Spine Topics
Anatomy of the spine
The spine is made of 33 individual bony vertebrae stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. Strong bones and muscles, flexible tendons and ligaments, and sensitive nerves ensure a healthy spine.
Back problems
Back pain
Back pain results when the spine is stressed by injury, disease, wear and tear, or poor body mechanics. Acute low back pain is abrupt, intense pain that subsides after a period of days or weeks. It typically resolves with rest, physical therapy, and other self-care measures. You play an important role in the prevention, treatment, and recovery of back pain.
Cervical myelopathy
Cervical myelopathy is compression of the spinal cord in your neck. It can feel like stiffness in the neck, numbness or pain in the arms or legs, loss of dexterity in the hands, balance issues, and trouble walking. It can happen subtly and slowly as we age, making it difficult to diagnose. Physical therapy and spinal injections can help relieve mild symptoms. Moderate to severe myelopathy requires surgery to prevent further damage of the spinal cord.
Leg pain (sciatica)
Sciatica is a shooting pain that begins in the lower back, radiates into the buttock and down the back of one leg. Pain is often caused by pressure on the sciatic nerve from a herniated disc, bone spurs or muscle strain. It typically improves with rest, physical therapy, and other self-care measures. Chronic pain may be helped with surgery.
Neck pain
Neck pain results when the spine is stressed by injury, disease, wear and tear, or poor body mechanics. Acute neck pain is abrupt, intense pain that can radiate to the head, shoulders, arms, or hands. It typically subsides with rest, physical therapy, and self-care measures. You play an important role in the prevention, treatment and recovery of neck pain.
Tailbone pain (coccydynia)
Coccydynia is tailbone pain at the bottom of the spine, an area called the coccyx. The pain can be caused by a fall, childbirth, excessive sitting, or a tumor. Diagnosis involves ruling out other conditions that cause pain near the coccyx. A coccyx injury may take weeks to months to heal. Most patients recover by sitting on a shaped cushion, physical therapy, and steroid joint injections.
Degenerative disc disease
As you age, the spine begins to show signs of wear and tear as the discs dry out and shrink. These age-related changes can lead to arthritis, disc herniation, or stenosis. Pressure on the spinal nerves may cause pain. Physical therapy, self-care, medication, and spinal injections are used to manage symptoms. Surgery may be an option if the pain is chronic.
Facet arthritis, facet joint syndrome
Facet joint syndrome is an arthritis-like condition of the spine that can be a significant source of back and neck pain. The cartilage inside the facet joint can break down and become inflamed, triggering pain signals in nearby nerve endings. Medication, physical therapy, joint injections, nerve blocks, and nerve ablations may be used to manage symptoms.
Herniated cervical disc
A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall. Neck or arm pain, numbness or tingling may result when the disc material compresses a spinal nerve. Treatment with medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be an option.
Herniated lumbar disc
A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall. Back or leg pain, numbness or tingling may result when the disc material compresses a spinal nerve. Treatment with medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be an option.
Cauda equina syndrome
Cauda equina syndrome is a rare condition caused by a large disc herniation compressing the nerve roots at the end of the spinal cord. Sudden back pain with numbness in the genital area, difficulty urinating, and leg weakness is a medical emergency. Prompt surgery to relieve the pressure may prevent permanent damage and restore bladder and bowel function.
Sacroiliac joint pain / fusion
Sacroiliac (SI) pain is felt in the low back and buttocks. The pain is caused by damage to the joint between the spine and hip. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem. Accurate diagnosis is important. Physical therapy, stretching exercises, pain medication, and joint injections are used first to manage the symptoms. Surgery can fuse the joint.
Spinal fractures
Fracture of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Spinal fractures occur from car accidents, falls, gunshot, or sports. Injuries can range from mild ligament and muscle strains, to fractures and dislocations of the bones, to debilitating spinal cord damage. Many fractures heal with conservative treatment. Surgery can realign the bones.
Spinal deformity, scoliosis
Spinal deformity is an abnormal curve of the vertebral column. Adult scoliosis and kyphosis can be caused by age-related wear and tear or from past surgeries. The facet joints and discs are no longer able to support the spine's normal posture. Pain results from stressed joints and pinched nerves, not the abnormal curve. Treatment can include medications, physical therapy, injections, or surgery.
Spinal stenosis
Spinal stenosis is the narrowing of the bony canals through which the nerves and spinal cord pass. Arthritis can cause the facet joints and ligaments to enlarge and thicken restricting the space for the nerves. The pinched nerves become inflamed and cause pain, cramping, or weakness in your legs or arms. Medication, physical therapy and spinal injections can help control symptoms. Chronic symptoms may require surgery.
Spondylolysis and spondylolisthesis
Spondylolysis and spondylolisthesis affect the joints that align the vertebrae one on top of the other. Spondylolysis is a weakness or stress fracture in the facet joint area. This weakness can cause the bones to slip forward out of normal position, called spondylolisthesis, and kink the spinal nerves. Treatment options include physical therapy, a back brace, or surgery.
Prevention & general health
Balance activities for home
Balance training consists of strengthening core muscles (abdominals, back extensors, and hip muscles) to improve balance and coordination. Balance exercises will improve your posture, prevent falls, and reduce injuries.
Exercises: core strengthening
Your core muscles support your spine. The muscles in your abdomen and back - which we call the "core" - are central to your everyday spine health. They are at the heart of any fitness plan to strengthen a healthy or ailing back. Just as you protect your heart through cardiovascular exercises, you will benefit from strengthening your back through core exercises.
Exercises: back stretches & strengthening
Exercise is a vital part of treating the spine after injury or surgery. Active therapeutic exercises distribute nutrients into the disc space, joints and soft tissues in the back. A regular exercise routine helps patients improve mobility and strength, minimize recurrence, and reduces the severity and duration of possible future episodes of back pain.
Exercises: neck stretches & strengthening
Exercise is a vital part of treating the spine after injury or surgery. Active therapeutic exercises distribute nutrients into the disc space, joints and soft tissues in the back. A regular exercise routine helps patients improve mobility and strength, minimize recurrence, and reduces the severity and duration of possible future episodes of neck and arm pain.
Posture and body mechanics
Good posture involves training your body to stand, walk, sit, and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities. The spine's curves work like a coiled spring to absorb shock, maintain balance, and to facilitate the full range of motion.
Non-surgical treatments
Braces for your back
Your doctor may prescribe a brace for you to wear after a spinal injury or surgery. It will immobilize your spine while you heal and will control pain by restricting your movement. Common back braces include the thoracic-lumbar-sacral brace (TLSO) and the lumbarsacral brace (LSO).
Braces for your cervical-thoracic spine
Injuries or fusion surgeries involving the neck and upper back require a cervical-thoracic brace to restrict movement. This rigid brace has a plastic padded chest jacket in two pieces, a front and back piece, fastened with Velcro straps. Supports for the chin and head arise from the chest jacket.
Braces for your neck
Your doctor may prescribe a neck brace for you to wear after a spinal injury or surgery. It will immobilize your head while you heal and will control pain by restricting your movement. Common neck braces include the soft cervical collar, Miami J collar, and Vista Multi-post.
Chiropractic care
Chiropractic medicine aims to improve health by restoring structure and function to the spine and other joints. Stress, accidents, overexertion, or other injuries may cause minor displacement of the spinal vertebra. When a vertebra is displaced, muscle tension or irritation to spinal nerves can result, causing pain (e.g., neck, back, headache).
Diaphragmatic breathing for pain
People experiencing pain tend to hold their breath during a flare-up or breathe fast and shallow. The fight-or-flight response is triggered when we are in pain or stressed. This increases our heart rate and muscle tension in our jaw, head, neck, and back. One way to turn off the fight-or-flight response is through diaphragmatic belly breathing.
Physical medicine & rehabilitation (PM&R)
Physiatry, also called physical medicine and rehabilitation, is a medical specialty that seeks to promote healing of patients who have suffered stroke, brain or spine injury. They also treat acute and/or chronic pain and musculoskeletal injuries. Many specialize in treating back and neck pain.
Physical therapy
Physical therapy is a nonsurgical approach to maintaining, restoring, and improving overall physical health. Pain-free mobility is crucial for independence, earning a living, and quality of life. A physical therapist can help people recover from an injury, disease, or surgery. PT may even help you avoid surgery altogether.
Self care for neck & back pain
Eight out of 10 people will suffer from back or neck pain at some point in their life. Acute pain is abrupt, intense pain that subsides after a period of days or weeks. Here are some tips to help you recover from acute back or neck pain — and when to see a specialist.
Transcutaneous electrical nerve stimulation
Transcutaneous Electrical Nerve Stimulation (TENS) is a noninvasive device placed on the skin that can help control pain. Use of this small, battery-operated device can block pain signals from reaching the brain and potentially reduce pain medication. TENS does not cure or eliminate the cause of pain.
Who treats spine problems?
Many specialists treat spine problems. Each has specific skills and plays an important role in patient care. Some spine specialists are physicians and some are non-physicians. The right specialist(s) to treat your condition depends on the type and severity of the problem.
Pain procedures
Bursa injections
Bursa injections contain a steroid to relieve joint pain and swelling caused by bursitis. A bursa is a fluid-filled sac that cushions the tendons and bones. A bursa can become inflamed from friction, injury, or arthritis. Bursitis can be painful because movement rubs against the bursa. An injection into the bursa can reduce pain and swelling.
Carpal tunnel syndrome surgery
Carpal tunnel syndrome causes tingling, numbness, or pain in the hand. The wrist bones and ligament form a tunnel, a passage for the median nerve and finger tendons. Repetitive strain may cause swelling that traps the nerve within the tunnel. Treatments include modifying activities, physical therapy, a wrist brace, medications, or surgery to free the nerve.
Epidural steroid injection (ESI)
An epidural steroid injection (ESI) can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to stenosis, spondylolysis, or disc herniation. Medicines are delivered to the epidural space, which is a fat-filled area between the bone and the protective sac of the spinal nerves. Pain relief may last for several days or even years.
Joint injections
A steroid injection can temporarily relieve pain caused by an inflamed joint due to arthritis, injury, or degeneration. The procedure has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from the joint. Second, it can be used as a treatment to relieve inflammation and pain.
Nerve block injection test
A nerve block injection can temporarily relieve back pain. The procedure is used as a diagnostic test to determine if the pain is actually coming from the medial branch nerve near the facet joint. If the block is successful, then a radiofrequency ablation may be recommended.
Occipital nerve block injection
An occipital nerve block injection can help relieve headache and neuralgia pain at the back of the skull. Sometimes numbing the occipital nerve blocks the pain signals and reduces chronic headache. The effects of a nerve block tend to be temporary. If successful, a radiofrequency ablation may be recommended for longer pain relief.
Sympathetic nerve block
A lumbar sympathetic block is an injection of a local anesthetic that can help relieve chronic leg and foot pain caused by conditions such as complex regional pain syndrome, reflex sympathetic dystrophy, vascular insufficiency, and shingles. Medications are delivered to the sympathetic nerves – a cluster of nerve cell bodies – along the front side of the spine.
Nerve radiofrequency ablation
Radiofrequency ablation is a procedure that destroys the nerve fibers carrying pain signals to the brain. It can provide lasting relief for people with chronic pain in the lower back, neck and arthritic joints. If you suffer recurrent pain and have had good relief with a nerve block injection, you may be a candidate for an Rf ablation.
Pain management
Acute pain starts suddenly and improves over time with healing. Chronic pain persists and is often present in ongoing conditions such as arthritis or cancer. Pain management is an integrated approach to making pain tolerable by learning coping skills. This may include exercise, physical therapy, medication, holistic therapies, and counseling.
Pain pump (intrathecal)
A pain pump delivers medication directly to the spinal cord. The system uses a small pump that is surgically placed under the skin of your abdomen. The pump sends medication through a catheter to the space around the spinal cord. Symptoms can be controlled with a smaller dose than is needed with oral medication.
Spinal cord stimulation
Spinal cord stimulation masks pain signals before they reach the brain. A small device, similar to a pacemaker, delivers electrical pulses to the spinal cord. It helps people better manage their chronic pain and reduce their use of opioid medications. It may be an option if you suffer chronic back, leg or arm pain.
Surgical treatments
Anterior cervical discectomy & fusion (ACDF)
Anterior cervical discectomy and fusion is a surgery to remove a herniated or degenerative disc in the neck. An incision is made in the throat area to reach and remove the disc. A graft is inserted to fuse together the bones above and below the disc. ACDF may be an option if physical therapy or medications fail to relieve your neck or arm pain caused by pinched nerves.
Anterior lumbar interbody fusion (ALIF)
Anterior lumbar interbody fusion is a surgery to treat disc problems in the low back. Fusion locks together two or more bones to stop painful motion and correct their alignment. Through an incision in the front of the belly, the disc is removed. A bone graft is placed in the empty space to restore the height and relieve nerve pinching. During healing, the bones fuse into one solid piece.
Artificial disc replacement (arthroplasty)
Artificial disc surgery replaces a worn-out disc in the spine with a device that moves like a natural disc. The device is made of metal plates with a ceramic or polymer core that flexes or glides. It's an alternative to spinal fusion, which stops all motion at the disc. The benefit of an artificial disc is less stress on adjacent discs compared to fusion.
Axial lumbar interbody fusion (AxiaLIF)
AxiaLIF is a minimally invasive spinal fusion to treat disc problems in the low back. Fusion stabilizes the spine to stop the painful motion and decompress pinched nerves. Through a small incision at the tailbone, the damaged disc is removed and a rod placed to correct the spacing between the vertebrae. During healing, the bones will fuse together.
Complex spine surgery
"Complex" spine surgery can refer to the difficulty, the risks, the length of recovery, or number of spine levels involved. Optimizing your bone health and physical condition before surgery will help avoid complications. This guide will help you mentally prepare and set realistic expectations for a 3 to 6-month long recovery and a year of healing.
Lateral lumbar interbody fusion (LLIF)
Lateral interbody fusion is a surgery to treat disc problems in the low back. In spinal fusion, two or more bones of the spine are joined to stop painful motion, decompress pinched nerves, and correct scoliosis. Through a small incision at the side of the waist, the disc is removed and a bone graft is inserted to restore the height and relieve nerve pinching. During healing, the bones will fuse together.
Lumbar discectomy
Lumbar discectomy is a surgery to remove a herniated or degenerative disc in the lower spine. The incision is made posterior, through the back muscles, to reach and remove the disc pressing on the nerve. Discectomy may be recommended if physical therapy or medication fail to relieve leg or back pain caused by pinched spinal nerves. The surgery can be performed open or minimally invasive.
Posterior cervical surgery
Posterior cervical surgery occurs in the back of the neck to relieve pressure on the nerves or spinal cord. The surgery may involve a single-level discectomy and foraminotomy or may be a more complex multi-level laminectomy and fusion. The surgery can be performed open or minimally invasive.
Preparing for lumbar spinal fusion
Spine fusion surgery permanently joins together one or more bony vertebrae. The fusion area is immobilized and held together with metal hardware until the body begins its natural healing process and new bone is formed (3 to 6 months). You must limit bending, lifting and twisting and prepare your home for recovery.
Spinal decompression (laminectomy)
Decompression surgery (laminectomy) removes the bony roof covering the spinal cord and nerves to create more space for them to move freely. Stenosis of the spinal canal can cause chronic pain, numbness, and muscle weakness in the arms or legs. Surgery may be recommended if your symptoms have not improved with physical therapy or medications.
Spine deformity surgery
Spine deformity surgery can correct alignment and posture of the spinal column. Scoliosis, kyphosis, and flat back conditions require custom solutions for each person’s unique global spinal balance to reduce pain and improve mobility. The goal of surgery is to stop progression of the curve, decrease day-to-day pain, and increase your quality of life.
Transforaminal lumbar interbody fusion (TLIF)
Transforaminal interbody fusion surgery is used to treat disc problems in the low back. Fusion locks together two or more bones to stop painful motion. Through small, minimally invasive incisions in the back, the disc is removed. A bone graft spacer is placed in the space to restore the height and relieve nerve pinching. During healing, the bones fuse together.
Vertebroplasty & kyphoplasty
Vertebroplasty and kyphoplasty are performed to treat vertebral compression fractures of the spine. These painful, wedge-shaped fractures can be caused by osteoporosis or injury. Left untreated, they can lead to a humped spine. By restoring the vertebra height with a balloon and injecting a cement into the fractured bone, patients can recover faster and reduce the risk of future fractures.
