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Diagnosis and Treatment of Spinal Pathology


    BaySpine > Spinal Disorders

Spinal Disorders


Definitions of some of the many different types of spinal disorders:
Bone Spurs
 

Compression Fractures

Degenerative Disc Disease

Herniated Disc

Kyphosis

Radiculopathy
 
Spondylosis/ Spondylolisthesis
Stenosis  .
 

 

 

 

 

 

 

 

 

 

Bone Spurs

The medical term for bone spurs is osteophytes, and they represent an enlargement of the normal bony structure. Osteophytes are a radiographic marker of spinal degeneration and are by and large a normal finding as aging progresses.

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Compression Fracture

The bones, or vertebrae, that make up your spine are very strong, but sometimes a vertebra can fracture just like any other bone in your body. Vertebra fractures are usually due to conditions such as: osteoporosis (a condition which weakens the bones), a very hard fall, excessive pressure, or some kind of physical injury.

When a bone in the spine collapses, it is called a vertebral compression fracture. These fractures happen most commonly in the thoracic spine (the middle portion of the spine), particularly in the lower vertebrae of the thoracic spine.
tenosis.

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Degenerative Disc Disease

Degenerative changes in the spine are often referred to those that cause the loss of normal structure and/or function. The intervertebral disc is one structure prone to the degenerative changes associated with wear and tear, aging, even misuse (e.g. smoking).

Long before degenerative disc disease can be seen radiographically, biochemical and structural changes occur. Some of these changes are not unlike those associated with osteoarthritis.

Over time the protein structure of the annulus fibrosis weakens and may become structurally unsound. Additionally, hydration of the disc decreases. These changes are linked and may lead to the disc’s inability to handle stress. Understanding the lumbar spine carries a large portion of the body’s weight; the stress from motion may result in a disc problem (e.g. herniation).

 

Herniated Disc

A ruptured disc is one that has ‘herniated’ meaning the disc contents have protruded through an opening in the wall of the disc. A Herniated Disc is categorized as a Non-Contained Disc.

A disc is basically two parts; a circular outer layer termed the Annulus Fibrosis and a Nucleus Pulposus, the gel-like center of the disc. The annulus fibrosis is made from sturdy bands of fibrous cartilage to encase the nucleus. If the annular wall weakens, cracks, or opens the nucleus may leak out from the disc.

Throughout the cervical, thoracic, and lumbar spine discs sit anchored in between vertebrae. Vertebral endplates made from cartilage along with a system of ligaments hold each disc in proper position. Therefore, discs cannot ‘slip’ out of place.  These small cushions slightly bend and twist while absorbing stress from body movement. Some types of body movement create more disc pressure such as jumping or lifting a heavy object. The way a disc absorbs stress and pressure is similar to a tube of toothpaste. Squeezing the tube places the contents under pressure. If the tube encasing the paste has a weak spot or a hole, the paste leaks out through the opening.

Certain herniations can be very painful while others cause no symptoms. Often when a disc herniates the nucleus spreads into the spinal canal compressing sensitive nerve roots. In addition, the nucleus releases a chemical agent that temporarily irritates surrounding nerve structures causing inflammation and pain.

Kyphosis

The word kyphosis is used to describe a "C"-shaped curve in the spine. A "kyphosis" curve has the opening of the "C" in the front of the body. This type of curve is the opposite of a "lordotic" curve in the spine. A lordotic curve has the opening facing towards the back. The normal spine has both types of curves, but in small amounts. These curves become a problem when they are larger than normal - the larger the curve, the more serious the problem. Many different conditions can lead to an excessive kyphosis.

The thoracic, or mid portion of the spine, normally has a kyphotic curve. The curves of the spine are usually measured in degrees. A thoracic kyphosis is normal when measured at 20-40 degrees. The cervical spine (neck) and lumbar spine (lower back) have "lordotic" curves that face the opposite direction - like a backward "C".  When the thoracic spine curves outside of the normal range, it creates a "hunchback" look and the shoulders slump forward. If the cervical or lumbar spines lose their lordotic shape and start to curve forward instead, it is an abnormal condition referred to as "kyphosis". The abnormal forward curvature can lead to problems within the spine in addition to an unusual appearance.

Kyphosis can have varying symptoms and degrees of severity, from minor changes to the shape of your back and neck, to severe deformity, neurologic deficits, and chronic pain. Kyphosis is most common in the thoracic spine, though it can also affect the cervical and lumbar spine.
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Radiculopathy

Radiculopathy is a a problem that results when a nerve in the neck or back is irritated as it leaves the spinal canal. This condition usually occurs when a nerve root is being pinched by a herniated disc or a bone spur.

When a nerve root leaves the spinal cord and the cervical spine and it travels down into the arm. Along the way each nerve supplies feeling to a part of the skin of the shoulder and arm. It also supplies electrical signals to certain muscles to move part of the arm or hand. When a nerve is irritated or pinched - by either a bone spur or a part of the intervertebral disc - it causes problems in the nerve and the nerve does not work quite right. This shows up as weakness in the muscles the nerve goes to, numbness in the skin that the nerve goes to and pain where the nerve travels. In the neck, this condition is called cervical radiculopathy. Similarly, when a nerve leaves the spinal cord and the lumbar spine it travels down the leg. Lumbar radiculopathy occurs when the nerves are irritated or pinched causes numbness, weakness, or pain to travel down the leg and/or foot.

This condition can be caused by a herniated disc, degeneration and/or bone spurs.

Spondylosis/Spondylolisthesis

Spondylosis refers to a defect in one of the vertebra in the lower back, usually the last vertebra of the lumbar spine. The area of the vertebra called the pedicle is affected. The pedicle is part of the bony ring that protects the spinal nerves, and is the portion that connects the vertebral body to the facet joints. When a spondylosis is present, the back part of the vertebra and the facet joints simply are not connected to the body - except by soft tissue. It is almost as if the back portion had been broken off and tried to heal - but never did. Actually, there is good evidence to suspect that this is exactly what has occurred. Spondylosis is not something people are born with, but it appears to first show up sometime in childhood. Interestingly, boys who are football linemen and girls who are gymnasts seem to be affected the most. The current thought is that the spondylosis is probably a stress fracture that never completely healed.

Spondylolisthesis is the term used to describe when one vertebra slips forward on the one below it. This usually occurs because there is a spondylosis in the vertebra on top. There are two main parts of the spine that keep the vertebrae aligned - the disc and the facet joints. When a spondylosis occurs, the facet joint can no longer hold the vertebra back. The intervertebral disc may slowly stretch under the increased stress and allow the upper vertebra to slide forward. In the vast majority of cases, the stretching only allows a small amount of forward slip. Furthermore, there is no real danger in an adult that the slipping will continue until the upper vertebra slips off.

Stenosis

In the normal spinal canal, the nerve roots are contained in the thecal sac and exit between each vertebra (foramina). The central spinal canal and the foramen contain the thecal sac and nerve roots respectively.

The canal and foramen are formed by bony structures (vertebral body, facets, pedicles) as well as soft tissue structures (ligamentum flavum, facet capsules, intervertebral disc annulus). As we age, degenerative changes occur in our spine causing narrowing of the central spinal canal area, and/or the area where the nerve roots exit the spinal canal (foramina). One of these degenerative changes is the formation of extra bony growths called osteophytes (bone spurs). Additionally, the large connective "band" (ligamentum flavum) which runs along the inside the spinal canal can become coarse and thickened also causing narrowing of the central canal space.
 
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