ames B. Carr, M.D.
Common Spinal Diagnoses
Degenerative Disc Disease
See this link on Youtube about DDD courtesy of OACM Orthopedics:
Degenerative Disc Disease
Your spine consists of a column of 33 vertebra and tissue that extends from the skull down to the pelvis. Degenerative Disc Disease (DDD) is a gradual degeneration or deterioration of the intervertebral discs, which aer made mostly of collagen and act as cushion between each vertebrae. These structures are prone to degenerative changes associated with normal wear and tear, an active lifestyle and/or the normal aging process. The gradual deterioration of the disc between the vertebra is referred to as degenerative disc disease. Treatment options for DDD include both surgical and conservative options. Pain resulting from DDD is caused by instability at the motion segment and inflammation from the degenerative discs. Conservative treatments include narcotic and non-narcotic pain medication, therapeutic exercises, exercise, heat, muscle relaxants, acupuncture, injections, etc. Surgical options include spinal fusion surgery to stabilize the vertebra or artificial disc replacement surgery. Degenerative changes can occur in all areas of the spine including cervical, thoracic and lumbar.
Disc Herniation and Sciatica
The bones that form your spinal column are cushioned by discs. Spinal disc are round and flat, with a tough outer layer (annulus) that surrounds a jelly-like material (nucleus). Healthy discs act as shock absorbents and help maintain flexibility in the spine. When damage to one or more discs occurs from an injury, disease or normal wear and tear the discs may bulge abnormally (herniate) or break open (rupture). An abnormally bulging disc or rupture disc is called a herniated disc. A bulging or herniated disc may press on a nerve in your spine, causing severe pain, numbness, tingling, loss of sensation and/or decreased reflexes in the extremities. Herniated discs occur most common in the lumbar region, but can also occur in all areas of the spine. Sciatica is a term used to describe the symptoms associated with pressure from a herniated disc on the sciatic nerve. The sciatic nerve is the largest nerve in the body and starts in the lower back at lumbar segment 3 (L3).
See this link on YouTube about disc herniation courtesy of Chiropractor Jackson:
Radiculopathy is a condition resulting from compression or irritation of the spinal nerves as they exit the spine. This can be due to mechanical compression of the nerve by a disc herniation, a bone spur (osteophytes) from osteoarthritis, or from thickening if surrounding ligaments. Symptoms include pain, numbness, tingling or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy).
Spondylosis refers to degeneration of the spine. The term can be used to describe degeneration in the:
Neck - called Cervical Spondylosis
Mid Back - called Thoracic Spondylosis
Low Back - called Lumbar Spondylosis
Most often, the term spondylosis is used to describe either degenerative disc disease or osteoarthritis of the spine, but is most often used to describe any manner of spinal degeneration.
Spondylolishtesis is the forward displacement of a vertebra. Especially
the fifth lumbar vertebra, most commonly occurring after a break or fracture.
Backward displacement is referred to as retrolisthesis. The bones in your
spine come together at several small joints that keep the bones lined up
while still allowing them to move. Spondylisthesis is caused by a problem
with one or more of these small joints that allows one bone to
move out of line.
Spondylolisthesis may be caused by any number of problems
with the small joints in your back. You could have:
A defective joint that you've had since birth (congenital)
A joint damaged by an accident of other trauma
A vertebra with a stress fracture caused from overuse of the joint
A joint damaged by an infection or arthritis
Spondyloslisthesis affects children and teens involved in sports. Some sports, such as gymnastics or weight lifting, can overuse back bones to the point of causing stress fractures in vertebrae, which can result in spondyloslisthesis.
Older adults can develop spondyloslisthesis, because wear and tear on the back leads to stress fractures. It can also occur without stress fractures when the disc and joints are worn down and slip out of place.
See this link about Spondylolysis and Spondylolisthesis:
Stenosis is described as narrowing of hte spinal canal, which can limit the amount of space around the spinal cord and spinal nerves. Pressure on the nerves and spinal cord (as a resulst of this limited space) can cause symptoms such as pain, numbness, and tingling.
Scoliosis and Spinal Deformity
Scoliosis is a sidways curavature of the spine that occurs most often during puberty. When viewed from the side, the spine should show a mild roundness in the upper back and show a degree of swayback (inward curvature) in the lower back. When a person with a normal spine is viewed from the front or back, the spine appears to be straight. When a person with scoliosis is viewed from the front or back, the spine appears to be curved. There are three types of complex spinal deformity: Scoliosis, Kyphosis, and Lordosis.
Treatments for scoliosis include:
Kyphosis: Kyphosis is characterized by an abnormally rounded upper back (more than 50 degrees of curvature).
Lordosis: Also called swayback, the spine of a person with lordosis curves significantly inward at the lower back.
Bracing: Bracing is the usual treatment choice for adolescents who have a spinal curve between 25 and to 40 degrees - particularly if their bones are still maturing and if they have at least two years of growth remaining. The purpose of bracing is to halt progression of the curve. It may provide a temporary correction, but usually the curve will assume its original magnitude when bracing is eliminated.
Surgery: Those who have curves beyond 40 degrees to 50 degrees are often considered surgical candidates. The goal is the make sure the curve does not get worse, but surgery does not perfectly straighten the spine. During the procedure, metallic implants are utilized to correct some of the curvature and hold it in the correct position until a bone graft, placed at the time of surgery, consolidates and creates a rigid fusion in the area of the curve. Scoliosis surgery usually involves joining the vertebrae together permanently - called spinal fusion.
Kyphosis Lordosis Scoliosis
See this link on Youtube about Scoliosis courtesy of OACM Orthopedics:
Scoliosis and Spinal Deformity
A spinal fracture is a serious injury. The most common fractures of the spine occur in the thoracic (mid back) and lumbar spine (lower back). These fractures are typically caused by high-velocity trauma, such as a car crash or fall from height, however spinal fractures are not always caused by trauma. For example, people with osteoporosis, tumors, or other underlying conditions that weaken bone can fracture a vertebra during normal, daily activities.
Compression Fracture: While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurological problems.
Transverse/Spinous Process: This fracture is uncommon and results from a rotation of extreme sideways (lateral) bending, and usually does not affect stability.
Nonsurgical treatment: most flexion injuries (compression fractures, burst fractures) can be treated in a brace for 6 to 12 weeks. By gradually increasing physical activity and doing rehabilitation exercises, most patients avoid post injury problems.
Surgical treatment: Surgery is typically required for unstable burst fractures that have:
Significant communition (fracture fragments)
Severe loss of vertebral body height
Excessive forward bending or angulation at the injury site
Significant nerve injury due to parts of the vertebral body or disc pinching the spinal cord.
These fractures should be treated surgically with decompression of the spinal canal and stabilization of the fracture.