What are Common Spine Injuries?

Degenerative Disc Disease

Degenerative Disc Disease, or DDD, occurs in many people as part of the normal aging process. It is sometimes referred to as arthritis of the back. The condition results from changes in the compressible spinal discs, which act as and shock-absorbing cushions between the vertebrae. With age, the discs can lose fluid, making them less flexible and more compressed, or they can develop tiny tears in the outer layer (annulus), which can cause pain by themselves or allow the jellylike inner layer (nucleus) to bulge, causing pressure on the spinal cord and/or nerves.

The most common symptom of DDD is deep aching lower back pain that can radiate to the top of the thighs. Pain in the morning is usually described as stiffness in the lower back. The condition can occur anywhere along the spine, but is most common in the neck (cervical) and lower back (lumbar) regions. The resulting neck or lower back pain is usually made worse by certain activities or prolonged sitting and standing. There may be bouts of severe pain, lasting from a few days to several months, before returning to a milder long-term, chronic pain. Many people don’t realize they have disc degeneration because it frequently causes no pain at all.

The cause of DDD is typically the normal wear and tear that occurs in the discs as a person ages. However, it can occasionally be caused by trauma (injury) or repetitive lifting. The affected disc becomes thinner and loses its cushioning ability. These changes affect the way the vertebrae in the spine move and bone spurs can result as well as bulging or disc leakage, all of which can cause pain when they contact the spinal nerves. Smoking, obesity, heavy lifting, and hereditary factors also lead to advanced degeneration.

DDD causes lower back pain in most people at some point in their lives. Symptoms usually resolve on their own; occasionally, medications and non-operative treatments (physical therapy) are needed. Surgery is performed for those whose symptoms do not improve.


Herniated Disc (Cervical and Lumbar)

A cervical disc herniation, or cervical radiculopathy, occurs when a small portion of a disc ruptures and causes pressure on spinal nerves in the neck. Small herniations are sometimes called bulges or protrusions, and people experiencing pain from the herniation often describe it as a pinched nerve.

Depending on which cervical disc has herniated, the specific pain symptoms may vary. In general, pressure on a spinal nerve causes discomfort in various sites along one or both arms, frequently down to the hand. There can be shooting, burning pains, weakness, and/or numbness.

Cervical disc herniations are most frequently caused by degeneration due to the normal aging process. As small tears in the disc’s outer layer (annulus) develop and enlarge over time, the jellylike inner layer (nucleus) may bulge outward, causing pressure on the spinal cord and nerves. Occasionally, trauma or an episode of heavy lifting causes sudden rupture of the disc resulting in symptoms.

Arm pain and discomfort from a disc herniation can often be resolved with medication and non-operative treatments (physical therapy). When these treatments are successful, arm pain tends to disappear first and it may take longer for weakness or numbness to improve. Surgery is performed for those whose symptoms do not improve.


Osteoarthritis

The term osteoarthritis is a general term that describes changes in the joints that occur as a person ages. Osteoarthritis of the spine causes joints along the spine to deteriorate and may result in the formation of bone spurs, cysts, and a narrowing of the disc space.

The most common symptom of spinal osteoarthritis is low back pain that may radiate and be felt in the pelvis, buttocks, groin, and down the front of the thighs. Osteoarthritis in the cervical region is also common, and the associated neck pain may also be felt along the shoulders and between the shoulder blades. Both low back and neck pain tend to be worse in the morning and late in the evening, and are often described as stiffness. A minor, steady or intermittent ache that may be aggravated by motion, loss of flexibility, and tingling or sensations of numbness around the spine may also be symptoms.

The primary cause of osteoarthritis is normal wear and tear on the body due to the aging process. Repetitive motion and injuries from sports or employment and excessive body weight can also accelerate the degenerative process. The joints become irritated and inflamed as cartilage surrounding the facet joints of the spine breaks down over time. The discs between the vertebrae also degenerate, and the decreased disc height affects how the joint moves. Pain may result from friction between the joints and the body often produces bone spurs and cysts that may also cause pressure on the spinal cord and/or nerves.

Patients can often play an active role in treating osteoarthritis to avoid deterioration and a worsening of their symptoms. Treating osteoarthritis generally involves avoiding damaging activities, managing the inflammation, reducing pain, controlling one’s weight, and maintaining flexibility with exercise.


Osteoporosis of The Spine

Osteoporosis is a spinal condition in which bones lose their density and become more porous and fragile. The condition can occur in anyone, but is much more likely in older females, especially after menopause. Diminished bone strength from osteoporosis occurs particularly in the spine and hips.

Osteoporosis by itself does not cause pain and many people will not know they have it until after it has progressed to a point that has severely weakened the vertebrae. In some cases, as the density of the spinal vertebrae decreases, they may lose their normal height. When this loss occurs, the front part of the vertebrae may take on a more wedged type of configuration, causing forward-leaning posture and increased curvature of the spine that will sometimes cause back pain. Whether the posture is affected or not, the primary risk of osteoporosis is spinal fracture. When this happens, there is often a sudden onset of sharp pain at the fracture site. Mild trauma, such as light lifting or even a heavy sneeze may be enough to fracture the weakened vertebrae.

Bone is continually remodeled, and osteoporosis results from a reduction in bone mineral density as the bone renews itself. Calcium helps build strong bones and vitamin D helps bones absorb and retain calcium. A deficiency in either of these substances can slow the rate of bone growth to the point that the bones become porous and brittle. Estrogen also affects the rate at which bone renews itself, and post-menopausal women experience an increase in bone loss for several years following the rapid decrease in estrogen production. Other factors that may increase the risk of osteoporosis include a lack of exercise, alcohol abuse, some medications (steroids) and smoking.

Fortunately, osteoporosis can be avoided with preventative steps and responds well to treatment when diagnosed early. Prevention typically involves an adequate intake of calcium and vitamin D, exercising regularly, limiting alcohol consumption, stopping smoking, and periodic bone mineral density testing following menopause. Treatment may involve similar steps, often in conjunction with treatment for fractures that may have resulted and medications to slow bone loss or increase bone production.

Sciatica

Sciatica describes an irritation of the sciatic nerve, which is the largest single nerve in the human body. The sciatic nerve begins from several nerves in the lower lumbar vertebrae and the sacrum at the bottom of the spine. These nerves combine to form the sciatic nerve, which travel through the buttocks and down each leg. Sciatic nerve irritation can result from compression of the sciatic nerve roots or from inflammation.

The primary symptom of sciatic nerve irritation is pain felt in the lower back or buttocks that travels down one leg, frequently to the foot. The pain can vary from a mild ache to a sharp, shooting pain and may sometimes feel like an electric jolt traveling down the leg. Muscular weakness, numbness or a tingling sensation down the leg and into the foot may also be symptoms. Pain in the leg is usually worse when sitting.

Sciatica can be caused by a variety of conditions that cause inflammation or pressure on the nerve roots connected to the sciatic nerve. The most frequent cause of sciatica is the degeneration and rupture of a lumbar disc due to the normal aging process. The ruptured disc may herniate and push against a nerve, causing pain in the low back, leg, or both. Occasionally, trauma or an episode of heavy lifting causes sudden rupture of the disc and symptoms. Sudden twisting, such as when golfing, can also cause herniations.

If symptoms include loss of bladder or bowel control, seek medical attention immediately. Minor sciatica will often disappear over time and it is rare for permanent nerve damage to result. If symptoms persist and worsen, or if they arise after a sudden injury, treatment may be necessary. Non-surgical treatments include controlling sources of inflammation and pressure, as well as physical therapy. Surgery is performed for those whose symptoms do not improve.

Scoliosis

Scoliosis is an abnormal curvature of the spine. It is most common in young adolescent females though it also occurs in boys. Sometimes scoliosis progresses slowly and may not be detected until a person is an adult. Scoliosis has a genetic component and frequently runs in families.

A typical spine has an elongated S-shape with the upper back curved outward and the lower back curved inward. The principal symptom of scoliosis is an abnormal curvature from side to side, most frequently in the upper back. One hip may be higher than the other, the shoulders and hips may be uneven, and one shoulder blade frequently appears more prominent than the other. The spine may also be rotated in from its normal position, causing the ribs on one side to be more prominent. Small curves usually cause no pain, but extensive curvature may cause back pain, breathing problems, and severe deformity.

The cause is unknown, but a family history of scoliosis increases the risk. Contrary to some beliefs, scoliosis is not caused by poor posture or carrying loads on the back.

The abnormal curve usually causes no pain, but deformity of the back may be noticed by family members. Regular screening by a health care practitioner can often detect curves while they are still small. Treatment generally involves preventing the curve from becoming worse with a brace. Where there is an extensive curve or a high likelihood of the curve progressing, surgery can be done to correct as much of the curvature as possible and fuse the spine to prevent future problems.

Cervical Stenosis

Spinal stenosis is a condition that causes a narrowing of the spinal canal, which can compress the spinal cord, resulting in pain, weakness, and/or numbness. When this condition occurs in the neck region it is referred to as cervical stenosis.

A narrowing of the spinal canal typically doesn’t cause symptoms unless it progresses to a point where it compresses the spinal cord or nerves. When this happens, intermittent or chronic pain, numbness, or weakness may be felt in the neck and shoulders and may extend down the arms to the hands. The neck pain is often described as stiffness, and people often complain of a numbness or heaviness in the arms and hands. In more severe cases, there can be difficulty using the arms and hands or difficulty walking.

Cervical stenosis is most frequently caused by degenerative changes (osteoarthritis) in the neck. After years of normal wear and tear, cushioning between bones in the spine may break down, allowing bones to wear against each other. At these sites, the body produces growths called bone spurs that may narrow the spinal canal, causing pressure on the spinal cord and nerves. Occasionally, large disc herniations and spinal tumors can narrow the spinal canal enough to compress the spinal cord.

Cervical stenosis may or may not require treatment depending on whether symptoms include pain or disability. Non-surgical treatments may include modifying activities to reduce stress on the spine, physical therapy, medications or injections to reduce pain and inflammation, or wearing a brace. In severe cases or those that are progressively worsening, surgery may be performed to correct the condition.


Lumbar Stenosis

The lumbar spine is made up of five vertebral bodies in the lower back. Nerves coming off the spinal cord travel though the spinal canal and exit the canal through small openings on the sides of the vertebral called foramen. Lumbar stenosis (spinal stenosis) is a condition whereby either the spinal canal (central stenosis) or vertebral foramen (foraminal stenosis) becomes narrowed. If the narrowing is substantial, it causes compression of the nerves, which causes the painful symptoms of lumbar spinal stenosis.

The most common cause of lumbar spinal stenosis is degenerative arthritis. As with other joints in the body arthritis commonly occurs in the spine as part of the normal ageing process. This can lead to loss of the cartilage between the bones at the joints, formation of bone spurs (osteophytes), loss of the normal height of the discs between the vertebrae of the spine (degenerative disc disease), and overgrowth (hypertrophy) of the ligamentous structures. Each of these processes reduces the normal space available for the nerves and can directly press on nerve tissues to cause lumbar spinal stenosis.

In most cases the treatment for lumbar spinal stenosis begins with conservative (non-operative) treatment. This can include medications to reduce inflammation, even short courses of oral cortisone medication, and pain medications.  Physical therapy can help in some cases. Cortisone (steroid) injections in the lumbar spine can also reduce the symptoms by decreasing inflammation and swelling around the nerve tissue. These can be repeated up to three times per year.

Surgery may be indicated for patients that do not improve with the above treatments, or if there is severe or progressive weakness or loss of bowel or bladder function (cauda equina syndrome). Depending on the examination findings and imaging studies there are various operations available for lumbar spinal stenosis.

The main goal of surgery is to remove the structures that are compressing the nerves in the spinal canal or vertebral foramen. This is a lumbar decompression surgery (laminectomy, laminotomy, foramenotomy). In some cases this can be performed alone, but in other cases it must be combined with lumbar fusion. If too much of the compressive structures need to be removed to free the nerve, the vertebrae may become unstable (spinal instability). This leaves the vertebrae with abnormal motion. If this occurs, a spinal fusion can be performed to make the vertebrae attached together and eliminate the motion at that level.

Surgery for lumbar spinal stenosis can be very successful in most cases for the leg symptoms. However, depending on the severity of the nerve compression and the length of time the nerve have been compressed, there may be some permanent damage that is not relieved with surgery. The success for back pain relief is less reliable with surgery than the relief of leg symptoms.

Spinal Trauma

Trauma, the result of physical injury to the spine, can lead to compression of one or more vertebrae and injury to the spinal cord or nerves. Vertebrae weakened due to osteoporosis can also fracture (break) with low level trauma.

The most common symptom of spinal trauma is the sudden onset of pain following a traumatic episode. In severe cases, where the fractured bone is pushed into the spinal cord or nerves, the damage may lead to pain, weakness, numbness, or paralysis.

Spinal trauma is typically caused by a violent force applied to the spine, which can compress and fracture vertebrae. Motor vehicle accidents and falls are frequent causes of spinal trauma.

Fractures may occur anywhere along the spine but are most common in the middle and lower back. The sudden onset of back pain following an injury is suspicious for a fracture. Treatment of spine fractures will depend on the symptoms and extent of the damage.


Spondylolisthesis

Spondylolisthesis is condition that occurs when one spinal vertebral body slips forward relative to another. It can occur anywhere along the spine, but typically occurs in the lumbar region. Spondylolisthesis is less common among young children, occurring primarily in adolescents and adults.

Symptoms resulting from spondylolisthesis vary. Some people have no pain or other symptoms. In extreme cases, the deformity may be a visible increase in the curvature of the spine in the lumbar region, which can affect movement. Often there is mild to moderate low back pain, particularly after exercising. If the forward slippage compresses a nerve, leg pain often develops.

Spondylolisthesis can be caused in several ways. The majority of cases occur in the elderly when the joints that allow the spine to bend forward (facet joints) wear with age and allow one vertebra to slip over another. In other cases, subjecting to spine to a sudden or repeated force may cause spondylolisthesis. Adolescent athletes that perform repetitive hyperextension, such as gymnasts, may be at increased risk for spondylolisthesis.

Spondylolisthesis may or may not require treatment depending on whether symptoms include pain or disability. Non surgical treatments may include modifying activities to reduce stress on the spine, physical therapy, medications or injections to reduce pain and inflammation, or wearing a brace. In severe cases or those that are progressively worsening, surgery may be performed to correct the condition.


Tumors of The Spine

Tumors that can be either cancerous (malignant) or noncancerous (benign) may occur within the spinal cord or vertebrae. Whether a spinal tumor is cancerous or not, it can cause pressure on the spinal cord and nerves, resulting in pain and potential disability.

The primary symptom of spinal tumors is back pain. The pain is sometimes worse while resting at night or when first waking in the morning, and may or may not occur with normal daily activities. In addition to pain, if the tumor causes pressure on the spinal cord, it may cause weakness in the legs and hips, and may even cause paralysis. Some tumors will also destroy bone and fracture vertebrae, which can cause noticeable spinal deformity.

Noncancerous tumors generally grow slowly, and it may take years before symptoms develop. Cancerous spinal tumors tend to grow quickly. When they arise, they are usually metastatic, meaning they originate and spread from a primary tumor elsewhere in the body. The most common cancerous tumors that metastasize are breast, lung, thyroid, and kidney cancer.

Spinal tumors are not the cause of most back pain. However if back pain occurs at rest, worsens at night, and persists, it may be the result of a tumor that requires medical attention. Treatments vary depending on the location within the spine and type of tumor.


Whiplash Injury

Whiplash was first defined in 1928 as a hyperextension followed by hyperflexion injury of the neck. These injuries are most common after low-velocity, rear-end collisions. Classically, the injury is thought to occur when the head is thrown backwards, although hyperflexion of the neck may occur when the head rebounds in a forward direction. Soft tissue stretch injuries to the muscles, ligaments and other anatomic structures may lead to acute and chronic symptoms.

Neck pain is the primary symptom associated with whiplash injury. Less commonly, pain can occur in the back of the head, jaw, shoulder, and upper and lower back. Whiplash victims may also experience dizziness, headache, neck stiffness, weakness and upper extremity numbness. These symptoms generally resolve over days or weeks, but may persist for years.

History alone is often enough to make the diagnosis of whiplash. Physical examination will often reveal decreased neck motion and possibly neck muscle spasm (tightness). If significant pain or neurologic deficit (weakness and/or numbness) is present, additional imaging may be needed to evaluate for fracture or other injury. X-rays provide assessment of bony anatomy and alignment. Magnetic resonance imaging (MRI) is occasionally considered if a neurologic deficit is noted.

Whiplash injury is generally treated conservatively, and symptoms often resolve with time alone. Anti-inflammatory and analgesic medications, however, effectively reduce the pain in the short term. Muscle relaxants may also be considered to limit spasm. If acute pain is present, a rigid cervical collar is considered until pain improves. If symptoms persist, physical therapy may also be appropriate. The utility of this therapy, however, has been questioned by some. Local modalities (heat, ultrasound, massage, electrical stimulation) may benefit patients on a symptomatic basis. Chiropractic care has not been well substantiated in the literature, but may benefit some patients.

Whiplash describes a hyperextension injury of the neck associated with pain symptoms not clearly localizable with imaging modalities. Patients are classically treated with rest and anti-inflammatory (possibly with analgesic and muscle relaxant medications). While the symptoms most often resolve within weeks to a few months with conservative therapy, some victims may continue to experience chronic symptoms.

If you are suffering from spine or back pain, please contact our office immediately to schedule an evaluation.

Dallas Orthopedics Institute
 9330 Poppy Drive
Dallas , TX 75218