Spinal Conditions & Anatomy
Anatomy of the Spine:
When viewed from the side, an adult spine has a natural S-shaped curve. The neck (cervical) and low back (lumbar) regions have a slight concave curve (Lordosis), and the thoracic and sacral regions have a gentle convex curve (Kyphosis). The curves work like a coiled spring to absorb shock, maintain balance, and allow range of motion throughout the spinal column.
• Cervical (neck)- the main function of the cervical spine is to support the weight of the head (about 10 pounds). The seven cervical vertebrae are numbered C1 to C7.
Getting an accurate diagnosis of the cause of back pain is critical, because different diagnoses will require very different treatment approaches. The sooner an accurate diagnosis is made, the sooner the patient can receive appropriate treatment for pain relief and to improve his or her ability to enjoy everyday activities.
Several tests may be used to diagnose a spinal condition, including a physical examination, neurological tests and imaging tests. A neurological exam will check your reflexes, muscle strength, walking ability, and ability to feel light touches, pinpricks or vibration. Imaging tests may include x-rays, CT scans, and MRI scans of multiple areas of the spine.
The three major types of spine fracture patterns are flexion, extension, and rotation.
• Axial burst fracture- The vertebra loses height on both the front and back sides. It is often caused by a fall from a height and landing on the feet.
Extension Fracture Pattern:
Rotation Fracture Pattern:
• Fracture-dislocation- This is an unstable injury involving bone and/or soft tissue in which a vertebra may move off an adjacent vertebra. These injuries frequently cause serious spinal cord compression.
The primary symptom of a spinal fracture is moderate to severe back pain that is made worse by movement. When the spinal cord is also involved, numbness, tingling, weakness, or bowel/bladder dysfunction may occur.
With disc herniations, the disk may move out of place (herniate) or break open (rupture) from injury or strain. When this happens, there may be pressure on the spinal nerves. This can lead to pain, numbness, or weakness. The lower back (lumbar area) of the spine is the area most commonly affected by a slipped disk. Slipped disks occur more often in middle-aged and older men and women, usually after strenuous activity.
Symptoms of a slipped disk in your lower back may include sharp pain in one part of the leg, hip, or buttocks and numbness in other parts. You may also feel pain or numbness on the back of the calf or sole of the foot. The same leg may also feel weak.
Symptoms of a slipped disk in your neck may include pain when moving your neck, deep pain near or over the shoulder blade, or pain that moves to the upper arm, forearm, and fingers. You can also have numbness along your shoulder, elbow, forearm, and fingers.
Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to aging and occurs mostly in people older than 50 years of age. People with a spine injury, narrow spinal canal, or diseases such as arthritis and scoliosis are also at increased risk of developing spinal stenosis.
While some people have no signs or symptoms, spinal stenosis can cause:
In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis) area. It is often due to an injury or developmental disorder.
Bone disease and fractures can also cause spondylolisthesis. Certain sport activities, such as gymnastics, weight lifting, and football, put a great deal of stress on the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. This can lead to a stress fracture on one or both sides of the vertebra. A stress fracture can cause a spinal bone to become weak and shift out of place.
In adults, the most common cause is abnormal wear on the cartilage and bones, such as arthritis.
Symptoms of spondylolisthesis may include:
Spinal tumors can occur inside the spinal cord (intramedullary), in the membranes (meninges) covering the spinal cord (extramedullary - intradural), or between the meninges and bones of the spine (extradural).
The symptoms of a spinal tumor depend on the location, type of tumor, and your general health. Tumors in the spinal cord usually cause symptoms, sometimes over large portions of the body, while tumors outside the spinal cord may grow for a long time before causing nerve damage. Symptoms of a spinal tumor may include abnormal sensations or loss of sensation, back pain, incontinence, muscle spasms, or muscle weakness.
An increased curve in the upper spine also can be caused by slouching. Called postural kyphosis, this condition doesn't involve any deformities in the spine and is most common in teenagers.
In addition to an abnormally curved spine, kyphosis can also cause back pain, stiffness, difficulty breathing, and fatigue in some people. Mild cases of kyphosis may produce no noticeable signs or symptoms.
Most cases of scoliosis are mild, but some children develop spine deformities that continue to get more severe as they grow. Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.
Signs and symptoms of scoliosis may include: uneven shoulders, one shoulder blade that appears more prominent than the other, uneven waist, or one hip higher than the other. Severe scoliosis may also cause the ribs on one side of the body to stick out farther than on the other side, back pain, and difficulty breathing.
Pediatric Spine Conditions: