Common Spine Conditions
Spinal disorders encompass a wide variety of conditions including:
- Degenerative Spine Conditions, e.g. Degenerative disc disease, disc herniation and stenosis. These can involve any region in the spine. Degenerative disorders are among the most common day to day pathologies a spine surgeon or Neurosurgeon will see in his or her career.
- Traumatic Spine Conditions e.g. spine fractures including osteoporotic vertebral fractures.
- Infectious Spine Conditions e.g. Discitis, epidural abscess
- Neoplastic Spine Conditions e.g. Primary or secondary tumours of the spine. These may involve the vertebrae, nerves or surrounding structures.
- Spinal Deformity Conditions e.g. Scoliosis, kyphosis and spondylolisthesis.
Symptoms
Spinal disorders can cause a wide range of symptoms and findings on a physical exam. Symptoms depend on the type of disorder, its severity, and its location within the spine. Symptoms may include:
- Sharp or dull pain in any region of the spine.
- Pain exacerbated by physical activity, standing or walking.
- Pain radiating into the arms or legs (brachalgia or sciatica)
- Limited motion and poor posture
- Abnormal or reduced sensations of the arms and/or legs, including tingling, burning or numbness
- Weakness in arms and/or legs
- Unsteadiness, with poor balance
- Lost hand dexterity or difficulty with fine-motor tasks, such as handwriting, buttoning shirts, etc.
- Loss of bladder or bowel function (usually in association with the previously mentioned symptoms)
Degenerative Back Conditions:
These conditions are not typically due to a specific injury but rather to age with repeated strains, sprains, and overuse of the back. Degenerative changes cause a gradual degeneration of the motion segments of the spine with the loss of normal structure and/or function. Degenerative conditions will occur at some stage in the vast majority of adults although many may remain asymptomatic.
Since most patients improve with time and non-operative treatment, surgery is only recommended when degeneration generates persistent back pain, leg or arm pain from nerve compression. Or when function is impeded e.g. arm or leg weakness or difficulty with balance and walking.
Severe weakness, irregular bladder and bowel control, numbness in the saddle area or bilateral leg pain may indicate a more serious finding, such as spinal cord or cauda equina compression with the need for urgent evaluation and possible urgent surgery.
I work collaboratively with physiotherapists, osteopaths and chiropractors in the region to guide my patients to a comprehensive back program, combining physical therapy, manipulation, activity modification, pain management, and appropriate surgery when indicated providing each individual with his or her best chance of recovery.
Frequently used terms:
- Spondylolisthesis
A forward slippage of one vertebra over the one below it, most commonly in the lumbar (lower back) region. It may develop in a weakened area of the vertebra during childhood or the adolescent years, or it could occur later in life as a result of degeneration. Spondylolisthesis can cause back pain and leg pain. - Spinal Stenosis
Narrowing of the spinal canal, and/or intervertebral foramen. Spinal stenosis is most often due to the normal aging process. This causes “pinching” of the spinal cord and/or nerve roots.
Degenerative changes including disc dehydration, cartilage loss and facet osteoarthritis, may lead the body to respond by growing new bone in the facet joints to help support the vertebrae. Over time, these boney overgrowths (spurs)- may narrow the space for the nerves to pass through. Another response to arthritis in the lower back is that ligaments around the joints increase in size; this also reduces the space for the nerves. Lastly reduction in disc height and disc budging also contributes to this limited room. Once the space has become small enough to irritate spinal nerves, painful symptoms result.
Spine stenosis can occur anywhere in the spine, commonly:
Cervical stenosis: In this condition, the narrowing occurs in the part of the spine in the neck. Leading to arm pain, pins and needles or numbness. In addition it may lead to weakness in arms / legs. Patients may notice unsteadiness or loss of hand dexterity.
Lumbar stenosis: In this condition, the narrowing occurs in the part of the spine in the lower back. It is the most common form of spinal stenosis. Symptoms include pain radiating down one or both legs (sciatica) or cramping in the buttocks, thighs or calves, and other neurological symptoms such as numbness/ parasthesia in the lower limbs.
- Sciatica
Pain radiating from the back down the leg. This may be due to a pinched nerve in the lumbar spine. - Brachalgia
This refers to pain radiating from the neck down the arm. This may due to a pinched nerve in the cervical spine. - Disc herniation / Bulging Disc/ Slipped Disc
Multiple terms are used to describe degenerative changes in the disc. Age or injury may cause discs to dry out or degenerate. As this happens, the jelly-like nucleus in the disc may bulge into the annulus (or extrude through a tear in the annulus), this may irritate a nearby nerve root, causing pain in the back or radiating down the arm or leg. As the disc dehydrates with subsequent height loss, this can also lead to the diffuse bulging of a disc, which also may irritate nearby nerve roots. - Spinal Instability
As a disc degenerates and flattens, vertebrae may become unstable, slipping back and forth and irritating facet joints and nerves. This may manifest as spondylolisthesis (forward slippage of one vertebra over the one below it). - Degenerative Disc Disease
Over the human life span, the discs naturally wear out.
Sports, injury and everyday activities contribute to the degeneration of the discs.
The discs act as shock absorbers between the vertebrae tend to dry out with age. Resulting in a loss of disc volume and disc height. Cracks in a disc’s exterior (annulus) may allow some of the soft inner material (nucleus propulsus) to escape and press on the spinal cord or nerves. In addition compressive loads transfer away from the nucleus with increase facet wear eventually causing increase motion segment mobility and osteophyte (spur) formation.
- Scoliosis
This is a sideways curvature of the spine causing it to resemble a letter “S” or “C” rather than a straight “I”.
Scoliosis can occur at any age in children or teenagers and can run in families, but in many cases its cause is not known. It may also occur as a result of degenerative changes in the spine resulting in uneven loads on the spinal column.
What is a lumbar discectomy?
A lumbar discectomy is performed to remove a prolapsed disc or disc fragment/s to relieve pressure on the spinal nerve roots or spinal cord. An x-ray will be taken during surgery and used to confirm the correct levels of the spine.
A cut (around 3-4 cm) is made in the middle of the back, over the site of the prolapsed disc. A small length of muscle is stripped from the back of the spine. A small boney window is created to identify the disc. A microscope is used for illumination and magnification.
Once the prolapsed disc is identified, the prolapsed disc or disc fragments are removed from the spine.
A small wound drain may occasionally be left for 1 day.
The cut is closed with stitches (usually absorbable stitches, with no need for stitch removal). Patients are usually fully mobile by the following day and discharged home.
What is a Lumbar Decompression Laminectomy?
This procedure is performed to relieve pressure on the nerve roots in the lower back. An x-ray will be taken during surgery and used to confirm the correct level of surgery.
A cut is made down the middle of the back, over the site where the nerves are compressed. The length of the incision depends on the number of levels involved- for one level, usually 3-4 cm.
A small length of muscle is stripped from the back of the spine, usually from one side only. The bones on the back of the spine (spinous process and laminae) are removed from the spine in a standard laminectomy. I tend to perform minimally invasive decompression by preservation of the spinous processes and midline structures.
Further bone and ligament is removed in the depth, until the pressure is relieved from the nerves of the spine.
A small wound drain may occasionally be left for 1 day.
The cut is closed with stitches (usually absorbable stitches, with no need for stitch removal).
What is a Lumbar Decompression and Pedicle Screw Fusion?
This procedure is performed to relieve pressure on the spinal nerves and stabilises the spine from slipping forward.
X-rays will be taken during surgery to determine the correct levels of surgery.
A cut is made down the middle of the back, or two small incisions (around 4-5cm each) on either side of the midline. To decompress the spine, the muscles are stripped from the bones at the back of the spine. The bones on the back of the spine (spinous process and laminae) maybe removed from the spine to relieve pressure.
Following the decompression, supporting screws are inserted into the pedicles of the vertebrae which require support. X-rays or a navigation system are usually used to monitor the screw insertion. The screws are then joined together with a number of rods and nuts.
A cage may also be added – this is inserted into the disc space. An interbody cage is a prosthetic device used to maintain the normal height of the disc space, improve stability and improve fusion across the disc space.
Bone graft substitute is packed within the disc space and along the sides of the rods to fuse the spine.
A small wound drain may be inserted for 1-2 days. The cut is closed with stitches (usually absorbable stitches, with no need for stitch removal).
What is an anterior cervical discectomy and fusion?
An anterior cervical discectomy and fusion is performed to treat damaged cervical discs. This surgery approaches the spine from the front. A skin crease cut is made across the side of the neck.
An x-ray is taken during surgery to confirm the correct level of the spine before removing the disc. Using a microscope the damaged disc is removed. Any bony spurs, which may be compressing the nerve roots and spinal cord, are also removed.
Once the disc is removed, the space between the neck bones is empty. To prevent the bones from collapsing and rubbing together, the open disc space is filled with an interbody cage containing bone graft substitute. An interbody cage is a prosthetic device used to maintain the normal height of the disc space and improve fusion.
Sometimes, a small metal plate with screws is used to help strengthen the fusion, or a cage with small screws within it maybe used as an alternative.
The cut is closed with stitches (usually absorbable stitches, with no need for stitch removal).
What is a cervical laminectomy?
A cervical laminectomy is performed to relieve the pressure on the spinal cord in the neck.
A cut will be made in the skin at the back of the neck. X-rays will be taken during surgery and used to confirm the correct levels of the spine.
Small portions of bone and ligaments will be removed from the affected cervical spine to relieve the pressure on the spinal cord.
The cut is closed with stitches
What is a Cervical Foraminotomy?
A cervical foraminotomy is performed to relieve cervical spinal nerve root compression.
An X-ray is taken during surgery and used to confirm the correct level of surgery.
A small cut is made in the back of the neck.
A small amount of bone and ligament is removed from the spine on the affected side to gain access to the nerves of the spine.
The structures which are compressing the nerve are removed to create space around the affected nerve.
The cut is closed with stitches.