It can be helpful to understand which part of the spine is causing your back pain and whether the pain is from a compressive or a mechanical problem.
It is important to determine what is, and what is not causing your back or neck pain.
Treatments for spinal problems range from conservative therapies, to more invasive therapies, including spinal injections and surgery.
So as you can imagine, it is subjected to a great deal of stress every day. Some of the wear and tear your spine experiences over a lifetime of use is normal. Some people put more wear and tear on their spine than others, such as athletes and people who work at jobs that are physically demanding. But even working at a desk job can put added strain on your spine. The normal function of your spine can also be affected by certain medical conditions. Bulging Disc, Facet Joint Syndrome, Herniated Disc, Myelopathy, Sacroiliac Joint Syndrome, and Scoliosis are some of the most common conditions affecting the spine.
You may think a bulging disc is the same as a herniated disc, but there is a difference. With a herniated disc, a crack occurs in the outer layer of the disc, called the annulus. The crack usually affects a small part of the disc, and it allows the soft inner material of the nucleus pulposus to rupture out of the disc. A bulging disc is different because the disc simply bulges outside the space it normally occupies between your vertebrae, but it doesn't rupture. A bulging disc affects a much larger part of the disc than a herniated disc. While it is more common to have a bulging disc than a herniated disc, a herniated disc is more likely to be painful. It's possible for you to have a bulging disc without feeling any pain at all.
A bulging disc is usually considered a normal part of aging. Some discs most likely begin to bulge as a part of both the aging process and the degeneration process of the intervertebral disc.
If there are bone spurs present on the facet joints behind the bulging disc, the combination may cause narrowing of your spinal canal in that area. This is sometimes referred to as segmental spinal stenosis.
Injury to your intervertebral disc, more commonly experienced by an athlete or a person with a very physical job, can weaken the disc and make it more prone to problems. Smoking tobacco can also cause your disc to weaken and deteriorate.
Bulging discs are fairly common in both young adults and older people. As the disc bulges out between the vertebrae and presses on a nerve, you will experience symptoms in whatever part of your body the affected nerve serves. The symptoms of a bulging disc may include pain, numbness, and muscle weakness.
Bulging discs sometimes press against your spinal cord. When this happens, symptoms may include:
Pain from a bulging disc may start slowly and get worse over time or during certain activities. The symptoms often get better within a few weeks or months.
Diagnosing a bulging disc begins with a complete history of the problem and a physical exam. Your doctor may ask whether you are aware when you have to urinate or have a bowel movement. If there is a problem, it could indicate that a bulging disc in your thoracic spine is pushing against your spinal cord. Your doctor may also want to perform certain diagnostic tests including an X-ray, MRI, or CT scan.
Your doctor may suggest taking X-rays of your spine. Although an X-ray can't show a bulging disc, it can give your doctor an idea of how much wear and tear is present in your spine.
The most common test to diagnose a bulging disc is the MRI scan. This test is painless and very accurate. It is usually the preferred test to do (after X-rays) if a bulging disc is suspected.
Sometimes, the X-ray and MRI do not tell the whole story. Other tests may be suggested. A myelogram, usually combined with a CT scan, may be necessary to give as much information as possible.
The treatment of a bulging disc depends on your symptoms. Most patients with a bulging disc do not need surgery. Your symptoms can usually be managed with conservative treatment such as watching and waiting to see whether your symptoms go away, pain medications, and physical therapy.
When surgery is needed to treat a bulging disc, your doctor will likely perform a laminotomy and discectomy. The term laminotomy means "make an opening in the lamina", and the term discectomy means "remove the disc." The purpose of taking out a bulging disc is to decompress your spinal cord or spinal nerves.
If the bulging disc is in your thoracic spine and surgery is needed, your doctor may perform transthoracic decompression, which is a way to decompress your spinal cord or spinal nerves by removing a small amount of the vertebral body and problem disc through a small opening in the side of your chest. If a large section of vertebra has to be taken out, you may also need spinal fusion.
If surgery on a bulging disc requires removal of a large section of bone and disc material, the section of spine may become loose or unstable. When this happens it may be necessary to fuse the bones right above and below the unstable section. Bone graft material is used to get the unstable bones to grow together. Rods, plates, and screws are commonly used to hold the bones in place so the bone graft heals.
A herniated disc occurs when the annulus (the outer fibers) of your intervertebral disc is damaged and the soft inner material of the nucleus pulposus ruptures out of its normal space. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal. There is very little extra space around your spinal cord, especially in the thoracic area. So when a herniated disc occurs in the mid back it can be extremely serious. In severe cases, the pressure on the spinal cord can lead to paralysis below the waist. Fortunately, herniated discs are not nearly as common in the thoracic spine as in the low back or lumbar spine.
Herniated discs can occur in children, although it is rare. A true herniated nucleus pulposus is most common in young and middle-aged adults and generally occurs in the low back. Disc herniations in the thoracic spine mostly affect people between age 40 and 60. In older folks, the degenerative changes that occur in the spine with aging make it less likely for them to suffer a true herniated disc.
Discs can rupture suddenly because of too much pressure all at once. For example, falling from a ladder and landing in a sitting position can cause a great amount of force through your spine. If the force is strong enough, either a vertebra can break or a disc can rupture. Bending places high forces on the discs between each vertebra in your spine. If you bend and try to lift something that is too heavy, the force can cause a disc to rupture.
Discs can also rupture from a small amount of force, usually because the annulus has been weakened from repeated injuries that add up over time. As the annulus becomes weaker, at some point lifting or bending can cause too much pressure across the disc. The weakened disc may rupture while you are doing something that five years earlier would not have caused a problem. This is due to the effects of aging on your spine, which is the most common reason for a herniated disc in the thoracic spine.
The material that has ruptured into the spinal canal from the nucleus pulposus can cause pressure on the nerves in your spinal canal. There is also some evidence that the nucleus pulposus material causes a chemical irritation of the nerve roots. Both the pressure on the nerve root and the chemical irritation can lead to problems with how your nerve root functions. The combination of the two can cause pain, weakness, and numbness in the area of your body to which the affected nerve supplies sensation.
In the thoracic spine, the pressure can also affect your spinal cord. This is due to the fact that there is little extra space within the spinal canal of your thoracic spine.
The first symptom of a herniated disc is usually pain. The pain is most often felt in the back, directly over the sore disc. Pain may also radiate around to the front of your body. Pressure or irritation on the nerves can also cause symptoms. Depending on which nerves are affected, a herniated disc can include pain that feels like it is coming from another part of your body, such as your heart, abdomen, or kidneys.
Herniated discs sometimes press against your spinal cord. When this happens, symptoms may include:
Pain from a herniated disc may start slowly and get worse over time or during certain activities. The symptoms often get better within a few weeks or months.
Diagnosing a herniated disc begins with a complete history of the problem and a physical exam. Your doctor may ask whether you are aware when you have to urinate or have a bowel movement. If there is a problem, it could indicate that a herniated disc in your thoracic spine is pushing against your spinal cord. Your doctor may also want to perform certain diagnostic tests including an X-ray, MRI, or CT scan.
Your doctor may suggest taking X-rays of your spine. Although an X-ray can't show a herniated disc, it can give your doctor an idea of how much wear and tear is present in your spine. X-rays can also show a disc that has become calcified. If part of the calcified disc appears to be pointing into your spinal cord, it's a good indication the disc is herniated.
The most common test to diagnose a herniated disc is the MRI scan. This test is painless and very accurate. It is usually the preferred test to do (after X-rays) if a herniated disc is suspected.
Sometimes, the X-ray and MRI do not tell the whole story. Other tests may be suggested. A myelogram, usually combined with a CT scan, may be necessary to give as much information as possible.
A herniated disc does not necessarily mean that you will need to undergo surgery. The treatment of a herniated disc depends on your symptoms. If your symptoms are getting better, your doctor may suggest conservative treatment such as watching and waiting to see whether your symptoms go away, pain medications, and physical therapy. Many patients who initially have problems due to a herniated disc find their symptoms completely resolve over several weeks or months.
If your symptoms are getting steadily worse, or if you experience bowel or bladder changes, your doctor may be more likely to suggest surgery.
The traditional way to surgically treat a herniated disc used to be to perform a laminotomy and discectomy. The term laminotomy means "make an opening in the lamina", and the term discectomy means "remove the disc." The purpose of taking out a herniated disc was to decompress the spinal cord or spinal nerves.
If the herniated disc is in your thoracic spine and surgery is needed, your doctor may perform transthoracic decompression, which is a way to decompress your spinal cord or spinal nerves by removing a small amount of the vertebral body and problem disc through a small opening in the side of your chest. If a large section of vertebra has to be taken out, you may also need spinal fusion.
A herniated disc in the thoracic spine may also be treated surgically with a costotransversectomy, in which a section of the transverse process (the small bone on the side of the vertebra) is taken off, which helps the doctor to see and then treat the injured disc through an incision through the back of the spine.
Video Assisted Thoracoscopy Surgery (VATS) is a way to perform thoracic surgery in which the doctor can see and treat the herniated disc using a small TV camera that is passed through your chest cavity.
If surgery on a herniated disc requires removal of a large section of bone and disc material, the section of spine may become loose or unstable. When this happens it may be necessary to fuse the bones right above and below the unstable section. Bone graft material is used to get the unstable bones to grow together. Rods, plates, and screws are commonly used to hold the bones in place so the bone graft heals.
Facet joint syndrome is pain at the joint between two vertebrae in your spine. Another term for facet joint syndrome is osteoarthritis.
The facet joints are the joints in your spine that make your back flexible and enable you to bend and twist. Nerves exit your spinal cord through these joints on their way to other parts of your body. Healthy facet joints have cartilage, which allows your vertebrae to move smoothly against each other without grinding. Each joint is lubricated with synovial fluid for additional protection against wear and tear.
When your facet joints become swollen and painful due to osteoarthritis, it is called facet joint syndrome.
Facet joint syndrome can be caused by a combination of aging, pressure overload of your facet joints, and injury.
Pressure overload on your facet joints is probably caused by degeneration of the intervertebral discs in your spine. As the discs degenerate, they wear down and begin to collapse. This narrows the space between each vertebra. This narrowing of the space between each vertebra affects the way your facet joints line up. When this occurs, it places too much pressure on the articular cartilage surface of the facet joint. The excessive pressure leads to damage of the articular surface and eventually the cartilage begins to wear away.
When facet joint arthritis gets bad enough, the cartilage and fluid that lubricate the facet joints are eventually destroyed as well, leaving bone rubbing on bone. Bone spurs begin to form around the facet joints. When bone spurs develop, they can take up space in the foramen (the opening between vertebrae where nerve roots exit the spine) and press into nerve roots. As the bone spurs begin to grow larger, they can eventually extend into the spinal canal itself. This leads to narrowing of your spinal canal, called spinal stenosis.
Patients with facet joint syndrome have difficulty twisting and bending their spine. If you have facet joint syndrome in your cervical spine (your neck), you may have to turn your entire body to look left or right. Facet joint syndrome in your lumbar spine (low back) may make it difficult for you to straighten your back or get up out of a chair.
Pain, numbness, and muscle weakness associated with facet joint syndrome will affect different parts of your body depending on which of your nerves are being affected. If the nerves affected are in your cervical spine, you may have symptoms in your neck, shoulders, arms and hands. If the nerves are in your lumbar spine you may have symptoms in your buttocks, legs, and feet.
The diagnosis of facet joint syndrome usually begins with a complete history and physical exam. Your doctor may order other diagnostic tests as well. X-rays may be recommended to determine whether there are abnormalities in your spine. A CT scan can sometimes show more detail about your facet joint surfaces. If the X-rays suggest something may be affecting your facet joints, your doctor may recommend a CT scan to get a better look. A bone scan can be useful in determining whether your facet joints are inflamed. An inflamed facet joint usually shows up as a hot spot on a bone scan.
Your doctor may also recommend that you undergo a fluoroscopic injection into your facet joint. During this test, a local anesthetic is injected into the joint. The doctor uses a fluoroscope to make sure the needle is actually in the joint before injecting the medication. It is difficult to put a needle into the joint without some guidance. A fluoroscope is a special TV camera that uses X-rays to allow the doctor to see on the screen the exact placement of the needle and to make sure it is positioned accurately.
Once the needle is in the right place, anesthetic is injected to numb your joint. If the pain goes away, your doctor can be relatively sure that the problem is coming from the facet joint that was injected and not somewhere else in your spine. The doctor may also add a dose of cortisone to the injection to help ease your pain. Cortisone is a powerful anti-inflammatory medication that calms the arthritis inside the joint and reduces pain. The effect is usually temporary, but it may last up to several months.
Once a diagnosis of facet joint syndrome has been confirmed, your doctor will likely recommend physical therapy to treat your symptoms. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability. Physical therapy may also include the use of ice to decrease blood flow to the affected area and reduce swelling. Ultrasound and electrostimulation may also be used to treat muscle spasms. Massage and muscle stretching may also be helpful. When you're feeling better, exercises will help you regain joint mobility, flexibility, and strength.
An injection into your facet joint using cortisone can be helpful for calming pain and inflammation.
Surgery may become an option if all conservative methods of treatment fail. Surgery on the facet joint usually consists of a fusion of the joint (also called an "arthrodesis"). To join the two vertebrae together, the doctor will usually insert several metal screws across the joint. Bone graft may also be placed around the joint to help fuse it. The bone graft may be removed from your pelvic bone right beside the sacroiliac (SI) joint, or it may come from a donor source.
Myelopathy is also called spinal cord compression. The disorder actually comprises several different medical conditions that cause neck pain, including:
The pain associated with myelopathy may be due to problems in the vertebrae and facet joints of your spine, as well as in the muscles, ligaments, and nerves of your spine.
Normal wear and tear is a common cause of myelopathy. As your body gets older, the normal wear and tear of every-day stress on your spine causes degenerative changes to occur. These changes affect your facet joints, intervertebral discs, and ligaments.
As the discs in your spine grow older they begin to dry out and calcify, which causes them to compress and for the space between your facet joints to close up. This puts added stress on the cartilage that keeps the joints in your spine working properly, and causes the cycle of degeneration to continue. Disc degeneration can also lead to a herniated disc, which can put additional pressure on your spine by pressing against your spinal cord or nerve roots. Degeneration and stress can also cause bone spurs to form. This makes your spinal canal narrow, compressing or squeezing your spinal cord.
Another common cause of myelopathy is injury, such as from car accidents, sports, and falls. These injuries often affect the muscles and ligaments that stabilize your spine, and can also cause bone fractures and joint dislocations. Injuries are a common cause of central cord syndrome.
Myelopathy can also be caused by an inflammatory disease like rheumatoid arthritis, which attacks the joints in your spine and typically affects the area of your upper neck. Less common causes of myelopathy include tumors, infections, and congenital abnormalities of the vertebrae which are present at birth.
The most common symptoms of myelopathy include neck stiffness, deep aching pain in one or both sides of your neck and possibly your arms and shoulders, and possibly stiffness and weakness in your legs and difficulty when walking. You may also feel a grating or crackling sensation when you move your neck. Patients with myelopathy commonly experience stabbing pain in their arm, elbow, wrist, or fingers, a dull ache in the arm, or numbness. Myelopathy can also cause position sense loss, which makes you unable to know where your arms are without looking at them, and incontinence.
The first step in diagnosing myelopathy is a medical history and physic al exam. Your doctor will look specifically for problems with your reflexes, particularly to see whether you have an exaggerated or overactive reflex, which is called hyper-reflexia. Your doctor will also check for muscle weakness particularly in your arms, numbness in your arms and hands, and atrophy, which is a condition in which your muscles deteriorate and shrink in size.
If the results of your history and physic al exam lead your doctor to believe you may have myelopathy, additional diagnostic tests may be ordered including X-rays to check the alignment of the vertebrae in your neck, an MRI to look for spinal cord compression, and a myelogram to check for bone spurs and narrowing of your spinal canal. An electromyogram (EMG) may be helpful in excluding other disorders that may cause symptoms similar to myelopathy.
Although surgery to decompress the spinal cord is the best treatment for most patients with myelopathy, watchful waiting is an appropriate approach for patients with mild symptoms. If your myelopathy is mild, your doctor may recommend a brace to immobilize your neck (cervical spine), exercises to improve neck strength and flexibility, manipulation, and pain medication such as a nonsteroidal antiinflammatory drug (NSAID). Some experts recommend against conservative treatment for myelopathy because some conservative treatments have been shown to not be helpful, and in some cases to cause neurological complications.
An epidural steroid injection (ESI) can be used to relieve the pain of a muscle strain or sprain, as well as to decrease inflammation. Injections can also help reduce swelling. Steroid injections are a combination of cortisone (a powerful anti-inflammatory steroid) and a local anesthetic that are given through your back into the epidural space. ESI is not always successful in relieving symptoms of inflammation. They are used only when conservative treatments have failed.
The main goal of surgery for myelopathy is to decompress the spine. Your doctor may choose to perform a laminotomy using a posterior approach (through an incision in your back), which opens up the vertebrae in your spine that may be pressing on your spinal cord to give your spinal cord more room. However, this procedure may not be appropriate for all patients because it can lead to segmental instability and development of kyphosis. Your doctor may also choose an anterior cervical approach (through the front of your neck), which allows your doctor to directly see and remove any bone spurs and disc materials that may be pressing on your spinal cord. During surgery, your doctor may also perform a spinal fusion to reduce the risk of complications after surgery.
In the first part of the 20th century, sacroiliac (SI) joint syndrome was the most common diagnosis for lumbago (low back pain). Any pain in the low back, buttock, or adjacent leg was usually referred to as SI joint syndrome.
Symptoms of SI joint syndrome are often difficult to distinguish from other types of low back pain. In most cases, there is a confusing pattern of back and pelvic pain that mimic each other, making diagnosis of SI joint syndrome very difficult.
The diagnosis of SI joint syndrome usually begins with a complete history and physical exam.Your clinical exam may include the following orthopedic tests used to determine whether your SI joints are involved. Pain during these tests is generally an indicator that the SI joints are indeed a problem.
Your doctor may order other diagnostic tests as well. X-rays may be recommended to determine whether there are abnormalities in your SI joint. A CT scan can sometimes show more detail about the joint surfaces and the surrounding bone. If the X-rays suggest something may be affecting your SI joints, your doctor may recommend a CT scan to get a better look. A bone scan can be useful in determining whether your SI joint is inflamed. An inflamed SI joint usually shows up as a hot spot on a bone scan of your pelvis.
Your doctor may also recommend that you undergo a fluoroscopic injection into your SI joint. During this test, a local anesthetic is injected into the joint. The doctor uses a fluoroscope to make sure the needle is actually in the joint before injecting the medication. Your SI joints are located fairly deep in the upper buttocks and are covered by thick muscle. It is difficult to put a needle into the joint without some guidance. A fluoroscope is a special TV camera that uses X-rays to allow the doctor to see on the screen the exact placement of the needle and to make sure it is positioned accurately.
Once the needle is in the right place, anesthetic is injected to numb your joint. If the pain goes away, your doctor can be relatively sure that the problem is coming from your SI joint and not somewhere else in your spine. The doctor may also add a dose of cortisone to the injection to help ease the pain. Cortisone is a powerful anti-inflammatory medication that calms the arthritis inside the joint and reduces pain. The effect is usually temporary, but it may last up to several months.
Patients commonly receive physical therapy treatment for SI joint problems. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
A stiff or "locked" joint responds best to mobilization, a form of stretching used to improve joint movement. Along with hands-on techniques used by the therapist, mobilization includes specific exercises to improve SI joint mobility. For conditions where the joint is too loose, such as arthritis or SI ligament injuries, stabilization treatments are chosen to hold the joint in correct alignment. Stabilization exercises involve posture and muscle training. Therapy sessions may be scheduled two to three times each week for up to six weeks, depending on the recommendations of your healthcare provider.
The goals of physical therapy are to help you:
Your doctor may also recommend a sacroiliac belt to help stabilize a loose and painful SI joint. The belt wraps around your hips to squeeze and hold your SI joints together. This supports and stabilizes your pelvis and your SI joints.
An injection into your SI joint using cortisone can be helpful for calming pain and inflammation. The injection usually gives temporary relief for several weeks or months.
Surgery may become an option if all conservative methods of treatment fail. Surgery on the SI joint usually consists of a fusion of the joint (also called an "arthrodesis"). Fusing the two sides of a joint together to reduce pain has been used for many years as a treatment for arthritic joints.
It is natural for the spine to curve forward and backward to a certain degree; this is what gives the side-view of the spine its "S"-like shape. But occasionally the spine twists and develops curves in the wrong direction--sideways. When the spine twists and develops an "S"-shaped curve that goes from side to side, the condition is known as scoliosis.
A scoliosis curve can occur in the thoracic spine, the lumbar spine, or both areas at the same time. When the vertebrae in the mid and low back curve to the side, the normal appearance and condition of the spine and its muscles changes. The severity of the scoliosis is measured in degrees by comparing the curves to "normal" angles. Curves can range in size from as little as 10 degrees to severe cases of more than 100 degrees. The amount of curve in the spine helps your doctor decide what treatment to suggest.
Scoliosis is divided into categories based on the age when it was diagnosed:
Scoliosis is most commonly seen in adolescents and adults. Adults can also develop scoliosis as a result of degeneration.
The different types of scoliosis, including the causes and symptoms of each type, are discussed below.
Most cases of scoliosis are first discovered and treated in childhood or adolescence--particularly during puberty when the curvature becomes more noticeable. When an adolescent has scoliosis with no known cause, doctors call the condition adolescent idiopathic scoliosis. The word "idiopathic" means that the cause of this form of scoliosis is unknown. This form of scoliosis can affect a child who is healthy and not having nerve, muscle, or other spine problems. It is the most common form of spinal deformity doctors see, affecting about three percent of the general population.
Adolescent idiopathic scoliosis affects children between 10 and 18 years old.
There are many theories as to why this type of scoliosis develops, but the root of the condition has yet to be discovered. Some of the theories include:
In many cases of adolescent scoliosis, the child will not even notice the problem. Because the majority of scoliosis patients do not suffer any physical pain from this disorder, it is often not discovered until the curves have progressed to become more obvious. In fact, if the child is suffering from severe back pain, a diagnosis other than idiopathic scoliosis must be considered.
Though the spine may curve sideways, in minor cases the curves are not obvious until the person bends over. Many schools currently screen young students for scoliosis, so referrals often come from school health workers. Parents or physical education instructors are also frequently the first to notice signs of scoliosis in a child.
Signs of scoliosis may include the following abnormalities in appearance:
Once scoliosis is diagnosed, concern may arise whether the curves will continue to grow bigger. There is no absolute way to tell, but this much is known:
Scoliosis that occurs (or is discovered) after puberty is called "adult scoliosis." Adult scoliosis can be the result of untreated or unrecognized childhood scoliosis, or it can arise during adulthood. The causes of adult scoliosis are usually different from the childhood types.
Most cases of adult scoliosis are idiopathic, which means that the cause is not known. Sometimes adult scoliosis is the result of changes in your spine due to aging and degeneration. The causes of adult scoliosis are further categorized into several subtypes:
Adult scoliosis is often painless. Patients with adult scoliosis commonly see a spine specialist because they notice a problem with the way their back looks. You may notice some of the following things about your body:
Back pain can eventually develop as the condition progresses. The deformity may cause pressure on your nerves and possibly even on your spinal cord. This can lead to weakness, numbness, and pain in your lower extremities. In severe cases, pressure on your spinal cord may cause loss of coordination in the muscles of your legs, making it difficult for you to walk normally. If your chest is deformed due to the scoliosis, your lungs and heart may be affected, leading to breathing problems, fatigue, and even heart failure. Fortunately these severe symptoms are rare.
Degenerative adult scoliosis occurs when the combination of age and deterioration of your spine leads to the development of a scoliosis curve in your spine. Degenerative scoliosis may be related to osteoporosis. Osteoporosis weakens your bones, making them more likely to deteriorate. The combination of these changes causes your spine to lose its ability to maintain a normal shape. Your spine begins to "sag" and as the condition progresses, a scoliotic curve can slowly develop.
Scoliosis developed in adulthood can be "secondary" to other spinal conditions that affect your vertebrae. Other conditions such as degeneration, osteoporosis (loss of bone mass), or osteomalacia (softening of the bones) can cause scoliosis. Scoliosis can also appear following spinal surgery for other conditions. The surgery may cause an imbalance in your spine that leads to scoliosis. Most of these secondary causes of scoliosis are considered degenerative adult scoliosis.
Degenerative adult scoliosis usually begins as low back pain. While there may also be a deformity that causes your back to look abnormal, usually pain is what motivates patients to seek treatment. The pain is probably not coming from the curve, but rather from the degeneration occurring in your spine.
A combination of the degeneration of your spine and scoliosis deformity may cause pressure on nerves and possibly even your spinal cord. This can lead to weakness, numbness, tingling and pain in your lower extremities. In severe cases, pressure on your spinal cord may cause loss of coordination in the muscles of your legs, making it difficult to walk normally.
If scoliosis is suspected, a diagnosis must be made before an appropriate treatment plan can be developed. Your doctor will begin by performing a complete history and a physical exam. Usually afterward, your doctor will order additional diagnostic tests including an X-ray so your doctor can see the structure of your spine and measure the curve.
Depending on the outcome of your history, physical examination, and initial X-rays, other tests may be ordered to look at specific aspects of your spine.
Whenever possible, nonsurgical treatments are chosen first for scoliosis. Spinal surgery will generally be a last resort due to the risks involved. Conservative treatments commonly include medication, bracing, and physical therapy and exercise.
In cases of adult and degenerative scoliosis, if osteoporosis is present, treatment of the osteoporosis may also slow the progression of your scoliosis. This can be accomplished in several ways. Your doctor may recommend medication to treat osteoporosis, and the addition of weight-bearing exercises when appropriate.
In cases of adolescent idiopathic scoliosis, the treatment chosen will vary depending upon the severity of the curve, the age of the patient, and how far along the child is in skeletal maturity. If the child's curve is minor (less than 15–20 degrees), the doctor will likely choose to monitor the curve for progression. The patient will normally have X-rays taken every four to six months during rapid growth years, and then once a year.
A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping with daily activities. Adolescents with idiopathic scoliosis should be encouraged to continue their normal activities, including sports.
Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful in maintaining flexibility, especially in the hamstrings and low back. Therapy sessions may be scheduled each week for four to six weeks, depending on the recommendations of your healthcare provider.
The goals of physical therapy are to help:
Bracing is usually considered with curves between 25 and 40 degrees, particularly if the patient is still growing and the curve is likely to get bigger. It is important that the patient wear the brace daily for the number of hours prescribed by the doctor. Scoliosis often affects more than one area of the spine. A brace can be used to support all the curved areas that need to be protected from progression.
Surgery is generally only considered in patients who have continual pain, difficulty breathing, significant disfigurement, or a steadily worsening curve angle. After skeletal maturity occurs, curves that are less than 30 degrees tend not to progress and, therefore, do not require surgery. Curves above 100 degrees are rare, but they can be life threatening if the spine twists the body to the point it puts pressure on the heart and lungs.
If a curve is 45 degrees or more, surgery is more likely to be considered. Each case of scoliosis is somewhat different and may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by the scoliosis--not just to straighten your spine. The goals of most surgical procedures for scoliosis include:
When scoliosis requires surgery, your doctor can choose from a number of different procedures including laminectomy and spinal fusion.
An incision is made in your chest or side, and your intervertebral discs are removed in the area of the curve to make it flexible. Screws can be placed in your vertebrae, and then connected by a metal rod. A bone graft is put in place of the discs that were removed so that the vertebra sitting next to each other will fuse together. The screws attaching the metal rod are tightened down, straightening the curve.
This approach is done through your back. Anchors are attached to your spine in the form of hooks, screws, or wires. These anchors are attached to spinal rods that straighten your spine. Bone grafting is done to fuse all instrumented vertebrae in patients whom have finished growing.
This surgery is actually two operations: one through the front, and the other through the back. The two operations may be staged on separate days or as part of one longer surgery. Staged procedures require one to two additional days in the hospital compared to a single surgical procedure.
Sometimes, a patient may choose not to have surgery because of the risks, even though it is recommended to them. However, there are also risks of leaving large curves untreated. Those risks include:
One possible complication specific to the surgical treatment of scoliosis is flat-back deformity. Your lumbar (lower) spine naturally has a slight inward curve called lordosis. When the vertebrae in your lumbar spine are fused together, this lordosis curve may be lost, leaving you with a "flat-back" deformity. The loss of curve may not appear right after surgery.
As with any medical treatment, individual results may vary. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a spine surgeon can tell if back or neck treatment is right for you.
As with any medical treatment, individual results may vary. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a spine surgeon can tell if shoulder arthroscopy is right for you.
As with any medical treatment, individual results may vary. The performance of shoulder replacements depends on age, weight, activity level and other factors. There are potential risks and recovery takes time. If you have conditions that limit rehabilitation you should not have this surgery. Only a spine surgeon can tell you if shoulder replacement is right for you.