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Spine Disorders

Chronic Degenerative Disorders 

Your backbone, or spine, is made up of 26 bone discs called vertebrae. The vertebrae protect your spinal cord and enable you to stand and bend. A number of problems can change the structure of the spine or damage the vertebrae and surrounding tissue. They include 

  • Infections 
  • Injuries 
  • Tumors 
  • Conditions, such as ankylosing spondylitis and scoliosis 
  • Bone changes that come with age, such as spinal stenosis and herniated disks 

Scoliosis 

Scoliosis is a disorder in which there is a sideways curve of the spine. Curves are often S-shaped or C-shaped. In most people, there is no known cause for this curve. This is known as idiopathic scoliosis. 

People of all ages can have scoliosis. The most common type is idiopathic scoliosis in children ages 10 to 12 and in their early teens. This is the time when children are growing fast. Girls are more likely than boys to have this type of scoliosis. Scoliosis can run in families. A child who has a parent, brother, or sister with idiopathic scoliosis should have regular checkups by the family doctor. 

Doctors classify curves as: 

  • Nonstructural, which is when the spine is structurally normal and the curve is temporary. In these cases, your doctor will try to find and correct the cause. 
  • Structural, which is when the spine has a fixed curve. The cause could be a disease, injury, infection, or birth defect. 

How is scoliosis diagnosed? 

Doctors use a medical and family history, physical exam, and tests when checking for scoliosis. An X-ray of the spine can help the doctor decide if a person has scoliosis. The X-ray lets the doctor measure the curve in degrees, and see its location, shape, and pattern. 

What are the treatment options? 

Treatment for scoliosis is based on age, how much more a person is likely to grow, the degree and pattern of the curve, and the type of scoliosis. Your doctor may recommend observation, bracing or surgery. 

  • Observation: Your doctor will check every four to six months to see if the curve is getting better or worse. Observation is used for those who have a curve of less than 25 degrees and are still growing. 
  • Bracing: Your doctor may advise wearing a brace to stop a curve from getting worse. 
  • Surgery: Your doctor may use surgery to correct a curve or stop it from getting worse when a person is still growing, the curve is more than 45 degrees, or the curve is getting worse. Surgery often involves fusing together two or more bones in the spine. Your doctor may also insert a metal rod or other device. They stay in the body and help keep the spine straight after surgery. See also: Scoliosis surgery in children.

More on Scoliosis 

Tumors of the Bone 

Spine tumors may arise in the cervical (neck), thoracic (mid-back) or lumbosacral (lower back) regions. They may originate in the spinal cord itself, the spinal roots, the dural sac which surrounds the spinal cord, or the vertebrae. They may be primary, originating from the spine or spinal cord, or metastatic, originating elsewhere. 

What are the symptoms? 

Neck or back pain are common presenting symptoms of spinal cord tumors. The pain is often present at night and is worsened with physical activity. The symptoms associated with spinal cord tumors also may vary depending on the level of involvement. Cervical tumors may cause weakness or numbness in the arms or legs. Thoracic and lumbosacral tumors may cause weakness or numbness in the chest area or legs. Difficulty walking is sometimes a complaint. 

How is a spinal cord tumor diagnosed? 

The diagnosis of a spinal tumor begins with the patient history and physical examination. Your doctor may order imaging studies that include plain X-rays, computerized tomography (CT or CAT) scans, and MRIs. Sometimes it is necessary to undergo additional, more specialized testing in order to clearly define a suspected tumor. Positron emission tomography (PET scans) and nuclear medicine bone scans may be ordered by your doctor to aid in the diagnosis. 

In many cases it is necessary to obtain a tissue specimen of the tumor to determine the exact type. This is most often done by a needle biopsy. The tissue is examined and enables your doctor to determine the exact type of the tumor, which will assist in determining the surgical and non-surgical treatment options. 

What are the treatment options? 

The nonsurgical options for treating spinal tumors include observation, chemotherapy and radiation therapy. Some tumors that are not causing major symptoms and do not appear to be aggressive in their behavior may be observed and followed with serial imaging (usually MRI). Some tumor types are sensitive to chemotherapy and/or radiation therapy. A course of chemo or radiation therapy may be the first line of treatment in these cases. 

Surgery for a spinal tumor is generally indicated for progressive motor weakness or loss of bowel or bladder control of short duration. Surgery may be required in situations where the spine has become unstable because of the tumor. Lastly, surgery may be the only available intervention for some tumors that are insensitive to radiation or chemotherapy. 

Surgical options for the treatment of spinal tumors vary from complete to partial removal. Your surgeon will weigh the risks of surgical removal against the other treatment options that may be available. 

Surgical stabilization of the spine may be necessary as a result of instability caused by the tumor itself or the surgery to remove it. This may be done by a surgical approach from the front or back of the spine. This may involve going through the neck, chest or abdomen. 

More on bone tumors

Cervical and Lumbar Disorders 

Cervical 

Cervical spondylosis is a disorder in which there is abnormal wear on the cartilage and bones of the neck. Cervical spondylosis is caused by chronic wearing away of the cervical spine, including the cushions between the neck vertebrae and the joints between the bones of the cervical spine. There may be abnormal growths or "spurs" on the bones of the spine. 

The major risk factor is aging. By age 60, most men and women show signs of cervical spondylosis on X-ray. Other factors that can make a person more likely to develop spondylosis are: 

  • Past neck injury 
  • Severe arthritis 
  • Past spinal surgery 

Common symptoms include: 

  • Neck pain (may radiate to the arms or shoulder) 
  • Neck stiffness that gets worse over time 
  • Loss of sensation or abnormal sensations in the shoulders, arms, or legs 
  • Weakness of the arms or legs 
  • Headaches, particularly in the back of the head 

Less common symptoms include: 

  • Loss of balance 
  • Loss of control over the bladder or bowels 

How is cervical spondylosis diagnosed? 

Examinations often show limited ability to bend your head toward the shoulder and rotate the head. Weakness or loss of sensation can be signs of damage to specific nerve roots or to the spinal cord. Reflexes are often reduced. The following tests may be done: 

  • CT scan or spine MRI 
  • Spine or neck X-ray 
  • EMG 
  • X-ray or CT scan after dye is injected into the spinal column 

What are the treatment options? 

Even if your neck pain does not go away completely, or it gets more painful at times, learning to take care of your back and prevent repeat episodes of your back pain can help you avoid surgery. 

Symptoms from cervical spondylosis usually stabilize or get better with simple, conservative therapy, including: 

  • Anti-inflammatory medications 
  • Narcotic medicine or muscle relaxants 
  • Physical therapy 
  • Cortisone injections to specific areas of the spine 
  • Various other medications to help with chronic pain 

If the pain does not respond to these measures, or there is a loss of movement or feeling, surgery may be considered. Surgery is done to relieve the pressure on the nerves or the spinal cord. 

Lumbar 

Lumbar pain felt in your lower back may come from the spine, muscles, nerves, or other nearby structures. It may also be due to problems in your mid or upper back, the testicles or ovaries, or a hernia in the groin. Lower back pain is the number-two reason that Americans see their doctor; second only to colds and flu. 

What are the symptoms? 

You may feel a variety of symptoms if you've hurt your back. You may have a tingling or burning sensation, a dull achy feeling, or sharp pain. Depending on the cause, you also may have weakness in your legs or feet. 

How is lumbar pain diagnosed? 

When you first see your doctor, you will be asked questions about your back pain, including how often it occurs and how severe it is. Your doctor will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches. 

During a physical exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. Your doctor also will move your legs in different positions, including bending and straightening your knees, to assess your strength as well as your mobility. To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system. 

Tests that might be ordered include an X-ray, myelogram (an X-ray or CT scan of the spine after dye has been injected into the spinal column), CT of the lower spine, or MRI of the lower spine

What are the treatment options? 

Many people benefit from physical therapy. The physical therapist will begin by using methods to reduce your pain. Then, the therapist will teach you ways to prevent getting back pain again. 

If your pain lasts longer than one month, your primary care doctor may send you to see either an orthopedist or neurologist. Hospitalization, traction, or spinal surgery should only be considered if nerve damage is present or the condition fails to heal after a prolonged period.

More on Chronic Low Back Pain 

Traumatic Spine Fractures and Spinal Cord Injuries 

Fracture of one or more bones of the spinal column of the middle (thoracic) or lower (lumbar) back is a serious injury. It is usually caused by high-energy trauma such as a car crash, fall, sports accident, or violent act. People with osteoporosis, tumors, or other underlying conditions that weaken bone can get a spinal fracture with minimal trauma or normal activities of daily living. Men experience fractures of the thoracic or lumbar spine four times as often as women. 

Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury. 

  • Compression fracture. While the front of the vertebra breaks and loses height, the back part of it does not. This type of fracture is usually stable and is rarely associated with neurological problems. See also: Compression fracture of spine.
  • Axial burst fracture. The vertebra loses height on both the front and back sides. It is often caused by a fall from a height when a person lands on their feet. 
  • Flexion/distraction fracture. The vertebra is literally pulled apart. This can happen in accidents such as a head-on car crash, in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt. 
  • Transverse process fracture. This fracture results from rotation or extreme sideways bending and usually does not affect stability. 
  • Fracture-dislocation. This is an unstable injury involving bone and/or soft tissue, in which one vertebra may move off the adjacent one. 

What are the symptoms? 

The primary symptom of spinal fracture or spinal cord injury is moderate to severe back pain that is made worse by movement. When the spinal cord is also involved, numbness, tingling, weakness, or bowel/bladder dysfunction may occur. 

How are these injuries diagnosed? 

After checking heart rate, breathing, and other vital signs, your doctor will locate the fractured part or parts of the spine and determine the extent of the damage. The doctor will determine exactly how the vertebra broke, and whether there is nerve injury and/or spinal instability.

A neurological exam may also be needed. This may include tests of sensory (temperature, pain, and pressure sensitivity), motor (muscle strength) and reflex functions of the nervous system. If there is neurological damage, certain tests can show whether the patient may recover some function or not. 

X-rays of the entire spine from multiple angles may be necessary to see bone alignment and check for damage to soft tissue. Sometimes, computed tomography (CT) or magnetic resonance imaging (MRI) scans are required to help the doctor better visualize the injury. 

What are the treatment options? 

Treatment goals include protecting nerve function and restoring alignment and stability of the spine. Your doctor will determine the best treatment method based upon the type of fracture and other factors. 

Doctors usually treat compression fractures and some burst fractures without surgery. With a simple compression fracture, patients may be required to wear a hyperextension brace for sitting and standing activities for six to twelve weeks. 

With a transverse process fracture, patients may need to wear a thoracolumbar corset and participate in an aerobic walking program. 

Some spinal fractures require surgical treatment. Steroids may be prescribed if the spinal cord is also injured. Surgery may be necessary for unstable burst fractures, flexion-distraction injuries, or fracture-dislocation injuries. Surgery realigns the spinal column and holds it together using metal plates and screws and/or spinal fusion

More on Spinal Cord Trauma

 

If you’d like more information on the spine or the doctors and services available at Scottsdale Healthcare Osborn Medical Center, please call 480-882-4000.