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The Spine

The SpineOur spine is the main support of our upper bodies. (Read about "Skeletal System") It lets us stand up straight, bend or twist. It also encases and protects the spinal cord. The nerves branch out from our spine to the rest of our bodies. (Read about "Nervous System")

The spine is made up of vertebrae. At the top are the cervical vertebrae. There are seven of them and they are referred to as C1-C7, starting at the top. The seventh one joins to the first of the thoracic vertebrae. These are the 12 that run down the back and provide a place for our ribs to attach. They are referred to as T1-T12, again from the top down. The lower inward curve of our back is made up of the five lumbar vertebrae. They are called L1-L5. Below that comes a set of five fused vertebrae called the sacrum that lies between the hipbones. Lastly comes the coccyx or the tailbone, another set of fused vertebrae.

The vertebrae join together at what are called the facet joints. Between each of the vertebrae are the disks, which provide cushioning and act as shock absorbers.

Traveling down the center of the spine is the spinal cord and at each of the vertebrae, nerves branch out through what are called the foramen to the rest of the body.

Diagnosis

If you are having pain or problems in your back or spine, you should see your doctor. Diagnosing a back problem usually starts with a medical history. Your doctor will ask you about any injuries or conditions that could be causing the symptoms. Next you'll probably get a physical. The doctor will check how limited your movements are, when and where pain occurs as you move your back and look for numbness or weakness in your arms and legs.

There are also a number of tests that can be performed, according to NIAMS. They include:

Many times, a number of these tests will be done to confirm a diagnosis. Below are some of the conditions and diseases that can affect the spine.

Vascular lesions

A vascular lesion is an abnormal cluster of snarled blood vessels. Vascular lesions can occur just about anywhere in the body. When they occur on the spinal cord, they can have dramatic impacts.

One of the more common is an arteriovenous malformation or AVM. An AVM is made up of tangled arteries and veins. Spinal AVMs can result in sudden, severe back pain. (Read about "Back Pain") It is often concentrated at nerve fibers where they exit the vertebrae; the pain is similar to that caused by a slipped disk. These lesions also can cause sensory disturbances, muscle weakness or paralysis in the parts of the body served by the spinal cord or the damaged nerve fibers.

Other types of vascular lesions include:

The term, cerebrovascular disorders, is also used when discussing vascular lesions.

(Read about "Vascular Lesions of the Central Nervous System")

Trauma

Trauma (accidents) may either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal. Spinal cord trauma can be caused by:

The National Spinal Cord Injury Association says that after a spinal cord injury, the nerves above the level of injury keep working, but nerves from the point of injury and below do not. Therefore, the higher the injury is on the spine, the more it can impact how the body moves and what a person can feel. In addition to the location of the injury, the impact also depends on the extent of the injury.

People who survive a spinal cord injury can develop medical complications such as chronic pain and bladder and bowel dysfunction. (Read about "Chronic Pain" "Incontinence" "Fecal Incontinence") They may also be more likely to develop respiratory and heart problems, according to NINDS. (Read about "Respiratory System" "The Heart & Cardiovascular System") Rehabilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support. The education and active involvement of the newly injured person and his or her family and friends is crucial. (Read about "Rehabilitation")

Arthritis

Arthritis causes swelling in the joints and connective tissue. Different forms of arthritis and rheumatic diseases can affect the spine, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and reactive arthritis (Reiter's syndrome).

(Read about "Arthritis and Rheumatic Diseases" "Osteoarthritis" "Rheumatoid Arthritis" "Ankylosing Spondylitis" "Reactive Arthritis")

moreSee diagnosis, treatment and prevention below.

Cervical spondylotic myelopathy (CSM)

When the compression of the cervical spine occurs, it is called cervical spondylotic myelopathy (CSM), according to the American Academy of Family Physicians (AAFP). AAFP calls CSM the most common spinal cord problem for people over the age of 55 in the United States. Some of the symptoms of CSM, according to AAFP include:

Stiff legs can also be a symptom of CSM. Pressure on the nerve can lead to peripheral neuropathy. (Read about "Peripheral Neuropathy") The symptoms can develop very slowly.

moreSee diagnosis, treatment and prevention below.

Degenerative disk disease

As we get older, the disks that form the cushioning between the vertebrae can shrink. AAOS says this is due to the fact that the water content in our body cells diminishes, as well as other chemical changes that occur. Without enough cushioning, the vertebrae can press against each other and pinch the nerve (Read about "Peripheral Neuropathy") or form bony spurs. These changes occur to some degree in everyone. AAOS says all of us will develop degenerative or "wear and tear" changes, and for the most part, the loss of function that results is not extensive. However, in severe cases of degenerative disk disease, there can be low back stiffness and pain. In addition, arthritic bone spurs and inflamed joints can cause nerve irritation and leg pain.

(Read about "Disk Problems")

moreSee diagnosis, treatment and prevention below.

Stenosis

The basic definition of stenosis is a narrowing of a vessel or a passageway. When spinal stenosis occurs, either the passageway the spinal cord goes through or the foramen are narrowed. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the cord and/or the nerves can be pinched and that can cause pain, numbness and loss of body functions. (Read about "Peripheral Neuropathy") Spinal stenosis most often results from a gradual, degenerative aging process, although it can be caused by other problems too. This disorder is most common in people over 50 years of age. However, it may occur in younger people who are born with a narrowing of the spinal canal or who suffer an injury to the spine.

NIAMS says potential causes of stenosis include:

moreSee diagnosis, treatment and prevention below.

Ruptured, slipped or herniated disk

It's known by many terms including, ruptured, slipped or herniated disk. No matter what it's called, it means the same thing. One of those pads between your vertebrae is bulging out of place in some way and putting pressure on a nerve. AAFP says that a ruptured disk usually squeezes just a couple of nerves at a time.

The disks are made up of two parts. There is a tough outer layer and a gel like center. A ruptured disk occurs when the center pushes the outer layer out of position. It usually happens as we get older and the disks lose some of their flexibility.

According to the American Academy of Orthopaedic Surgeons (AAOS), symptoms of a ruptured disk can include:

The North American Spine Society (NASS) says most ruptured disks occur in the bottom two disks of the lumbar spine just around our waists. When the disk problem is in this area, the pain can extend from the buttocks down the leg. (see sciatica below) Ruptured disks can also occur in other parts of the spine. If they happen in the cervical area, that's the upper part, it can cause pain, weakness and numbness in the shoulders and arms, according NASS.

Most of the time, a ruptured disk does not need surgery. (Read about "Neurosurgery") NASS says 80 to 90 percent of people improve without surgery. Occasionally a ruptured disk will cause a person to lose bladder or bowel control. (Read about "The Urinary System" "Digestive System") Losing bladder and bowel control can be a symptom of a massive herniated disk resulting in what is called cauda equina syndrome, according to American Association of Neurological Surgeons. AAOS calls that an emergency and suggests you call your doctor immediately.

(Read about "Disk Problems")

moreSee diagnosis, treatment and prevention below.

Sciatica

The sciatic nerve is the large nerve that extends from the lower end of the spinal column in the pelvis and all the way down the leg. (Read about "Nervous System") If this nerve is compressed, the compression causes a number of symptoms, including:

The extent of the pain can vary from a mild discomfort or ache to excruciating pain. Sitting for a long period of time can make it worse. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), causes of sciatica include:

Disks provide cushioning between the vertebrae and act as shock absorbers. As disks degenerate with age, they can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. In the most extreme cases of sciatica, when the nerve is pinched between the disk and an adjacent bone, the symptoms involve numbness and some loss of motor control over the leg due to interruption of nerve signaling.

NASS says sciatica hits about one to two percent of the population. AAOS says it is most likely to occur in people who are 30-50 years of age.

moreSee diagnosis, treatment and prevention below.

Spondylolysis and Spondylolisthesis

Spondylolysis is a stress fracture in the lower spine. (Read about "Bone Fractures") It may result from a degenerative condition or an accident or may be acquired at birth. AAOS says it is a common cause of lower back pain in young athletes. Sometimes, the stress fracture weakens the bone so much that it moves out of place. This is called spondylolisthesis. Poor alignment of the spinal column when a vertebra slips forward onto the one below it can place pressure on the spinal cord or nerve roots at that place. Athletes are vulnerable, especially if they are involved in sports that put a lot of stress on the back. Genetics (Read about "Genetics") can also play a role in the development of these conditions. Sometimes, these conditions do not cause any noticeable symptoms. If symptoms are present, they can include:

Treatment depends on how much the problem is interfering with a person's life. Initial treatment options include physical therapy (Read about "Rehabilitation") and anti-inflammatory medication. (Read about "Medicine Safety") In some cases, surgery is an option. (Read about "Neurosurgery")

moreSee diagnosis, treatment and prevention below.

Osteoporosis

Osteoporosis can also cause spinal problems. The bones become weak and brittle. They can fracture and collapse. (Read about "Bone Fractures") The Society of Cardiovascular and Interventional Radiology (SCVIR) says that osteoporosis causes 700,000 fractures of the vertebrae each year. Many older people lose height because of this. The result can mean pressure on the spinal cord or the nerves that go out to the rest of the body. (Read about "Age and Bone Loss")

(Read about "Osteoporosis")

moreSee diagnosis, treatment and prevention below.

Scoliosis

Scoliosis is also called curvature of the spine. It is a condition where the spine, when viewed from the back, forms an "S" shape instead of a straight line. It can result in stenosis of the spine and the accompanying problems.

(Read about scoliosis in "Curvature of the Spine")

moreSee diagnosis, treatment and prevention below.

Spinal Tumors and Cysts

Spinal tumors can be benign or malignant, according to the National Institute of Neurological Disorders and Stroke (NINDS). (Read about "Bone Cancer" "Bone Tumors - Benign") Benign tumors are noncancerous and malignant tumors are cancerous. (Read about "Cancer: What It Is") A biopsy, a surgical procedure in which a sample of tissue is taken from a suspected tumor, helps doctors diagnose the type of tumor. (Read about "Biopsy") NIAMS says tumors may affect the spinal canal directly by inflammation or by growth of tissue into the canal. Tissue growth may lead to bone resorption (bone loss due to over activity of certain bone cells) or displacement of bone and the eventual collapse of the supporting framework of the vertebral column. Spinal cord tumor symptoms depend on the size and location of the tumor, and can include pain, sensory changes and motor problems or weakness.

A cyst is a closed sac that can be filled with fluid. A spinal cyst may be associated with a tumor or be present by itself. Like a tumor, a cyst can apply pressure to the spinal column or the nerves, leading to pain and other symptoms. Syringomyelia is a disorder in which a cyst forms within the spinal cord, according to NINDS. NINDS says that this cyst, called a syrinx, expands and elongates over time, destroying the center of the spinal cord. Since the spinal cord connects the brain to nerves (Read about "The Brain" "Nervous System") in the extremities, this damage results in pain, weakness and stiffness in the back, shoulders, arms or legs. Other symptoms may include headaches and a loss of the ability to feel extremes of hot or cold, especially in the hands.

One cause of back pain and sciatica can be spinal synovial cysts, which form as the result of deteriorating conditions (arthritis) involving the facet joints.

moreSee diagnosis, treatment and prevention below.

Diagnosis, Treatment and Prevention

A thorough medical history and physical exam is often the first step to identify any dangerous conditions or underlying problems that may be causing back pain. A doctor can examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment. Among the diagnostic tests that may be used are:

NASS says that most doctors will take a conservative approach to most back issues. AAOS says that 75 to 90 percent of people get over their symptoms within 6 weeks. Here are some of the things that might be recommended.

If the pain continues for more than three months, AAOS says that some sort of surgery might be recommended. There are a number of types of surgery depending on the problem. (Read about "Neurosurgery")

Prevention

Though some back problems can't be avoided, there are things we can do to delay or even prevent back injuries. Here are some tips from NIAMS.

Watch the posture, especially at work and while sitting. Poor posture can result in a number of spinal problems.

Related Information:

    Stretching and Health

    Back Pain

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

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By printing and/or reading this article, you agree that you accept all terms and conditions of use, as specified online.