Scientific developments in spine surgery have led to amazing results
The spine is important in protecting the spinal cord, rib cage and nerves. Thirty-three ring-shaped bones called vertebrae form the spine and protect the spinal cord from injury. These vertebrae protect the brain stem and the spinal cord, support the skull, and allow for a wide range of head movement.
Spinal diseases vary according to the symptoms and location of the injury. Therefore, the doctor starts with the initial and physical treatments and the last resort would be surgery, which witnessed a remarkable development in recent years that led to performing some operations with local anesthesia and some are done by endoscopy. Endoscopic spine surgery is a type of state-of-the-art surgery that uses small tubular system or micro incisions, assisted with an endoscope for visualization. This type of minimally-invasive spine surgery provides patients with quicker recovery and less pain than traditional spine surgery. Before talking about diseases, it is necessary to explain the anatomy of the spine and its importance in the body.
Your spine is made up of a column of bones called vertebrae. Between each vertebra is a shock-absorbing disc that prevents the bones from rubbing together. The intervertebral discs are designed to absorb pressure and keep the spine flexible by acting as cushions during body movement. Inside the disc is a gel-filled center called the nucleus, much like a tire tube.
Degenerative spine conditions
Degenerative disc disease (DDD) affects the discs that separate the spine bones. As you age, the spine begins to show signs of wear and tear as the discs dry out and shrink. These age-related changes can lead to arthritis, disc herniation, or spinal stenosis. Pressure on the spinal cord and nerves may cause pain. Physical therapy, self-care, medication, and spinal injections are used to manage symptoms. Surgery may be an option if the pain is chronic.
Degenerative disc disease (spondylosis) can occur in any area of the spine (cervical, thoracic, lumbar), but is most common in the low back. It’s not actually a disease, but rather a condition in which your discs “degenerate” and lose their flexibility and height to cushion the spine. Discs have a limited blood supply, so once injured they can’t repair themselves easily. Age-related changes to discs include discs dry out and shrink – the disc nucleus is made of about 80% water. As you get older it slowly loses water and flexibility, which puts more stress on the disc annulus.
Small tears occur in the annulus – sometimes the gel-like nucleus pushes through a tear in the wall and touches nearby nerves. This material has inflammatory proteins that can irritate nerves and cause pain. The tears also affect tiny nerves in the annulus and cause discogenic pain with small micro-motion instability of the disc. Over time the proteins dry up, and the discs become stiffer.
Disc gets thinner – due to the loss of water, the discs get thin and the distance between vertebrae begin to collapse. Which is why we get shorter as we age. Bone spurs grow – without the discs holding apart the vertebrae, they can rub on each other causing abnormal bone growths.
Excess motion – abnormal rubbing adds stress to the facet joints. Pinched nerves may result in back or leg pain (sciatica). Spinal canal narrows – the added stress causes the ligaments and facet joints to enlarge (hypertrophy) as they try to compensate and spread the load over a larger area. This over-growth causes the spinal canal to narrow, which can compress the spinal cord and nerves causing pain. The symptoms of a degenerative disc vary from person to person. Many people with deterioration have no pain, while others may experience pain so intense that it interferes with daily activities. Pain often starts in one of three ways: a major injury followed by sudden and unexpected pain, a trivial injury followed by sudden back pain or pain that starts gradually and gets progressively worse.
Usually, the pain begins in the lower back, and may be felt in one or both of your legs and buttocks (sciatica). It’s often described as pressure or burning pain. You may also feel numbness or tingling in your leg and foot, which usually is not a cause for concern unless you have weakness in your leg muscles. You may have chronic underlying pain that is a nagging annoyance, and occasional episodes of intense muscle pain from time to time. These episodes last from a few days to a few months. Sitting usually causes the most pain because in this position your discs have more weight on them. Activities such as bending or twisting usually make your pain worse, and lying down tends to relieve the pain. You may actually feel better if you walk or run rather than sit or stand for too long.
With continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is a ruptured, or herniated, disc. The fragments of disc material can then press on the nerve roots located just behind the disc space. This can cause pain, weakness, numbness, or changes in sensation. Most disc herniations happen in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra. A herniated disc can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disc. Most people who have a herniated disc don’t need surgery to correct the problem. Disc herniation is most often the result of a gradual, aging-related wear and tear called disc degeneration. As you age, your spinal discs lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist. Sometimes, severe injury can cause a normal disc to herniate. Injury may also cause an already herniated disc to worsen.
Most herniated discs occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine). The most common signs and symptoms of a herniated disc are arm or leg pain, if your herniated disc is in your lower back, you’ll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disc is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
People who have a herniated disc often experience numbness or tingling in the body part served by the affected nerves. Muscles served by the affected nerves tend to weaken. Herniated discs can occur in any part of the spine and are more common in the lower back (lumbar spine), but also occur in the neck (cervical spine). The area in which pain is experienced depends on what part of the spine is affected.
Several words are used to describe the extent of a disc herniation seen on MRI examination. A disc herniation occurs when the soft cushion between the spinal bone ruptures. A portion of that disc can herniate, or push outwards, against the spinal cord or the spinal nerves. The pressure on the nerves causes the symptoms typical of a disc herniation. The types of disc herniation that occur include:
- Disc Protrusion: Commonly called a disc bulge, a disc protrusion occurs with the spinal disc and the associated ligaments remain intact but form an outpouching that can press against the nerves.
- Disc Extrusion: A disc extrusion occurs when the outer part of the spinal disc ruptures, allowing the inner, gelatinous part of the disc to squeeze out. Disc extrusions can occur with the ligaments intact, or damaged.
- Disc Sequestration: A disc sequestration occurs when the center, gelatinous portion of the disc is not only squeezed out but also separated from the main part of the disc.
Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms. Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. Causes of spinal stenosis may include overgrowth of bone, herniated discs, thickened ligaments, tumors and spinal injuries.
Symptoms of the stenosis include numbness or tingling and weakness in a hand, arm, foot or leg, problems with walking and balance, bowel or bladder dysfunction (urinary urgency and incontinence), pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit. Treatment of stenosis includes surgery, muscle relaxants, steroid injections, or NSAIDs.
The types of spinal stenosis are classified according to where on the spine the condition occurs. It’s possible to have more than one type. The two main types of spinal stenosis are:
Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in your neck.
Lumbar stenosis. In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of spinal stenosis.
Most people with spinal stenosis are over the age of 50. Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. These include trauma, congenital spinal deformity such as scoliosis, and a genetic disease affecting bone and muscle development throughout the body. Spinal imaging can differentiate these causes. Rarely, untreated severe spinal stenosis may progress and cause permanent numbness, weakness, balance problems, incontinence, paralysis.
Osteoarthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and lower back. Sometimes, osteoarthritis produces spurs that put pressure on the nerves leaving the spinal column. This can cause weakness and pain in the arms or legs. In general, osteoarthritis happens as people get older. Younger people may get it from one of several different causes including injury or trauma to a joint or a genetic defect involving cartilage. For people younger than age 45, osteoarthritis is more common among men. After age 45, osteoarthritis is more common among women. Osteoarthritis occurs more often among people who are overweight. It also occurs more frequently in those who have jobs or do sports that put repetitive stress on certain joints.
Osteoarthritis of the spine is caused by osteoporosis where the bones become porous and weaker, increasing the risk of fractures, especially in the hip, spinal vertebrae, and some peripheral joints, such as the wrists.
Osteoarthritis of the spine may cause stiffness or pain in the neck or back. It may also cause weakness or numbness in the legs or arms if it is severe enough to affect spinal nerves or the spinal cord itself.
Usually, the back discomfort is relieved when the person is lying down. Some people experience little interference with the activities of their lives. Others become more severely disabled. In addition to the physical effects, a person with osteoarthritis might also experience social and emotional problems. For instance, a person with osteoarthritis that hinders daily activities and job performance might feel depressed or helpless.
A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be benign or malignant. There are some types of tumors that start inside the bones of the spine such as chordoma, cartilaginous sarcoma, osteosarcoma, plasmacytoma, and Ewing sarcoma. Spinal tumors can be benign or malignant; primary tumors originate in the spine or spinal cord, and metastatic or secondary tumors result from cancer spreading from another site to the spine. About one-third of primary spinal cord tumors arise in cells within the spinal cord. Syringobulbia is a neurological disorder characterized by a fluid-filled cavity (syrinx) within the spinal cord that extends to involve the lower brainstem (medulla). It usually occurs as a slit-like gap within the lower brainstem that may affect one or more of the cranial nerves. Intramedullary tumors are rare, accounting for only five to 10 percent of all spinal tumors. Benign tumors such as meningiomas and neurofibromas account for 55 to 65 percent of all primary spinal tumors.
A metastatic tumor is one that has spread from cancer in another part of the body. A metastatic spinal tumor, therefore, is a tumor that first started in another place in the body and spread to the spine. A metastatic tumor is sometimes called a secondary tumor. The original tumor, located elsewhere in the body, is called the primary tumor. The metastatic spinal tumor grows in the spine, but it is composed of cells from the primary tumor. As metastatic spinal tumors grow, they may weaken the vertebrae. A compression fracture may eventually occur in the weakened vertebrae. In some cases, a compression fracture is the first symptom of a metastatic spinal tumor. Sometimes these tumors cause pain as they grow. This pain is usually described as an aching pain in the bones that is not relieved by rest. If the growing tumor compresses the spinal cord or nerve roots, it may cause problems with movement or sensation (clumsiness, numbness, pins-and-needles) in the arms or legs. In severe cases, bowel or bladder control may be compromised.
Depending on the type of tumor, radiation therapy and chemotherapy may be used to slow, stop, or shrink it. Surgical removal of metastatic spinal tumors can rapidly and effectively relieve pressure on the spinal cord or nerve roots. This generally provides relief from neurological symptoms like radiating pain, numbness, weakness, clumsiness, etc. If the tumor compromises the stability of the spine, surgery to stabilize the spine with metallic implants may be useful.