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Friday, 20 October 2017
Spinal Conditions

The Spinal Unit treats a full range of spinal conditions, including:

Lumbar Disc Prolapse

The aging disc loses its flexibility and there is a decrease in its water content.

As a result of the degeneration process the outer thick wall (annulus fibrosis) splits or ruptures. Following this the inner gel-like material (nucleus pulposus) leaks out. This is the disc herniation and people aged 30-50 are at most risk of this.

Disc herniation can press against a nerve leading to nerve root irritation and if this occurs in the lumbar spine it can give rise to a condition known as sciatica. The nerve that is irritated is one of the nerves that forms the sciatic nerve. This results in pain that radiates below the knee on the affected side.

Lumbar Spinal Stenosis

Lumbar spinal stenosis is the  narrowing of the spinal canal through which the nerves travel down the spine and exit at each level to supply either the legs. This most commonly occurs in the aging spine due to degenerative disc bulges, enlargement of the facet joints and thickening of the ligamentum flavum.

Chronic symptoms arising from lumbar spinal canal stenosis are pain into both legs, with occasional weakness and numbness which can be felt in the buttocks, legs or calves. These symptoms tend to become more severe with walking or standing. The pain is usually relieved on sitting and leaning forwards.

Spondylolisthesis

Spondylolisthesis is a condition where one vertebra slips forward on the adjacent vertebra. This is most common in the lumbar spine.  This is a reasonably common condition and in may cases may be asymptomatic. It most commonly occurs due to degenerative changes, but may also be as a result of a stress fracture. Other reasons for this condition may be due to previous surgery, trauma and congenital.

The degree of forward slippage can be graded from 1 (minimal) to 5 (complete displacement) when the vertebrae is sitting in front of the one below.

This condition may be asymptomatic or it may cause problems in the way of back pain and nerve root irritation.

Degenerative Disc Disease

Degenerative disc disease is part of the natural wear and tear of a normal aging spine. This can occur from an early age. If you have chronic back pain, you may have degenerative disc disease. As the spine ages, the intervertebral discs lose their hydration and ability to act as a shock absorber. As a result of this the spine becomes more rigid and stiff and patient’s tend to lose movement.

Degenerative disc disease can affect any part of the spine. It is however most common in the mobile lumbar spine.

Patients most commonly present with chronic lower back pain. Symptoms can be variable. In many patients they are worse when sitting, bending and lifting with less pain when lying or walking.

There are many reasons for back-pain with degenerative disc disease being one cause. If the pain is disabling you seek the appropriate assessment. This will allow a management plan to help with your symptoms. Many patients make a good recovery with physiotherapy and pain management. Only a few patients will ever need surgery.

Cervical Disc Prolapse

Disc prolapses can occur in the neck as a result of degenerative disc disease. The disc prolapse can cause pressure on the nerve as it exits. This can cause pain down the arm. This is called brachalgia. The pressure on the nerve can also cause pins and needles or weakness in the arm or hand depending on the nerve involved.

Cervical Stenosis

Degenerative disease in the cervical spine can cause pressure on the spinal cord. This may present with symptoms in the upper & or lower limbs. Many patients complain of feeling increasingly clumsy and poor balance. If left this can progress to paraplegia.

Coccydynia

This is a condition that usually presents with on-going pain in the region of the coccyx. This may occur as a result of an injury or may have an insidious onset. Management is initially with modification of daily activities. Treatment can involve manipulation of the coccyx and the injection of local anaesthetic and steroid into the sacrococcygeal joint. In a few cases, removal of the coccyx may be appropriate.

Spinal Trauma

Injuries to the bones of the spine can be due to major forces, such as road traffic accidents, a fall from a height or as a result of sports injuries. Injuries can also occur with mimimal trauma in osteoporotic bone. Fractures of the spine can occur in any area of the spine. In most cases theses are often stable and can be treated by conservative measures, such as a brace. Some injuries do require further assessment in the way of CT or MRI scans. In a few cases surgical stabilisation of the spine may be necessary to prevent damage to the spinal cord or nerves. Some fractures may also require surgery to prevent further deformity.

In osteoporosis fractures usually occur in the thoracic and lumbar spine. These are termed fragility fractures. The vertebrae can collapse with only a minimal amount of trauma. These fractures can be extremely painful initially. The vast majority will however settle and rarely require any operative intervention. The fractures that fail to settle may be benefit from vertebroplasty or kyphoplasty after several months.

Spinal Tumours

Primary spinal tumours of the spine are rare. Spread of cancer to the spine (spinal metastases) is however becoming more common. This can present in a variety of ways. Neurological symptoms may include nerve pain in the arm or leg, or a feeling of unsteadiness. Symptoms can also include back pain and a loss of function to the bowel or bladder. The commonest tumours presenting in the spine spread from areas such as the breast, prostate, lung and kidney. The above symptoms should not be ignored and urgent medical attention is necessary to prevent deterioration.