Spondylosis (Osteo-Arthritis)
Spinal arthritis is relatively common and is most likely to occur in people over age fifty. It represents an ongoing, degenerative process in the spine, and may be associated with a number of other degenerative spinal conditions. In particular, osteoarthritis is associated with degenerative discs in the spine. Degenerative discs and osteoarthritis often occur hand in hand because the disc and facet joints (the joints in the back affected by osteoarthritis) are both part of the same three-joint complex. It is thought that degenerating discs can place undue stress on the facet joints, thus over time leading to degeneration and formation of osteoarthritis in the facet joints (also called zygapophyseal joints). This may be why the two degenerative conditions are so often seen together. If the disc as well as the facet joints become painful as a result of degenerative changes in the spine, the condition is often called spondylosis. However, degenerative disc disease and osteoarthritis are different conditions and can occur separately: one can have degenerative discs without any facet osteoarthritis; or one can have facet osteoarthritis without degenerative discs.
Other anatomical markers of disc degeneration that often occur in conjunction with osteoarthritis—and may or may not cause pain or other symptoms—include: |
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- Synovial cysts. Over time, degeneration of the facet joints in the lower back can result in formation of a fluid-filled sac called a synovial cyst. These cysts are benign in and of themselves, but if they put pressure on the spinal canal they can cause symptoms of spinal stenosis.
- Bone spurs (osteophytes). It is thought (though not proven) that over time the combination of disc degeneration and small amounts of instability can cause bone spurs to form. If the bone spurs impinge on the spinal canal, this can cause pain and symptoms from spinal stenosis. It should be noted that bone spurs are simply radiographic markers of degeneration, and are not in and of themselves painful (unless they pinch a nerve root).
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Spondylolisthesis
Spondylolisthesis is the term used to describe the presence of a spondylolysis where there has also been forward translation of the vertebra with the lysis (usually L5), on the vertebra below (usually the sacrum).
In the majority of cases the degree of anterior translation is slight, but in approximately 20% of cases the displacement of the upper vertebra can be marked.
It can be congenital (born with it) associated with a “pars defect”, degenerative, or traumatic.
The development of a spondylolysis which then goes on to a spondylolisthesis is usually associated with significant low back pain, but in most cases the situation will stabilize and pain will settle. It is only where severe pain persists, or features of nerve root irritation or compression develop that surgical intervention is indicated at this stage.
In cases where symptoms resolve some activity modification may be required to reduce the risk of exacerbating episodes of pain. It is also General fitness to maintain abdominal musculature tone is important.
If symptoms persist surgical intervention may be considered, and would usually take the form of a spinal fusion. However despite the often impressive x-ray appearance of this condition surgery of this type is required in less than 20% of cases.
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Spinal Stenosis
Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected.
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Lateral Recess Stenosis
In 1981, a International Study carried out to determine the anatomical reasons behind failed back surgery found that the the most common reason for a bad surgical result was failure of the surgeon to either identify or adequately treat the entity know as "lateral spinal stenosis" (LSS).
The primary researchers behind the 1981 study continued to monitor the failed back surgery situation and, even at the year 2000, the start of a new millennium, they concluded that LSS continued to be the primary reason for surgical failure. Sadly, this situation continues to be true. The reasons behind this astonishing observation are difficult to comprehend because such a high failure rate would not be tolerated in any other surgical specialty.
Because of the importance of this subject Burton Report has been focused on attempting to better inform physicians and patients and make them more aware of the need for more specific diagnosis and more appropriate surgical therapy based on this information. Surgeons and their patients need to reflect on the observation that "there is no such thing as a non-specific patient, there are, however, non-specific surgeons." This observation is eminently applicable to spine surgery and spine surgeons.
Lateral spinal stenosis was first described in 1940 by neurosurgeon Henk Verbiest.
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Disc Herniation
A slipped disc can happen anywhere in the spine, and surprisingly, a slipped disc does not actually slip. Instead, the disc, which is located between the bones of the spine (vertebrae), splits or ruptures. When this happens, the inner gel-like substance (nucleus pulposus) leaks out. This is called a herniation of the nucleus pulposus—or a herniated disc. People between the ages of 30 and 50 are most at risk for herniation because the elasticity and water content of the nucleus pulposus decrease with age.
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Kyphosis
Kyphosis is a progressive spinal disorder that can affect children or adults. This disorder may cause a deformity described as humpback or hunchback. Kyphosis can be in the form of hyperkyphosis or sharp angular gibbus deformity. Abnormal kyphotic curves are more commonly found in the thoracic or thoracolumbar spine, although they can be cervical.
Lordosis
Lordosis is defined as an excessive inward curve of the spine. It differs from the spine's normal curves at the cervical, thoracic, and lumbar regions, which are, to a degree, either kyphotic (near the neck) or lordotic (closer to the low back). The spine's natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement.
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Scoliosis
Scoliosis is an abnormal sideways curve of the spine. The cause is usually unknown. Surgery is recommended in severe cases.
In profile, the healthy spine has three natural curves that form a loose ‘S’ shape: at the neck, upper back and lower back. From the rear, the healthy spine should look straight. When a person has scoliosis, they have an abnormal sideways curve that makes the spine look tilted when viewed from the rear.
Scoliosis tends to develop in late childhood. About one in every two people is thought to have mild scoliosis, which is painless, does not worsen and does not need treatment. However, severe scoliosis is a painful and debilitating condition that tends to worsen with age. About three children out of every 1000 have scoliosis that needs medical treatment.
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