Degenerative Disc Disease (DDD) or Spondylosis refers to the gradual deterioration of the disc between the vertebrae in the backbone. This disease is very common, and affects as much as 40-50% of people over the age of 40. The disorder also becomes increasingly common as we age. It is a disease of wear and tear similar to osteoarthritis. It commonly happens in the lumbar spine (low back), though it can occur at any spinal level.
In DDD, the discs get flattened, losing their normal height. This disc height is what separates the disc above from the one below. Nerve pathways may become narrowed and cause nerve impingement, inflammation, and pain, when the disc height is lost.
Degenerated discs become much thinner and sometimes the vertebrae also develop small, rough areas which irritate the nearby nerves. Severe neck pain and stiffness and pain down the arms and hands can result from this .
Medication and exercises are the first line of management.
Cervical spondylosis is a very common condition where there is chronic degeneration of the bones of the neck (cervical spine) and the cushions between the vertebrae (inter vertebral disc). This is managed by cervical spine surgery where the worn out discs or bone spurs are removed - depending on the underlying problem. Sometimes the gap would be filled by a graft of bone or other implants made of metal combined with bone.
Symptoms of spondylosis may be as mild as occasional backaches or could be chronic low back pain that is severe enough to limit daily activities. The mechanical type of pain increases as more stress or load is placed on the lower back. Bending, lifting, and twisting are the types of movement that may exacerbate it.
Degenerative Disc Disease requires surgery only rarely. The commonly used non-surgical treatments include anti-inflammatory drugs, physiotherapy and exercise programs. Surgery is required when the patient has very severe debilitating symptoms; pain interferes with activities of daily living, and non-surgical treatment has failed after a reasonable period of time, usually at least six months.
Fusion surgery is usually done and this permanently stops the motion of the spine at the level of the degenerated disc. This helps to relieve pain. Fusion surgery works best when limited to one or two discs. As we have five discs in the lumbar spine, the un-fused discs take over to provide adequate function of the lower back.
Sometimes an artificial disc can also be inserted into the disc space after removing the entire degenerated disc. This helps to restore disc height, improve spine function, and ease the debilitating pain.
Slipped disc is a common term used to refer to a prolapsed disc. This is a disorder when the inner, softer part of the disc bulges out through a weakness in the outer part of the disc. The bulging disc may then press on nearby nerves and cause discomfort and pain. Back pain, ache in the arm or leg and pinpricks felt in feet, toes and hands are the usual symptoms.
Surgery is considered for disc prolapse if the symptoms of the bulging disc have not settled after about six weeks or so. One may opt for:
Keyhole surgery or microdiscectomy spine surgery, which is typically performed when there is a prolapsed disc in the lumbar (lower back) region which is pressing against a nerve.
Disc replacement - Here, an artificial disc is implanted into the spine to imitate the functions of a normal disc (carry load and allow motion). Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. The treatment for bulging disc and prolapsed disc is a disc replacement done in the cervical (neck) spine.
The Greek term for slipping of the spine is Spondylolisthesis. This term refers to the abnormal forward movement of one vertebra over the one below. It is in the lumbar spine that this forward slip of the vertebra happens most often. Pressure on the nerve roots associated with the affected vertebrae, as well as pain and dysfunction are caused by the slippage and herniation of the disc. The types of spondylolisthesis include:
Type 1 - Congenital spondylolisthesis
Congenital spondylolisthesis is a condition where a person is born with the abnormality of the posterior bony arch of the spine, which causes the slippage. It happens at the L5-S1 level commonly and is associated with abnormality of the facet joints. Symptoms include back pain during the adolescent growth spurt. CT and MRI scans are required to diagnose the dysplasia (abnormal bone formation).
Type 2 - Isthmic spondylolisthesis
Isthmic spondylolisthesis is a defect in a part of the bone called the pars interarticularis. This bone connects the upper joint of one vertebra to the lower joint. Stress fracture in individuals with a hereditary predisposition (some minor abnormality or weakness of the pars at birth) usually causes this. Sometimes a defect may exist without any forward slip, and this is called spondylolysis. This can also be painful.
Type 3 - Degenerative spondylolisthesis
Forward slippage secondary to arthritis of the spine is known as Degenerative spondylolisthesis. This process is usually also associated with Spinal stenosis. Long standing degenerative disc disease, leading to weak facet joints in the back of the spine is the reason. This is usually seen at L4-L5 level. This is also called Lumbar Spondylolisthesis.
For all the above conditions , surgery is indicated, if the slippage progressively worsens or if back pain does not respond to nonsurgical treatment and begins to interfere with daily life. In the congenital and high dysplastic group, spondylolisthesis surgery is done at early stages to prevent neurological complications.
Abnormal curvatures if the spine are referred to as scoliosis and kyphosis. In the normal spine, there are normal curves if seen from the sides, but the spine is seen as a straight column from the front. In scoliosis, the spine shows curvatures from the front. In kyphosis, there is abnormal forward bending of the spine.
Scoliosis is a Greek word meaning curvature. Ancient physicians thought poor posture was the primary cause of scoliosis. Today it is clear that scoliosis is either congenital (present at birth) or developmental and may be hereditary. The spine curves to the side in the shape of an "S" or "C". The curvature is measured in degrees.
Types of scoliosis
Scoliosis is classified according to the affected age groups:
- Infantile scoliosis: from birth to 3 years old
- Juvenile scoliosis: from 3 to 9 years old
- Adolescent scoliosis: from 10 to 18 years old
We can also classify according to the direction of the curve. A spinal curve to the right is called Dextroscoliosis ("dextro" = right). This is the most common type, usually occurring in the thoracic spine.
It can occur on its own (forming a "C" shape) or with another curve bending the opposite way in the lower spine (forming an "S").
A spinal curve to the left is called Levoscoliosis ("levo" = left). This is quite common in the lumbar spine, but when this rarely occurs in the thoracic spine it indicates a higher probability that the scoliosis may be secondary to a spinal cord tumor. Scoliosis may also be classified according to location. Thoracic scoliosis is curvature in the middle (thoracic) part of the spine. This is the most common location for spinal curvature. Lumbar scoliosis is curvature in the lower (lumbar) portion of the spine. A curvature that includes vertebrae in both the lower thoracic portion and the upper lumbar portion of the spine is called a Thoracolumbar scoliosis. Adolescent Idiopathic Scoliosis is yet another condition that starts around the onset of puberty in otherwise healthy boys and girls. It is more common in girls.
Physical signs may include uneven shoulders, one hip lower than the other, a rib hump when bent over at the waist and leaning to one side.
The obvious symptom of scoliosis is an abnormal curve of the spine. In some cases, the head may appear off center or one hip or shoulder may seem higher than the opposite side. In severe scoliosis the heart and lungs may dysfunction leading to breathlessness and chest pain. Back pain, rib pain, and abdominal pain are the other symptoms.
Treatment goal is to stabilize the spine to prevent additional curvature. Patients who are pain free may not seek treatment until the deformity is noticed.
Unfortunately, that stage may be actually too late to treat the disease. The size of the curve is measured in degrees on an X-ray. The progression of scoliosis is monitored by periodic x-ray studies. There are non surgical options for Scoliosis treatment for minor deformities, but the more severe and progressive ones require surgery.
For curvature of greater magnitude, surgery is needed. The goal of scoliosis surgery is to achieve a well-balanced spine in which the patient's head, shoulders and trunk are centered correctly over the pelvis. Instrumentation to reduce the magnitude of the deformity and fusion to prevent future curve progression are the steps involved.
Use of staples on the convex side of the curve, to correct and maintain the curve till the patient is skeletally mature, is a recent development in the treatment of Scoliosis. These staples allow differential growth to take place i.e. less growing speed on the stapled side than the concave side thereby correcting the curve as the child grows.
Nitinol is a titanium based alloy. Spinal implants made from Nitinol are also now being used. The C shaped staples are in the shape of 'C' when they are manufactured at room temperature. When the staples are cooled to below freezing point the prongs become straight but clamp down into the bone in a 'C' shape when the staple returns to body temperature providing secure fixation. These are called Shape Memory Alloy (SMA) staples. As no fusion is done the child grows normally and even the residual deformity tends to improve with growth.
This novel procedure was performed for the first time in India at Apollo Hospitals on a 6-yr old girl, from a small town near Madurai, by the senior spine surgeon Dr. Sajan Hegde and his team.
Back pain normally does not occur with scoliosis but in case there is pain, the symptoms can be lessened with physical therapy, massage, and scoliosis exercises. These are mainly done to strengthen the muscles of the back. Medical treatment is mainly limited to pain relievers. These will not however cure scoliosis and will not be able to correct the abnormal curve.
A spinal tumor is a growth that develops within your spinal canal or within the bones of your spine. It may be cancerous or noncancerous.
Tumors that affect the bones of the spine (vertebrae) are known as vertebral tumors.
Tumors that begin within the spinal cord itself are called spinal cord tumors.
There are two main types of tumors that may affect the spinal cord:
Intramedullary tumors begin in the cells within the spinal cord itself, such as astrocytomas or ependymomas.
Extramedullary tumors develop within the supporting network of cells around the spinal cord. Although they don't begin within the spinal cord itself, these types of tumors may affect spinal cord function by causing spinal cord compression and other problems. Examples of extramedullary tumors that can affect the spinal cord include schwannomas, meningiomas and neurofibromas.
Tumors from other parts of the body can spread (metastasize) to the vertebrae, the supporting network around the spinal cord or, in rare cases, the spinal cord itself.
Spinal tumors or growths of any kind can lead to pain, neurological problems and sometimes paralysis. Whether cancerous or not, a spinal tumor can be life-threatening and cause permanent disability.
Treatment for a spinal tumor may include surgery, radiation therapy, chemotherapy or other medications.
Depending on the location and type of spinal tumor, different signs and symptoms can develop, especially as a tumor grows and affects your spinal cord, surrounding nerves or blood vessels.
Signs and symptoms of tumors affecting the spinal cord may include:
- Back pain, sometimes radiating to other parts of your body
- Loss of sensation, especially in your arms or legs
- Difficulty walking, sometimes leading to falls
- Decreased sensitivity to pain, heat and cold
- Loss of bowel or bladder function
- Muscle weakness that may occur in varying degrees and in different parts of your body, depending on which nerves or part of the spinal cord is compressed
Back pain is a common early symptom of both noncancerous and cancerous spinal tumors. Pain may also spread beyond your back to your hips, legs, feet or arms and may become more severe over time in spite of treatment.
Spinal tumors progress at different rates. In general, cancerous spinal tumors grow more quickly, and noncancerous spinal tumors tend to develop very slowly.
When to see a doctor
There are many causes of back pain, and most back pain isn't caused by a spinal tumor. But because early diagnosis and treatment are important for spinal tumors, see your doctor about your back pain if:
- It's persistent and progressive
- It's not activity related
- It gets worse at night
- You have a history of cancer and develop new back pain
Seek immediate medical attention if you experience:
Progressive muscle weakness or numbness in your legs or arms
Changes in bowel or bladder function
It's not clear why most spinal tumors develop. Experts suspect that defective genes play a role. But it's usually not known whether such genetic defects are inherited, occur spontaneously or are caused by something in the environment, such as exposure to certain chemicals. In some cases, however, spinal cord tumors are linked to known inherited syndromes, such as neurofibromatosis 2 and von Hippel-Lindau disease.
Types of spinal cord tumors
Spinal cord tumors are classified according to their location in the spine.
Your spinal cord is a long column of nerve fibers that carries messages to and from your brain. Wrapped around the entire spinal cord are three protective membranes known as meninges. The tough outer later is the dura mater, the middle layer is the arachnoid membrane and the innermost later is the pia mater.
Spinal cord tumors may be classified as intradural or extradural depending on where they occur relative to these protective membranes of the spinal cord.
Intradural tumors occur within the dura mater and are further divided into two subcategories:
Extramedullary tumors. These tumors develop outside the spinal cord, such as in the surrounding dura mater (meningiomas) or in the nerve roots that extend out from the spinal cord (schwannomas and neurofibromas). These tumors are noncancerous in most cases.
Intramedullary tumors. These tumors begin in the supporting cells within the spinal cord. Most are either astrocytomas or ependymomas. In rare cases, intramedullary tumors from other parts of the body can spread through the bloodstream to the spinal cord itself.
Spinal cord tumors are more common in people who have:
Neurofibromatosis 2. In this hereditary disorder, noncancerous tumors develop on or near the nerves related to hearing, which may lead to progressive hearing loss in one or both ears. Some people with neurofibromatosis 2 also develop spinal canal tumors, frequently multiple and of several different types.
Von Hippel-Lindau disease. This rare, multisystem disorder is associated with noncancerous blood vessel tumors (hemangioblastomas) in the brain, retina and spinal cord and with other types of tumors in the kidneys or adrenal glands.
A prior history of cancer. Any type of cancer can travel to the spine, but the cancers that may be more likely to affect the spine include breast, lung, prostate and multiple myeloma.
Both noncancerous and cancerous spinal tumors can compress the spinal cord and nerves, leading to a loss of movement or sensation at and below the level of the tumor and sometimes to changes in bowel and bladder function. Nerve damage may be permanent.
However, if a spinal tumor is caught early and treated aggressively, it may be possible to prevent further loss of function and, with aggressive rehabilitation, regain nerve function. Depending on its location, a tumor that compresses the spinal cord itself may be life-threatening.
Spinal tumors sometimes may be overlooked because they're not common and their symptoms resemble those of more common conditions. For that reason, it's especially important that your doctor know your complete medical history and perform both general physical and neurological exams.
If your doctor suspects a spinal tumor, one or more of the following tests can help confirm the diagnosis and pinpoint the tumor's location:
Spinal magnetic resonance imaging (MRI). MRI uses a powerful magnet and radio waves to produce images of your spine. MRI accurately shows the spinal cord and nerves and yields better pictures of bone tumors than computerized tomography (CT) scans do. A contrast agent that helps to highlight certain tissues and structures may be injected into a vein in your hand or forearm during the test.
Some people may feel claustrophobic inside the MRI scanner or find the loud thumping sound it makes disturbing. But you're usually given earplugs to help with the noise, and some scanners are equipped with televisions or headphones. If you're very anxious, ask about a mild sedative to help calm you. In certain situations, a general anesthetic may be necessary.
Computerized tomography (CT). This test uses a narrow beam of radiation to produce detailed images of your spine. Sometimes it may be combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see.
Biopsy. The only way to determine the precise nature of a spinal or vertebral tumor is to examine a small tissue sample (biopsy) under a microscope. The biopsy results will help determine treatment options.
How the sample is obtained depends on your overall health and the location of the tumor. Doctors may use a fine needle to withdraw a small amount of tissue, or the sample may be obtained during surgery. These procedures can be associated with significant risks and should only be performed at a center that specializes in spine tumors.
Ideally, the goal of spinal tumor treatment is to eliminate the tumor completely, but this goal may be complicated by the risk of permanent damage to the spinal cord and surrounding nerves. Doctors also must take into account your age and overall health. The type of tumor and whether it arises from the structures of the spine or spinal canal or has spread to your spine from elsewhere in your body also must be considered in determining a treatment plan.
Pediatric neurosurgery consultation Pediatric neurosurgery consultation
Treatment options for most spinal tumors include:
Monitoring. Some spinal tumors may be discovered before they cause symptoms — often when you're being evaluated for another condition. If small tumors are noncancerous and aren't growing or pressing on surrounding tissues, watching them carefully may be all that's needed.
This is especially true in older adults for whom surgery or radiation therapy may pose special risks. During observation, your doctor will likely recommend periodic CT or MRI scans to monitor the tumor.
Surgery. This is often the treatment of choice for tumors that can be removed with an acceptable risk of spinal cord or nerve injury damage.
Newer techniques and instruments allow neurosurgeons to reach tumors that were once considered inaccessible. The high-powered microscopes used in microsurgery make it easier to distinguish tumor from healthy tissue.
Doctors also can monitor the function of the spinal cord and other important nerves during surgery, thus minimizing the chance of their being injured. In some instances, very high frequency sound waves might be used during surgery to break up tumors and remove the fragments.
Unfortunately, even with the latest technological advances in surgery, not all tumors can be removed completely. When the tumor can't be removed completely, surgery may be followed by radiation therapy or chemotherapy or both.
Recovery from spinal surgery may take weeks or longer, depending on the procedure. You may experience a temporary loss of sensation or other complications, including bleeding and damage to nerve tissue.
Radiation therapy. This may be used to eliminate the remnants of tumors that remain after surgery, to treat inoperable tumors or to treat those tumors where surgery is too risky. It may also be the first line therapy for metastatic tumors (those that travel to the spine region from other cancers of the body). Radiation may also be used to relieve pain or when surgery poses too great a risk.
Medications may help ease some of the side effects of radiation, such as nausea and vomiting.
Depending on the type of tumor you have, your radiation therapy team may be able to modify your treatment to help prevent damage to surrounding tissue from the radiation and improve the treatment's effectiveness. Modifications may range from simply changing the dosage of radiation to using sophisticated techniques such as 3-D conformal radiation therapy.
A specialized type of radiation therapy called proton beam therapy may be used to treat some vertebral tumors, such as chordomas and chondrosarcomas, and some childhood cancers when spinal radiation is required.
Stereotactic radiosurgery (SRS). This method of delivering radiation is capable of delivering a high dose of precisely targeted radiation. In SRS, doctors use computers to focus radiation beams on tumors with pinpoint accuracy and from multiple angles.
There are different types of technology used in radiosurgery to stereotactically deliver radiation to treat spinal tumors, such as a Gamma Knife machine.
SRS has certain limits on the size and specific type of the tumors that can be treated, but where appropriate, it has proved quite effective, and growing research supports its use for the treatment of spinal and vertebral tumors. However, further study is needed to determine the best technique, radiation dose and schedule for SRS in the treatment of spinal tumors.
Chemotherapy. A standard treatment for many types of cancer, chemotherapy uses medications to destroy cancer cells or stop them from growing. Your doctor can determine whether chemotherapy might be beneficial for you, either alone or in combination with radiation therapy.
Side effects may include fatigue, nausea, vomiting, increased risk of infection and hair loss.
Other drugs. Because surgery and radiation therapy as well as tumors themselves can cause inflammation inside the spinal cord, doctors sometimes prescribe corticosteroids to reduce the swelling, either after surgery or during radiation treatments. Although corticosteroids reduce inflammation, they are usually used only for short periods to avoid serious side effects as muscle weakness, osteoporosis, high blood pressure, diabetes and an increased susceptibility to infection.
Although there aren't any alternative medicines that have been proved to cure cancer, some alternative or complementary treatments may help relieve some of your symptoms.
One such treatment is acupuncture. During acupuncture treatment, a practitioner inserts tiny needles into your skin at precise points. Research shows that acupuncture may be helpful in relieving nausea and vomiting. Acupuncture may also help relieve certain types of pain in people with cancer.
Be sure to discuss the risks and benefits of complementary or alternative treatment that you're thinking of trying with your doctor. Some treatments, such as herbal remedies, could interfere with medicines you're taking.
At Mayo Clinic, we take the time to listen, to find answers and to provide you the best care.
A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal — often causes permanent changes in strength, sensation and other body functions below the site of the injury.
If you've recently experienced a spinal cord injury, it might seem like every aspect of your life will be affected.
Many scientists are optimistic that advances in research will someday make the repair of spinal cord injuries possible. Research studies are ongoing around the world. In the meantime, treatments and rehabilitation allow many people with a spinal cord injury to lead productive, independent lives.
Your ability to control your limbs after spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.
The lowest part of your spinal cord that functions normally after injury is referred to as the neurological level of your injury. The severity of the injury is often called "the completeness" and is classified as either of the following:
Complete. If almost all feeling (sensory) and all ability to control movement (motor function) are lost below the spinal cord injury, your injury is called complete.
Incomplete. If you have some motor or sensory function below the affected area, your injury is called incomplete. There are varying degrees of incomplete injury.
Additionally, paralysis from a spinal cord injury may be referred to as:
Tetraplegia. Also known as quadriplegia, this means your arms, hands, trunk, legs and pelvic organs are all affected by your spinal cord injury.
Paraplegia. This paralysis affects all or part of the trunk, legs and pelvic organs.
Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.
Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:
- Loss of movement
- Loss of sensation, including the ability to feel heat, cold and touch
- Loss of bowel or bladder control
- Exaggerated reflex activities or spasms
- Changes in sexual function, sexual sensitivity and fertility
- Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
- Difficulty breathing, coughing or clearing secretions from your lungs
Emergency signs and symptoms
Emergency signs and symptoms of spinal cord injury after an accident may include:
- Extreme back pain or pressure in your neck, head or back
- Weakness, incoordination or paralysis in any part of your body
- Numbness, tingling or loss of sensation in your hands, fingers, feet or toes
- Loss of bladder or bowel control
- Difficulty with balance and walking
- Impaired breathing after injury
- An oddly positioned or twisted neck or back
When to see a doctor
Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it's safest to assume that trauma victims have a spinal injury until proven otherwise because:
A serious spinal injury isn't always immediately obvious. If it isn't recognized, more severe injury may occur.
Numbness or paralysis may develop immediately or come on gradually as bleeding or swelling occurs in or around the spinal cord.
The time between injury and treatment can be critical in determining the extent of complications and the amount of recovery.
If you suspect that someone has a back or neck injury:
- Don't move the injured person — permanent paralysis and other serious complications may result
- Call 102 or your local emergency medical assistance number
- Keep the person still
- Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives
- Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck