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Common Conditions

Herniated Disc

Many patients have heard the terms ‘slipped or ruptured disc,’ ‘pinched nerve,’ or ‘sciatica.’ These terms most often refer to the irritation of a nerve root as it exits the spine due to compression by a herniated disc. While there are other causes of nerve root irritation, disc herniations, especially in the lower back, are by far the most common. This is probably the #1 condition treated by pain management physicians.

Compression Fractures

Osteoporosis is a condition characterized by a loss of bone density, leaving bones weak and at increased risk of fractures. One of the most common complications of osteoporosis is vertebral compression fractures where the vertebral body collapses under the weight of the structures above it. Most people do not even realize they have a compression fracture and do not to seek medical care because they assume their symptoms are simply part of the aging process. For others, compression fractures can be very painful and debilitating. Whether painful or not, vertebral compression fractures can lead to additional fractures, spinal deformity, loss of the ability to function, and can even cause breathing difficulties. People with osteoporosis are at higher risk for compression fractures that may result from a minor fall or simple daily activities such as bending or lifting.

In addition to pain, other signs and symptoms of a compression fracture include:

  • Loss of height, one of the reasons many older people seem to shrink as they age
  • Kyphosis or ‘humpback’
  • Loss of balance
  • Neurological symptoms such as numbness, tingling, or weakness

A recent study by the Journal of Bone and Mineral Research looked at the death rates of nearly 900,000 patients with vertebral compression fractures and showed that patients who had their compression fractures treated with kyphoplasty or vertebroplasty were 37% less likely to die over a four-year period.

Degenerative Disc Disease

DDD is a common condition in aging adults. Our intervertebral discs are made up of protein, cartilage, and water and serve as shock absorbers for the spine. As we age, these discs gradually dry out and lose their strength and resilience. These changes are gradual as most people do not know they have degenerative disc disease and only a small portion of the general population actually becomes symptomatic from their degenerated discs.

The most helpful investigation to screen for this condition in an MRI (magnetic resonance imaging) study. Common findings seen on an MRI that are characteristic of DDD are:

  • Disc bulging
  • Dehydration (loss of water from center of disc)
  • Decreased disc height (flattening of disc)
  • Endplate changes – or changes to the vertebral body above and below the disc

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Facet Joint Inflammation

Back and neck pain is usually caused by disc herniation or degenerative disc disease. However, there are other anatomical structures that can cause pain in the lower back and neck including zygapophysial joints, otherwise known as facet joints. Facet joints are small stabilizing joints located between and behind adjacent vertebrae and they function to guide and limit movement of the spine. Just like hip and knee joints, these facet joints also go through wear and tear as we age and can eventually develop arthritis, a sometimes painful condition characterized by joint inflammation.

Lower back pain due to facet joint inflammation usually follows surgery or trauma to that spinal segment. Neck pain due to facet joint disease is more common than pain attributed to disc herniations or degenerative disc disease.

Sacroiliac Joint Dysfunction

Dysfunction of the sacroiliac joint may cause low back and/or leg pain. Pain coming from sacroiliac joint inflammation can mimic the pain caused by a number of other spinal structures including lumbar discs, nerve roots, facet joints, or hips. Typically the pain is felt on one side of the low back or buttocks and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend all the way to the ankle or foot.

Spinal Stenosis

The word stenosis refers to abnormal condition characterized by the constriction or narrowing of an opening or passageway in the body. The term stenosis is widely used in medicine for different parts of the body including blood vessels, intestines, and the spinal column. Although stenosis can affect many other parts of the spine, the term ‘spinal stenosis’ usually refers to the central canal of the spinal column.

Spinal stenosis places pressure on the spinal nerves and/or spinal cord. While some patients are born with this narrowing, most cases of spinal stenosis occur in patients over the age of 50 and are the result of aging or wear and tear on the spine.

Many patients with spinal stenosis do not have symptoms until other conditions further compress the spinal canal. Some of these other conditions that can cause spinal compression include:

  • Calcification (thickening and hardening of the spinal ligaments)
  • Osteophytes (hard bony growths on bones and joints)
  • Herniated or bulging discs
  • Spondylolisthesis (slipping of one vertebra onto another)
  • Trauma (such as from an accident)

The symptoms of spinal stenosis include:

  • Low back pain that may be relieved when bending forward or sitting.
  • Neck pain
  • Pain, weakness, or numbness in the upper or lower extremities.
  • Burning sensations, tingling, and pins and needles in the involved extremity.
  • Hand clumsiness.
  • Gait and balance disturbances.

Bladder and bowel problems (in severe cases).

Although rare, very severe cases can also cause significant loss of function or even paraplegia.

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