Spinal Surgery
The spine is made up of individual bones called vertebrae, which provide support for the spine. These vertebrae are connected in the front of the spine by intervertebral discs that help support the spine and also allow it to move. The many ligaments and muscles that are attached to the back of the spine provide the power for movement.
Spine and Arthritis
Arthritis is a greek word which means( arthro- , joint + -itis , inflammation)inflammation of a joint. It involves a group of conditions involving damage to the joints of the body. It occurs when the cartilage in the joints is worn down as a result of wear and tear, aging, injury or misuse. Arthritis is the leading cause of disability in people older than fifty-five years . There are different forms of arthritis viz: osteoarthritis , rheumatoid arthritis , psoriatic arthritis , autoimmune diseases , Septic arthritis , Gouty arthritis etc.
Osteoarthritis ( OA, also known as degenerative arthritis degenerative joint disease), the most common form of arthritis, also includes loss of cartilage, overgrowth of bone and the formation of bone spurs. It is a clinical condition in which low-grade inflammation in the joints, caused by abnormal break down of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those joints.
As the bone surfaces become less well protected by cartilage, the bones under the cartilage to rub together and the patient experiences pain upon weight bearing, including walking and standing. Further there can be loss of regional muscles(atrophy),and loosening of the ligaments(ligament laxity)
Osteoarthritis can occur in any joint but most often occurs in the hips, knees, hands or the spine.
In medical terms, the bone spurs are called osteophytes. Osteophytes may be found in areas affected by arthritis such as the disc or joint spaces where cartilage has deteriorated. The body's production of osteophytes is a futile attempt to stop the motion of the arthritic joint and deal with the degenerative process. It never completely works. The evidence of bony deposits can be found on an x-ray.
A bone spur may cause nerve impingement at the neuroforamen. The neuroforamen are passageways through which the nerve roots exit the spinal canal. Sensory symptoms include pain, numbness, burning and pins and needles in the extremities below the affected spinal nerve root. Motor symptoms include muscle spasm, cramping, weakness, or loss of muscular control in a part of the body
In the spine, osteoarthritis can cause stiffness and pain in the neck or in the lower back. Cervical arthritis (also called cervical spondylosis) affects the upper spine and neck. Lumbar or lumbosacral arthritis affects the lower back and pelvic area. Ankylosing Spondylitis is another type of spinal arthritis.
Low back pain
It is a common musculoskeletal disorder causing back pain in the lumbar vertebrae of the spine. Clinically it can be divided into acute , sub acute or chronic in its clinical presentation. Low back pain can occur because of injury to the soft tissues which are muscles, tendons, ligaments, or to the bones.
An acute lower back injury may be caused by a traumatic event, like a car accident or a fall. It occurs suddenly and its victims will usually be able to pinpoint exactly when it happened.
Common conditions associated with Low back ache/pain:
Coccydynia :Pain in the lowest end of the spine or tailbone pain called coccyx pain or coccydynia ).
Sacro iliac Dysfunction: Pain from the sacroiliac joint at the bottom of the lumbar spine, called sacroiliac joint dysfunction.
Chronic lower back pain : It has a more insidious onset, occurring over a long period of time.
Physical causes may be:
- osteoarthritis or rheumatoid arthritis
- degeneration of the discs between the vertebrae,
- a spinal disc herniation
- a vertebral fracture (such as from osteoporosis ),
- a tumor (including cancer ) or infection.
Spinal cord injury
Spinal Cord Injury refers to an injury of the spinal tissue. Spinal cord injury can occur from many causes, including:
- Trauma such as automobile accidents , falls , gunshots , diving accidents , war injuries , etc.
- Tumor such as meningiomas, ependymomas, astrocytomas, and metastatic cancer.
- Ischemia resulting from occlusion of spinal blood vessels, including dissecting aortic aneurysms , emboli , arteriosclerosis .
- Developmental disorders , such as spina bifida , meningomyolcoele , and other.
- Neurodegenerative diseases , such as Friedreich's ataxia , spinocerebellar ataxia , etc.
- Demyelinative diseases , such as MultipleSclerosis .
- Transverse myelitis , resulting from spinal cord stroke , inflammation , or other causes.
- Vascular malformations , such as arteriovenous malformation (AVM), dural arteriovenous fistula (AVF), spinal hemangioma , cavernous angioma and aneurysm .
Spinal stenosis
Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected.
It may occur because of spinal degeneration with aging or because of spinal disc herniation, osteoporosis or a tumour. Spinal stenosis may affect the cervical vertebrae|cervical spine, the lumbar vertebra /lumbar spine or both.
Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs, thighs, feet or buttocks, or loss of bladder and bowel control.
This can be fairly corrected through the surgery of spine. Various types of surgeries to correct Stenosis:
- Laminotomy - when only a small portion of the lamina is removed to relieve pressure on the nerve roots;
- Foraminotomy - when the foramin (the area where the nerve roots exit the spinal canal) is removed to increase space over a nerve canal. This surgery can be done alone or along with a laminotomy;
- Medial Facetectomy - when part of the facet (a bony structure in the spinal canal) is removed to increase the space;
- Anterior Cervical Discectomy and Fusion - the cervical spine is reached through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone, which in time will fuse the vertebrae.
- Cervical Corpectomy - when a portion of the vertebra and adjacent intervertebral discs are removed for decompression of the cervical spinal cord and spinal nerves. A bone graft, and in some cases a metal plate and screws, is used to stabilize the spine.
- Laminoplasty - a posterior approach in which the cervical spine is reached from the back of the neck and involves the surgical reconstruction of the posterior elements of the cervical spine to make more room for the spinal canal.
Sciatica
The term sciatica is commonly used to describe pain traveling in the distribution of the sciatic nerve Sciatica is a set of symptoms including pain caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve , or by compression or irritation of the sciatic nerve itself. Sciatica is a symptom caused by a disorder occurring in the lumbar spine.
The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.
Disc Herniation
Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber).
A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body's weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.
Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.
Many patients with back pain, leg pain, or weakness of the lower extremity muscles are diagnosed with a herniated disc. When a disc herniation occurs, the cushion that sits between the spinal vertebra is pushed outside its normal position.
Spondylolisthesis
Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine. The symptoms that accompany a spondylolisthesis include pain in the low back, thighs, and/or legs, muscle spasms, weakness, and/or tight hamstring muscles. Some people are symptom free and find the disorder exists when revealed on an x-ray. In advanced cases, the patient may appear swayback with a protruding abdomen, exhibit a shortened torso, and present with a waddling gait.
Spondylolisthesis can be congenital (present at birth) or develop during childhood or later in life. The disorder may result from the physical stresses to the spine from carrying heavy things, weightlifting, football, gymnastics, trauma, and general wear and tear. As the vertebral components degenerate the spine's integrity is compromised.
Another type of spondylolisthesis is degenerative spondylolisthesis, occurring usually after age 50. This may create a narrowing of the spinal canal (spinal stenosis). This condition is frequently treated by surgery.
Lumbar Laminectomy
Lumbar laminectomy is a surgical procedure most often performed to treat leg pain related to herniated discs, spinal stenosis, and other related conditions. 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. Spondylolisthesis (the slipping of one vertebra onto another) can also lead to compression.
The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing or trimming the lamina (roof) of the vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance the ability to obtain a solid fusion and support unstable areas of the spine.
Degenerative Disc Disease
The spine is made up of number of vertebral bones stacked one on top of the other. In between the vertebrae are discs which lend mobility to the spine and act as shock absorbers. On the back side, there are two small joints at each levels - called facet joints. This type of structure allows one to bend and rotate in different directions.
When the discs wear out, the spine at that particular level does not function normally and the back becomes painful. The degeneration of disc leads to a condition called Degenerative Disc Disease. Whereas large majority of such patients can be treated with painkillers, braces, physical therapy, small percentage of such patients do not respond to non-operative treatment and need surgery.
There are two options in such conditions:
- Spinal Fusion
- Disc Replacement
In spinal fusion surgery, the disc (which is a soft material between two vertebrae) is removed and the space is packed with bone graft. In due course of time, the bone creates a solid bony bridge across the two vertebrae. By doing away with movement, previously painful segment is made pain free.
However, the disadvantage of this procedure is that not only does this takes away normal movements of spine at that particular level but also ultimately leads to degeneration of higher level of spine which were uninvolved earlier on. This thus leads to pain in uninvolved segment over the course of time.
Modern innovative operative treatment for Degenerative Disc Disease is - Disc Replacement. After removing the disc, it is replaced by an artificial disc which thus restores movements in that particular segment and also does not make higher motion segment of vertebral column painful in the longer run.
The Artificial Disc is an alternative to spinal fusion for patients who have one or two degenerated, painful discs usually between L4/L5 and L5/S1
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