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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