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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