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Neuroscience

Diseases and Conditions of the Spine

Overview
Types
Causes & Symptoms
Diagnosis
Treatments Options

Overview

Extending from the neck to the pelvis, the spinal column supports the weight of the upper body and houses the spinal cord – the delicate system of nerves that carry signals to control body movement and transmit sensation. The spinal column, also called the spine, is constructed of 33 bones called vertebrae stacked on top of each other. An opening in each one creates a channel for the spinal cord.

In adults, the spinal cord descends from the base of the brain to just below the rib cage, but nerves leave the spinal cord and run for many inches inside the spinal column. There are also small nerves that enter and leave the spinal column through spaces called foramen. Between each vertebral body, there’s a disc, which cushions the vertebral bodies and allows for some flexibility.

Disorders and diseases

There are a number of disorders and diseases that affect various parts of the spine:

• Degenerative disorders
  · Arthritis
  · Disc degeneration
  · Osteoporosis
  · Spinal stenosis
  · Deformitys
  · Nerve compression
  · Disc herniations
• Infections
  · Abscess
  · Osteomyelitis
  · Discitis
  · Meningitis
• Traumatic injuries
  · Fractures
  · Disc herniations
  · Neurologic injury
• Spine tumors

Virtually all of these ailments have one thing in common – pain. Typically, the pain is located in the midline of the neck or back, and may spread to the limbs or trunk.

Causes and Symptoms of Spine Conditions

The aging process results in a decrease in bone strength as well as reduced muscle tone and elasticity. The discs begin to lose fluid and flexibility, compromising their ability to cushion the vertebrae. Pain can be the result of something as minor as a strained muscle or something as serious as a compressed nerve.

Symptoms – seven warning signs

Most patients with back pain recover relatively quickly with no lasting complications. There are seven warning signs that a serious condition may be present. Patients should call their doctor whenever one of these signs is evident:

1. The pain persists, is severe, and extends to the limbs or trunk.
2. Arm or leg pain increases when patients bend.
3. Severe pain follows a recent fall.
4. Significant back pain lasting more than several weeks.
5. Pain becomes worse when patient rests, or if pain awakens the patient, especially if a fever is present.
6. Persistent bowel or bladder problems.
7. Numbness or weakness in the legs.

Diagnosis of spine conditions

An assortment of diagnostic procedures can be used to determine the cause of low back pain:

• Physical examination
• X-rays
  · Traditional – looks for broken bones or injured vertebrae
  · Discography – special contrast dye injected into spinal disc
• Myelograms
• CT scan
• MRI scan
• Electrodiagnostic procedures – measures electrical conduction in nerves and muscles
• Bone scans – diagnoses infection, fractures or bone disorders
• Ultrasound imaging

Treatment options – non-surgical

Non-surgical treatment is the hallmark of spine management. Even in cases where surgery is performed, permanent self-care is required. Non-surgical treatments include:

• Bed rest/reduced activity
• Therapeutic exercise
• Physical therapy
• Medications
  · Pain relief
  · Anti-inflammatory
  · Anti-convulsants (for some types of nerve pain)
  · Anti-depressants (used for pain relief)
  · Injection of steroids/anesthetic agents directly into the spinal area
• Complementary treatments
  · Acupuncture
  · Biofeedback
  · Herb therapy
  · Massage
  · Psychological support

· Lifestyle/job modification

Treatment options – surgical

Thanks to advances in surgical techniques, people with spine conditions can choose from a wide array of surgical options that are effective in treating many spine disorders. These procedures include:

• Decompression procedures
  · Diskectomy – a portion of a damaged disc is removed.
  · Microdiskectomy – a surgical microscope is used during a diskectomy.
  · Laminotomy – a portion of the lamina (the bone at the back of the spinal column) is removed. This is usually done to access a disc herniation which is putting pressure on the nerve.
  · Laminectomy – the entire lamina is removed and possibly part of a disc or bone spur.
  · Minimally invasive surgery – a procedure similar to knee arthroscopy, wherein the surgical procedure is done through smaller incisions, causing less disruption to muscle and soft tissue.
• Fusion procedures
  · Performed to make the spine more stable
  · Two or more vertebrae are locked together, or fused, using a bone graft
  · Metal supports may also be used
• Reconstruction
  · Degenerative, traumatic, infectious or tumor-induced deformity are corrected with metal implants, fusion, bracing and rehabilitation

Links

Teri Holwerda, an Advanced Practice Nurse at Saint Mary’s, has authored a number of helpful articles on spinal disorders. You can view them here.

Learn more about the Spine Program at Saint Mary’s

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