Common Spine Disorders

Arthritis/Degenerative Disc Disease

Part of the normal aging process involves the wear and tear of joints and the tissues which support the joints. The facet joints in the spine are extremely vulnerable to this degeneration process. In addition, the disc tends to dry out and narrow, allowing the vertebra to come closer together and become irritated. Bony outgrowths known as bone spurs may form, narrowing the exit for the nerves and therefore causing irritation.

Non-steroidal anti-inflammatory drugs (NSAIDS) may help reduce the process of inflammation of the joints and reduce the pain, stiffness and other symptoms associated with arthritis. Movement and gentle exercise is critical in maintenance of joint nutrition and function. Strengthening of the muscles surrounding the affected joints is also an effective means of improving the stability of the joint, thereby decreasing the pain and dysfunction.

Bulging or Ruptured Disc

Commonly known as a "slipped disc", a ruptured or herniated disc is usually the result of excessive wear of the disc and surrounding joints from exaggerated or repeated movement. As the disc wears out, the inner, the jellylike substance that cushions and absorbs the shock of movement for the spine, deteriorates and begins to bulge into the outer rings of the disc, the annulus. The pressure on the annulus can cause a tear and result in pain due to the many pain fibers present in this tissue.

As a disc bulges, its middle or nucleus, moves closer to the outer edge of the annulus. Sudden or repeated motion can cause the annulus to rupture, allowing the material of the nucleus to squeeze out and irritate a nerve. Occasionally, symptomatic bulging or ruptured discs heal spontaneously, requiring no other interventions once the pain has diminished. If pressure on a nerve continues, however, neurological signs such as decreased muscle strength, diminished reflexes, or sensation changes ensue. Permanent nerve damage can result if the pressure on the nerves is not relieved.

Decompression of the nerves is accomplished through a laminectomy, where a small piece of bone is removed from the spine to allow the surgeon access to the damaged disc for removal. A discectomy,or removal of the damaged portion of the disc, can also be accomplished through the use of microsurgical techniques, when a small incision is made, and the disc removed with the aid of a microscope.

Spondylolisthesis

Spondylolisthesis is a condition in which one vertebral body slips forward on the next level vertebral body. In most people, no significant pain or other symptoms occur. In about 20% of people who acquire spondylolisthesis, the slippage causes additional disc degeneration and nerve root impingement can result. Most patients suffer low back pain and leg pain is present less commonly. As with other conditions in the back, some patients respond to conservative care such as physical therapy, inflammation management, and altered activity levels. For others, the management of spondylolisthesis can include surgery to remove damaged disc material. A spinal fusion may be indicated to stabilize the spine.

Spinal Stenosis

Spinal stenosis occurs when the tissues and joints of the spine are enlarged to due degeneration or inflammation and the resulting space for the spinal cord and the exiting nerves is inadequate. The pressure on the nerves, and sometimes on the blood supply to the nerves, increases in the standing position, causing increased pain and dysfunction. Conservative treatment of spinal stenosis includes physical therapy, activity modification and management of the inflammation. Some patients respond well to epidural injections, with results lasting from three months to a year in some cases.

Surgical intervention is almost always indicated to physically increase the space around the spinal column and nerves to give them adequate room. Surgery is successful in alleviating the pain and discomfort in approximately 80% of cases. Unfortunately, the effectiveness can deteriorate if the patient suffers from significant degenerative disease, due to the progressive nature of osteoarthritis.