Patient Awareness

Overview

Spine is like the central pillar of our body. It is divided in 5 basic segments cervical (neck region), thoracic or dorsal (chest region), lumbar (lower back), sacral (pelvic region) and coccyx or tail bone area. Among this all segments cervical and lumbar are highly mobile and that’s why they account for majority of spine related problems. Spine has few basic duties. It transfer upper body parts weight to lower limbs/legs, it protects the spinal cord. It gives flexibility as well as stability to our body. Normally this machine functions very well to accomplish its responsibilities. But sometimes this machine malfunctions due to various reasons.

Common spine problems, symptoms and treatment:

Sciatica / Slipped disc :

Symptoms – young to middle aged active individual (3rd to 4th decade) presents with acute/sub acute back pain with severe single/both leg pain. Here regular exercises such as walking, standing become nearly impossible or very painful. Lying down may decrease the pain. The pain might be associated with tingling, numbness or weakness, in extreme cases with bowel bladder involvement. Usually starts after unaccustomed heavy activity.
MRI proves the diagnosis.
Treatment – depends upon the severity of slip disc –
Mild cases require bed rest for 6 weeks with pain control.
Moderate cases can be treated with transforaminal block injections.
Severe cases are best treated with micro surgery/ MIS discectomy.
Red flags Pain increases during conservative treatment.
Deterioration/ appearance of nerve weakness/ bowel bladder dysfunction.
require urgent surgery.

Back Pain
Causes

Spondylosis :

Spine tends to degenerate as a normal ageing process. Study shows 85% population experiences at least one episode of back pain in their lifetime. It is also one of the most common reasons of sickness absenteeism only after common cold. The discs located between the vertebras as well as the facet joints degenerates with age. Combined with this sedentary lifestyle, wrong posture of sitting leads to poor core muscle strength. All this combined together gives rise to back pain, decreased endurance, easy fatigability, Difficulty in getting up from ground level, bending forward, sitting/standing/walking for long duration, long travel.

Treatment involves mostly symptomatic exercise to build the core muscle strength. Weight reduction, yoga, core strengthening exercise, and short term anti inflammatory drugs SOS.

Muscle sprain :

Usually affected population is a sportsman or an active individual with unaccustomed sporting activity or heavy work.

Symptoms Para-spinal muscle stiffness and tenderness, extreme difficulty in turning in bed/ sitting/ standing. Usually short duration of symptoms. Treatment, rest and medication.

Lumbar canal stenosis :

When Spondylosis advances the disc bulges out in neural canal, ligaments and facet joints hypertrophies all this gradually reduces space for spinal nerve. Nerve adjusts in a narrow space till it’s no longer could manage. After critical narrowing walking becomes slow and difficult due to nerve pain in the legs. Patient complains heaviness, pain, tingling, and numbness in their legs while walking. If left untreated this condition may give rise to permanent nerve damage or partial paralysis of nerves. Most of these advanced problems are best treated with surgical management decompression alone or decompression with segmental fusion based on case merit. The safety and efficacy of the surgery matches international standards at our centre.

Spondylolysis :

Young individuals sometimes have congenital / traumatic defect of vertebral posterior arch pars interarticularis, which gives rise to early onset back pain with activity. This condition is usually treatable with rest, brace and medicines. Refractory cases might require surgical intervention.

Spondylolisthesis :

Definition – Where the superior block move forward in respect of inferior block.

Spine fracture :

Any high velocity fall or road traffic accident can give rise to spine fractures. It’s a dangerous condition as there may be injury to spinal cord which gives rise to partial and complete permanent paralysis. For this grave injury early evaluation and management of this condition is warranted.

Spine Fracture is serious form of injury. It requires immediate medical attention. The fracture can be at cervical, lumbar, or dorsal/thoracic region. Depending on the severity of the fracture the prognosis of spine fracture can be good to poor. As spinal column surrounds the spinal cord and gives protection to it, a spinal column fracture can jeopardize all these functions and give rise to partial to complete paralysis. Early medical and surgical intervention may improve the paralyzed state depending upon case merit.

Osteoporotic spine fracture :

This is completely different from acute spine fracture. Osteoporosis is a disease where the bones in whole body become weak due to deficiency of calcium. The bones may become so weak that it gets fractured by own body weight or trivial trauma. Usually it affects very old (65- 80years) age group. Patients complain of moderate to severe pain in the back when getting up or turning in bed, with time it aggravates. Treatment is bed rest with anti-osteoporotic therapy. Refractory cases can be benefited from day-care procedures called vertebroplasty/ kyphoplasty where bone cement is put to fill the bony gap.

Spine infection :

It can be pyogenic or tubercular, fungal (very rare). If any back or neck pain which is continuous, increases with bed rest, associated with fever, weight loss and not relieved by pain killer , the chance of infection is there. It is proven by MRI.

Treatment is antibiotic therapy with or without surgery depending upon case merit.

Spine tumor :

It can be-

Other less common causes of back pain:

Causes of Neck pain :

Our neck or cervical spine is the most mobile segment of our spine. All common pathologies explained in back pain section can also affect cervical spine.

Common pathologies of cervical spine –

Less common pathology

Congenital/ traumatic abnormality of cranio-vertebral junction:
Surgical methods for C-V junction abnormality
Occipito cervical fusion
C1- C2 fusion
Odontoid screw fixation

Scoliosis :

It is defined as sideways curve of more than 10 degree in spine. Most common cause is adolescent idiopathic scoliosis (AIS). Females are most commonly affected (age group -5- 15 years). There are other causes of scoliosis like, congenital defects of spinal column, neuromuscular disease, neurofibromatosis, degenerative etc. The curve can be corrected by surgery when indicated.

Kyphosis :

In kyphosis there is abnormal forward bend in the spine. The cause of this condition can be various like trauma, tuberculosis, congenital, osteoporosis etc.