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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.
Chiari I malformation
Chiari I malformation is a condition in which the lower part of the brain, called the cerebellar tonsil, herniates down through the skull and into the spinal canal. The herniated tissue presses against the brainstem and blocks the normal flow of cerebrospinal fluid (CSF). Depending on the extent of herniation, these malformations cause a variety of symptoms that range from mild to severe.
Degenerative disc disease
Degenerative disc disease (spondylosis) is caused by the breakdown of your intervertebral discs. As you age, your spine begins to show signs of wear and tear as your discs dry out and shrink. These age-related changes can lead to arthritis, disc herniation, or spinal stenosis, which can put pressure on your spinal nerves and may cause pain. Physical therapy, self-care, pain medication, and spinal injections are used first to control 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.
Neck pain results when the spine is stressed by injury, poor posture, disease, wear and tear, or poor body mechanics. Acute neck pain is abrupt, intense pain that subsides after a period of days or weeks. It can also radiate to the head, shoulders, arms, or hands. 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 term that describes leg pain, numbness, or tingling that radiates along the sciatic nerve. It starts in the low back and radiates into the buttock and down the back of your leg. The pain is often caused by pressure on the nerve roots in the lower spine from disc herniation or stenosis. Acute sciatica typically resolves with rest, exercise, and other self-care measures. Some people suffer from chronic pain that continues despite treatment.
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 relatively mild ligament and muscle strains, to fractures and dislocations of the bony vertebrae, to debilitating spinal cord damage. Depending on how severe your injury is, you may experience pain, difficulty walking, or be unable to move your arms or legs (paralysis). 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 (spon-dee-low-lye-sis) and spondylolisthesis (spon-dee-low-lis-thee-sis) are conditions that affect the moveable joints of the spine that help keep the vertebrae aligned one on top of the other. Spondylolysis is actually a weakness or stress fracture in one of the facet joints. This weakness can cause the vertebrae to slip forward out of their normal position, a condition called spondylolisthesis. Treatment options include physical therapy to strengthen the muscles surrounding the area. Sometimes the patient is placed in a brace. In severe cases, surgery is also an option.
Prevention & general health
Exercise for a healthy back
Exercise is a vital part of improving and maintaining normal, comfortable back function. It is important to exercise regularly so you can maintain your fitness level. Regular exercise is important to prevent back pain and injury. A program of strengthening, stretching and aerobic exercises will improve your overall fitness level. Research has shown that people who are physically fit are more resistant to back injuries and pain, and recover quicker when they do have injuries, than those who are less physically fit.
Core exercises to strengthen the spine
Just as the stays support the mast and the cables support the bridge, 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 regimen designed 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.
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.
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 injection & rhizotomy
A facet injection is a minimally invasive procedure that can temporarily relieve neck or back pain caused by inflamed facet joints. The cause of facet joint pain (arthritis, injury, degeneration) 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 your facet joints. Second, it can be used as a treatment to relieve inflammation and pain caused by various spine conditions. The effects of facet injections 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 your spinal cord. The system uses a small pump that is surgically placed under the skin of your abdomen and delivers medication through a catheter to the area around your spinal cord - 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.
While we have all experienced pain, the term remains difficult to define. According to the International Association for the Study of Pain, pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."
Spinal cord stimulation
Spinal cord stimulation uses low voltage stimulation of the spinal nerves to block the feeling of pain. It helps you to better manage your pain and potentially decrease the amount of pain medication. 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 implanted in the body transmits an electrical current to your spinal cord. The result is a tingling sensation instead of pain.
Anterior cervical discectomy and fusion (ACDF)
Anterior cervical discectomy and fusion (ACDF) is a surgery to remove a herniated or degenerative disc in the cervical (neck) spine. The incision is made in the front of the spine, through the throat area. After the disc is removed, a bone graft is inserted to fuse together the vertebrae above and below the disc space. Your doctor may recommend a discectomy if physical therapy or medications fail to relieve your neck or arm pain caused by compressed 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).
Posterior lumbar discectomy
Posterior lumbar discectomy is a surgical procedure performed to remove a herniated or degenerative disc in the lower spine. The surgeon approaches the spine from posterior, through the back muscles. Your doctor may recommend a discectomy if physical therapy or medication fail to relieve leg or back pain that is caused by inflamed and compressed spinal nerves. Discectomy may also be recommended 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)
Narrowing of the spinal canal, a condition called spinal stenosis can cause chronic pain, numbness, and muscle weakness in your arms or legs. The condition primarily afflicts elderly people and is caused by degenerative changes that result in enlargement of the facet joints and thickening of the ligaments. Constriction of the spinal cord and nerves may be effectively relieved with a spinal decompression procedure if your symptoms have not improved with physical therapy or medications. This 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 (VCF) of the spine. These fractures, which can be painful and limit spine mobility, are commonly caused by osteoporosis, spinal tumors, and traumatic injury. Traditional treatments of bed rest, pain medication, and braces are slow to relieve the pain. By injecting bone cement into the fractured bone and restoring the vertebra height, these procedures offer patients faster recovery and reduce the risk of future fractures in the treated bone.