1. Slipped Or Herniated Disc
It is a condition of nerve compression which arises when the disc in the lower back area of the spine starts degenerating (weakening). People between 25 to 40 years of age are more prone to a rapid model of nerve compression due to high activity levels. The chances of slipped disc increases in patients who are obese and have a sedentary lifestyle or an individual who occasionally indulges in unaccustomed strenuous activity at one end of the spectrum versus those who challenge the mechanical endurance of the back with very strenuous activity.
Slipped disc, also termed Prolapsed Intervertebral Disc (PID) represents acute or repetitive failure of the disc due to abnormal forces transferred to it when the supporting muscles are inefficient to carry the pressure. This protrusion in the disc causes a mechanical compression and the nucleus pulposus (disc gel) causes severe inflammation of the nerve, resulting in enhanced pain.
Treatments: In order to treat a slipped disc, a patient is advised to take complete bed rest for over 3-6 weeks, thereby, reducing the force on the injured disc and allowing it to heal. During the course of recovery, the pain is controlled with medications, steroids, injections and physiotherapy. Once the pain is reduced to tolerable limits, the doctor advises a patient to gradually get back to daily activities. A patient is also advised to perform some exercises on a regular basis.
However, in most complex cases of a herniated disc, doctors remove the fragment by performing a minimally invasive (key-hole) surgery. The major aim of this surgical treatment is to remove loose fragments and free the nerve, thereby relieving the pain and the annulus (disc covering) starts healing naturally. A patient can resume daily tasks within a week of the surgery.
2. Stenosis Or Narrowing Of Nerves In The Elderly
Represents a slow progressive compression of neural elements. The spine is a part of the human body that starts degenerating with ageing. It is an ongoing process that accelerates after 30 years of age.
The wear and tear in the spine result in loss of turgidity and compressibility of the disc. This reduces the effective space available for nerves in the neural foramen and central canal, resulting in the narrowing of nerves and space, for as long as possible.
The rate of narrowing of nerves and effective space varies from person to person. However, an individual can reduce the effect of stenosis with the help of regular exercise and lifestyle modifications.
If a condition of “slow progressive functional paralysis" arises, then surgical intervention is a must. Though true paralysis is rare, the activities slow down to an extent wherein routine activities are painfully restricted.
3. Slippage Of Bone Or Spondylolisthesis
Spondylolisthesis is a Greek word which is bifurcated as spondylosis, meaning vertebrate, and oliothesis, meaning slipping. It means the abnormal slipping or dislocation between two vertebrae. It’s a pure mechanical failure where a link in the central pillar is unstable
What Are The Symptoms?
The symptoms of spondylolisthesis vary from person to person, some may experience no symptoms while others may experience chronic low back pain, leg pain, or neurogenic claudication from spinal stenosis.
The pain may arise due to weakness of the spine or abnormal movement at the level of the spondylolisthesis causing irritation or inflammation. This pain is typically relieved with proper rest and worsens with activities such as standing and walking. This posture-related pain or type of activity is referred to as mechanical pain.
In other patients, symptoms may include leg pain (sciatica, radiculopathy) or even weakness and or numbness due to irritation of nerve roots that can be stretched or compressed by the slipped vertebrae.
However, in adult patients, the slippage may be a result of other degenerative changes, such as arthritis or spondylosis of the spine, such as enlarging ligaments (hypertrophy), disc bulging, bone spurs and facet joint overgrowth. These changes affect the spinal canal by narrowing it, leading to neurogenic claudication and spinal stenosis.
Tests And Diagnosis
- X-ray: X-rays provide an overall assessment of the bone anatomy as well as the curvature and alignment of the vertebral column. Flexion/extension or dynamic X-rays (that show the spine in motion) are obtained to learn if there is any instability or abnormal /excessive movement in the spine at the affected levels.
- Magnetic Resonance Imaging (MRI): It is an advanced imaging technique that provides detailed images of soft tissues like nerve roots and the spinal cord. MRIs are useful in locating stenosis and its complexity by identifying nerve root or spinal cord compression.
- Computed Tomography (CT) scan: This scan uses X-rays and a computer to provide images that are more detailed than general X-rays.
Non-operative treatment is usually recommended for patients as the first line of treatment to patients’ experiencing mechanical pain. The careful use of over the counter anti-inflammatory medications is suggested for the management of pain. However, for chronic pain spinal injections are also given to patients.
Along with medication, your doctor may also suggest undertaking physical therapy to work on posture, balance and spinal mechanics. This therapy is often combined with the strengthening of the back, abdominal muscles and flank to provide dynamic support to the lower lumbar spine.
Some weight loss, reconditioning, lifestyle modifications and ergonomic efficiencies may also be useful.
For severe, progressive and intolerable pain in the back/legs that does not improve with conservative treatments such as medication, physical therapy, and activity modulation, surgery is suggested. The objective of the surgery is to relieve the pressure that is on any of the nerve roots and to strengthen the attachment between the vertebrate.
Surgery is also suggested for patients with numbness and/or weakness. However, in adult patients with spondylolisthesis, this usually consists of decompression and spinal fusion.
4. Spinal Deformity
7. Trauma Or Fractures