Spinal Fractures - Spondylolisthesis - Scoliosis - Kyphosis - Lordosis
Part 3: Common Spinal Disorders
There are many types of back and neck disorders that affect the majority of the population in the United States. Injury, aging, general health, and lifestyle may influence the development of some conditions. Most spinal disorders are known to result from soft tissue injury, structural injury, and degenerative, or congenital conditions.
Structural disorders are those affecting the bones and discs. Nerve roots may become irritated or damaged when injury involves a vertebra (ver-ta-bra) or disc. Pain and weakness are symptoms that may accompany a structural injury.
Spinal Fractures are different from a broken arm or leg. A spinal fracture may involve the spinal cord. The spinal column is the spinal cord's suit of armor. Damage to the armor could cause injury to the spinal cord and any of its 31 pairs of nerve roots. Fractures in the spine may include the vertebral (ver-tee-brawl) body and its attachments such as the facet joints (fah-set), pars articularis (parz are-tick-you-lar-es), and spinous process. Damage to any of these bony elements may cause injury to the spinal cord and nerve structures.
Compression Fractures are the most common. The vertebral body is the largest single unit of a vertebra. Its structural integrity is similar to a cardboard box. Visualize a cardboard box. It appears to be big and sturdy but is hollow inside. Sudden and excessive force to the box creates pressure. Force can cause the box to crush into a wedge shape. The force is distributed and may affect other spinal structures. It could be assumed that the smaller cervical (sir-ve-kal) vertebrae would be more susceptible to injury based on size. Compression fractures do not occur as often in the lumbar spine because these vertebrae are the largest and most dense.
Other fractures may result from forces that cause the body to torque (twist). Even a direct blow to the spine can cause fracture. Others parts of the vertebra including the facet joints or other bony processes may break causing vertebral dislocation and paralysis. Although bone is a hard material it can crack, split, or break away from the parent bone. Spinal fractures require immediate medical attention. An unstable fracture can be a serious condition causing bone fragments to press against the spinal cord or nerves.
Osteoporosis (os-t-o-pour-o-sis) is a disease that adversely effects bone density. It can cause bones to become porous, weak, and sometimes delicate as porcelain. Osteoporotic bone is especially susceptible to fracture. The type of fracture is diagnosed by x-ray. Treatment depends on the type of fracture and the location. Some fractures require surgical intervention and others require bracing to stabilize the spine. The first step is to stop movement to control and minimize injury.
When a vertebra fractures the body's first response is to begin healing. Initially a granular material called a callus is formed at the fracture site. Collagen (call-ah-gin), a protein is transported to the site through the blood stream. Collagen helps to mend and knit the fracture together. After new bone is joined with the old bone it is hardened through a process called calcification (kal-see-fi-cay-shun).
Plastics have revolutionized the brace and cast business today. Years ago a patient with a broken back had no other choice than to wear a plaster cast. Today, casts and braces are made from plastics and other materials. Braces are custom-fitted, removable, and designed to be comfortable. Today, most spinal fractures are more of an inconvenience than a tragedy.
Spondylolisthesis (spon-de-low-lis-thee-sis) means one vertebra slips over the one below. This disease primarily affects the elderly as a degenerative disease but, it can be congenital (present at birth) or discovered early in life. Childhood spondylolisthesis may result if the pars articularis (parz are-tick-you-lar-es) does not fuse during early development. Posterior vertebral weakness results when these bony elements do not grow together. Spondylolisthesis may occur following injury or overuse because the bony weakness makes the area weak and susceptible to break. A spine expert is best qualified to treat this condition.
Elderly or degenerative spondylolisthesis develops when the stabilizing spinal structures begin to deteriorate. This usually occurs in the lower back, which carries most of the body's weight. Sometimes the spinal joints become arthritic and wear out, which may cause spinal instability. As vertebrae (ver-ta-bray) lose normal alignment one vertebra may slip forward over the vertebra below it. When this happens the neural foramina (space where nerves leave the spinal canal) may become closed causing nerve compression and sciatica. This condition is similar to spinal stenosis.
In most cases, spondylolisthesis is treated non-surgically. Treatment may include a course of physical therapy, steroid-anesthetic injections, and medication (prescription or over-the-counter) for inflammation and pain. When nonsurgical treatment fails, and depending on the patient's symptoms, a surgical procedure may be considered. In cases of severe slippage or instability, a spinal fusion may be necessary. Spinal fusion helps to stabilize the weak area of the spine using rods, screws, or plates, and bone graft. Leg pain, weakness, or numbness may be alleviated by a surgical procedure called a foraminotomy (for-am-not-toe-me). This procedure increases the size of the neuroforamen and cleans away debris that clogs the neural foramina.
Abnormal Spinal Curvature
Scoliosis (sko-lee-oh-sis) is a term taken from a Greek word meaning curvature. During the 19th Century physicians thought poor posture was the primary cause of scoliosis. Today scoliosis is known to be either congenital (present at birth) or developmental and may be hereditary. The disease causes the spine to curve laterally (to the side) usually in the shape of an "S" or "C". The curve is measured in degrees. Some curves are severe.
Idiopathic Scoliosis (id-dee-oh-path-ick sko-lee-oh-sis) is the childhood version of adult scoliosis. It is hereditary and primarily affects healthy young girls during their early teens. Physical signs may include uneven shoulders, one hip lower than the other, a rib hump when bent over at the waist and leaning to one side. When maturity is reached the disease may stabilize or slowly degenerate over time. In an adult with scoliosis, the curve may have begun to develop during childhood but went unnoticed.
Whatever the patient's age, the goal is to stabilize the spine to prevent additional curvature. Some patients with scoliosis are pain free and do not seek treatment until deformity is noticed. Unfortunately, at that point it may be too late to treat the disease. The size of the curve is measured in degrees on an x-ray. The progression of scoliosis is monitored by periodic x-ray studies. When scoliosis is severe it may cause the spine to rotate, which can cause spinal spacing to narrow on the opposite side of the body.
Kyphosis (ky-foe-sis) is the normal curvature of the rib-bearing thoracic spine. Excessive kyphosis may develop as a result of poor posture early in life. Kyphosis means the spine is bent forward. Although kyphosis usually affects women, it is found to develop in men too. An excessive form of kyphosis may cause a hump to form in the shoulder blade area of the upper back. Kyphosis may affect men and women with osteoporosis.
Lordosis (lor-doe-sis) is the normal contour of the neck and lower back. Excessive lordosis may cause an extreme inward curve in the lower back. This condition is also called swayback.
This article is an excerpt from the book Save Your Aching Back and Neck: A Patient’s Guide, edited by Dr. Stewart Eidelson.