Spinal Disc Degeneration

Also known as Degenerative Disc Disease, Spinal Disc Degeneration is not actually a disease; rather, it is a description of changes in spinal discs that can occur as a person ages. It is estimated that 30% of the population between the ages of 30-50 years old will develop some degree of disc wear that leads to disc degeneration. Unlike most tissues of the body, discs have a very low blood supply, making it difficult to heal once injured. Causes of Spinal Disc Degeneration include the drying out of the disc over time, poor posture, overuse, and traumatic injuries.

Spinal Stenosis

Spinal Stenosis is a narrowing of the spinal canal that houses the spinal cord. This narrowing can compress the spinal cord and the surrounding nerves causing pain, tingling, or numbness in the legs, arms, or torso. Spinal Stenosis affects men and women equally and usually occurs in people over the age of 50. Most often, Spinal Stenosis develops in the low back and the neck, but can affect any part of the spine. Symptoms are typically gradual at the beginning and worsen over time. Some people are born with a congenital form of Spinal Stenosis, but most conditions arise as a result of degeneration that occurs with aging. Causes of Spinal Stenosis can include osteoarthritis, rheumatoid arthritis, herniated discs, traumatic injury, spinal tumors, Paget’s Disease of the bone, scoliosis, spondylolisthesis, and achondroplasia (genetic condition associated with dwarfism).

Back Sprain/Strain

Back sprains and strains can occur when the muscles or ligaments of the back are overused or abnormally stretched or torn. The lower back is especially prone to sprains and strains because of it’s weight bearing capacity and function in moving, twisting, and bending. Back Sprains are caused by injuries to ligaments or discs. Back Strains result from the repetitive overuse of the muscles, over stretching of the muscles or tendons, unaccustomed activity level or intensity, and insufficient warm- up prior to engaging in exercise. Most thoracic (mid-back) and lumbar (low back) sprains and strains are directly related to heavy lifting, twisting motions, sports activities, poor posture and body mechanics, motor vehicle accidents, and falls. Symptoms can include pain when the muscles are used and when at rest, dull or achy pain, soreness, tightness in the muscles or associated joint, limited range of motion in the affected area, and muscle weakness or inability to use the involved muscle group at all.

Sciatic Pain

Sciatic Pain (Sciatica) is leg pain, numbness, or weakness that radiates down the sciatic nerve. Originating in the low back, the sciatic nerve passes through the buttocks and down the back of each leg into the feet. Typically, Sciatica affects one leg, but can affect both. Symptoms may include either a dull, sharp, or burning pain radiating down the buttock or leg; pain that is made worse by sitting; difficulty moving the leg, foot and/or toes; or numbness, tingling, and weakness in the leg, calf, and/or toes. Common low back conditions, such as, Herniated Disc, Degenerative Disc Disease, Spondylolisthesis, and Spinal Stenosis can trigger Sciatic Pain. Other causes include Piriformis Syndrome, Sacroiliac Joint Dysfunction, automobile accident, and sports injury to the low back or pelvis.

Facet Joint Sydrome & Facet Joint Imbrication

A facet joint is a small stabilizing joint containing synovial fluid. Located in the spine between adjacent vertebrae, the facet joints provide flexibility and allow for wide range of motion of the spine in daily activities. Nerves from the spinal cord exit through these joints and travel throughout the body. Healthy facet joints allow the vertebrae to glide smoothly across each other without pain or grinding. Two of the most common facet joint conditions are Facet Joint Syndrome and Facet Joint Imbrication. Facet Joint Syndrome most frequently develops in the neck (cervical) and low back (lumbar) regions of the spine. Inflammation from Osteoarthritis and/or Degenerative Joint Disease can cause increased pressure on the facet joints. They may become swollen and painful, placing excessive amounts of force on the articular cartilage. Over time, the cartilage begins to wear away making it more difficult to bend, twist, or straighten the spine. Symptoms of Cervical Facet Syndrome include: Neck pain, stiffness, discomfort in the shoulders, headaches, and tingling, numbness and weakness in the arms and hands. Those with Lumbar Facet Syndrome may experience low back pain, stiffness, difficulty twisting, bending, and arching, and pain/weakness in the buttocks or thighs. Facet Joint Imbrication is also most frequently found in the neck (cervical) and low back (lumbar) but, can occur anywhere in the spine. Improper motion patterns caused by poor posture leads to the facet joint dysfunction. Other causes of Facet Joint Imbrication are Degenerative Joint Disease, whiplash, abnormal stress, tension, or trauma. Symptoms of Cervical Facet Imbrication include: Neck pain, loss in range of motion, muscle stiffness, headaches, pain/weakness of the shoulders or arms, and radiating pain, tingling, or numbness in the arms or hands. People experiencing Lumbar Facet Imbrication may have symptoms of sciatic pain, buttock or leg pain, tingling or numbness of the buttock, leg or foot, muscle stiffness, and difficulty bending, twisting, or arching.

Disc Herniation

Spinal discs are made up of a tough, fibrous, outer ring of tissue called the annulus that protects a soft gel-like interior. Disc Herniations are generally due to age-related degeneration, poor posture, lifting injuries, repetitive spinal strain, and trauma. When stress is placed on the spine where a disc is injured or deteriorated, a tear or rupture in the the disc’s outer ring can allow the soft center fluid to bulge outward. If some of the gel-like fluid escapes the outer most layer of the ring and presses on the spinal cord or nerve roots, it can trigger back pain, neck pain, and nerve pain that can radiate down the arms or legs and into the hands or feet. The severity of pain and symptoms of a Disc Herniation will depend upon the stage of herniation and the specific nerve root upon which it is impinging.

There are four stages of Disc Herniation:

Degeneration/Bulging Disc is considered a contained injury in that there is no rupture within the outermost layer of the disc (annulus). A small portion of the soft center protrudes outward but does not leak out of the fibrous outer ring.

Prolapsed Disc is the next progression of a disc herniation where more of the gel-like center seeps through a weakened or torn region of the annulus and may displace sufficiently to press on nearby muscles, ligaments, and nerves causing debilitating pain and weakness.

Disc Extrusion is a non-contained injury where there is a rupture in a region of the annulus and the gel-like center of the disc is leaked into the spinal canal where nerve root irritation or compression can cause pain, numbness, tingling, muscle weakness, and other debilitating symptoms.

Disc Sequestration occurs when there is a complete rupture of the annulus and the gel-like fluid escapes through the tear, moves into the spinal canal, and separates from the disc altogether. This type of herniation causes the most serious pain syndromes and can lead to paralysis as a result of compression of the spinal canal by the sequestered disc. In this case, surgery may be considered as a method of intervention.

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