Back Pain

Vertebral discs are the spinal column’s shock absorbers. The discs cushion the vertebral bones and allow the spine to twist and bend. Vertebral discs are composed of two main parts, a soft inner nucleus (nucleus pulposis) and a tough, fibrous outer wall (annulus fibrosis).

Disc Wall Weakens

Vertebral discs can be damaged by the normal wear of aging or by traumatic injury. Problems often begin when fibers in the outer wall crack and weaken. Radial tears form in and around sensitive nerve fibers in the disc wall.

Nucleus Pushes Through Disc Wall

The disc’s soft nucleus pushes through to the outer edge of the disc wall. This causes local back pain at the disc level.

Rupture Presses Against Nerve Roots

As the herniation pushes out of the disc wall, disc material may press against the large nerve roots. This can result in pain radiating down one or both legs.

Cervical Radiculopathy

The spinal cord branches out to all parts of the body. The part of a nerve that connects to the spinal cord is called a nerve root. If one of these roots is injured or pinched, pain, weakness, numbness or tingling may be felt in the part of the body served by that nerve.

Herniated Disc

When a spinal disc ruptures, it may press on a nerve root.

Spinal Stenosis

The bones creating the spinal canal may grow inward, pinching a nerve root.

Degenerative Disc Disease

If a spinal disc weakens, vertebral bones above and below may touch, pinching nearby nerve roots. Bony spurs also may press on the nerves.

Degenerative Disc Disease

This condition is a weakening of one or more vertebral discs, which normally act as a cushion between the vertebrae. This condition can develop as a natural part of the aging process, but it may also result from injury to the back.

Disc Wall Tears

Degenerative disc disease generally begins when small tears appear in the disc wall, called the annulus. These tears can cause pain.

Disc Wall Heals

The tears heal, creating scar tissue that is not as strong as the original disc wall. If the back is repeatedly injured, the process of tearing and scarring may continue, weakening the disc wall.

Disc Center Weakens

Over time, the nucleus (center) of the disc becomes damaged and loses some of its water content. This center is called the pulposus, and its water content is needed to keep the disc functioning as a shock absorber for the spine.

Disc Wall Tears

Over time, the nucleus (center) of the disc becomes damaged and loses some of its water content. This center is called the pulposus, and its water content is needed to keep the disc functioning as a shock absorber for the spine.

Disc Wall Heals

Unable to act as a cushion, the nucleus collapses. The vertebrae above and below this damaged disc slide closer together. This improper alignment causes the facet joints — the areas where the vertebral bones touch — to twist into an unnatural position.

Bone Spurs Form

In time, this awkward positioning of the vertebrae may create bone spurs. If these spurs grow into the spinal canal, they may pinch the spinal cord and nerves (a condition called spinal stenosis).

Symptoms

The site of the injury may be painful. Some people experience pain, numbness or tingling in the legs. Strong pain tends to come and go. Bending, twisting and sitting may make the pain worse. Lying down relieves pressure on the spine.

Disc Herniation (Slipped Disc)

This rupture of a vertebral disc can be caused by the normal wear of aging or by traumatic injury. A herniated disc can push painfully against a nerve root, sending pain down the sciatic nerve and resulting in a burning, tingling and/or numbing sensation from the lower back down to one or both feet.

The Healthy Disc

Vertebral discs are the spinal column’s shock absorbers. The discs cushion the vertebral bones and allow them to twist and bend. Vertebral discs are composed of two main parts, a soft inner nucleus (nucleus pulposis) and a tough, fibrous outer wall (annulus fibrosis).

Herniated Disc

A herniated disc occurs when small tears form in the wall of an injured disc. Damaged pieces of the nucleus (which can harden and break apart with age) push through the tears and out of the disc wall. The herniated disc often compresses a nerve root, causing pain.

Facet Joint Syndrome

This condition is a deterioration of the facet joints, which help stabilize the spine and limit excessive motion. The facet joints are lined with cartilage and surrounded by a lubricating capsule that enables the vertebrae to bend and twist.

Joint Damage

Facet joint syndrome occurs when the facet joints become stressed and damaged. This damage can occur from everyday wear and tear, injury to the back or neck or because of degeneration of an intervertebral disc.

Cartilage Loss

The cartilage that covers the stressed facet joints gradually wears away. The joints become swollen and stiff. The vertebral bones rub directly against each other, which can lead to the growth of bone spurs along the edges of the facet joints.

Symptoms

Pain from facet joint syndrome differs depending on which region of the spine is damaged. If the upper (cervical) spine is affected, pain may be felt in the neck, shoulders, and upper or middle back. The person may also experience headaches .If the lower (lumbar) spine is affected, pain may be felt in the lower back, buttocks and back of the thigh.

Treatment

Facet joint arthritis is first treated conservatively with rest, ice, heat, anti- inflammatory medications, and physical therapy. In addition, facet joint blocks may be administered not only to diagnose facet joint pain but also to treat it. If non-surgical methods fail to relieve pain, a facet rhizotomy or bone fusion may be performed.

Kyphosis

This unnatural curving of the spine is a deformation caused by disease or damage to the vertebrae.

How it Forms

Kyphosis has several causes. Bad posture can loosen the spine’s ligaments, causing a curve to develop over time. Disease or physical damage to the bones of the spine can weaken and collapse the vertebrae, allowing the spine to curve. Diseases that are common culprits include osteoporosis, Scheuermann’s disease, Pott’s disease or spinal tumors.

Symptoms

In most cases, the only symptom may be the slight appearance of a hump in the upper back. If the kyphosis is severe, the person may have aches in the neck and lower back.

Treatment

Most people with kyphosis don’t need treatment. Risks can be limited by increasing calcium intake, and doing weight-bearing exercise to strengthen bones. If intervention is needed, an orthopedic brace may prevent further curvature in growing children. In very few cases, spinal fusion surgery may straighten the spine.

Metastatic Cancer

In most cases, spinal metastatic cancer is caused by cancer transferring to the vertebrae from somewhere else in the body. Over time, the spinal column collapses, causing deformity and constant pain.

Cancer Reaches Spine

The condition begins when cancer cells travel through the blood stream to a vertebra.

Vertebral Bone Deformed

The cancer destroys and dissolves the vertebral bone. The diseased bone becomes weak and deformed.

Discs Collapse

The cancer spreads to the discs above and below the vertebra, causing the discs to collapse. The collapse squeezes the nerve roots, causing pain.

Post Laminectomy Syndrome

Post laminectomy syndrome, also called failed back syndrome, is a continuous and chronic pain that can develop after certain types of back surgery.

Sciatica

The spinal cord branches out to all parts of the body. The part of a nerve that connects to the spinal cord is called a nerve root. If one of these roots is injured or pinched, pain, weakness, numbness or tingling may be felt in the part of the body served by that nerve.

Herniated Disc

When a spinal disc ruptures, it may press on a nerve root.

Spinal Stenosis

The bones creating the spinal canal may grow inward, pinching a nerve root.

Degenerative Disc Disease

If a spinal disc weakens, vertebral bones above and below may touch, pinching nearby nerve roots. Bony spurs also may press on the nerves.

Symptoms

The nerve roots leaving the lower back serve the legs. When a lumbar root is injured, pain, weakness, numbness or tingling may be felt in the buttocks, leg or foot. This pain is usually called sciatica.

Scoliosis

About two percent of people are affected by this deformation of the spine, which causes the normally straight spine to curve.

Causes

While scoliosis can run in families, in most cases its cause is unknown. It frequently develops before puberty and goes unnoticed because it often causes no pain. In adults, scoliosis may develop due to worsening of a slight curvature from childhood, or it could be caused by degenerative diseases of the spine such as kyphosis or osteoporosis.

Symptoms

Scoliosis can limit a person’s ability to move normally. It can also bring on pain and reduced ability to breathe if a misshapen rib cage restricts normal lung growth.

Identifying Scoliosis

Warning signs include uneven shoulders, a protrusion of one or both shoulder blades, an uneven waist or an elevated hip. A person experiencing any of these symptoms should see a physician for an accurate diagnosis.

Treatment

Most people with scoliosis don’t need treatment. Early detection is important, because medical observation is needed during the growing years to make sure the curve doesn’t worsen. If intervention is needed, an orthopedic brace may prevent further curvature. In some cases, spinal fusion surgery may be needed to straighten and stabilize the spine.

Spinal Stenosis (Arthritis)

Spinal stenosis results from new bone and soft tissue growth on the vertebrae, which reduces the space in the spinal canal. When the nerve roots are pinched, a painful burning, tingling and/or numbing sensation is felt from the lower back down to the legs and sometimes all the way to the feet.

Healthy Spine

In a healthy spine, the spinal canal has a rounded triangular shape that holds the spinal cord without pinching. Nerve roots leave the spinal canal through openings called nerve root canals which are also free of obstruction.

Affected Spine

New bone growth within the spinal canal causes compression of the nerve roots, which leads to the pain of spinal stenosis.

Spine Anatomy

Articular Facet Joints

The articular facets are where two neighboring vertebrae attach.

Spinous Process

The spinous process protrudes from the back of each vertebra. Muscles and ligaments that move and stabilize the vertebrae attach to the spinous processes.

Disc

Discs separate vertebrae. They are made of tough, elastic material that allows the spine to bend and twist naturally.

Lamina

The flat plates of the lamina create the outer wall of the vertebral canal and help protect the spinal cord.

Vertebral Canal

The spinal cord sits in this channel formed by the lamina and the vertebral body.

Spondylosis/Spondylolisthesis

In this condition, damage to bones or joints causes vertebrae to slip forward and distort the spinal cord. This animation will show two types of spondylolisthesis, degenerative and isthmic.Spondylolisthesis.

Degenerative Spondylolisthesis

Degenerative spondylolisthesis occurs when the joints weaken, allowing a vertebra to slip forward. Nerve roots may become pinched, causing pain to radiate to the legs and feet.

Isthmic Spondylolisthesis

Isthmic spondylolisthesis occurs when vertebral bone fractures, allowing a vertebra to slip forward. This can also pinch nerve roots, causing pain to radiate to the legs and feet.

Vertebral/Spinal Fractures

This type of fracture is a collapse of the vertebral bone that can affect one or more vertebra. It can result in a severe deformity of the spinal column. Compression fractures may affect any of the vertebrae, but most commonly occur in the lower thoracic and upper lumbar regions.

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