Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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The spine is resilient, but it is not indestructible. It bears the weight of our upper body, absorbs the impact of our steps, and twists and bends thousands of times a day. This constant mechanical stress accumulates over a lifetime. Additionally, the spine is vulnerable to sudden trauma and genetic conditions that can compromise its structure. Understanding why a spine problem has developed is the first step in determining whether surgery is the right solution.
The causes of spinal issues generally fall into two broad categories: acute injuries and degenerative conditions. Degenerative conditions, on the other hand, are the result of the natural aging process, where the parts of the spine slowly wear out over time. Identifying the root cause is critical because it dictates the urgency and type of treatment required. This section explores the various ways the spine can be injured and the biological processes that lead to chronic back conditions.
Despite its frightening name, degenerative disc disease is not really a “disease” but a natural part of aging. We are born with spinal discs that are plump and hydrated, much like a grape. As we age, these discs naturally lose water content and begin to dry out, resembling a raisin. This process causes the discs to lose height and become less effective as shock absorbers.
For many people, this process is painless. However, for others, the dried-out disc becomes inflammatory or unstable. As the disc collapses, the vertebrae above and below it move closer together. This procedure can narrow the openings where nerves exit the spine, leading to pinching. The outer wall of the disc can also develop tears, which can be a source of deep, aching back pain.
Spinal stenosis refers to a narrowing of the spaces within your spine. This narrowing can occur in the center of the spine (central canal stenosis) or in the side openings (foraminal stenosis). It is typically a result of osteoarthritis, the “wear and tear” arthritis.
As the discs collapse and the joints of the spine wear down, the body tries to repair itself by growing extra bone. These bony overgrowths are called bone spurs or osteophytes. While the body intends to stabilize the spine, these spurs encroach on the space needed by the nerves. This crowding chokes the nerves, leading to pain that is often worse when standing or walking and better when sitting or leaning forward.
A herniated disc, often called a slipped or ruptured disc, is a common consequence of disc degeneration or sudden injury. The disc has two parts: a tough outer ring (annulus) and a soft, jelly-like center (nucleus). Imagine the disc as a donut made of jelly.
When the outer ring tears, the soft inner jelly can push out into the spinal canal. This leaked material takes up space that belongs to the nerves. It presses against the sensitive nerve roots, causing sharp, shooting pain, numbness, or weakness in the arms or legs. The result is the mechanical compression that surgeons often target during a discectomy.
When a herniated disc occurs in the lower back, it often presses on the sciatic nerve, the large nerve that runs down the back of the leg. This causes the condition known as sciatica.
Patients often describe this condition as an electric shock or burning sensation that travels from the buttock down to the foot. The pain is in the leg, but the issue is in the back.
When a similar herniation happens in the neck, it is called cervical radiculopathy. Instead of leg pain, patients feel pain shooting down the arm into the hand.
They might also experience numbness in specific fingers or weakness in their grip. This is because the nerves exiting the neck control the upper limbs.
This tongue-twisting term describes a condition where one vertebra slips forward over the one below it. It is a problem of alignment instability. There are a few ways this can happen. In younger people, it is often due to a small stress fracture in a specific part of the vertebra called the pars interarticularis (isthmic spondylolisthesis).
In older adults, it is usually due to degenerative changes in the joints and discs that allow the bone to slide forward (degenerative spondylolisthesis). This slippage can stretch the nerve roots and narrow the spinal canal. Surgery for this condition usually involves fusing the bones to stop the slipping and restore proper alignment.
Sudden, high-impact events like car accidents, falls from heights, or sports collisions can cause fractures in the spine. These injuries can range from minor compression fractures, where the front of the vertebra collapses slightly, to severe burst fractures, where the bone shatters and pushes into the spinal canal.
Trauma can also injure the ligaments that hold the spine together, leading to instability. In severe cases, these injuries can damage the spinal cord itself, leading to paralysis. Surgery for trauma is often urgent and aims to stabilize the broken bones to prevent further damage to the nervous system.
The spine naturally has curves when viewed from the side, but it should appear straight when viewed from the front. Scoliosis is a condition where the spine curves sideways and twists. While often associated with adolescents, it can also develop or worsen in adulthood due to degeneration (adult degenerative scoliosis).
Kyphosis is another deformity where the upper back curves forward excessively, creating a hunched appearance. These deformities can alter the biomechanics of the body, leading to muscle fatigue and pain. If the curve becomes severe enough, it can compress the lungs or abdominal organs. Surgery for deformity involves using screws and rods to straighten the spine and hold it in a balanced position.
Although rare, infections and tumors can affect the spine and require surgical intervention. Osteomyelitis is an infection of the spinal bone, while discitis is an infection of the disc space. These infections can destroy the bone and cause instability or abscesses that press on the nerves.
Tumors can be primary (starting in the spine) or metastatic (spreading from cancer elsewhere in the body). Both infections and tumors can weaken the vertebrae, causing them to fracture or collapse. Surgery is often needed to remove the diseased tissue and reconstruct the spine to support the body’s weight.
While biology plays a giant role, lifestyle choices significantly impact spinal health. Smoking is a major risk factor. Nicotine constricts blood vessels, reducing the blood supply to the spinal bones and discs. This procedure accelerates degeneration and hinders healing after injury or surgery.
Obesity is another critical factor. The spine supports the body’s weight; excess weight places constant, increased mechanical load on the discs and joints, speeding up wear and tear. Lack of core strength and poor posture also contribute to back problems by failing to provide adequate muscular support for the spinal column.
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Yes. Lifting a heavy object with poor form—specifically bending at the waist instead of the knees—places massive pressure on the lumbar discs. If the load is too great, the disc wall can tear, leading to a herniation.
There is a strong genetic component to disc degeneration. If your parents or siblings had back problems or required surgery, you may be genetically predisposed to similar issues due to the quality of your collagen and connective tissues.
Osteoporosis itself (thinning bones) is usually painless. However, it makes the vertebrae fragile. A minor fall or even a sneeze can cause a compression fracture in weakened bone, which is very painful and a common cause of hunching in older adults.
Emotional stress can cause muscle tension, particularly in the neck and lower back. While stress doesn’t structurally damage the spine, it can exacerbate pain symptoms and cause painful muscle spasms.
Many patients with arthritis report increased pain with weather changes. It is believed that drops in barometric pressure allow tissues in joints to expand slightly, which can irritate sensitive nerves in an arthritic spine.
Stenosis of the spine happens when the spinal canal narrows and compresses the spinal cord and nerves. If not treated, it can cause long-lasting pain,
Spinal stenosis is a condition where the spinal canal narrows. This can cause a lot of pain and discomfort. Did you know that over 200,000
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