Scoliosis
Fractures and Dislocations
Fractures and dislocations can occur anywhere
in the body. The vertebral bodies which help support
the weight of the upper body can break resulting
in a compression fracture. These types of fractures
can be very painful and even disabling.
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It is important for the physician to determine
the nature of these fractures. Some fractures
can be caused by dangerous or serious conditions
such as cancers, malignancies, or advanced osteoporosis.
These are called pathological fractures. Other
types of fractures may occur through traumatic
events.
A dislocation is a term used to describe a condition
where a joint has been disrupted and has separated
to the point where the two adjacent bones are
no longer aligned or touching. When a joint is
dislocated the spine becomes unstable and is unable
to protect the spinal cord or nerves.
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Degenerative Disc Disease
Degenerative Disc Disease (DDD) is a natural
condition of the body that causes deterioration
of the intervertebral discs. This is a gradual
process that may compromise the spine. Although
DDD is relatively common, its effects are usually
not severe enough to warrant significant medical
intervention. The intervertebral disc is one structure
prone to degenerative changes associated with
aging. Long before Degenerative Disc Disease can
be seen radiographically, biochemical and histologic
(structural) changes occur. Over time the collagen
(protein) structure of the annulus fibrosis weakens
and may become structurally unstable. Additionally,
water and proteoglycans(PG) content decreases.
PGs are molecules that attract water. These changes
are linked and may lead to the disc's inability
to handle mechanical stress.
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Herniated Disc
Herniation of the nucleus pulposus (HNP) occurs
when the nucleus (gel-like substance) breaks through
the annulus fibrosis (tire-like structure) of
an intervertebral disc (spinal shock absorber).
Injury to the disc may result in pain, numbness,
tingling or loss of muscle strength. Disc injuries
in the neck region may affect the arms or hands
while disc injuries in the low back may affect
the legs or feet. People between the ages of 30
and 50 appear to be vulnerable because the elasticity
of the disc and water content of the nucleus decreases
with age.
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Facet Syndrome
Facet syndrome is a common spinal disorder affecting
the posterior joints that results in pain, stiffness
and inflammation. Increased stress at the facets
results in stretching of the ligamentous capsule,
deterioration of the smooth cartilaginous surfaces
and increased friction at the joint. In facet
syndrome, the symptoms of pain, discomfort and
weakness frequently localize to the spine, nonetheless
a small percentage may be felt in the extremities
or other body areas.
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Foraminal Stenosis
The spinal nerves pass through openings on
the side of the spine called intervertebral foramen.
Foraminal stenosis occurs when these openings
are smaller than normal. This condition can be
the result of injury, degenerative change or congenital
anomaly. The smaller opening may result in compression
of the nerve. This irritation often causes symptoms
of numbness, weakness, burning or tingling in
the involved extremity. Long standing or severe
stenosis may result in a functional loss.
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Spinal Stenosis
Spinal stenosis is a condition where the size
of the spinal canal is reduced. This may lead
to compression of the spinal cord. Symptoms often
include pain, numbness, tingling and weakness.
Severe cases may actually cause loss of function
and may even lead to disability. Spinal stenosis
is more common in patients over fifty years of
age. Many factors can cause stenosis including
injury and degenerative change.
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Fibromyalgia
Fibromyalgia is a chronic disorder associated
with widespread soft tissue pain, tenderness and
fatigue. A person with fibromyalgia will experience
pain when up to 18 specific areas called tender
points are pressed. Pushing carefully on these
specific points during an examination causes discomfort
or pain. The pain of fibromyalgia is more than
normal muscle aches common after physical exertion.
Fibromyalgia often can be severe enough to disrupt
a person's daily work and activities. The cause
of fibromyalgia is not known.
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Osteoporosis
Osteoporosis is commonly called the "fragile
bone disease." It is due to loss of bone
density caused by a deficiency in such bone-building
nutrients as calcium, vitamin D and other vitamins
and minerals. The most common complication of
osteoporosis is compression fracture. In people
with advanced osteoporosis, compression fractures
can occur as the result of simple daily activities
such as bending, carrying heavy loads, or a minor
fall.
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Osteoarthritis (DJD)
Osteoarthritis, also called degenerative joint
disease (DJD), is the most common type of arthritis.
OA can occur in almost any joint of the body but
most commonly occurs in the fingers, hips, knees
and spine. Over time changes occur within the
smooth cartilaginous surfaces of the joint. These
changes lead to a loss of elasticity and the cartilage
becomes stiff or brittle making it susceptible
to injury. This will lead to stiffness, pain and
crepitation at the joint. Advanced cases may actually
result in significant damage to the bone itself.
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Spondylolisthesis
Spondylolisthesis occurs when one vertebrae
slips forward (translation) in relation to the
adjacent vertebrae. Stability is inversely proportional
to the degree of translation. The ability of a
vertebrae to “slip” in relation to its
neighbor can be caused by many factors, including
facet or disc degeneration, trauma or a defect
in a region of the vertebrae called the pars interarticularis.
Severe cases may result in spinal cord or nerve
compression and can require surgical intervention.
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Sprain/Strain
Sprains and strains are two of the most common
causes of back pain. They can be caused by trauma,
overuse, lack of conditioning, and improper body
mechanics. The term sprain is used when this injury
occurs in a ligament. Conversely, strain is used
when the affected tissue is muscle or tendon.
Typically, patients will complain of increased
pain with activity and relief at rest. Treatment
will often include a period of rest followed by
a therapeutic exercise program to increase flexibility
and strength.
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Compression
Fracture
Compression fractures can occur in any vertebra
(spinal bones) and is described as a collapse
of the vertebra.
Symptoms
- The first symptom of a compression fracture
may be sudden and severe back pain that remains
in one local area. Some persons may experience
numbness/tingling, or weakness in the arms or
legs if the spinal cord or nerves leading away
from the fracture have been compressed. If multiple
fractures occur in an area of the back, the
person will develop a forward hump-like curvature
to the back.
Causes
- There are many possible causes of compression
fractures. Car accidents, falls, and weakening
of the bone due to pathology (i.e. cancer),
or Osteoporosis are common.
Diagnosis
- The diagnosis is based on observation
of the aforementioned symptoms and x-rays of
the spine. Additional tests (i.e. bone scan,
blood tests) may be needed to diagnose the actual
cause of the compression fracture.
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Cancer
If you have severe back pain, it is natural
to wonder whether or not the pain might be a
sign of cancer. Tumors in the spinal column
may cause pain from expansion of the bone or
from weakening the bone, which in turn can result
in spinal fractures, compression (pinching)
of the nerves, or spinal instability.
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Discitis
Discitis, or disc space infection, is an inflammatory
lesion of the intervertebral disc that occurs
in adults but more commonly in children. Its
cause has been the subject of debate, although
most authors believe it to be infectious. The
infection probably begins in one of the continguous
end plates, and the disc is infected secondarily.
Severe back pain that begins insidiously is
characteristic of the disease.
Discitis
in Children
Although most children will continue to walk
in spite of the pain, young children may refuse
to ambulate. The characteristic finding is extension
of the spine and the child's complete refusal
to flex the spine. Children with discitis usually
are not systemically ill. They rarely have an
elevated temperature and their white blood cell
count is frequently normal. However the erythrocyte
sedimentation rate is usually increased. Lateral
radiographs of the spine usually will reveal
disc space narrowing with erosion of the vertebral
end plates of the contiguous vertebrae. bone
scanning may be helpful in localizing a lesion
that is difficult to diagnose clinically. Some
bone scans are falsely negative, so the diagnosis
of disc space infection should not be excluded
simply because the bone scan is normal. Magnetic
resonance imaging (MRI) seems to be helpful
in identifying a disc space infection.
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Kyphosis
Kyphosis
is the abnormal forward bending of the spine.
In kyphosis, the curve of the spine is abnormal,
forming a hump.
What
is going on in the body?
The
normal spine rounds slightly in the chest area,
with arching in the lower back and neck regions.
Excessive kyphosis can occur mainly in the chest
area of the spine, causing the roundness of
the back to appear exaggerated.
What
are the signs and symptoms of the condition?
Symptoms
are usually minimal, unless the deformity is
severe. In that case, the back may ache or,
rarely, nerve problems may arise. The hamstrings,
or muscles at the back of the thigh, may also
be tight.
What
are the causes and risks of the condition?
Kyphosis
is generally caused by an abnormal posture.
Other possible causes include: · a significant
fracture of the vertebra, which can cause the
back to angle forward · spinal surgery
· Scheuermann's disease, which results
in wedging of the vertebrae. This disease is
usually seen in teenage boys, and its cause
is unknown. Pott's disease, which refers to
kyphosis due to collapse of the vertebra when
tuberculosis infects the spine · osteoporosis
in elderly women, which causes a type of kyphosis
known as dowager's hump · spinal tumors,
or surgery to remove them · nerve disorders
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Lordosis
Lordosis is a disorder defined by an excessive
inward curve of the spine. It differs from the
spine's normal curves at the cervical, thoracic,
and lumbar regions, which are, to a degree,
either kyphotic or lordotic. The spine's natural
curves position the head over the pelvis and
work as shock absorbers to distribute mechanical
stress during movement.
Lordosis can be found in all age groups. It
primarily affects the lumbar spine, but does
occur in the neck (cervical). When found in
the lumbar spine, the patient may appear swayback,
the buttocks more prominent, and in general
an exaggerated posture. A lumbar lordosis can
be painful sometimes affecting movement.
Certain
disease processes can adversely affect the structural
integrity of the spine and contribute to lordosis.
Some common causes include achondroplasia, discitis,
kyphosis, obesity, osteoporosis, and spondylolisthesis.
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Ligamentous
Hypertrophy
Ligaments run up and down the spinal column.
Hypertrophy of the ligaments in the vertebral
canal (the posterior longitudinal ligament --
runs up and down along the back side of the
vertebral bodies, and the ligamentum flavum
-- runs up and down under the posterior bone
ring made up of the lamina and spinous process)
can increase their mass enough that they narrow
the canal (stenosis) sometimes to the point
that the spinal cord and/or nerve roots running
through the canal are compressed. When the posterior
longitudinal ligament in front and ligamentum
flavum behind the spinal cord hypertrophy the
cord is almost "circumferentially"
surrounded and compressed).
Hypertrophy
of the ligamentum flavum laterally near the
facet joint can also contribute to foraminal
narrowing (stenosis) with potential nerve compression
(pinching).
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Obesity
According to the American Obesity Association
(AOA) 64.5 percent of adult Americans
(about 127 million) are categorized as being
overweight or obese (1). The unfortunate truth
is that obesity is becoming a global epidemic
affecting adults and children.
Connection
to Back Pain
Most people know that obesity contributes to
the development of coronary heart disease, diabetes,
high blood pressure, and colon cancer. However,
did you know that obesity is a contributing
factor to back pain? It is true. Being overweight
or obese can significantly contribute to symptoms
associated with osteoporosis, osteoarthritis
(OA), rheumatoid arthritis (RA), degenerative
disc disease (DDD), spinal stenosis, and spondylolisthesis.
The
spine is designed to carry the body's weight
and distribute the loads encountered during
rest and activity. When excess weight is carried,
the spine is forced to assimilate the burden,
which may lead to structural compromise and
damage (e.g. injury, sciatica).
One
region of the spine that is most vulnerable
to the effects of obesity is the low back; the
lumbar spine. Lack of exercise and bodily conditioning
leads to poor flexibility and weak muscles in
the back, pelvis, and thighs. This can increase
the curve of the lower back causing the pelvis
to tilt too far forward. Further, this is detrimental
to proper posture and as posture weakens, other
regions of the spine (neck) may become painful.
You
may try to dismiss the cause of some of these
spinal disorders to the process of normal aging.
It is true that with age body tissues can cause
changes to spinal anatomy (2). However, if you
are overweight or obese, chances are you have,
or will have, back pain.
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Trauma
Trauma to the spine refers to injury that has
occurred to bony elements, soft tissues and/or
neurological structures. The two things that
surgeons are most concerned about, in the case
of spinal trauma, are instability of the vertebral
column and actual or potential neurological
injury.
Stability to the spinal column can be compromised
when bony elements are injured or there is disruption
to soft tissues such as ligaments. Instability
causes the back to become unable to successfully
carry normal loads, which can lead to permanent
deformity, severe pain and in some cases catastrophic
neurological injuries. Most often the instability
comes from a fracture in one of the bony parts
of the vertebra, specifically the vertebral
body, the lamina or the pedicles.
In
the case of trauma, dislocations and fractures
happen simultaneously and can result in a very
unstable spinal column. They can occur in any
region of the spine and are associated with
a degree of neurological injury. A surgeon needs
to restore the mechanical stability of the spine
to try and prevent more neurologic injury, progressive
deformity or prolonged incapacitation pain.
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Back
pain in pregnancy
Introduction to back pain during pregnancy
For pregnant women, back pain during pregnancy
is not a trivial matter. If not addressed, it
can have a negative impact on your daily lifestyle,
cause missed time from work, and make your delivery
more difficult. Back pain in the course of your
pregnancy can also create problems that will
continue for an extended period after delivery.
Addressing
back pain during pregnancy
While it is fairly common, back pain during
pregnancy should definitely not be accepted
as just part of the process. To help make your
pregnancy as pleasant as possible and facilitate
an easier delivery, back pain should be always
be addressed as quickly as possible and managed
throughout your pregnancy.
Low
back pain of long duration (several weeks or
months) during pregnancy is a predictor for
post partum back pain (pain after birth). For
this reason, pregnant women are encouraged to
seek appropriate treatment for back pain during
pregnancy.
Likewise,
any post partum pain that lasts longer than
six to eight weeks should be treated in order
to avoid chronic or recurring back problems.
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Radiculopathy
lumbar radiculopathy, which refers to pain in
the lower extremities in a dermatomal pattern.
A dermatome is a specific area in the lower
extremity innervated by a specific lumbar nerve.
This pain is caused by compression of the roots
of the spinal nerves in the lumbar region of
the spine. Diagnosing leg and back pain begins
with a detailed patient history and examination.
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Scoliosis
Scoliosis is defined as a side-to-side deviation
from the normal frontal axis of the body. Although
traditional, this definition is limited since
the deformity occurs in varying degrees in all
three planes: back-front; side-to-side; top-to-bottom.
Scoliosis is a descriptive term and not a diagnosis.
As such, a search is made for the cause. In
more than 80% of the cases, a specific cause
is not found and such cases are termed idiopathic,
i.e., of undetermined cause. This is particularly
so among the type of scoliosis seen in adolescent
girls. Conditions known to cause spinal deformity
are congenital spinal column abnormalities,
neurological disorders, genetic conditions and
a multitude of other causes. Scoliosis does
not come from carrying heavy things, athletic
involvement, sleeping/standing postures, or
minor lower limb length inequality.
In managing AIS, the judgment of the surgeon
and the participation of informed patients and
families are as important in determining treatment
outcome as surgical techniques. Decision-making
in the management of AIS remains complex despite
the availability of data on natural history,
prognosis of different curve patterns, brace
treatment factors, and surgical innovations.
The management of AIS includes several steps
and treatment options:
· screening and early detection of deformity,
· observation of changes in deformity
over time with informed judgment regarding prognosis,
orthotic and non-operative interventions,
· surgical planning and operating.
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Sciatica
This is a condition which causes pain down the
back of one or both thighs. Inflammation of
the sciatic nerve (which is the largest nerve
in the body-about the diameter of your little
finger) can be either constant or intermittent.
Success in solving this problem is directly
correlated to the diagnosis. Sciatica can be
caused by a pinched nerve as it exits the low
back spine or it can be caused by prostatic
cancer. Odds are usually that the cause is some
structural imbalance, but there are so many
potential causes, some serious and some benign,
it is better to at least know that there may
be a grave cause to the symptoms.
This doesn't mean that you shouldn't immediately
incorporate a strategy to eliminate any structural
imbalances. In most cases, this will resolve
the problem. If the problem doesn't respond
to these basic efforts, then professional assistance
may be needed. The first effort in relieving
sciatic symptoms should be to review Hip Pain.
Trigger points can accumulate in the piriformis
muscle forcing a contraction and strangulation
of the sciatic nerve. The tennis ball exercise
should be incorporated to help to relax the
piriformis muscle. Stretching may be beneficial,
but that is more of a "try an see"
exercise.
If there are no improvements with this approach,
refer to Low Back Pain to better understand
the relationship between the sciatic nerve and
the low back spine. Seeking help from a chiropractor
or orthopedist may be indicated if the solution
can't be found at home.
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