Signs and Symptoms
Understanding spinal symptoms can be quite complex. However, a simple pathophysiology (abnormalities) lesson can be very helpful.
Spinal pathology refers to the abnormality causing spine problems. Any pathology that causes pressure on the spinal cord or nerves may result in symptoms, namely:
• Pain
• Numbness
• Tingling
• Weakness, or
• Abnormalities in your ability to use your hands, legs, bladder or bowels.
SPINE COMPOSITION
The spinal column is the structure that supports your body from your head to your pelvis. It consists of a series of blocks of bone, separated from each other by a “disc” (sometimes referred to as a jelly donut or shock absorber). The complex interaction between the blocks of bone and disc allow a SPECIFIC amount of movement between every vertebra.
The spinal cord and peripheral nerves are located within the bony part of the spinal column. The complex interaction between the spinal column, and the spinal cord is the key to understanding your symptoms.
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Spinal problems do not always require surgery. Conservative treatments are the best way to address back pain. Spinal surgery can be delayed or eliminated in the vast majority of new neck and back injuries.
Physical therapy is the best initial form of treatment in many cases after the initial injury to assess stable, non-emergent conditions. Neck and back injuries often require strengthening and re-education of the muscles around the spine to better support the spinal column.
Rehabilitation is offered when the patient’s normal functional capacity is reduced after a back injury. The goal is to regain prior functional status in order to return to daily living and working abilities.
Strengthening of the paraspinous muscles will help decrease repeat injury to the spine. Pilates or other forms of core body strengthening is often used to develop abdomen, thoracic and back (core) strength.
Intervertebral disc decompression (computerized traction) therapy is an option for acute and sub acute disc injuries. The system allows the disc some relief from the natural compression process while it is still in the healing phase.
Proper diagnosis through the use of X-rays, MRI, CT scan are common modalities for proper diagnosis of the problem.
Injections into the symptomatic region such as epidural and selective nerve root blocks as well as other specialized injections are diagnostic and can also be therapeutic in many instances.
Medication is an integral part of conservative treatment as it can help reduce the inflammatory process that leads to spasm, pain and further deterioration of the injured spine.
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When conservative and non-surgical treatment has failed surgery may be considered. Common conditions and treatment options are listed below:
Stenosis – Narrowing of the spinal canal which may result in nerve compression are:
Developmental Stenosis – occurs as people age and the ligaments of the spine thicken and harden, discs bulge, bones and joints enlarge, and bone spurs (called osteophytes) form.
Disc Herniation – occurs when the inner part of the disc (nucleus pulposus) breaks through the outer encapsulating ring (anulus fibrosus) causing a collapse of the disc. The vertebral disc loses its ability to absorb weight through the spinal column which affects its ability to function normally.
Congenital Narrowing – refers to tightening or narrowing of the canal around the spinal cord, called spinal stenosis. This condition occurs when spinal canal ligaments thicken and harden and bone and joints enlarge usually noted in patients entering their fifth decade of life. If a patient is born with a narrow spinal canal problems can present in their third decade of life.
Spinal Tumor – are rare, and are either benign or malignant. Either way they are dangerous because they may compress the spinal cord and cause neurologic dysfunction.
Spinal Trauma – often caused by automobile or fall accidents result in spinal fractures and/or movement (slippage) of vertebral bodies. These events can cause sudden compression of the spinal cord or nerves which need immediate treatment.
Procedures to address these problems:
Laminectomy – helps relieve pressure on the spinal cord by opening the spinal canal. The lamina which is the posterior roof of the spinal canal is either lifted or removed to create more space for the spinal cord and nerves. A fusion may be considered if stabilization is an issue.
Diskectomy – a common surgical procedure to treat the damaged discs by either removing the ruptured portion of the disc (microdiskectomy) in order to relieve the pressure on the nerve.
Vertebrectomy/Corpectomy – surgical removal of a portion of the vertebral body in the process of excising tumor, fractured bone, or infected bone imbedded in the vertebral body. A mechanism of support scaffolding is often used to stabilize the spine at this time.
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Instability – is caused by the mechanical changes of the spinal column creating incorrect movement resulting in pain
Degenerative Disc Disease (DDD) – is the loss of normal structure and function of the intervertebral discs associated with wear and tear related to aging and accumulated trauma. DDD includes herniated, bulged, flattened discs with vertebral body end plates damage.
Spondylolithesis – occurs when a vertebra slides forward in relation to the adjacent vertebra more often in the lumbar spine. Symptoms include difficulty walking due to pain, weakness or sensation changes in the lower back, legs secondary to the impingement of the spinal cord and/or nerves.
Pars Fracture – causes vertebral instability as a crack occurs in and area of the vertebral called the pars interarticularis. This type of fracture can lead to spondylothesis.
Vertebral Fracture – causes a change in the distribution of structural forces, because the vertebral body carries up to 90 percent of the body’s weight.
Procedures to address these problems:
Spinal Fusion – is surgery that involves fusing adjacent vertebrae in order to stabilize the spine and reduce pain.
Posterior – approach to spinal fusion involves performing a partial diskectomy and often laminotomy followed by the placement pedicle screws inserted into the upper and lower vertebrae and connected with rods or plates.
Transforaminal Lumbar Interbody Fusion (TLIF) – is a lateral approach of the spine for placement of an intervertebral body spacer to fuse the adjacent vertebral bodies. Pedicle screws are inserted afterwards to help maintain stability.
Anterior Lumbar Interbody Fusion (ALIF) – approaches the vertebral bodies from the front through the abdomen. A metal plating system is placed to stabilize the spine while the intervertebral body spacer fuses the adjacent bodies.
Anterior/ Posterior (360) – is similar to an ALIF, but includes a posterior approach to secure the spine with pedicle screws and rod system.
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Advanced Instrumentation / New Technology – helps make surgery safer and less invasive
Microscopes – used for minimally invasive surgery allow the surgeon to see the finest details of the surgical site helping the surgeon distinguish tissue more efficiently.
Neurodiagnostic Monitoring – SSEP and EMG evaluation during surgery informs the surgeon of immediate neurological changes occurring during the surgical procedure.
Endoscopic – use long thin tubular cameras and surgical tools through very small incisions to perform the traditional operation.
Motion Preservation Surgery – traditionally the only form of spinal stabilization was a fusion. Dr. Lauryssen is on the cutting edge of alternate technology rather than fusion in order to preserve motion:
Artificial Discs – have been studied for years and recently one product has been approved by the FDA as an alternative to spinal fusion. Its believe that the benefits of artificial discs include, but not limited to preserving motion of the spine resulting in less restriction of motion and improved preservation of adjacent discs. The ADR is FDA approved for the lower back and at OMC ADR for the neck is being investigated currently.
New Technologies – are currently being proposed as studies that Dr. Lauryssen is considering to offer his patients. Many of these technologic advances have being used in other countries for many years already. They are now being allowed as studies by the FDA for the American market.
Comprehensive Team Approach – increases the speed and success rate of recovery after surgery. Spine trained neurosurgeons and orthopaedic surgeons combine their knowledge and skills to optimize the patient’s care. In addition, the following specialists round out the team approach:
Pain Management – anesthesiologists, psychiatrists and pain specialists are consulted to help the patient manage with pre- and post-operative pain.
Rehabilitation – physical therapists, occupational therapists and physiatrists are utilized to optimize the patients’ post-operative recovery.
Alternative Medicine – acupuncturists, chiropractors and massage therapist are also available to help with the recovery process.