Low Back Pain Spondylosis and Instability
Low Back Pain – There Are Many Causes
Next to the common cold, low back pain is pervasive in society. Ask around it won’t be hard to find someone affected with it, someone you know, or even perhaps you. It is far more complex than just a disc problem. Back pain can occur at nearly any age from a wide variety of causes. Trauma, sports injuries, aging, and even out of the blue. Sometimes people can’t recall a specific cause for low back, it just shows up. Back pain has so many potential causes that even if it just shows up seeming without a cause, known medically as idiopathic, it may arise from a large variety of underlying problems.
Spine Anatomy: The Basic
A quick look at a spine anatomy models shows it is a multi-segmental long chain connecting the upper cervical spine or neck, the middle thoracic spine, to the lower lumber or back region. It is not like a ball and socket joint in any way. It is vastly more complex.
There are 7 cervical vertebrae, 12 thoracic and 5 lumbar, however, variations occur. Spanning across this a network of many muscle groups, ligaments,
Aging of the Spine: Arthritis and Spondylosis
Aging of the spine can occur at almost any age. The first sign usually is the loss of water content in the discs, known as disc desiccation or degeneration. As this progresses disc loss of height occurs, changes in the hinge twin facet joints at each vertebral level occur. Bone spurs may develop. Collectively this is called Spondylosis. Another way of saying arthritis of the spine.
Compression Fractures
Compression fractures are wedge-shaped deformities of the vertebral body. They can occur anywhere along the spine, however, are mostly seen in the thoracic region, where there are 12 vertebral bodies. Compression fractures may be seen commonly in osteoporosis, where the brittle bones due to calcium loss result in the collapse of the vertebrae. It can happen with minimal events in severe osteoporosis, to very traumatic injuries. This is what is commonly referred to as a broken back. Falls, skiing injuries, all can result in traumatic compression fractures. If stable without neurological compromise conservation treatment and rest is the treatment. The problem with the compression deformity is the normal alignment of each spinal segment is altered. This leads to long term abnormal segmental wear.
Segmental Instability, Spondylosis, and Spondylolisthesis
When the normal alignment of each joint is affected, the disc height diminishes as the result of a loss of water, known as disc degeneration. The two hinge facet joints at each segment begin to wear as a result. The normal cartilage lying between the two facet joints wear like any other cartilage, resulting in malalignment and pain. Spondylosis occurs when the weakness portion of the pedicule, the pars interarticularis suffers a stress fracture. This can be from trauma as in a fall, or certain sports are prone to develop this. Football lineman, wrestlers, and gymnasts. If the pars defect widens and slips spondylolisthesis may occur. This is a forward movement of one vertebra on the other. If the slippage is large enough, the spinal canal and nerve roots may be comprised.
Spinal Surgery
Now, look at some of the arrays of screws, plates, rods some of our patients get put in them. Some are even in their 70’s. It is no wonder the success rate for back surgery has not improved, despite the ever-increasing number of components that surgeons can place in patients spine. Back surgery in the United States is only approximately 50% successful. It is higher in Europe, as surgery is more heavily scrutinized, and the indications are more clearly defined. Just operated on someone with low back pain is a poor prognostic sign. Specific lesions, neurological signs correlating with diagnostic imaging signs, and Physical examination findings are much more precise.
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