The inter-vertebral discs are the shock-absorbing cushions between each pair of vertebrae in the spine. Disc prolapse refers to shifting of the gel-like middle part (nucleus) of the disc, out of its normal position. Slipped disc can occur anywhere in the spine, in the neck, middle or lower back.
Presentation and symptoms can vary greatly. Most patients complain of neck or back pain, which is made worse by bending or twisting. As the bulge advances it can press on a spinal nerve, causing arm or leg pain (nerve root or radicular pain), numbness, tingling or muscle weakness.
A careful medical history and physical examination helps making the diagnosis. Plain X-rays can show changes of the spinal alignment or decreased disc height. CT and MRI scan gives a more detailed picture of the discs, ligaments, spinal cord and nerves and will identify a disc protrusion.
Degeneration of the inter-vertebral discs occurs in most people from routine "wear and tear" as part of the normal aging process. It is sometimes called arthritis of the spine. With age, the discs (which act as shock-absorbing cushions) lose fluid, making them less flexible and more compressed.
Degeneration in the discs is typically the normal wear and tear that occurs as a person ages. On occasion it can be caused by repetitive strain or injury. Obesity, smoking, heavy lifting and hereditary factors can also lead to advanced degeneration.
Although it starts with damage to one or more disc(s), degenerative disc disease eventually affects all parts of the spine. The degenerated discs become thinner and lose their cushioning ability changing the way the affected spinal segments move. Abnormal spinal movement alters the loading of the involved joints, ligaments and muscles causing pain. Bone spurs (osteophytes) may form around the damaged disc space which can also cause pain when they press on the spinal nerves.
Degenerative Disc Disease (arthritis of the spine) causes lower back or neck pain in most people at some point in their lives. Symptoms often resolve on their own. In most cases, appropriate exercise, some modification of activities, and physical therapy is sufficient to eliminate or reduce the pain. Medications may also be helpful to reduce inflammation. Surgery is performed for those whose symptoms do not improve on conservative treatment.
Spinal stenosis is a disorder in which the spinal canal narrows. This narrowing can cause pressure on the delicate neural structures, including the spinal cord, cauda equina or exiting nerve roots. It occurs most often in the neck (cervical) or lower back (lumbar).
In younger patients a disc herniation is the most common cause of spinal stenosis. Later on spinal degeneration (arthritis) is the main reason. In the spine, arthritis occurs as the disc degenerates and loses water content. This causes collapse of the disc spaces and loss of disc space height.
When we are young, discs have a high water content (left). As discs age and dry out, they may lose height or collapse (right). This puts pressure on the facet joints and may result in arthritis.
Spinal settling results in increased loading of facet joints so they also begin to degenerate and develop arthritis. The joint-lining cartilage wears away and new bone formation occurs to help support the vertebrae. Over time, this bone overgrowth - called spurs or osteophytes - may narrow the space for the nerves to pass through.
As a part of arthritis in the spine the ligaments around the joints become thicker. This also lessens space for the nerves. Once the space has become small enough to irritate spinal nerves, painful symptoms result.
Presentation varies depending on the location of the stenosis.
Spinal stenosis in the neck presents with neck pain. This pain may radiate into the shoulders or arms, followed by a tingling sensation or numbness in the arms or hands. In severe cases increasing pressure on the spinal cord can lead to myelopathy — progressive weakness in the arms and legs, difficulties with walking and disturbance of bladder and bowel function.
In the lumbar spine (lower back) spinal stenosis presents with low back pain. It can also cause numbness and tingling in the buttocks, legs and feet. Patients may feel a burning sensation or heaviness in the lower limbs when standing straight or walking. These symptoms are often relieved by bending forward or sitting.
Diagnosis is based on the presenting symptoms and thorough clinical examination. X-rays will show aging changes, like loss of disk height or bone spurs. CAT scan and MRIs are helpful to further evaluate the condition.
Nonsurgical treatment options focus on restoring function and relieving pain.
Dr Szabo uses this multi-disciplinary approach for the treatment of spinal stenosis.
In severe cases or those that are progressively worsening, surgical decompression may be necessary. Dr Szabo will only recommend surgery when nonsurgical treatment options fail to improve the symptoms. Depending on the patient's condition decompression of the spine may require only a minimally invasive laminotomy or traditional laminectomy sometimes combined with spinal fusion.
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Though rare, acute cauda equina syndrome is a serious medical emergency. It usually requires decompression surgery on the spine within 24 hours, in order to remove pressure from the nerves.
Seventy-five percent of all people will experience back pain at some time in their lives. The total cost in lost productivity is enormous. Back pain is the second leading cause of absenteeism from work, after the common cold and accounts for 15% of sick leaves. Back injuries cause 100 million lost days of work annually, and are the most costly injury for employers. The cost of a back pain injury claim far surpasses others. The average total cost per claim in 1989, was $18,365.00.
After 52 weeks of back injury disability and absenteeism, only 25% of injured workers return to work. After two years of disability, the return rate is zero. For 85% of back pain sufferers, the primary site of injury is the lower lumbar spine.
The good news is that the vast majority of back-injured patients, probably greater than 90%, will recover completely without surgical treatment. Only 2 to 3% of the population with back pain have a herniated disc and only 1% have compression of a nerve root (leg symptoms).
Minimally invasive spine surgery (MISS) is sometimes called less invasive spine surgery. In these procedures, doctors use specialized instruments to access the spine through small incisions.Because minimally invasive spine surgery (MISS), does not involve a long incision, it avoids significant damage to the muscles surrounding the spine. In most cases, this results in less pain after surgery and a faster recovery.