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Spine Conditions and Treatments

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Cauda Equina Syndrome

 

What is cauda equina syndrome?
Your spinal cord actually ends at about the level of your hip bones, but the nerves that go to your legs continue in a thick sheath that resembles a horse’s tail – the “cauda equina.” Compression or inflammation of the nerve roots can cause symptoms of pain, altered reflexes, decreased strength and decreased sensation.

What can I do about it?
You should see a doctor right away if you have new-onset low back pain, along with any of the following:

  • Difficulty urinating
  • Difficulty having a bowel movement
  • Numbness or tingling in your inner thighs or perianal region

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Compression Fracture

 

What is a compression fracture?
Compression fractures of the vertebral body are fairly common, especially in postmenopausal women. They happen when the strength of the spinal column cannot withstand the weight of the body. In other words, the bones of the spine get weak and can’t support your weight anymore, so they get crushed – or compressed – much like crushing a Styrofoam cup. Vertebral compression fractures usually are caused by osteoporosis. In cases of severe osteoporosis, the “trauma” that causes the fracture can be minor – such as stepping out of a bathtub or vigorous sneezing.

How are compression fractures diagnosed?
While the diagnosis can be suspected from the patient’s history and the physical exam, plain X-rays, as well as occasional CT or MRI, are often helpful in accurate diagnosis and prognosis.

How are compression fractures treated?
Traditional conservative treatment includes bed rest, pain control and physical therapy. Interventional procedures such as vertebroplasty can be considered in those patients who do not respond to conservative treatment.

Most patients make a full recovery – or at least significant improvements – from their compression fractures after 6 to 12 weeks, and can return to a normal exercise program after the fracture is fully healed. A well-balanced diet, regular exercise, calcium and Vitamin D supplements, smoking cessation and medications to treat osteoporosis (such as bisphosphonates) may help prevent additional compression fractures.

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Degenerative Disc Disease

 

What is degenerative disc disease (DDD)?
Do not worry – it’s not really a “disease!” DDD is a phrase used to describe the normal, age-related changes in your spinal discs. When we are young, the spinal discs are soft and spongy; they act as the shock absorbers in our spine, allowing us to bend and twist. As we age, the discs lose some of their cushion, which can cause back pain.

Will my spine continue to degenerate?
The word “degenerative” might make you think that the symptoms will get worse with age, but that is not always true. The disc does continue to degenerate over time, but the low back pain usually gets better.

What can I do about it?
The pain often gets worse with movements such as bending over, reaching up, or twisting, so avoiding these motions can help you feel better. Keeping the muscles in your stomach and back – your “core” – strong will also help your back feel better.

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Herniated Disc

 

What are discs?
Discs are the structures that serve as shock absorbers between the vertebrae of the spinal column. The center of the disc, called the nucleus, is soft and springy (like the filling of a jelly donut) and accepts the shock of standing, walking, running, etc. The outer ring of the disc, called the annulus, provides structure and strength to the disc. The annulus is comprised of a complex series of interwoven layers of fibrous tissues which hold the nucleus in place (like a radial tire).

What is a herniated disc?
The term herniated (also known as slipped, protruded or ruptured) – disc is a little misleading. The disc itself does not slip. Rather, the soft material inside the disc (nucleus pulposus) squishes out from a tear in the tough outer ring (annulus). When the disc has herniated or ruptured, it may create pressure against one or more of the spinal nerves which can cause pain, weakness or numbness in the neck and arm.

What are the treatments for herniated cervical discs?
Depending upon the results of the physical and radiologic examination and the severity of your condition, your doctor may offer you two forms of treatment. The first common treatment prescribed for neck pain caused by the herniated cervical disc is conservative therapy. Conservative therapy may consist of a period of a cervical collar, cervical traction, analgesics, chiropractic and/or physical therapy.

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Myelopathy

 

What is myelopathy?
If disc or bone push on the spinal cord, the symptoms are called myelopathy. The signs of myelopathy are variable, but typically are also associated with decreased motor and sensory functions, sometimes involving arms and legs, and sometimes altering bowel and bladder control. There may also be increased reflexes or potentially absent reflexes if the cord injury is severe.

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Radiculopathy

 

What is radiculopathy?
Radiculopathy is irritation of a nerve near your spine. This can be caused by a disc herniation, bone spur, or tumor that presses on a nerve root. You may experience pain radiating down the arm or leg. You might feel numbness, tingling or burning. You may also feel weak in that extremity.

Since each nerve root supplies a specific muscle group and sensory area, a physician can often interpret the patient’s symptoms and physical findings and determine which nerve root is irritated. For many people, radiculopathy will get better with time, medication and physical therapy.

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Sciatica

 

What is sciatica?
Sciatica is the common term for “radiculopathy." This is irritation of a nerve in your buttock region.

Image showing the sciatic nerve

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Scoliosis

 

What is scoliosis?
Scoliosis is a condition in which the spine curves abnormally from side to side (S-shaped or C-shaped). In addition to the side-to-side deformity, the spine usually twists or rotates as well. Very small curves are very common. Most of us do not have perfectly straight spines, and small degrees of scoliosis don’t usually cause any problems.

Who gets scoliosis?
Idiopathic scoliosis usually starts in childhood, most commonly in girls between the ages of 10 and 16. “Idiopathic” means that we don’t really know what causes it. Scoliosis is a common feature of many neuromuscular disorders such as muscular dystrophies or cerebral palsy.

Who needs scoliosis surgery?
Scoliosis surgery is usually reserved for young people with very large curves who are not done growing yet; without surgery, they run the risk of becoming so bent and twisted that their heart and lungs and other internal organs cannot work properly. If you’ve reached adulthood with a small degree of scoliosis, you probably don’t need surgery simply to correct the bend in your spine.

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Spinal Stenosis

 

What is spinal stenosis?
Spinal stenosis is a narrowing in the space of your vertebrae that carries your spinal cord and the nerves to your arms and legs. This space is normally very small, and many different diseases and conditions can make the canal get even smaller. Arthritis, falls, accidents, and wear and tear on the bones and joints in the spine play a part in stenosis. As the spinal canal shrinks, the nerves that go through it are squeezed. This squeezing may cause pain, numbness, tingling, weakness or clumsiness in your neck, back, arms, or legs. Many adults have this kind of stenosis.

Illustration showing spinal stenosis

Is spinal stenosis the same thing as a ruptured disc?
No. A ruptured – or herniated – disc usually pinches one or two nerves at a time. The pain caused by a pinched nerve is called radiculopathy. Spinal stenosis usually affects many nerves at once; this can lead to a more serious condition called myelopathy.

What can I do for the pain and numbness?
Depending on how bad your symptoms are, you can choose several different treatment options. If your pain is tolerable, you can try an exercise program or physical therapy to strengthen your back muscles and improve your posture. You can also try medications to reduce the pain and inflammation.

If your symptoms are severe – you can’t stand up straight or you can’t walk any significant distance – then you may need to see a spine surgeon.

What can a spine surgeon do for me?
There are several different surgeries that can take pressure off the nerves of your spine.

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Spondylolisthesis

 

What is spondylolisthesis?
This is when one vertebrae slips forward (subluxates) relative to the others. Degenerative subluxation of lumbar vertebrae (spondylolisthesis) is a cause of acquired stenosis of the lumbar spinal canal, particularly at the L4 and L5 levels, and may manifest clinically with neurogenic intermittent claudication as well.

Image showing a disection of the lumbar

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Spondylolysis

 

What is spondylolysis?
This is a defect of the wing-shaped pars of the vertebrae (the pars intra-articularis). The defect can be congenital, meaning that you were born with it, or it can be acquired later in life. Because the defect is in the area of the vertebrae that connects the front (vertebral body) to the back (posterior elements), a spondylolysis may allow one vertebra to slide forward or backward over the bone below. This can cause compression or squeezing of the spinal cord or nerve roots.

Who gets spondylolysis?
Some people are born missing part of the wing-shaped region of the vertebra, or this area can become damaged from strenuous physical activity, especially during adolescents. Some athletes – especially weight lifters, football players, gymnasts, and divers – are at increased risk of developing this condition.

What can be done about spondylolysis?
Spondylolysis starts out as a stress fracture, and most people will recover with conservative treatment. The first steps are pain relief medication, such as ibuprofen, and rest, which means stopping the activity that aggravated it in the first place! At the same time, you should continue gentle stretching and strengthening exercises. Surgery is rarely indicated, but you may need to wear a brace for awhile to really give the stress fracture a rest and a chance to heal.

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Spondylosis

 

What is spondylosis?
This is just a fancy word for osteoarthritis of the spine. The arthritis can cause bone spurs (osteophytes), deterioration of the discs (the shock absorbers) between your vertebrae, and/or damage to the facet joints that connect the vertebrae. Any of these can cause stenosis of your spinal canal.

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