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Spine Conditions

Annular Tears

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

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.

Central Cord Syndrome

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.


Radiculopathy is a symptom, rather than a condition in and of itself. Radicular pain is caused by compression or inflammation of a spinal nerve. The symptoms of radiculopathy include numbness, weakness or pain, often along a prescribed area that is dependent upon the area of spine and nerves affected. Symptoms may be worsened by certain activities, such as sitting or walking. Sciatica is a form of radiculopathy. Radiculopathy may be treated by rest, medication or surgery in some cases (discectomy).


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

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

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.

Tumors of the Spine

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.

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