Annular tears are spinal conditions in which a disc cushioning the bones of the spine, or vertebrae, tears suddenly or over time. As the outer portion of the disc is torn, the inner, soft portion protrudes, often causing pain. There are three main types of annular tears:
- Radial Tear – These are usually caused by the aging process. They may lead to herniation of the disc.
- Concentric Tear – These are often caused by injury to the spine.
- Peripheral Tear – These are often caused by injury. They may cause the disc to break down over time.
Annular tears are typically discovered during a specialized CT scan or MRI, as part of a diagnostic workup to determine the cause of back pain. The size of the tear does not foretell its ability to create painful symptoms; a small annular tear may become quite painful if the inner layer of the disc protrudes against a nerve. Annular tears are usually treated with conservative treatment aimed at symptom management, including physical therapy, pain medication, exercise, or deep tissue massage. If discomfort continues, an epidural injection may be indicated. Surgery is normally not indicated for an annular tear not associated with other additional spinal problems.
Arthritis of the spine occurs when cartilage in the discs between the vertebrae and cartilage in the joints begins to degenerate. As the cartilage wears down, pain and swelling can occur. Bone spurs may also develop as bone rubs against bone. Arthritis of the spine usually occurs in the neck or the lower back. The nerves can become irritated, leading to pain or weakness in the arms or legs. Common complaints include pain, numbness of a limb, tenderness, stiffness, weakness, or a crunching sound of bone against bone. Many patients complain of pain in the early morning with diminished pain during the day and a return of pain by the end of the day’s activities. While often a condition of the elderly, arthritis sometimes sets in during midlife or at an even younger age. Obesity and a job or sports activity requiring repetitive movements increase the risk of developing arthritis of the spine. Treatment typically involves a variety of exercises and mild pain medication. Surgery may be needed if severe symptoms persist despite other treatments. Some patients are candidates for minimally invasive spinal surgery to relieve severe symptoms.
Back pain is one of the most common human afflictions and most people experience neck pain at some point in their lives as well. These conditions can be acute or chronic. Back and neck pain may follow an injury or develop unrelated to activity. The spinal area consists of the spinal cord, bones, joints, muscles, ligaments, tendons, cartilage, and nerves, all of which can contribute to the sensation of pain. The pain message is delivered to the brain via the nerves and spinal cord. Pain that continues for a long period of time can cause anxiety and stress for the individual, which can begin an unpleasant cycle of physical pain and emotional stress.
Neck pain can radiate into the shoulder, upper back and arm while lower back pain is often felt in the hip or leg. Spine-related pain becomes more common as one ages. Common causes include age-related degenerative disorders, improper lifting and chronic wear and tear, but there are dozens of possible causes. Often, back and neck pain resolve on their own or with minimal intervention such as rest, pain medicine or anti-inflammatory medication. Severe or ongoing pain warrants a medical evaluation.
Bone spurs, sometimes called ostephytes, are bony growths that develop over time. As a spinal disc or joint wears down, the ligaments around it become loose. Eventually, the ligaments toughen and these bony growths may appear. Many bone spurs fail to produce symptoms or cause damage; they are often considered a natural part of aging although they sometimes have another cause. If they press upon a nerve or the spinal cord, however, discomfort may become apparent. Bone spurs can cause pain upon standing and walking. If the spur is in the neck region, pain may radiate into the shoulders or the sufferer may experience a headache. Spurs in the lower back may cause pain that radiates into the legs. If a nerve becomes increasingly compressed by a bone spur, weakness, tingling, and numbness of the affected limbs may develop. Treatments may include a brief initial rest period, muscle relaxants, anti-inflammatory medication, epidural injections, physical therapy, and exercise. When a bone spur severely compresses a nerve or the spinal cord, surgery may be required. Some patients are candidates for minimally invasive spinal surgery to relieve severe symptoms.
Central cord syndrome is a serious spinal cord injury that leads to impairment of the arms and hands. Usually, a less significant degree of leg symptoms or balance impairment is also present, and bladder dysfunction may be as well. Central cord syndrome is the result of damage to nerve fibers that transfer messages between the brain and the spinal cord. Most patients have some degree of paralysis or difficulty controlling fine movements in the hands and arms. Neck pain may be present and the sufferer may experience aching, burning or tingling in the affected areas. Central cord syndrome can occur at any age, but typical presentations include a young person who has a severe neck injury or an older person with a degenerative neck condition who subsequently experiences a neck injury. Diagnosis is typically made by MRI. Treatment frequently involves physical therapy, rest, and medication. Occupational therapy may be needed. Surgery is required if ongoing compression of the spinal cord is present. With treatment, most patients experience significant improvement over time.
Degenerative spine conditions are defined as those that cause a gradual loss of function and healthy spine structure over time. While often considered a normal part of the aging process, they may also be due to arthritis, infection, tumor or other condition. Degenerative conditions may be painful and they may cause nerve irritation or impingement. Symptoms include chronic pain, occasional sharp pains, limited range of motion, and physical deformity. Degenerative spine conditions with nerve involvement may cause weakness or numbness of a limb. Occasionally, sufferers will experience bladder, bowel, or sexual dysfunction as the result of a degenerative spine condition compressing a nerve. Degenerative spine conditions are usually found on an x-ray, CT scan, or MRI. Typical treatments include a short period of rest, physical therapy, medication, exercise, or temporary bracing. Surgery is sometimes needed to relieve unrelenting pain or restore function. Some patients are candidates for minimally invasive spinal surgery to relieve severe symptoms.
The vertebrae of the spine protect the spinal cord and give supportive structure to the back. A disc is found between each of the vertebrae, which provides cushioning and protection. Injury and degeneration can damage these discs, resulting in a variety of spinal problems.
A bulging disc occurs when the disc extends beyond the space it should occupy. This condition is common among adults and is often considered to be a natural part of the aging process. A large portion of the disc is typically involved and the misshapened disc is often discovered during diagnostic testing rather than because of patient symptoms. Bulging discs usually require no treatment other than following good ergonomic practices and avoiding back strain.
Herniated / Ruptured / Slipped Discs
A ruptured disc, also called a herniated disc or a slipped disc, may become painful if it causes pressure on a nerve root or the spinal cord. The disc is referred to as being ruptured because the tough outer lining has ruptured or split, allowing some of the inner disc cartilage to be released. The inner disc cartilage, or nucleus, feels like cooked crab meat or shrimp when squished between your fingers. When this material presses against a nearby nerve root or the spinal cord, pain in the back or pain, numbness, or tingling in the body or limb areas served by the nerve may become evident. The sufferer may notice impaired movement in the affected area. In some cases, such as when no nerve root is severely compressed, no symptoms of a ruptured disc are apparent and the patient may be unaware of it until it is found during diagnostic testing.
Treatment for a ruptured disc is often dependent on whether or not the patient is experiencing symptoms. Chronic pain or interference with the ability to work or care for oneself frequently necessitate treatment, including physical therapy, a short course of pain medication, or muscle relaxants. Often, a brief rest period is ordered, followed by stretching or strengthening exercises. Occasionally, surgery is required when conservative measures fail or symptoms such as loss of bowel or bladder control are present. Some patients are candidates for minimally invasive spinal surgery to relieve severe symptoms. A herniated disc without symptoms requires no treatment other than following good ergonomic practices and avoiding back strain.
The condition known as a “collapsed” disc occurs when a disc between two vertebrae loses height in its outer, tough layer. The disc doesn’t actually collapse, but the compression due to height loss can affect the spinal nerves or spinal cord. This condition is frequently the result of the aging process, as the disc dries out and reduces in size over the years. Other degenerative conditions may also cause this spine problem. When the disc becomes compressed, there is less room for the nerves and spinal cord. Also, less cushioning can cause the vertebrae to grind against each other, irritating the nerve.
A patient may have no symptoms of a collapsed disc, but if the spinal cord or a nerve root is involved, pain, weakness, numbness or tingling may be noticeable in the area served by the nerve. Treatment typically consists of rest, physical therapy, special exercises, pain medication, or injections into the epidural space. Some patients are candidates for minimally invasive spinal surgery to relieve severe symptoms.
Sciatica is a condition in which pressure is placed upon the sciatic nerve or it is damaged in some way. This long nerve begins from nerve roots in the spine and runs through the buttock, leg, and foot, carrying sensation and allowing movement. A person may experience pain on only one side or on both sides. A person may find that some positions or activities will reliably worsen symptoms, and others may give relief. The pain is often described as stabbing, radiating, or electric, but it can also feel like an ache. Sciatica pain can range from mild to severe. Other symptoms include weakness, tingling, and numbness in the affected area. Sciatica can be the result of a herniated lumbar disc, spinal stenosis, a tumor, or other condition. Treatment involves correcting the underlying condition. Typical treatments include pain medicine, anti-inflammatory medication, muscle relaxants, gentle stretching exercises, special positioning for sleep, physical therapy, epidural injections, and sometimes surgery.
Spinal stenosis is a narrowing of the spinal canal containing the spinal cord and nerve root bundle, or a narrowing of one or more exit canals through which a nerve root exits the spine. It occurs when a nearby structure, such as a degenerated vertebral disc or facet joint, protrude into a space in the spine normally occupied by the spinal cord or a nerve root. Arthritis of the spine is the most common cause but it can also develop due to a tumor, injury, herniated disc, defect from birth, or other condition. Some patients have no noticeable symptoms but many experience pain in the back or pain, weakness, cramping, numbness or tingling in the leg. Symptoms are often experienced on one side of the body. Typically, pain worsens when standing or walking for a long period of time and is relieved by sitting down or leaning forward from the waist, but some people experience other patterns of activity-related improvement and worsening. Diagnosis is usually made from a medical history and physical, and neurological testing, x-ray, CT scan, MRI, or myelogram. Treatment consists of pain medication, anti-inflammatory medicine, injections into the epidural space or the facet joints, or physical therapy. Sometimes surgery is needed due to unrelenting pain, worsening weakness in the legs affecting the ability to walk, or other severe problems. Surgical strategy is tailored to the individual person’s needs, and targets removal of abnormal structures compressing the spinal cord or a nerve root, and restoration of lasting, normal spinal function. Some patients are candidates for minimally invasive spinal surgery to relieve severe symptoms.
Spinal fractures are serious conditions that often result from a car accident, fall from a great height, or a strong impact. People with osteoporosis, an abnormally low bone mineral density, have weaker bone structures and are at risk of a spinal fracture from minimal trauma. Sometimes, the spinal cord itself is injured, resulting in weakness, numbness, tingling, loss of normal bladder or bowel function or severe paralysis.
The primary symptom is pain that is made worse by movement. Diagnosis is made by a combination of a medical history and physical examination, neurological testing, x-ray, CT scan, and/or MRI. Treatment of a spinal fracture is dependent on the severity of the fracture, the type of fracture, and whether the spinal cord is involved. Some patients heal with bracing or casting while others require surgery. Spinal fracture surgery may utilize bone cement, bone grafting, or metal hardware to stabilize the spine. Physical therapy is frequently needed after surgery.
Spondylolisthesis is a condition in which one vertebra slips partially in front of the vertebra beneath it, sometimes pressing on a nerve root. Occurring in both children and adults, there are several types of spondylolisthesis.
- Degenerative – This is the most common form. It occurs as a person ages and is due to degeneration of the joints in the back of the spine at the level involved..
- Isthmic – This form occurs when the vertebrae develop small fractures in a critical area needed to maintain normal spinal alignment.
- Congenital – This form develops as the result of abnormal vertebrae formation present at birth. In some cases, children are born with abnormally thin vertebrae. Symptoms may not begin until the child becomes active in sports or experiences a growth spurt.
Less common causes of spondylolisthesis include disease such as osteoporosis, or injury. While some cases are asymptomatic, others cause lower back pain, pain in the leg and foot, or numbness down the leg. Sometimes, spasms will occur in the hamstring muscle. Spondylolisthesis is graded according to severity, with grade I being the least serious and grade IV being the most severe. It is usually diagnosed by x-ray, CT scan, or MRI. Most patients respond to conservative measures, such as physical therapy, a back brace, anti-inflammatory medications, or an epidural injection. Patients with severe, unrelenting symptoms may require surgical intervention to stabilize the spine and/or alleviate pressure upon a nerve. Surgical strategy is tailored to the individual person’s needs, and targets removal of abnormal structures compressing a nerve root, and restoration of lasting, normal spinal function. Some patients are candidates for minimally invasive spinal surgery to relieve severe symptoms.
Spinal tumors may develop anywhere along the spine and vary in size, origin, and severity. They may be benign or cancerous. Primary spinal tumors originate in the spinal cord or its linings, or in the vertebral bones spine, while metastatic tumors originate in another part of the body and spread to the spine. Symptoms of a spinal tumor include back or neck pain, often worse at night. Weakness or numbness in the legs, arms, or chest may also indicate a spinal tumor. Occasionally, bowel or bladder incontinence may signal a tumor. Diagnosis is usually the result of x-ray, CT scan, MRI, PET scan, or bone scan. Depending on many variables, including tumor type, symptoms, and a person’s age and general health, treatment of spinal tumors may include close follow-up with monitoring CT or MRI studies, medication to reduce inflammation, surgery, radiation, or chemotherapy.
Vertebral compression fractures occur when one or more vertebra in the spine break, often in the lower back. The most common cause is osteoporosis, but a car accident, fall, or other condition can also be at fault. Common symptoms include pain in the back or neck that may also be felt in the hip, leg, or abdomen. Pain may come on suddenly or develop over time. Weakness, tingling, or numbness may be experienced if the fracture leads to nerve compression. In some cases, the sufferer may experience bowel or bladder dysfunction. A person with vertebral compression fractures due to osteoporosis may experience height loss or have a stooped-over appearance. Diagnosis is usually made by x-ray, CT scan, or MRI. Many fractures heal on their own. Typical treatments consist of pain medication, muscle relaxants, rest, carefully directed exercises, or a back brace. Patients with osteoporosis or osteopenia are encouraged to ensure adequate intake of calcium and vitamin D, and patients with osteoporosis may have other medication recommended. A procedure called kyphoplasty may be recommended. This involves the insertion of a small catheter into the partially collapsed vertebral bone, and then restoring the height of the collapse bone by inflating with fluid a special balloon inserted through the catheter. After removal of the balloon, the opened space is then filled with bone cement. In rare cases, a larger surgery may be indicated to stabilize the spine or reduce pressure upon the spinal cord.