Spine

Low Back Pain

Low back pain is very common problem. More than 80% of people have at least one episode of low back pain during their lifetime. Your back is formed by bones, muscles, nerves, and ligaments that work together to help you stand and bend. The bones of the back are called vertebrae, which together form the spinal column. Between each stacked pair of vertebrae in the spinal column is a disc acting like cushions or shock absorbers.

Nonspecific back pain

The pain is not clearly caused by a specific disease, abnormality, or serious injury of the spine. This type of pain most often represents a strain in one or more of the muscles in the lower back, and it can be severe.

Serious potential causes

Rarely, back pain is caused by a potentially serious spinal condition, such as an infection, tumour, or "cauda equina syndrome," which causes leg weakness and bowel or bladder dysfunction as well as back pain. Other potential causes include vertebral (spinal) compression fractures, in which one or more vertebrae become fractured as a result of weakening and thinning of the bones due to osteoporosis.

Degenerative disc disease

Over time, normal wear and tear can lead to degenerative disc "disease" (breakdown of the spinal discs), with the development of small cracks and tears and/or loss of fluid in the discs. This can lead to changes in the neighbouring spinal vertebrae, including the formation of bone spurs (areas of bony overgrowth). Bulging and herniated discs — Too much wear and tear on spinal discs can lead to the bulging of a disc, in which the outer covering is weakened and the disc protrudes. Some people may develop sciatica (pain that extends down the back of the leg) if the bulging disc presses on a nerve.

Osteoarthritis

Osteoarthritis can affect the joints that connect the vertebrae to one another, called the facet joints. This condition, known as facet joint arthropathy, can lead to bone spurs around the joint and may cause low back pain. Spondylolisthesis — Spondylolisthesis is a condition in which one of the vertebrae of the lower spine "slips" forward in relation to another. Spondylolisthesis is usually caused by stress on the joints of the lower back and may be associated with facet joint arthropathy TREATMENT Unless the low back pain is caused by a serious medical condition (which is uncommon), it typically resolves fairly quickly. Most of the patients can be managed with a short period of relative rest, Activity modifications, physical modalities, Analgesics, muscle relaxants and physiotherapy exercises. Surgery - Only a small minority of people with low back pain will require surgery.

Sciatica (Lumbar Radiculopathy)

Sciatic nerve starts in the lower back and runs down the back of each leg. The nerve controls the muscles in the lower leg and provides sensation to the back of the thigh, lower leg and the sole of your foot. Sciatica is the term given to the pain, numbness or tingling sensation radiating along the course of the nerve. Severe cases of sciatica present with muscle weakness. Common causes for sciatica include irritation of the sciatic nerve roots due to herniated disc in lumbar region, bony overgrowth or stenosis from degenerative disorders in lumbar spine, compression of the nerve under piriformis muscle in the buttocks. Examination by your doctor may help to find out the reason for the irritated nerve root. X-rays and other specialized imaging tools, such as a magnetic resonance imaging (MRI) scan can confirm your doctor's diagnosis.

The condition usually gets controlled with relative rest, medications and physical therapy. You might need surgery if you have leg pain persisting for 3 months or more of nonsurgical treatment.

Neck Pain

The neck or cervical spine is formed by seven cervical vertebrae bone C1 to C7. In between adjacent vertebra are discs, which act as shock absorbers. There are supporting ligaments and muscles. Neck pain can be classified as "acute" (lasting less than six weeks) or "chronic" (lasting more than 12 weeks). While most episodes of acute pain resolve quickly, some people do go on to have chronic pain.

Causes of Neck pain

• Cervical strain: Can occur when there is an injury to the muscles of the neck, causing tightness of the cervical and upper back muscles.
• Cervical spondylosis: A condition caused by abnormal wear and tear (called degenerative changes) of the cervical spine.
• Cervical facet osteoarthritis: The facet joints are located on sides of the vertebrae, and arthritis in this area can cause pain in the side of the neck.
• Whiplash injury: "Whiplash" is a term used to describe injury caused by a traumatic event that causes an abrupt forward/backward movement of the neck. Whiplash can affect many of the structures in the neck, including the muscles, ligaments, and joints. Most people with neck pain will not need an imaging test. In some cases, an imaging test such as an X-ray, computed tomography [CT] scan, or magnetic resonance imaging [MRI]) will be recommended.

In most cases, neck pain can be treated conservatively with medications, ice or heat, and stretching exercises and postural corrections. Surgery may be recommended for those with symptoms related to nerve or spinal cord compression (cervical spondylotic myelopathy or cervical radiculopathy).

Cervical Radiculopathy

Cervical radiculopathy means that a nerve in the neck (a cervical nerve) is pinched. This can happen because of an injury to the cervical spine (vertebrae) in the neck, or due to age related degeneration of the cervical disc. This condition can cause pain or loss of feeling (numbness) that runs from your neck all the way down to your arm and fingers. Treatment With rest, the condition often gets better over time. Wearing a soft neck collar (cervical collar) for short periods of time. Doing exercises (physical therapy) to strengthen your neck muscles. Taking medicines. Surgery: This may be needed if other treatments do not help. The type of surgery that is used will depend on the cause of your condition.

Lumbar Disc prolapse (Disc Herniation)

The lumbar spine is made up of the lower five vertebrae. Doctors often refer to these vertebrae as L1 to L5. Intervertebral discs separate the vertebrae. A disc is made of two parts. The center, called the nucleus, is spongy. It provides most of the disc's ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Healthy discs work like shock absorbers to cushion the spine. They protect the spine against the daily pull of gravity. They also protect it during strenuous activities that put strong force on the spine, such as jumping, running, and lifting. Causes Herniation occurs when the nucleus in the center of the disc pushes out of its normal space. The nucleus presses against the annulus, causing the disc to bulge outward. Sometimes the nucleus herniates completely through the annulus and squeezes out of the disc.

Spinal Canal Stenosis

Spinal stenosis describes a clinical syndrome of buttock or leg pain. These symptoms may occur with or without back pain. It is a condition in which the nerves in the spinal canal are compressed. The spinal canal is the hollow tube formed by the bones of the spinal column. Anything that causes this bony tube to shrink can squeeze the nerves inside. There are many reasons why symptoms of spinal stenosis develop. Some of the more common reasons include congenital stenosis (being born with a small spinal canal), spinal degeneration, spinal instability, disc herniation. Diagnosis begins with a complete history and physical examination. The best way to see the effects and extent of lumbar spinal stenosis is with a magnetic resonance imaging (MRI) scan. Non-operative Treatment Unless your condition is causing significant problems or is rapidly getting worse, most doctors will begin with nonsurgical treatments. Up to one-half of all patients with mild-to-moderate lumbar spinal stenosis can manage their symptoms with conservative (nonsurgical) care. Neurologic decline and paralysis in this group is rare. Surgery The main surgical procedure used to treat spinal stenosis is lumbar laminectomy. Some patients also require fusion surgery along with the laminectomy procedure if spinal instability is present.

Spondylolisthesis

Normally, the bones of the spine (the vertebrae) stand neatly stacked on top of one another. Ligaments and joints support the spine. Spondylolisthesis alters the alignment of the spine. In this condition, one of the spine bones slips forward over the one below it. As the bone slips forward, the nearby tissues and nerves may become irritated and painful.
Spondylolisthesis may very rarely be congenital, which means it is present at birth. It can also occur in childhood as a result of injury. In older adults, degeneration of the disc and facet (spinal) joints can lead to spondylolisthesis.
A condition called spondylolysis can lead to the slippage that happens with spondylolisthesis. Spondylolysis is a defect in the bony ring of the spinal column. It affects the pars interarticularis. This defect is most commonly thought to be a stress fracture that happens from repeated strains on the bony ring. Participants in gymnastics and football commonly suffer these strains.
The slippage is graded from I through IV, one being mild, IV often causing neurological symptoms. An ache in the low back and buttock areas is the most common complaint in patients with spondylolisthesis. Pain is usually worse when standing, walking, or bending backward and may be eased by resting or bending the spine forward. Nerve compression can cause symptoms where the nerve travels and may include numbness, tingling, slowed reflexes, and muscle weakness in the legs.
Diagnosis begins with a complete history and physical exam. Doctors will usually order X-rays of the low back. The X-rays are taken with your spine in various positions. They can be used to see which vertebra is slipping and how far it has slipped.
Non-Operative Treatment Most patients with symptoms from degenerative spondylolisthesis do not need surgery and respond well to nonoperative care. Medications may be prescribed to help ease pain and muscle spasm. If your doctor diagnoses an acute pars fracture that has the potential to heal, it may be recommended that you wear a rigid back brace for two to three months. This usually occurs in children and teenagers who begin having back pain and see their doctor early on. Surgery Surgery is used when the slip is severe and when symptoms are not relieved with nonsurgical treatments.

Spine Fractures

Spinal fractures anywhere along the spine mostly result from serious injuries like high-energy trauma. Other fractures can be the result of a lower-impact event, such as a minor fall, in an older person whose bones are weakened by osteoporosis. Spinal fracture symptoms may include:

• Pain in the back or neck
• Tingling or numbness in limbs
• Weakness or paralysis of limbs
• Uncontrolled muscle contractions
• Loss of urinary or bowel control

Spinal fractures require an evaluation on emergency basis. It is diagnosed using: X-rays to check for fractures or dislocations of the spine Spine CT scan to get detailed view of the broken spinal bone. MRI scan to determine soft tissue damage to the ligaments and discs, and assess spinal cord injury.

When a spinal fracture is suspected, the first step is to stabilize the individual. This may be done through the use of a backboard, stretcher or cervical collar to prevent the person from moving and sustaining further injuries. Minor fractures of the spine can be managed with rest and medication. Whereas more severe fractures might require surgery to realign the bones. If left untreated, spinal fractures can lead to permanent spinal cord injury, nerve damage and paralysis.

Osteoporosis spine

Osteoporosis is the condition in which bone become weaker and hence have high chance of breaking with slight or no injury. The bones in the spine are called vertebrae. When they break due to osteoporosis, they are called as vertebral compression fractures. Osteoporotic spine most often breaks in the upper thoracic region. These fractures cause pain over the back. Multiple such fractures cause decreased height of the patient along with rounded back deformity called as kyphosis. Osteoporosis is diagnosed by testing the bone density through DEXA scan. It is recommended for women over 65 years and in men over 70 years. Osteoporotic fractures are better prevented than treated. Eating diet rich in calcium, getting adequate vitamin D, having an active lifestyle, medications to increase your bone density as per your doctors recommendations are the things you can do. Treatment of the fractures include rest, pain relief medications, brace. Surgery is recommended for those with severe pain, not responding to the conservative management. The two types of vertebral augmentation methods available are kyphoplasty and vertebroplasty. Both are minimally invasive procedures.

Spine Deformities

Two types of spinal deformities are Scoliosis and kyphosis.

Scoliosis

This is the abnormal curvature of the spine in sideways. Scoliosis most frequently occurs in children and teenagers. It can occur in adults, either as the progression of the pre-existing deformity, or as a newly diagnosed condition due to degeneration of spine or osteoporosis. Symptoms vary with age of onset and severity of the deformity. Sitting imbalance, breathing difficulty or delayed development are common symptoms in infants and young children. Cosmetic problems, shoulder height imbalance is common in the adolescent age group. Back pain, sciatica, leg weakness or numbness are common presentations in adults.

Kyphosis

This is the abnormal curvature of the spine in forward direction giving a rounded shape to the back. The patient presents with inability to stand straight. When this occurs along with scoliosis, it’s called as kyphoscoliosis. Treatment is based on the severity and progression of the deformity. Milder forms of deformity are managed with special spinal braces, along with exercises to improve the flexibility and strength of the spinal musculature. Surgery is recommended for those with neurological involvement (weakness, numbness, bowel and bladder dysfunction), worsening of the degree of deformity, unstable deformities.

Spinal Arthritis

Spinal arthritis refers to the arthritis happening in the small joints called as facet joints in the neck and back or the sacroiliac joint between the spine and pelvis. They fall into two broad categories: Inflammatory arthritis and Osteoarthritis.

Osteoarthritis of the Spine

Osteoarthritis (noninflammatory or degenerative arthritis) is the most common form of spinal arthritis. It develops through wear and tear in the cartilage lining of facet joints. Degeneration of the spinal discs can put more pressure onto the facet joint and can lead to further damage to the cartilage.

Rheumatoid Arthritis of the Spine

RA is an autoimmune disorder, meaning that the immune system turns on itself. It attacks synovium — the lining of the joints.

Spondyloarthritis

Spondyloarthritis is a group of inflammatory diseases that affect both the joints and the locations where the ligaments and tendons attach to the bones (entheses). Most common forms include Ankylosing spondylitis, Psoriatic arthritis, Reactive arthritis.

Symptoms of Arthritis

• Includes back pain, neck pain, stiffness and radiculopathy (sciatica) Management
• Medications, Physical therapy, Lifestyle modification, postural precautions.
• Rarely, surgical interventions are required.