows the cervical [neck] spine. The spinal canal with the whitish fluid is violated by a large sized disc herniation as marked with the white arrow. The Red arrow points to the spinal nerves and spinal cord which are being pushed back by the disc herniation. The Blue arrow points to the white spinal fluid.

Fortunately, most neck and arm pain resolves within a few weeks. If the symptoms are not resolving/improving, Physical Therapy and Injections are options with good success rates.

When a patient fails conservative management, Cervical Fusion is an option to release the pressure on the nerves.

Lumbar Disc Herniations [low back]

Although a large percentage of the population experiences low back pain, disc herniations which tend to cause leg pain/numbness [sciatica] are much less common. Some risk factors for developing sciatica is young age [30-50] years old and stressful occupations.

Disc herniations cause compression on the nerve roots which leads to inflammation and sciatica. Sciatica involves pain in the side of the back and buttock region which radiates at times to the legs/feet. Some numbness and weakness may also be present. The pain usually worsens with prolonged sitting or increased abdominal pressure [such as having bowel movements].

The MRI above shows a similar view of the low back. The spinal canal with the whitish fluid is violated by a large, golf sized disc herniation as marked with the white arrow. The Red arrow points to the spinal nerves which are being pushed back by the disc herniation. The Blue arrow points to the white spinal fluid.

Fortunately, most sciatica resolves within a few weeks. If the symptoms are not resolving/improving, Physical Therapy and Injections are options with good success rates.

When a patient fails conservative management, a surgical Microdiscectomy is an option to release the pressure on the nerves.

Cervical Myelopathy [Arm and leg weakness with potential loss of bowel/bladder/sexual function]

 Can my spine effect my urination/defecation or sexual function?

Although not common, spine injuries can significantly affect bowel, bladder or sexual function. This is one the “Red Flags” that doctors fear with back/neck problems.

When there is excessive pressure on the spinal cord [image marked with red circle around the area where the color of the spinal cord has changed to white showing permanent injury to the cord], the nerves which control one’s urination, defecation or sexual function can be permanently injured. Also, the individual’s balance and hand control become affected. The term myelopathy is used to refer to cord compression and the above resulting dysfunctions.

If any of the above symptoms are present, immediate evaluation by a doctor is crucial to prevent progressive worsening of the symptoms. At times, even with treatment, some of the lost function can not be recovered.

 

Degerative Disc Disease [low back]

Disc problems such as herniations are usually associated with leg pain and symptoms. However, in degenerative disc disease, the patients usually complain of low back pain as the main symptom that they have.

When you look closely at the discs, you notice that the L5/S1 disc [white arrow] is dark compared to the rest of the discs which are more whitish in color. The dark disc is considered degenerated and has lost its “normal fluid”.

Degenerative disc disease is controversial. Many asymptomatic individuals above the age of 25 have “black discs” that do not cause any problems. As such, its difficult to blame a black disc for back pain in some whereas others have no problems with it. Discography is commonly used to try to identify discs which are “painful’; again, discography is also controversial as normal, asymptomatic people may have painful discs on discography.

Nevertheless, if the symptoms are not resolving/improving with time, Physical Therapy is a good option with minimal risks. Injections tend not to be as helpful in this type of problem.

For patients that can absolutely not live with their pain, Surgical Fusion may be an option.

Spondylolisthesis [low back]

Spondylolisthesis is the slippage of one vertebrae upon another. There are multiple “types” of slippage. The degenerative type is commonly seen in the elderly population and the “isthmic” type is commonly seen in the younger population.

In the degenerative “older” type, the patient usually has symptoms of Spinal Stenosis with increase chance of back pain. If the slippage is unstable, back pain becomes more significant.

The isthmic [younger] type of slippage is likely present from early adulthood; the patients tend to become symptomatic in their twenties or thirties.

Above, the 4th lumbar vertebra [white arrow] has slipped forward compared to the 5th lumbar vertebra [blue arrow]. This is an example of degenerative [older patients] type of slippage.

Both types of slippage respond well to physical therapy; epidural injections can also help calm the nerves down.

If the pain is not responsive to the therapy and injections, Lumbar Fusion surgery is the treatment of choice with good prognosis.

Spinal Stenosis [low back]

Spinal stenosis is a common problem noted in the elderly population. As we age, the joints in the spine become arthritic and form bone spurs; the ligaments “thicken” and the discs collapse and “protrude” into the spinal canal.

The spinal canal has a limited amount of space, and as the bony spurs, disc and ligament invade into the canal, the nerves have less room available to them. The increasing pressure on the nerves cause some back and mostly leg pain which usually worsens with standing or walking; the leg pain is usually relieved by sitting.

The MRI above shows the spinal canal narrowing at the point of the two white arrows. The fluid in the canal narrows as a result of “Spinal Stenosis”.

Most people are able to control exacerbation of their pain with Medications and Physical Therapy When medications are no longer effective, Epidural Steroid Injections are tried which have a reasonable success rate to help calm the irritated nerve roots down.

If all of the above treatments fail and the patient is unable to live with the pain, the option of surgical Decompression is offered. Only a small percentage of people end up having surgery for this condition. Potential Surgical Complications have to be weighed against the potential benefit of the surgery and a decision can then be made to proceed with surgical intervention.

Compression Fractures [low back]

Compression fractures are commonly seen in the elderly population. Women are more likely to suffer these fractures. The fractures do not necessarily only happen after falls and may occur during activities of daily living [such as coughing, getting out of bed, etc].

Although the fractures are very painful initially, most patients with compression fractures have relatively quick recovery. The initial treatment may include bed rest, bracing, pain medication, Cacitonin and other medications depending on the location and severity of the fracture.

Rarely, the fracture may cause problems with weakness or numbness in the legs; bowel and bladder function may also get affected. In these cases, rapid intervention with surgery is absolutely necessary. Fortunately, this type of situation is exceedingly rare.

If the fracture continues to cause significant pain at about 2 to 3 weeks after the injury, however, surgical intervention via Kyphoplasty may be appropriate. This procedure is “minimally invasive”; the average patient has quick pain relief with rapid recovery and is usually able to return to their normal daily activities within a few days of the procedure.

MOVE IMAGE TO LOCAL SERVER

Kyphoplasty image
The left panel shows a fractured vertebra; the vertebra is compressed in the front and has lost its usually square/rectangular shape. With kyphoplasty, a balloon is introduced into the vertebra which can “jack up” the vertebra via inflation of the balloon. Cement is then injected to keep the proper shape of the vertebra with significant pain relief.

 

Cervical Arthritis [Neck pain]

As we age, our joints start to break down secondary to naturally occurring wear and tear. The neck is no exception to the above rule.

Cervical arthritis is the wear and tear breakdown of the joints and discs between the vertebrae in the neck region. The breakdown of the cartilage may lead to neck and arm pain.

Unfortunately, we all develop cervical arthritis with time. Fortunately, however, only a few people with arthritis develop symptoms from it.

Most people are able to control exacerbations of their pain with Medications and Physical Therapy. When medications are no longer effective, Epidural Steroid Injections are tried which have a reasonable success rate to help calm the irritated nerve roots down.

If all of the above treatments fail and the patient is unable to live with the pain, the option of Cervical Fusion is offered. Only a small percentage of people end up having surgery for this condition. Potential Surgical Complications have to be weighed against the potential benefit of the surgery and a decision can then be made to proceed with surgical intervention.

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