Compression
Fracture
Compression fractures can occur in any vertebra (spinal bones)
and is described as a collapse of the vertebra.
Symptoms
- The first symptom of a compression fracture may be sudden
and severe back pain that remains in one local area. Some
persons may experience numbness/tingling, or weakness in the
arms or legs if the spinal cord or nerves leading away from
the fracture have been compressed. If multiple fractures occur
in an area of the back, the person will develop a forward
hump-like curvature to the back.
Causes
- There are many possible causes of compression fractures.
Car accidents, falls, and weakening of the bone due to pathology
(i.e. cancer), or Osteoporosis are common.
Diagnosis
- The diagnosis is based on observation of the aforementioned
symptoms and x-rays of the spine. Additional tests (i.e. bone
scan, blood tests) may be needed to diagnose the actual cause
of the compression fracture.
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Cancer
If you have severe back pain, it is natural to wonder whether
or not the pain might be a sign of cancer. Tumors in the spinal
column may cause pain from expansion of the bone or from weakening
the bone, which in turn can result in spinal fractures, compression
(pinching) of the nerves, or spinal instability.
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Discitis
Discitis, or disc space infection, is an inflammatory lesion
of the intervertebral disc that occurs in adults but more
commonly in children. Its cause has been the subject of debate,
although most authors believe it to be infectious. The infection
probably begins in one of the continguous end plates, and
the disc is infected secondarily. Severe back pain that begins
insidiously is characteristic of the disease.
Discitis
in Children
Although most children will continue to walk in spite of the
pain, young children may refuse to ambulate. The characteristic
finding is extension of the spine and the child's complete
refusal to flex the spine. Children with discitis usually
are not systemically ill. They rarely have an elevated temperature
and their white blood cell count is frequently normal. However
the erythrocyte sedimentation rate is usually increased. Lateral
radiographs of the spine usually will reveal disc space narrowing
with erosion of the vertebral end plates of the contiguous
vertebrae. bone scanning may be helpful in localizing a lesion
that is difficult to diagnose clinically. Some bone scans
are falsely negative, so the diagnosis of disc space infection
should not be excluded simply because the bone scan is normal.
Magnetic resonance imaging (MRI) seems to be helpful in identifying
a disc space infection.
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Kyphosis
Kyphosis
is the abnormal forward bending of the spine. In kyphosis,
the curve of the spine is abnormal, forming a hump.
What
is going on in the body?
The
normal spine rounds slightly in the chest area, with arching
in the lower back and neck regions. Excessive kyphosis can
occur mainly in the chest area of the spine, causing the roundness
of the back to appear exaggerated.
What
are the signs and symptoms of the condition?
Symptoms
are usually minimal, unless the deformity is severe. In that
case, the back may ache or, rarely, nerve problems may arise.
The hamstrings, or muscles at the back of the thigh, may also
be tight.
What
are the causes and risks of the condition?
Kyphosis
is generally caused by an abnormal posture. Other possible
causes include: · a significant fracture of the vertebra,
which can cause the back to angle forward · spinal
surgery · Scheuermann's disease, which results in wedging
of the vertebrae. This disease is usually seen in teenage
boys, and its cause is unknown. Pott's disease, which refers
to kyphosis due to collapse of the vertebra when tuberculosis
infects the spine · osteoporosis in elderly women,
which causes a type of kyphosis known as dowager's hump ·
spinal tumors, or surgery to remove them · nerve disorders
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Lordosis
Lordosis is a disorder defined by an excessive inward curve
of the spine. It differs from the spine's normal curves at
the cervical, thoracic, and lumbar regions, which are, to
a degree, either kyphotic or lordotic. The spine's natural
curves position the head over the pelvis and work as shock
absorbers to distribute mechanical stress during movement.
Lordosis can be found in all age groups. It primarily affects
the lumbar spine, but does occur in the neck (cervical). When
found in the lumbar spine, the patient may appear swayback,
the buttocks more prominent, and in general an exaggerated
posture. A lumbar lordosis can be painful sometimes affecting
movement.
Certain
disease processes can adversely affect the structural integrity
of the spine and contribute to lordosis. Some common causes
include achondroplasia, discitis, kyphosis, obesity, osteoporosis,
and spondylolisthesis.
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Ligamentous
Hypertrophy
Ligaments run up and down the spinal column. Hypertrophy of
the ligaments in the vertebral canal (the posterior longitudinal
ligament -- runs up and down along the back side of the vertebral
bodies, and the ligamentum flavum -- runs up and down under
the posterior bone ring made up of the lamina and spinous
process) can increase their mass enough that they narrow the
canal (stenosis) sometimes to the point that the spinal cord
and/or nerve roots running through the canal are compressed.
When the posterior longitudinal ligament in front and ligamentum
flavum behind the spinal cord hypertrophy the cord is almost
"circumferentially" surrounded and compressed).
Hypertrophy
of the ligamentum flavum laterally near the facet joint can
also contribute to foraminal narrowing (stenosis) with potential
nerve compression (pinching).
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Obesity
According to the American Obesity Association (AOA) 64.5
percent of adult Americans (about 127 million) are categorized
as being overweight or obese (1). The unfortunate truth is
that obesity is becoming a global epidemic affecting adults
and children.
Connection
to Back Pain
Most people know that obesity contributes to the development
of coronary heart disease, diabetes, high blood pressure,
and colon cancer. However, did you know that obesity is a
contributing factor to back pain? It is true. Being overweight
or obese can significantly contribute to symptoms associated
with osteoporosis, osteoarthritis (OA), rheumatoid arthritis
(RA), degenerative disc disease (DDD), spinal stenosis, and
spondylolisthesis.
The
spine is designed to carry the body's weight and distribute
the loads encountered during rest and activity. When excess
weight is carried, the spine is forced to assimilate the burden,
which may lead to structural compromise and damage (e.g. injury,
sciatica).
One
region of the spine that is most vulnerable to the effects
of obesity is the low back; the lumbar spine. Lack of exercise
and bodily conditioning leads to poor flexibility and weak
muscles in the back, pelvis, and thighs. This can increase
the curve of the lower back causing the pelvis to tilt too
far forward. Further, this is detrimental to proper posture
and as posture weakens, other regions of the spine (neck)
may become painful.
You
may try to dismiss the cause of some of these spinal disorders
to the process of normal aging. It is true that with age body
tissues can cause changes to spinal anatomy (2). However,
if you are overweight or obese, chances are you have, or will
have, back pain.
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Trauma
Trauma to the spine refers to injury that has occurred to
bony elements, soft tissues and/or neurological structures.
The two things that surgeons are most concerned about, in
the case of spinal trauma, are instability of the vertebral
column and actual or potential neurological injury.
Stability to the spinal column can be compromised when bony
elements are injured or there is disruption to soft tissues
such as ligaments. Instability causes the back to become unable
to successfully carry normal loads, which can lead to permanent
deformity, severe pain and in some cases catastrophic neurological
injuries. Most often the instability comes from a fracture
in one of the bony parts of the vertebra, specifically the
vertebral body, the lamina or the pedicles.
In
the case of trauma, dislocations and fractures happen simultaneously
and can result in a very unstable spinal column. They can
occur in any region of the spine and are associated with a
degree of neurological injury. A surgeon needs to restore
the mechanical stability of the spine to try and prevent more
neurologic injury, progressive deformity or prolonged incapacitation
pain.
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Back
pain in pregnancy
Introduction to back pain during pregnancy
For pregnant women, back pain during pregnancy is not a trivial
matter. If not addressed, it can have a negative impact on
your daily lifestyle, cause missed time from work, and make
your delivery more difficult. Back pain in the course of your
pregnancy can also create problems that will continue for
an extended period after delivery.
Addressing
back pain during pregnancy
While it is fairly common, back pain during pregnancy should
definitely not be accepted as just part of the process. To
help make your pregnancy as pleasant as possible and facilitate
an easier delivery, back pain should be always be addressed
as quickly as possible and managed throughout your pregnancy.
Low
back pain of long duration (several weeks or months) during
pregnancy is a predictor for post partum back pain (pain after
birth). For this reason, pregnant women are encouraged to
seek appropriate treatment for back pain during pregnancy.
Likewise,
any post partum pain that lasts longer than six to eight weeks
should be treated in order to avoid chronic or recurring back
problems.
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Radiculopathy
lumbar radiculopathy, which refers to pain in the lower extremities
in a dermatomal pattern. A dermatome is a specific area in
the lower extremity innervated by a specific lumbar nerve.
This pain is caused by compression of the roots of the spinal
nerves in the lumbar region of the spine. Diagnosing leg and
back pain begins with a detailed patient history and examination.
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Scoliosis
Scoliosis is defined as a side-to-side deviation from the
normal frontal axis of the body. Although traditional, this
definition is limited since the deformity occurs in varying
degrees in all three planes: back-front; side-to-side; top-to-bottom.
Scoliosis is a descriptive term and not a diagnosis. As such,
a search is made for the cause. In more than 80% of the cases,
a specific cause is not found and such cases are termed idiopathic,
i.e., of undetermined cause. This is particularly so among
the type of scoliosis seen in adolescent girls. Conditions
known to cause spinal deformity are congenital spinal column
abnormalities, neurological disorders, genetic conditions
and a multitude of other causes. Scoliosis does not come from
carrying heavy things, athletic involvement, sleeping/standing
postures, or minor lower limb length inequality.
In managing AIS, the judgment of the surgeon and the participation
of informed patients and families are as important in determining
treatment outcome as surgical techniques. Decision-making
in the management of AIS remains complex despite the availability
of data on natural history, prognosis of different curve patterns,
brace treatment factors, and surgical innovations.
The management of AIS includes several steps and treatment
options:
· screening and early detection of deformity,
· observation of changes in deformity over time with
informed judgment regarding prognosis, orthotic and non-operative
interventions,
· surgical planning and operating.
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Sciatica
This is a condition which causes pain down the back of one
or both thighs. Inflammation of the sciatic nerve (which is
the largest nerve in the body-about the diameter of your little
finger) can be either constant or intermittent. Success in
solving this problem is directly correlated to the diagnosis.
Sciatica can be caused by a pinched nerve as it exits the
low back spine or it can be caused by prostatic cancer. Odds
are usually that the cause is some structural imbalance, but
there are so many potential causes, some serious and some
benign, it is better to at least know that there may be a
grave cause to the symptoms.
This doesn't mean that you shouldn't immediately incorporate
a strategy to eliminate any structural imbalances. In most
cases, this will resolve the problem. If the problem doesn't
respond to these basic efforts, then professional assistance
may be needed. The first effort in relieving sciatic symptoms
should be to review Hip Pain.
Trigger points can accumulate in the piriformis muscle forcing
a contraction and strangulation of the sciatic nerve. The
tennis ball exercise should be incorporated to help to relax
the piriformis muscle. Stretching may be beneficial, but that
is more of a "try an see" exercise.
If there are no improvements with this approach, refer to
Low Back Pain to better understand the relationship between
the sciatic nerve and the low back spine. Seeking help from
a chiropractor or orthopedist may be indicated if the solution
can't be found at home.
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