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Anatomy of the Spine
Anatomy of the Spine
The spine is made of 33 individual bony vertebrae stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. Strong bones and muscles, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine. Yet, any of these structures affected by strain, injury, or disease can cause pain.
Back pain results when the spine is stressed by injury, poor posture, disease, wear and tear, or poor body mechanics. Acute low back pain is abrupt, intense pain that subsides after a period of days or weeks. It typically resolves with rest, exercise, and other self-care measures. Some people suffer from chronic pain that continues despite treatment.
Leg pain (sciatica)
Sciatica is a shooting pain that begins in the lower back, radiates into the buttock and down the back of one leg. The pain is often caused by pressure on the sciatic nerve from a herniated disc, bone spurs or muscle strain. You play an important role in the prevention, treatment, and recovery of sciatic pain. Sciatica typically improves with rest, exercise, and other self-care measures. Chronic pain that continues despite treatment may be helped with surgery to relieve the underlying cause.
Neck pain results when the spine is stressed by injury, disease, or wear and tear. With the most range of motion, the cervical spine can be prone to overuse and injury. If acute, abrupt and intense pain can radiate to the head, shoulders, arms, or hands. Pain typically subsides within days or weeks with rest, exercise and self-care measures. You play an important role in the prevention, treatment and recovery of neck pain. However, if chronic, pain will persist despite treatment and need further evaluation.
Chiari I malformation
Chiari I is a condition in which the bony space enclosing the lower part of the brain is smaller than normal. Crowding pushes the cerebellar tonsils through the skull and down into the spinal canal. The herniated tonsils press against the brainstem and block the flow of cerebrospinal fluid. Symptoms vary widely; most common include headache, neck pain, dizziness, numbness/tingling in the arms, and sleep problems. Treatment options include monitoring of mild symptoms or surgery to expand the space.
Degenerative disc disease
Degenerative disc disease is a condition caused by the breakdown of 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, pain medication, and spinal injections are used first to manage the symptoms. Surgery is an option if the pain is chronic.
Herniated cervical disc
A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall. Neck or arm pain, numbness or tingling may result when the disc material touches or compresses a spinal nerve. Treatment with rest, pain medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery to remove a portion of the disc and any bone spurs may be recommended.
Herniated lumbar disc
A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall. Back or leg pain, numbness or tingling may result when the disc material touches or compresses a spinal nerve. Treatment with rest, pain medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery to remove a portion of the disc and any bone spurs may be recommended.
Cauda equina syndrome
Cauda equina syndrome is a rare condition but has serious consequences if not treated promptly. It is most often caused by a large disc herniation in the lower back that compresses the nerve roots at the end of the spinal cord. These nerve roots are bundled together and resemble the tail of a horse. This is how they get their name. Cauda equina means "horse's tail" in Latin.
Sacroiliac joint pain
Sacroiliac (SI) joint pain is felt in the low back and buttocks. The pain is caused by damage or injury to the joint, ligaments, cartilage or muscles. Sacroiliac pain can mimic or occur along with other conditions, such as a herniated disc or hip problem. Accurate diagnosis is important to determine the source of pain and best treatment. Physical therapy, stretching exercises, pain medication, and joint injections are used first to manage the symptoms. Pain that continues despite treatment may be helped with surgery to fuse the joint and stop all motion.
A fracture or dislocation of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Most spinal fractures occur from car accidents, falls, gunshot, or sports. Injuries can range from mild ligament and muscle strains, to fractures and dislocations of the bones, to debilitating spinal cord damage. Depending on the severity, you may have pain, difficulty walking, or be unable to move your arms or legs. Many fractures heal with conservative treatment; however severe fractures may require surgery to realign the bones.
Spinal stenosis is the narrowing of the bony space (canals) through which the nerves and spinal cord pass. Arthritis can cause the facet joints and ligaments to enlarge and thicken restricting the space for the nerves to move freely. The pinched nerves become inflamed and cause pain, cramping, numbness or weakness in your legs, back, neck, or arms. Medications, physical therapy and spinal injections can help control the symptoms. Chronic symptoms may require surgery to remove bone and open space for the nerves.
Spondylolysis and spondylolisthesis
Spondylolysis and spondylolisthesis are conditions that affect the moveable joints of the spine that keep the vertebrae bones aligned one on top of the other. Spondylolysis is a weakness or stress fracture in one of the facet joints. This weakness can cause the bones to slip forward out of normal position, called spondylolisthesis. Treatment options include physical therapy to strengthen the muscles. A back brace may be used to support the spine. In some cases, surgery may be needed to realign and fuse the bones.
Prevention & general health
Exercise for a healthy back
Exercise is a vital part of improving and maintaining a normal healthy back. It is important to exercise regularly so you can maintain your fitness level and prevent back pain and injury. A program of strengthening, stretching and aerobic exercises will improve your overall fitness level. Research shows that people who are physically fit are more resistant to back injuries and pain. They also recover quicker from injuries than those who are less physically fit.
Core Exercises to strengthen the spine
Your core muscles support your spine. The muscles in your abdomen and back - which we call the "core" - are central to your everyday spine health. They are at the heart of any fitness plan to strengthen a healthy or ailing back. Just as you protect your heart through cardiovascular exercises, you will benefit from strengthening your back through core exercises.
Posture for a healthy back
Good posture involves training your body to stand, walk, sit, and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities. The spine's curves work like a coiled spring to absorb shock, maintain balance, and to facilitate the full range of motion throughout the spinal column.
Braces and orthotics
Your doctor may prescribe a neck or back brace for you to wear after a spinal injury or surgery. A brace does three things: immobilizes your spine during healing; stabilizes injured areas; controls pain by restricting movement.
Chiropractic medicine aims to improve health by restoring structure and function to the spine and other joints. Stress, accidents, overexertion, or other injuries may cause minor displacement (subluxation) of the spinal vertebra. When a vertebra is displaced or an extremity is affected, muscle tension or irritation to the spinal nerves can result, causing pain (e.g., neck, back, headache, whiplash) and impairing overall health.
Physical Medicine & Rehabilitation
Physiatry, also called physical medicine and rehabilitation (PM&R), is a medical specialty that primarily uses physical means to help in diagnosis, healing, and rehabilitation. Physiatrists specialize in the diagnosis and treatment of patients with chronic illness (e.g., stroke) or injury (e.g., spinal cord, brain), acute and chronic pain, and musculoskeletal injuries (e.g., sports-, work-related). Many physiatrists specialize in the treatment of back pain.
The principles of physical therapy have been part of healing arts since recorded time. Physical therapy is an important part of a nonsurgical approach to restore, maintain, and promote overall health. Working with a doctor, a physical therapist (PT) will help patients who have suffered an accident, injury, or disease, or those recovering from surgery.
Self care for neck & back pain
Eight out of 10 people will suffer from back or neck pain at some point in their life. Acute pain is abrupt, intense pain that subsides after a period of days or weeks. However, some people continue to suffer from pain that continues despite nonsurgical or surgical treatment methods. This long-term pain is called chronic pain.
Who treats spine problems?
Of the many types of specialists who treat spine problems, each has specific skills and plays an important role in patient care. Some spine specialists are physicians and some are non-physicians. The right specialist(s) to treat your condition depends on the type and severity of the problem. Spine problems can arise from soft tissues (muscles, tendons, ligaments), nerves, or bone.
Carpal tunnel syndrome surgery
Carpal tunnel syndrome is a condition that causes tingling, numbness, or pain in the hand. The wrist bones and ligament form a tunnel, a passage for the median nerve and finger tendons. Repetitive strain may cause swelling that pinches and traps the nerve within the tunnel. Prompt treatment increases the chances that symptoms will stop and long-term damage to the nerve will be prevented. Self-care can include modifying activities, stretching, and icing. Conservative treatments include physical therapy, a wrist brace, or medications. A surgical procedure that re-opens the space and frees the nerve may be an option.
Epidural steroid injection (ESI)
An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation. Medicines are delivered to the spinal nerve through the epidural space, the area between the protective covering of the spinal cord and vertebrae. The effects of ESI tend to be temporary. Pain relief may last for several days or even years.
Facet iInjection & rhizotomy
A facet injection is a minimally invasive procedure that can help relieve neck or back pain caused by inflamed facet joints. The cause of facet joint pain (arthritis, injury) is not well understood and can be similar in nature to disc pain. The procedure has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from the facet joints. Second, it can be used as a treatment to relieve inflammation and pain. The effects tend to be temporary – providing relief for several days or even years.
Intrathecal drug pump
Intrathecal drug delivery, or "pain pump," is a method of giving medication directly to the spinal cord. The system uses a small pump that is surgically placed under the skin of your abdomen. The pump delivers medication through a catheter to the space around your spinal cord. It is similar to an epidural that women may have during childbirth. Because the medication is delivered directly to the spinal cord, your symptoms can be controlled with a much smaller dose than is needed with oral medication.
Acute pain starts suddenly and improves over time with healing. Chronic pain persists and is often present in ongoing conditions such as arthritis or cancer. Pain management is an integrated approach to making pain tolerable by learning physical, emotional, intellectual and social skills. This may include exercise, physical therapy, medication, holistic therapies, and counseling. With these techniques, you stay in control of your health.
Spinal cord stimulation
Spinal cord stimulation delivers low voltage current to the spine to block the feeling of pain. When turned on, the stimulation feels like a mild tingling in the area where pain is felt. It helps you to better manage symptoms and potentially decrease use of pain medications. It may be an option if you have long-term (chronic) leg or arm pain and have not found relief through traditional methods. A small battery-powered generator is implanted in the body and transmits an electrical current to the spinal cord.
Anterior cervical discectomy and fusion (ACDF)
Anterior cervical discectomy and fusion is a surgery to remove a herniated or degenerative disc in the neck. An incision is made in the throat area to reach the front of the spine. The disc is removed and a graft is inserted to fuse together the vertebrae above and below the disc. ACDF surgery may be recommended if physical therapy or medications fail to relieve your neck or arm pain caused by pinched spinal nerves. Patients typically go home the same day; recovery time takes 4 weeks.
Chiari decompression surgery
Chiari decompression is a surgical procedure performed to treat a Chiari malformation and syringomyelia. Bone at the back of the skull and spine is removed to widen the foramen magnum. The dura overlying the tonsils is opened and a patch is sewn to expand the space, similar to letting out the waistband on a pair of pants. The goals of surgery are to control the progression of symptoms, relieve compression of the brainstem and spinal cord, and restore the normal flow of cerebrospinal fluid (CSF).
Minimally Invasive Spine Surgery (.pdf)
Minimally invasive surgery (MIS) uses advanced technology to treat back and neck pain caused by various spinal conditions. As the words suggest, the surgical “invasion” of the body is minimized. Special instruments and viewing systems allow surgeons to work through small incisions, sometimes shorter than an inch. These include tubular retractors, image-guidance systems, and endoscopes. Although surgeons have been doing traditional “open” approaches a lot longer than MIS, open techniques use larger incisions and disrupt more of the back muscles.
Posterior lumbar discectomy
Lumbar discectomy is a surgery to remove a herniated or degenerative disc in the lower spine. The incision is made posterior, through the back muscles. A small window of bone is drilled to reach and remove the disc material pressing on the nerve. Discectomy may be recommended if physical therapy or medication fail to relieve leg or back pain caused by pinched spinal nerves. It may also be needed if you have signs of nerve damage, such as weakness or loss of feeling in your legs. The surgery can be performed in an open or minimally invasive technique.
Preparing for lumbar spinal fusion
Spinal fusion is a surgical procedure performed to permanently join together one or more bony vertebrae of the spine. Fusing bones together can prevent painful motion and provide stability. An unstable spine can result from an injury, disease, or the natural aging process. When these changes allow abnormal movement of the vertebrae to rub against one another, back, leg, or arm pain may result. Fusing the vertebrae stabilizes and aligns the spine, maintains the normal disc space between the vertebrae, and prevents further damage to your spinal nerves and cord.
Spinal decompression (laminectomy)
Decompression is a surgery that removes the bony roof (laminectomy) covering the spinal cord and nerves to create more space for them to move freely. Narrowing or stenosis of the spinal canal can cause chronic pain, numbness, and muscle weakness in the arms or legs. Stenosis is often caused by age-related osteoarthritis, enlarged joints, and thickened ligaments. Decompression may be recommended if your symptoms have not improved with physical therapy or medications. The surgery requires a hospital stay from 1 to 3 days and recovery takes between 4 to 6 weeks.
Vertebroplasty & kyphoplasty
Vertebroplasty and kyphoplasty are minimally invasive procedures performed to treat vertebral compression fractures of the spine. These painful, wedge-shaped fractures can be caused by osteoporosis, spinal tumors, or injury. Left untreated, they can lead to a humped spine (kyphosis). Traditional treatments of bed rest, pain medication, and braces are slow to relieve the pain. By restoring the vertebra height with a balloon and injecting a cement into the fractured bone, patients can recover faster and reduce the risk of future fractures.