Download Basic Diseases That Affect The Vertebral Column And Management.

Basic Diseases That Affect The
Vertebral Column And Management.
Dr. Adrian. C. O. Adams
Anatomy of the Human Vertebral
Column.
1.
2.
3.
4.
5.
6.
7.
The Basics of Back Pain.
Degenerative Back Conditions.
Sciatica.
Spinal Deformities/Scoliosis.
Spinal Stenosis .
Spondylosis/Spondylolisthesis.
Spinal Tumors
The Basics of Back Pain
What causes back pain?
•
•
•
•
•
•
•
•
Disc herniation - A herniated disc is a rupture or tear of the cartilage that surrounds
the vertebral discs. Pressure from the vertebrae above and below the affected disc
squeezes the cushioning substance (nucleus pulposus) out of the disc. The nucleus
pulposus can press against spinal nerve roots. This can cause severe leg pain and may
cause nerve damage if not treated properly.
Osteoarthritis/spinal stenosis - This is characterized by the constriction or narrowing
of the vertebral canal, the space that surrounds the spinal column.
Ankylosing spondylitis - Ankylosing spondylitis is a chronic inflammatory disease that
first affects the spine and adjacent structures. As the disease progresses, vertebrae
will fuse together. This disease has a strong hereditary tendency and primarily affects
men under 30 years of age.
Spondylolisthesis - Spondylolisthesis is the partial forward movement (dislocation) of
one vertebra over the one below it. Usually, the fifth lumbar vertebra is dislocated
over the first sacral vertebra.
Infection (less than 1 percent of cases)
Cancer (less than 1 percent of cases)
Fracture Trauma - An injury due to an accident or fall may cause a fracture or muscle
strain.
Non-spinal causes
How is back pain diagnosed?
• Interrogation
• Physical Examination
• Extensive Testing
How is back pain treated?
• Medication
• Physiotheropy
Degenerative Disc Disease
As discs lose their water content because of
disease or age, they lose their height, bringing
the vertebrae closer together. As a result, the
nerve openings in your spine become more
narrow. When this happens, the discs don’t
absorb the shocks as well, particularly when
you are walking, running, or jumping.
What Causes Degenerative Disc Disease?
• Aging
• Back Injuries
What Are the Symptoms?
• Degenerative disc disease may cause back and/or leg pain, as
well as functional problems such as tingling or numbness in your
legs or buttocks, or difficulty walking.
How is it Diagnosed?
• Interrogation
• Physical Examination
• Extensive Testing
How is Degenerative Disc Disease Treated?
• Non-surgical treatments – Not all patients with pain from
degenerative disc disease require surgery. For mild to
moderate pain, more conservative treatment methods can
include medications, physical therapy, and chiropractic care.
• Spinal fusion – A procedure called a spinal fusion can be used
to surgically treat degenerative disc disease.
Sciatica
The term sciatica describes a symptom rather
than a specific disease. Some use it to mean
any pain starting in the lower back and going
down the leg. Others use the term more
specifically to mean a nerve dysfunction
caused by compression of one or more lumbar
or sacral nerve roots from a spinal disc
herniation.
Cause
•
•
•
•
•
Spinal disc herniation
Spinal stenosis
Piriformis syndrome
Pregnancy
Tumours
What Are the Symptoms?
• Pain that radiates to the back of the leg.
Diagnosis
•
•
•
Interrogation
Physical Examination (Lasègue's sign)
Extensive Testing
Management
• Medication
Although medicines are commonly prescribed for the treatment of
sciatica, evidence for analgesics is poor. Specifically, NSAIDs do not
appear to improve immediate pain and all NSAIDs appear about
equivalent. Evidence is also lacking in use of opioids and muscle
relaxants. In those with sciatica due to piriformis syndrome,
botulinum toxin injections may improve pain and or function. There
is little evidence for steroids, either epidural or by pill.
• Surgery
Surgery for unilateral sciatica involves the removal of part of the
disc, known as a discectomy. While it results in short term benefits,
long term benefits appear to be equivalent to conservative care.
Treatment of the underlying cause of the compression is needed in
cases of epidural abscess, epidural tumors, and cauda equina
syndrome.
Scoliosis
It is a medical condition in which a person's
spinal axis has a three-dimensional deviation.
Although it is a complex three-dimensional
condition, on an X-ray, viewed from the rear,
the spine of an individual with scoliosis can
resemble an "S" or a "?", rather than a straight
line.
Signs and symptoms
•
•
•
•
Uneven musculature on one side of the spine
A rib prominence or a prominent shoulder blade, caused by rotation of the ribcage
in thoracic scoliosis
Uneven hips, arms or leg lengths
Slow nerve action (in some cases)
Causes
•
•
Congenital
Idiopathic
Diagnosis
•
•
•
Interrogation
Physical Examination (Adams forward bend test)
Extensive Testing
Management
•
•
•
•
•
Observation
Bracing
Painkilling medication
Exercise
Surgery :
Anterior fusion: This surgical approach is through an incision at the side
of the chest wall.
Posterior fusion: This surgical approach is through an incision on the back
and involves the use of metal instrumentation to correct the curve.
Thoracoplasty: The removal (or resection) of typically four to six
segments of adjacent ribs that protrude. Each segment is one to two inches long.
Surgery without fusion: These Vertical, Expandable Prosthetic Titanium
Ribs (VEPTR) provide the benefit of expanding the thoracic cavity and straightening
the spine in all three dimensions while allowing it to grow.
Spinal Stenosis
With age, the spinal canal – located in the lower
back – can narrow, resulting in spinal stenosis.
The narrowing process, which is gradual,
reduces the space available for the spinal cord
and nerves. If only a small amount of spinal
narrowing occurs, no pain will result. Spinal
stenosis may lead to leg pain, numbness,
and/or tingling. In advanced cases, weakness
may also be present.
What causes spinal stenosis?
• Spinal stenosis occurs when bulging discs, arthritic spurs, and
thickened tissues combine to "compress" the nerves traveling through
the spinal canal.
Signs and symptoms
• The most common symptom of spinal stenosis is pain, numbness
and/or tingling in legs that is pronounced when standing or walking.
What are treatment options for spinal stenosis?
• Medical Treatment
Taking non-steroidal anti-inflammatory drugs
(NSAIDs) for relief.
Receiving cortisone injections directly into the
spinal column to provide short-term relief.
Engaging in exercise and physical therapy that
focuses on strengthening the back and abdominal muscles as well as
stretching.
• Surgical Treatment
Laminectomy: The most common type of surgery for this
condition, laminectomy involves the removal of the lamina, a
portion of the vertebra, to make room for the nerves. Some
ligaments and bone spurs may also be removed. The surgery
requires making an incision into the back.
Foraminotomy: The foramen is the area in the vertebrae where
the nerve roots exit. The procedure involves expanding this area to
provide more space for the nerve roots.
Spinal fusion: This procedure is done in cases of instability and
involves joining the bones together with screws or bone grafts to
provide spinal stability. It may be combined with laminectomy
surgery. The surgery lasts several hours and can be done using one
of two methods:
Spondylolisthesis
Spondylolisthesis is a condition in which one of
the bones of the spine (vertebrae) slips out of
place onto the vertebra below it. If it slips too
much, the bone might press on a nerve,
causing pain. Usually, the bones of the lower
back are affected.
Types of spondylolisthesis
•
•
•
•
•
•
Congenital spondylolisthesis
Isthmic spondylolisthesis
Degenerative spondylolisthesis
Traumatic spondylolisthesis
Pathological spondylolisthesis
Post-surgical spondylolisthesis
What are the symptoms of spondylolisthesis?
•
•
•
Low back pain
Muscle spasms in the hamstring muscles
Numbness
How is spondylolisthesis diagnosed?
•
An X-ray of the lower back can show a vertebra out of place. A computed
tomography (CT) or magnetic resonance imaging (MRI) scan — which produce more
detailed images — might be needed to more clearly see the bones and nerves
involved.
How is spondylolisthesis treated?
• Conservative treatment
• Physical therapy
• Surgery
• Surgery might be necessary if the vertebra continues to slip or if the
pain is not relieved by conservative treatment and begins to
interfere with daily activities. The main goals of surgery for
spondylolisthesis are to relieve the pain associated with an irritated
nerve, to stabilize the spine where the vertebra has slipped out of
place, and to increase the person’s ability to function. Usually two
surgical procedures are used to treat spondylolisthesis.
Decompressive laminectomy, which involves removing the part of
the bone that is pressing on the nerves. Although this procedure can
reduce pain, removing a piece of bone can leave the spine unstable.
Spinal fusion, is performed to provide stability. In a fusion, a piece
of bone is transplanted to the back of the spine. As the bone heals,
it fuses with the spine — creating a solid mass of bone — keeping
the spine from moving and stabilizing it. In some cases, instruments
such as rods or screws are used to hold the vertebra firm as the
fusion heals.