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Spine Conditions

Herniated Disc

The bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged, it may bulge or break open. This is called a herniated disc. It may also be called a slipped or ruptured disc.

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Spinal Stenosis

Spinal Stenosis is a condition due to narrowing in and around the spinal canal causing nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity. There are several different types of spinal stenosis affecting all regions of the spine (cervical, thoracic and lumbar spine). The most common is degenerative stenosis, occurring in virtually the entire adult population as a result of the natural process of aging. It is a degenerative narrowing of the spinal canal, nerve root canals and/or intervertebral foramina caused by bone and/or ligament hypertrophy in local, segmental or generalized regions. The narrowing results in compression of spinal nerves and nerve roots, causing a constellation of symptoms, including lower back pain, neurogenic claudication and lower extremity pain.

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Whiplash Syndrome

Whiplash is a nonmedical term used to describe neck pain following an injury to the soft tissues of your neck (specifically ligaments, tendons, and muscles). It is caused by an abnormal motion or force applied to your neck that causes movement beyond the neck's normal range of motion. The most frequent cause of whiplash is a car accident. The speed of the cars involved in the accident or the amount of physical damage to the car may not relate to the intensity of neck injury; speeds as low as 15 miles per hour can produce enough energy to cause whiplash in occupants, whether or not they wear seat belts.

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Arthritis of the spine can be a very painful and debilitating problem that often affects individuals 40 or older. If left untreated, it can lead to physiological problems such as muscle breakdown or weakness, as well as psychological problems such as anxiety and depression. Sometimes, a person with arthritis of the spine can suddenly suffer excruciating pain that will keep him or her bedridden and unable to perform normal daily activities. Classic symptoms include pain and numbness in the back, neck, head, and shoulders. Symptoms may be different for different people, and the frequency and intensity will also vary. Some areas may ache from time to time and be all right other times. Bending and other everyday movements may also cause pain. Numbness is the neck area is very common, although other areas, including the arms and legs, may also experience numbness. In some cases, frequent urination or the urgent need to urinate may occur.

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Scoliosis is not a disease—it is a descriptive term. All spines have curves. Some curvature in the neck, upper trunk and lower trunk is normal. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis. However, when there are abnormal side-to-side (lateral) curves in the spinal column, we refer to this as scoliosis.

Scoliosis is not a disease—it is a descriptive term. All spines have curves. Some curvature in the neck, upper trunk and lower trunk is normal. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis. However, when there are abnormal side-to-side (lateral) curves in the spinal column, we refer to this as scoliosis.

Scoliosis affects 2% of women and 0.5% of men in the general population. There are many causes of scoliosis, including congenital spine deformities, genetic conditions, neuromuscular problems and limb length inequality. Other causes for scoliosis include cerebral palsy, spina bifida, muscular dystrophy, spinal muscular atrophy and tumors. Over 80% of scoliosis cases, however, are idiopathic, which means that there is no known cause. Most idiopathic scoliosis cases are found in otherwise healthy people.

Idiopathic scoliosis is broken down into four categories based on age: (1) infantile: children ages 3 and under, (2) juvenile: 3-9 years old, (3) adolescent: 10-18 years old, and (4) adult: after skeletal maturity. The most common form of scoliosis, representing approximately 80% of idiopathic scoliosis cases, is Adolescent Idiopathic Scoliosis (AIS), which develops in young adults around the onset of puberty.

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Kyphosis is a forward rounding of your upper back. Some rounding is normal, but the term "kyphosis" usually refers to an exaggerated rounding, more than 50 degrees. This deformity is also called round back or hunchback.

With kyphosis, your spine may look normal, or you may develop a hump. Kyphosis can occur as a result of developmental problems; degenerative diseases, such as arthritis of the spine; osteoporosis with compression fractures of the vertebrae; or trauma to the spine. It can affect all ages.

Mild kyphosis may cause few problems. But severe cases can affect your lungs, nerves, and other tissues and organs, causing pain and other problems. Treatment for kyphosis depends on your age, the cause of the curvature and its effects.

Because kyphosis initially often produces no signs and symptoms, it may go unnoticed until a routine physical examination or a school screening for scoliosis. But some people may notice pain, a rounding of the shoulders or a hump on the upper back.

Have your child examined if you see any of the signs of kyphosis. Also, if you develop any of the signs or symptoms, see your doctor for an examination to determine whether you need further evaluation.

Although rare, kyphosis can lead to serious health problems, such as physical deformity, breathing difficulties or damage to internal organs that are affected by the postural changes. So it's important to see a doctor if you experience signs or symptoms of kyphosis.

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Spondylolisthesis is a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra. Forward slippage of one vertebra on another is referred to as anterolisthesis, while backward slippage is referred to as retrolisthesis. Spondylolisthesis can lead to a deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the exiting nerve roots (foraminal stenosis).

There are five major types of lumbar spondylolisthesis.

  1. Dysplastic spondylolisthesis: Dysplastic spondylolisthesis is caused by a defect in the formation of part of the vertebra called the facet that allows it to slip forward. This is a condition that a patient is born with (congenital).
  2. Isthmic spondylolisthesis: In Isthmic spondylolisthesis, there is a defect in a portion of the vertebra called the pars interarticularis. If there is a defect without a slip, the patient has spondylolysis. Isthmic spondylolisthesis can be caused by repetitive trauma and is more common in athletes exposed to hyperextension motions including gymnasts, and football linemen.
  3. Degenerative spondylolisthesis: Degenerative spondylolisthesis occurs due to arthritic changes in the joints of the vertebrae due to cartilage degeneration. Degenerative spondylolisthesis is more common in older patients.
  4. Traumatic spondylolisthesis: Traumatic spondylolisthesis is due to direct trauma or injury to the vertebrae. This can be caused by a fracture of the pedicle, lamina or facet joints that allows the front portion of the vertebra to slip forward with respect to the back portion of the vertebra.
  5. Pathologic spondylolisthesis: Pathologic spondylolisthesis is caused by a defect in the bone caused by abnormal bone, such as from a tumor.

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Spinal Stenosis

Spinal Stenosis is a condition due to narrowing in and around the spinal canal causing nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity. There are several different types of spinal stenosis affecting all regions of the spine (cervical, thoracic and lumbar spine).

The most common indication for surgery in persons aged over 60 in the United States is Lumbar Spinal Stenosis. Currently, it is estimated that as many as 400,000 Americans, most over the age of 60, may already be suffering from the symptoms of lumbar spinal stenosis and this number is expected to grow as members of the baby boom generation begin to reach their 60s over the next decade.

According to the U.S. Census Bureau, people over 60 will account for 18.7% of the domestic population in 2010 versus 16.6% in 1999. According to the United Nations' Population Division, Department of Economic and Social Affairs, the trend is global with the number of persons aged 60 years or older estimated to be nearly 600 million in 1999 and is projected to grow to almost 2 billion by 2050, at which time the population of older persons will be larger than the population of children (0-14 years) for the first time in human history. The majority of the world's older persons reside in Asia (53 per cent), while Europe has the next largest share (25%).

The prevalence of musculoskeletal disorders and the cost to treat them led the World Health Organization and the United Nations to declare 2000-2010 be the Decade committed to improving quality of life to people with bone and joint disease and injuries throughout the world.

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Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy). It is less commonly found in the middle portion of the spine (thoracic radiculopathy).

Risk factors for radiculopathy are activities that place an excessive or repetitive load on the spine. Patients involved in heavy labor or contact sports are more prone to develop radiculopathy than those with a more sedentary lifestyle. A family history of radiculopathy or other spine disorders also increase the risk of developing radiculopathy.

Radiculopathy is caused by compression or irritation of the nerves as they exit the spine. This can be due to mechanical compression of the nerve by a disk herniation, a bone spur (osteophytes) from osteoarthritis, or from thickening of surrounding ligaments.

Other less common causes of mechanical compression of the nerves is from a tumor or infection. Either of these can reduce the amount of space in the spinal canal and compress the exiting nerve.

Scoliosis can cause the nerves on one side of the spine to become compressed by the abnormal curve of the spine.

Other causes of radiculopathy include diabetes which can decrease the normal blood flow to the spinal nerves. Inflammation from trauma or degeneration can lead to radiculopathy from direct irritation of the nerves.

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Degenerative Disk Disease

Degenerative disc disease refers to a syndrome in which a compromised disc causes low back pain. Lumbar degenerative disc disease usually starts with a torsional (twisting) injury to the lower back, such as when a person rotates to put something on a shelf or swing a golf club. However, the pain is also frequently caused by simple wear and tear on the spine.

Despite its rather dramatic label, degenerative disc disease is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although not all will have pain or ever receive a formal diagnosis. In fact, after a patient reaches 60, some level of disc degeneration is deemed to be a normal finding, not the exception.

Lumbar Degenerative Disc Disease Pain and Symptoms

Most patients with lumbar degenerative disc disease will experience low-grade continuous but tolerable pain that will occasionally flare (intensify) for a few days or more. Pain symptoms can vary, but generally are:

Centered on the lower back, although it can radiate to the hips and legs

  • Frequently worse when sitting, when the discs experience a heavier load than when patients are standing, walking or even laying down
  • Exacerbated by certain movements, particularly bending, twisting or lifting

The low back pain associated with lumbar degenerative disc disease is usually generated from one or both of two sources:

  • Inflammation, as the proteins in the disc space irritate the surrounding nerves, and/or
  • Abnormal micro-motion instability, when the outer rings of the disc - the annulus fibrous – are worn down and cannot absorb stress on the spine effectively, resulting in movement along the vertebral segment

Excessive micro-motion, combined with the inflammatory proteins, can produce ongoing low back pain.

Fortunately, over time the pain from lumbar degenerative disc disease usually decreases, rather than becoming progressively worse. This is because a fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position, eliminating the micro-motion that generates the pain.

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Cervical Radiculitis

Cervical Radiculitis is a spinal disorder in which the nerve roots located in the upper portion, or cervical, of the spine are compressed. When one or more of the spinal disc located in the cervical portion of the spine push against the various nerves connected to the spinal cord, pain results.

Unfortunately, the spinal nerves run throughout he entire body. This means that the pain associated with Cervical Radiculitis can be felt throughout the body, not just in the cervical disc that is affected. Pain from Cervical Radiculitis may be felt in the shoulders, neck, chest or arms, depending on which of the cervical disc and associated nerves are affected. You may also experience numb or tingling fingers or a weakness of the muscles located in the chest and arms.

It is relatively easy to diagnosis Cervical Radiculitis. Doctors rely on a variety of imaging tools to view the cervical spine and any disks that may be affected. These include MRI's and CT Scans. Doctors may also order electrodiagnostic test to confirm the diagnosis.

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