Spine arthritis or “spondylosis”:
Osteoarthritis results from degenerative wear and tear between bones at a joint. Inflammation is commonly associated with this destructive joint process and results in the deep, aching pain of osteoarthritis. Associated changes, including bone spurs (“osteophytes”) and thickening of bone, create a crowding effect around the local area and may result in “pinching” of nerves. In the spine, this condition is called “spondylosis” and impacts the neck, mid-back, and low back or “lumbar” spine. Structures of the spine typically affected by arthritis are identified below.
Any of the paired joints that connect the rear portions of vertebral bones can suffer arthritis. These joints may develop bone spurs and collide with other structures, and the joints themselves become enlarged. This results in increased pressure or squeezing of tissue and nerves around the facets.
Large bone spurs may form, resulting in the decreased range of spinal movement and crowding of other tissues in the area. “Modic changes” of the vertebral body endplates are often reported on MRI radiology reports in patients with degenerative arthritis of the spine.
Dehydration of the spinal discs leads to decreased disc height and reduced mobility of each level of the affected spine. The limited space between degenerating spinal discs also causes the vertebral bones and facet joints to deteriorate more rapidly.
As bone spurs form and reduces the distance between spinal bones and joints, nerves are often compressed and squeezed, resulting in common symptoms such as sciatica. This is the origin of the condition referred to as a “pinched nerve in the spine.”
Spinal disc bulges or disc herniation:
Disc bulging and the more severe disc herniation are common problems experienced by tens of millions of Americans of all ages. Following prolonged pressure or instability of the spine, these bulges may occur without a specific history of a back injury. However, hundreds of thousands of patients each year do suffer sudden spine injuries that lead to disc herniation, such as following a car accident.
The mechanism behind disc bulges involves the development of weakness or breaks in the tough outer protective layer of the spinal disc. Once the outer coating of the disc is compromised, the inner jelly-like shock absorber portion of the disc may begin to push outward, creating a bulge seen on MRI. A disc bulge on an MRI sounds frightening, but most people with this find do not have any significant pain or disability from a simple disc bulge. A disc herniation, on the other hand, is typically meant to communicate a more severe form of disc bulge that often is associated with pain and disability. Other terms associated with more severe types of disc bulging include “disc prolapse” and “disc extrusion.”
Once a disc herniation or significant bulge pushes far enough into the spinal canal or neural foramen, it may exert considerable pressure on either the spinal cord or nerve roots. If the pressure is high enough, the nerve tissues will begin to malfunction and produce a wide variety of symptoms. The most commonly reported early symptoms include increased sensitivity in the extremities, numbness, tingling, or mild muscle weakness of the arms or legs. Late signs of compressed nerves include severe pain levels and muscle dysfunction, which may rarely progress to muscle paralysis with possible bowel or bladder dysfunction. Paralysis, bowel, or bladder problems indicate a potential medical emergency, and anyone with the symptoms should seek immediate medical attention.
Neuroforaminal stenosis or “nerve pinching”:
Patients are often diagnosed with problems of “stenosis” of the neuroforamen in radiology MRI reports. In simpler terms, this is nerve pinching occurring as the nerve roots exit the spinal canal. The pinching often occurs due to either disc herniation or facet enlargement into the canal where the nerve is exiting. The nerve pinching and symptoms associated with this form of stenosis is medically referred to as “radiculopathy.”
Radiculopathy symptoms resulting from neuroforaminal stenosis include:
- Pain radiating down an arm or leg
- Numbness or tingling down an arm or leg
- Arm or leg weakness
Central spinal canal stenosis:
Another common form of “stenosis” is that which impacts the central spinal column. The spinal cord and nerve roots at lower levels run within the bony protected area formed by openings within the vertebral bodies. If the spine degenerates, the central canal of the spine can become decreased in size and result in loss of space for the spinal cord or nerve roots. As the spine closes in on the spinal cord, significant symptoms may start to appear as a result.
Central canal stenosis symptoms include:
- Difficulty standing for periods of time
- Leg weakness with standing or walking
- Balance problems
- Increased clumsiness with daily tasks
- Difficulty using the hands for everyday tasks
- Significant and progressive weakness in arms & hands
- Considerable pain, numbness, tingling down arms or legs
- Bowel or bladder dysfunction (such as loss of control)
NOTE: If you are experiencing hand clumsiness, balance difficulties, severe extremity weakness, bowel dysfunction, or bladder dysfunction, please contact a healthcare provider immediately. These symptoms could indicate the need for urgent medical attention.
Scoliosis is a structural disorder of the spine characterized by abnormal side bending and rotation of the vertebral column. The condition is prevalent, and severity can range from mild and symptom-free to very severe with disabling pain. Scoliosis may develop in children or, more often, is acquired later in life from degenerative spinal disorders. When scoliosis causes problems, symptoms may include:
- Mid-back or lower back pain
- Pinched nerves
- Asymmetry of the body with leaning to one side
- In severe cases, it may interfere with the heart or lungs
SI Joint pain:
Sacroiliac, or SI, joint pain occurs when there is irritation or inflammation of the joints at the base of the spine. This can be related to a variety of underlying causes, such as osteoarthritis, ligament strain, certain autoimmune disorders, following pregnancy, or from joint irritation due to L5-S1 spinal fusion. Pain coming from the SI joint often includes:
- Pain or aching across the buttocks or very low back area
- Significant discomfort when transitioning from sitting to standing
- Pelvic or lower back when laying down on left or right sides
- Tenderness in the region of the dimples in the low back area
Spondylolisthesis is when one vertebra slips forwards or backward over another. This condition can be caused by an injury or fracture of a vertebra (spondylolysis) or from degenerative slipping of the facet joints that destabilizes the lower spine. The slipping can result in crowding of the nerve roots leading to nerve compression and associated symptoms. Spinal cord pinching may also occur due to the abnormal position of the vertebral bones. There are different grades of spondylolisthesis, which indicate the relative severity of the slippage from a mild grade 1 to most severe grade 4. Also, this type of spinal movement can be described as relatively stable or unstable, which can provide another indication of the severity.
Failed back surgery syndrome and adjacent segment disease:
Though spine surgery may be indicated in selected severe cases, it can lead to new problems in the spine following these invasive approaches. Reports for the incidence of these surgical failures for a patient undergoing spinal surgery exceed 40% in medical studies. Given the frequency of this occurrence, a diagnosis named “failed back surgery syndrome” or FBSS was created to describe the phenomenon among spinal post-surgical patients. We have found formal references in the medical literature and studies dating back to the 1970s.
In addition to FBSS, another related condition known as “adjacent segment disease” has been described. This condition is considered to be a sub-type of failed back surgery syndrome by some. The adjacent segment disorder applies to patients suffering new and progressive deterioration from the spinal levels immediately above or below a previous surgery. The condition is thought to occur secondary to the increased stress placed on those levels next to the original spinal surgical site. There is concern about destabilizing the spine around the area of spine surgery due to the loss of normal ligament, tendon, and muscle function.