The Spine

Our spine is the main support of our upper bodies. (Read about "Skeletal System") It lets us stand up straight, bend or twist. It also encases and protects the spinal cord. The nerves branch out from our spine to the rest of our bodies. (Read about "Nervous System")

The spine is made up of vertebrae. At the top are the cervical vertebrae. There are seven of them and they are referred to as C1-C7, starting at the top. The seventh one joins to the first of the thoracic vertebrae. These are the 12 that run down the back and provide a place for our ribs to attach. They are referred to as T1-T12, again from the top down. The lower inward curve of our back is made up of the five lumbar vertebrae. They are called L1-L5. Below that comes a set of five fused vertebrae called the sacrum that lies between the hipbones. Lastly comes the coccyx or the tailbone, another set of fused vertebrae.

The vertebrae join together at what are called the facet joints. Between each of the vertebrae are the disks, which provide cushioning and act as shock absorbers.

Traveling down the center of the spine is the spinal cord and at each of the vertebrae, nerves branch out through what are called the foramen to the rest of the body.

Diagnosis

If you are having pain or problems in your back or spine, you should see your doctor. Diagnosing a back problem usually starts with a medical history. Your doctor will ask you about any injuries or conditions that could be causing the symptoms. Next you'll probably get a physical. The doctor will check how limited your movements are, when and where pain occurs as you move your back and look for numbness or weakness in your arms and legs.

There are also a number of tests that can be performed, according to NIAMS. They include:

• X-rays can show many problems. AAOS says it is useful for both degenerative spine problems and disk issues. (Read about "X-rays")
• MRI is most useful for soft tissue issues such as disks, ligaments, the spinal cord, nerves and tumors. (Read about "MRI - Magnetic Resonance Imaging")
• CT scan takes a look at the structure of the spine and the areas around it. (Read about "CT Scan - Computerized Tomography")
• A myelogram uses a liquid dye that is injected into the spinal column. X-rays cannot penetrate the dye, so the spinal column and the nerves show up. It can show pressure on the nerves from herniated disks, bone spurs or tumors. (Read about "X-rays" "Bone Tumors - Benign")
• A bone scan uses a radioactive material that is injected. It attaches to the bone, especially where the bone is breaking down or being built up. That makes it effective for discovering degenerative bone problems such as arthritis or fractures.

Many times, a number of these tests will be done to confirm a diagnosis. Below are some of the conditions and diseases that can affect the spine.

Vascular lesions

A vascular lesion is an abnormal cluster of snarled blood vessels. Vascular lesions can occur just about anywhere in the body. When they occur on the spinal cord, they can have dramatic impacts.

One of the more common is an arteriovenous malformation or AVM. An AVM is made up of tangled arteries and veins. Spinal AVMs can result in sudden, severe back pain. (Read about "Back Pain") It is often concentrated at nerve fibers where they exit the vertebrae; the pain is similar to that caused by a slipped disk. These lesions also can cause sensory disturbances, muscle weakness or paralysis in the parts of the body served by the spinal cord or the damaged nerve fibers.

Other types of vascular lesions include:

• capillary telangiectases
• cavernous malformations
• venous malformations

The term, cerebrovascular disorders, is also used when discussing vascular lesions.

(Read about "Vascular Lesions of the Central Nervous System")

Trauma

Trauma (accidents) may either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal. Spinal cord trauma can be caused by:

• motor vehicle accidents (Read about "Car Safety")
• falls
• water injuries (Read about "Water Safety")
• sports injuries (Read about "Avoid Sports Injury")
• gunshot or assault

The National Spinal Cord Injury Association says that after a spinal cord injury, the nerves above the level of injury keep working, but nerves from the point of injury and below do not. Therefore, the higher the injury is on the spine, the more it can impact how the body moves and what a person can feel. In addition to the location of the injury, the impact also depends on the extent of the injury.

People who survive a spinal cord injury can develop medical complications such as chronic pain and bladder and bowel dysfunction. (Read about "Chronic Pain" "Incontinence" "Fecal Incontinence") They may also be more likely to develop respiratory and heart problems, according to NINDS. (Read about "Respiratory System" "The Heart & Cardiovascular System") Rehabilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support. The education and active involvement of the newly injured person and his or her family and friends is crucial. (Read about "Rehabilitation")

Arthritis

Arthritis causes swelling in the joints and connective tissue. Different forms of arthritis and rheumatic diseases can affect the spine, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and reactive arthritis (Reiter's syndrome).

(Read about "Arthritis and Rheumatic Diseases" "Osteoarthritis" "Rheumatoid Arthritis" "Ankylosing Spondylitis" "Reactive Arthritis")

See diagnosis, treatment and prevention below.

Cervical spondylotic myelopathy (CSM)

When the compression of the cervical spine occurs, it is called cervical spondylotic myelopathy (CSM), according to the American Academy of Family Physicians (AAFP). AAFP calls CSM the most common spinal cord problem for people over the age of 55 in the United States. Some of the symptoms of CSM, according to AAFP include:

• a stiff neck
• a feeling of weakness in the arms and legs
• hands that are numb
• arm pain

Stiff legs can also be a symptom of CSM. Pressure on the nerve can lead to peripheral neuropathy. (Read about "Peripheral Neuropathy") The symptoms can develop very slowly.

See diagnosis, treatment and prevention below.

Degenerative disk disease

As we get older, the disks that form the cushioning between the vertebrae can shrink. AAOS says this is due to the fact that the water content in our body cells diminishes, as well as other chemical changes that occur. Without enough cushioning, the vertebrae can press against each other and pinch the nerve (Read about "Peripheral Neuropathy") or form bony spurs. These changes occur to some degree in everyone. AAOS says all of us will develop degenerative or "wear and tear" changes, and for the most part, the loss of function that results is not extensive. However, in severe cases of degenerative disk disease, there can be low back stiffness and pain. In addition, arthritic bone spurs and inflamed joints can cause nerve irritation and leg pain.

(Read about "Disk Problems")

See diagnosis, treatment and prevention below.

Stenosis

The basic definition of stenosis is a narrowing of a vessel or a passageway. When spinal stenosis occurs, either the passageway the spinal cord goes through or the foramen are narrowed. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the cord and/or the nerves can be pinched and that can cause pain, numbness and loss of body functions. (Read about "Peripheral Neuropathy") Spinal stenosis most often results from a gradual, degenerative aging process, although it can be caused by other problems too. This disorder is most common in people over 50 years of age. However, it may occur in younger people who are born with a narrowing of the spinal canal or who suffer an injury to the spine.

NIAMS says potential causes of stenosis include:

• Osteoarthritis - which is the most common form of arthritis and is more likely to occur in middle-aged and older people. It is a chronic, degenerative process that may involve multiple joints of the body. It wears away the surface cartilage layer of joints, and is often accompanied by overgrowth of bone, formation of bone spurs and impaired function. (Read about "Osteoarthritis")
• Spondylolisthesis - which is a condition in which one vertebra slips forward on another. (See more on spondylolisthesis below)
• Rheumatoid arthritis - an autoimmune disease, which usually affects people at an earlier age than osteoarthritis does and is associated with inflammation and enlargement of the soft tissues of the joints. (Read about "Rheumatoid Arthritis")
• Scoliosis - which is a curvature of the spine (Read about "Curvature of the Spine")
• Paget's disease of bone - which is a chronic disorder that typically results in enlarged and deformed bones. Excessive bone breakdown and formation cause thick and fragile bone. As a result, bone pain, arthritis, noticeable deformities and fractures can occur. (Read about "Paget's Disease of Bone")
• Tumors - may affect the spinal canal directly by inflammation or by growth of tissue into the canal. Spinal tumors can be benign or malignant. (See more on spinal tumors below)
• Trauma - can either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal. (See more on trauma below)

See diagnosis, treatment and prevention below.

Ruptured, slipped or herniated disk

It's known by many terms including, ruptured, slipped or herniated disk. No matter what it's called, it means the same thing. One of those pads between your vertebrae is bulging out of place in some way and putting pressure on a nerve. AAFP says that a ruptured disk usually squeezes just a couple of nerves at a time.

The disks are made up of two parts. There is a tough outer layer and a gel like center. A ruptured disk occurs when the center pushes the outer layer out of position. It usually happens as we get older and the disks lose some of their flexibility.

According to the American Academy of Orthopaedic Surgeons (AAOS), symptoms of a ruptured disk can include:

• pain
• weakness
• numbness and tingling (Read about "Paresthesia" "Peripheral Neuropathy")

The North American Spine Society (NASS) says most ruptured disks occur in the bottom two disks of the lumbar spine just around our waists. When the disk problem is in this area, the pain can extend from the buttocks down the leg. (see sciatica below) Ruptured disks can also occur in other parts of the spine. If they happen in the cervical area, that's the upper part, it can cause pain, weakness and numbness in the shoulders and arms, according NASS.

Most of the time, a ruptured disk does not need surgery. (Read about "Neurosurgery") NASS says 80 to 90 percent of people improve without surgery. Occasionally a ruptured disk will cause a person to lose bladder or bowel control. (Read about "The Urinary System" "Digestive System") Losing bladder and bowel control can be a symptom of a massive herniated disk resulting in what is called cauda equina syndrome, according to American Association of Neurological Surgeons. AAOS calls that an emergency and suggests you call your doctor immediately.

(Read about "Disk Problems")

See diagnosis, treatment and prevention below.

Sciatica

The sciatic nerve is the large nerve that extends from the lower end of the spinal column in the pelvis and all the way down the leg. (Read about "Nervous System") If this nerve is compressed, the compression causes a number of symptoms, including:

• shock-like or burning low back pain
• pain through the buttocks and down one leg to below the knee, occasionally reaching the foot
• numbness
• loss of motor control over the leg

The extent of the pain can vary from a mild discomfort or ache to excruciating pain. Sitting for a long period of time can make it worse. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), causes of sciatica include:

• ruptured disk (see above), which is by far the most common cause of sciatica (Read about "Disk Problems")
• tumors or cysts (see below)
• degeneration of the sciatic nerve root

Disks provide cushioning between the vertebrae and act as shock absorbers. As disks degenerate with age, they can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. In the most extreme cases of sciatica, when the nerve is pinched between the disk and an adjacent bone, the symptoms involve numbness and some loss of motor control over the leg due to interruption of nerve signaling.

NASS says sciatica hits about one to two percent of the population. AAOS says it is most likely to occur in people who are 30-50 years of age.

See diagnosis, treatment and prevention below.

Spondylolysis and Spondylolisthesis

Spondylolysis is a stress fracture in the lower spine. (Read about "Bone Fractures") It may result from a degenerative condition or an accident or may be acquired at birth. AAOS says it is a common cause of lower back pain in young athletes. Sometimes, the stress fracture weakens the bone so much that it moves out of place. This is called spondylolisthesis. Poor alignment of the spinal column when a vertebra slips forward onto the one below it can place pressure on the spinal cord or nerve roots at that place. Athletes are vulnerable, especially if they are involved in sports that put a lot of stress on the back. Genetics (Read about "Genetics") can also play a role in the development of these conditions. Sometimes, these conditions do not cause any noticeable symptoms. If symptoms are present, they can include:

• pain
• spasms
• tightness

Treatment depends on how much the problem is interfering with a person's life. Initial treatment options include physical therapy (Read about "Rehabilitation") and anti-inflammatory medication. (Read about "Medicine Safety") In some cases, surgery is an option. (Read about "Neurosurgery")

See diagnosis, treatment and prevention below.

Osteoporosis

Osteoporosis can also cause spinal problems. The bones become weak and brittle. They can fracture and collapse. (Read about "Bone Fractures") The Society of Cardiovascular and Interventional Radiology (SCVIR) says that osteoporosis causes 700,000 fractures of the vertebrae each year. Many older people lose height because of this. The result can mean pressure on the spinal cord or the nerves that go out to the rest of the body. (Read about "Age and Bone Loss")

(Read about "Osteoporosis")

See diagnosis, treatment and prevention below.

Scoliosis

Scoliosis is also called curvature of the spine. It is a condition where the spine, when viewed from the back, forms an "S" shape instead of a straight line. It can result in stenosis of the spine and the accompanying problems.

(Read about scoliosis in "Curvature of the Spine")

See diagnosis, treatment and prevention below.

Spinal Tumors and Cysts

Spinal tumors can be benign or malignant, according to the National Institute of Neurological Disorders and Stroke (NINDS). (Read about "Bone Cancer" "Bone Tumors - Benign") Benign tumors are noncancerous and malignant tumors are cancerous. (Read about "Cancer: What It Is") A biopsy, a surgical procedure in which a sample of tissue is taken from a suspected tumor, helps doctors diagnose the type of tumor. (Read about "Biopsy") NIAMS says tumors may affect the spinal canal directly by inflammation or by growth of tissue into the canal. Tissue growth may lead to bone resorption (bone loss due to over activity of certain bone cells) or displacement of bone and the eventual collapse of the supporting framework of the vertebral column. Spinal cord tumor symptoms depend on the size and location of the tumor, and can include pain, sensory changes and motor problems or weakness.

A cyst is a closed sac that can be filled with fluid. A spinal cyst may be associated with a tumor or be present by itself. Like a tumor, a cyst can apply pressure to the spinal column or the nerves, leading to pain and other symptoms. Syringomyelia is a disorder in which a cyst forms within the spinal cord, according to NINDS. NINDS says that this cyst, called a syrinx, expands and elongates over time, destroying the center of the spinal cord. Since the spinal cord connects the brain to nerves (Read about "The Brain" "Nervous System") in the extremities, this damage results in pain, weakness and stiffness in the back, shoulders, arms or legs. Other symptoms may include headaches and a loss of the ability to feel extremes of hot or cold, especially in the hands.

One cause of back pain and sciatica can be spinal synovial cysts, which form as the result of deteriorating conditions (arthritis) involving the facet joints.

See diagnosis, treatment and prevention below.

Diagnosis, Treatment and Prevention

A thorough medical history and physical exam is often the first step to identify any dangerous conditions or underlying problems that may be causing back pain. A doctor can examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment. Among the diagnostic tests that may be used are:

• X-rays - A conventional x-ray can look for broken bones or an injured vertebra. Discography uses contrast dye to enhance a spinal disc prior to an x-ray. Myelograms also enhance the diagnostic imaging of an x-ray. In this procedure, the contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray. (Read about "X-rays")
• Computerized tomography (CT) scan - In CT scan x-rays are passed through the body at various angles and are detected by a computerized scanner to produce two-dimensional slices. (Read about "CT Scan - Computerized Tomography")
• Magnetic resonance imaging (MRI) - MRI can be used to evaluate the lumbar region for bone degeneration or injury or disease in tissues and nerves, muscles, ligaments, and blood vessels. (Read about "MRI - Magnetic Resonance Imaging")
• Ultrasound imaging - Ultrasound or sonography, uses high-frequency sound waves to obtain images inside the body. The sound wave echoes are recorded and displayed as a real-time visual image. Ultrasound imaging can show tears in ligaments, muscles, tendons, and other soft tissue masses in the back. (Read about "Ultrasound Imaging")
• Electromyography (EMG) - EMG may be used to assesses the electrical activity in a nerve and detect if muscle weakness results from injury or a problem with the nerves that control the muscles. (Read about "Medical Procedures")
• Bone scans - Bone scans, using a small amount of radioactive material that collects in the bones, are another type of procedure that can be used to diagnose and monitor infection, fracture, or disorders in the bone. (Read about "Bone Fractures")
• Thermography - Thermography involves the use of infrared sensing devices to measure small temperature changes in order to detect the presence or absence of nerve root compression. (Read about "Nervous System")

NASS says that most doctors will take a conservative approach to most back issues. AAOS says that 75 to 90 percent of people get over their symptoms within 6 weeks. Here are some of the things that might be recommended.

• Rest is usually the first step with nonsteroidal anti-inflammatories, such as ibuprofen or aspirin.
• NIAMS says that corticosteroid injections can be used to reduce some of the inflammation.
• Physical therapy to help restore muscle strength to stabilize the spine and to maintain flexibility. (Read about "Rehabilitation")
• A brace or corset to provide support. NIAMS says corsets are often used for people with weak abdominal muscles or older patients with degenerative problems in more than one place.
• NASS says other treatments can include ultrasound (Read about "Ultrasound Imaging"), electric stimulation and hot or cold packs.

If the pain continues for more than three months, AAOS says that some sort of surgery might be recommended. There are a number of types of surgery depending on the problem. (Read about "Neurosurgery")

• Discectomy or microdiscectomy - A discectomy is surgery that removes part of a herniated disk, according to AAOS. A microdiscectomy uses a special instrument to view the disk and nerves, which makes it possible to use smaller incisions. These procedures can relieve some of the pressure that is causing either back or leg pain. AAOS says surgery is 90 percent successful if most of the pain is in the leg. The disk or another could rupture again however. In some cases, an artificial replacement disk might be an option, after the damaged disk is removed. An artificial disk can preserve motion, and may be an alternative to fusion as well. The Food and Drug Administration (FDA) says the artificial disk may help restore the natural distance between the two vertebrae, which may allow movement at the level where it is implanted. The new disk is placed in the spine through a small incision near the belly button. The diseased or damaged disk is removed and the artificial disk is placed in the space. Patients require general anesthesia, according to FDA. (Read about "Anesthesia")
• Foraminotomy - A foraminotomy is a surgical procedure that relieves pressure on a nerve. To relieve pressure on a spinal nerve, the surgeon may remove bone or other tissue that is affecting the nerve, usually where the nerve exits the spinal column.
• Spinal fusion - Spinal fusion is used to treat injuries, ruptured disks and scoliosis. Two or more vertebrae are fused together using bone and/or metal rods. It decreases the flexibility. AAOS says over a quarter million spine fusions are done each year, with more done to the lower (lumbar) back than the upper (cervical) area.
• Vertebroplasty - Vertebroplasty is when a glue type substance is injected into a fractured vertebrae to stabilize it.
• Kyphoplasty - Kyphoplasty is much the same as vertebroplasty, but before the glue substance is injected, a balloon is put in to lift the vertebrae apart and reestablish a person's height.
• Laminectomy - Laminectomy is the removal of the bony area at the back of the vertebra, the lamina, to relieve pressure. It is often done in conjunction with discectomy and fusion.
• Laminotomy - Laminotomy is the partial removal of the bony area at the back of the vertebra, the lamina, to relieve pressure.
• Laminoplasty - Laminoplasty is the cutting of the bony area at the back of the vertebra, the lamina, and hinging it back to increase the size of the spinal canal. The lamina can be kept open through various techniques such as bone struts, sutures, metal plates or spacers and tension bands.

Prevention

Though some back problems can't be avoided, there are things we can do to delay or even prevent back injuries. Here are some tips from NIAMS.

• Regular exercise with stretching helps keep our muscles strong and flexible. (Read about "Stretching and Health")
• Always lift things the correct way to avoid injury. Proper lifting techniques along with exercise can help prevent back injuries and problems. (Read about "Avoid Back Pain" "Back Tips" "Neck Pain and Work")
• Avoid being overweight and putting stress on the spine. (Read about "Obesity" "Fighting Weight Gain" "Losing Weight")
• Don't smoke. (Read about "Quit Smoking")

Watch the posture, especially at work and while sitting. Poor posture can result in a number of spinal problems.

Related Information:

    Stretching and Health

    Back Pain