Compression Fracture
Compression fractures can occur in any vertebra (spinal bones) and is
described as a collapse of the vertebra.
Symptoms - The first symptom of a compression fracture ;may be sudden and severe
back pain that remains in one local area. Some persons may experience
numbness/tingling, or weakness in the arms or legs if the spinal cord
or nerves leading away from the fracture have been compressed. If multiple
fractures occur in an area of the back, the person will develop a forward
hump-like curvature to the back.
Causes - There are many possible causes of compression fractures. Car accidents,
falls, and weakening of the bone due to pathology (i.e. cancer), or Osteoporosis
are common.
Diagnosis - The diagnosis is based on observation of the aforementioned symptoms
and x-rays of the spine. Additional tests (i.e. bone scan, blood tests)
may be needed to diagnose the actual cause of the compression fracture.
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Cancer
If you have severe back pain, it is natural to wonder whether or not the
pain might be a sign of cancer. Tumors in the spinal column may cause
pain from expansion of the bone or from weakening the bone, which in turn
can result in spinal fractures, compression (pinching) of the nerves,
or spinal instability.
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Discitis
Discitis, or disc space infection, is an inflammatory lesion of the intervertebral
disc that occurs in adults but more commonly in children. Its cause has
been the subject of debate, although most authors believe it to be infectious.
The infection probably begins in one of the continguous end plates, and
the disc is infected secondarily. Severe back pain that begins insidiously
is characteristic of the disease.
Discitis in Children
Although most children will continue to walk in spite of the pain, young
children may refuse to ambulate. The characteristic finding is extension
of the spine and the child's complete refusal to flex the spine. Children
with discitis usually are not systemically ill. They rarely have an elevated
temperature and their white blood cell count is frequently normal. However
the erythrocyte sedimentation rate is usually increased. Lateral radiographs
of the spine usually will reveal disc space narrowing with erosion of
the vertebral end plates of the contiguous vertebrae. bone scanning may
be helpful in localizing a lesion that is difficult to diagnose clinically.
Some bone scans are falsely negative, so the diagnosis of disc space infection
should not be excluded simply because the bone scan is normal. Magnetic
resonance imaging (MRI) seems to be helpful in identifying a disc space
infection.
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Kyphosis
Kyphosis is the abnormal forward bending of the spine. In kyphosis, the
curve of the spine is abnormal, forming a hump.
What is going on in the body?
The normal spine rounds slightly in the chest area, with arching in the
lower back and neck regions. Excessive kyphosis can occur mainly in the
chest area of the spine, causing the roundness of the back to appear exaggerated.
What are the signs and symptoms of the condition?
Symptoms are usually minimal, unless the deformity is severe. In that case,
the back may ache or, rarely, nerve problems may arise. The hamstrings,
or muscles at the back of the thigh, may also be tight.
What are the causes and risks of the condition?
Kyphosis is generally caused by an abnormal posture. Other possible causes
include: · A significant fracture of the vertebra, which can cause
the back to angle forward · Spinal surgery · Scheuermann's
disease, which results in wedging of the vertebrae. This disease is usually
seen in teenage boys, and its cause is unknown. Pott's disease, which
refers to kyphosis due to collapse of the vertebra when tuberculosis infects
the spine · Osteoporosis in elderly women, which causes a type
of kyphosis known as Dowager's Hump · Spinal tumors, or surgery
to remove them · Nerve disorders.
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Lordosis
Lordosis is a disorder defined by an excessive inward curve of the spine.
It differs from the spine's normal curves at the cervical, thoracic,
and lumbar regions, which are, to a degree, either kyphotic or lordotic.
The spine's natural curves position the head over the pelvis and work
as shock absorbers to distribute mechanical stress during movement.
Lordosis can be found in all age groups. It primarily affects the lumbar
spine, but does occur in the neck (cervical). When found in the lumbar
spine, the patient may appear swayback, the buttocks more prominent, and
in general an exaggerated posture. A lumbar lordosis can be painful sometimes
affecting movement.
Certain disease processes can adversely affect the structural integrity
of the spine and contribute to lordosis. Some common causes include achondroplasia,
discitis, kyphosis, obesity, osteoporosis, and spondylolisthesis.
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Ligamentous Hypertrophy
Ligaments run up and down the spinal column. Hypertrophy of the ligaments
in the vertebral canal (the posterior longitudinal ligament -- runs up
and down along the back side of the vertebral bodies, and the ligamentum
flavum -- runs up and down under the posterior bone ring, made up of the
lamina and spinous process) can increase their mass enough that they narrow
the canal (stenosis) sometimes to the point that the spinal cord and/or
nerve roots running through the canal are compressed. When the posterior
longitudinal ligament in front and ligamentum flavum behind the spinal
cord hypertrophy the cord is almost "circumferentially" surrounded
and compressed.
Hypertrophy of the ligamentum flavum laterally near the facet joint can
also contribute to foraminal narrowing (stenosis) with potential nerve
compression (pinching).
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Obesity
According to the American Obesity Association (AOA)
, 64.5% of adult Americans (about 127 million) are categorized as being overweight
or obese. The unfortunate truth is that obesity is becoming a global epidemic
affecting adults and children.
Connection to Back Pain
Most people know that obesity contributes to the development of coronary
heart disease, diabetes, high blood pressure, and colon cancer. However,
did you know that obesity is a contributing factor to back pain? It is
true. Being overweight or obese can significantly contribute to symptoms
associated with osteoporosis, osteoarthritis (OA), rheumatoid arthritis
(RA), degenerative disc disease (DDD), spinal stenosis, and spondylolisthesis.
The spine is designed to carry the body's weight and distribute the
loads encountered during rest and activity. When excess weight is carried,
the spine is forced to assimilate the burden, which may lead to structural
compromise and damage (e.g. injury, sciatica).
One region of the spine that is most vulnerable to the effects of obesity
is the low back; the lumbar spine. Lack of exercise and bodily conditioning
leads to poor flexibility and weak muscles in the back, pelvis, and thighs.
This can increase the curve of the lower back causing the pelvis to tilt
too far forward. Further, this is detrimental to proper posture and as
posture weakens, other regions of the spine (neck) may become painful.
You may try to dismiss the cause of some of these spinal disorders to the
process of normal aging. It is true that with age body tissues can cause
changes to spinal anatomy. However, if you are overweight or obese, chances
are you have, or will have, back pain.
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Trauma
Trauma to the spine refers to injury that has occurred to bony elements,
soft tissues and/or neurological structures. The two things that surgeons
are most concerned about, in the case of spinal trauma, are instability
of the vertebral column and actual or potential neurological injury.
Stability to the spinal column can be compromised when bony elements are
injured or there is disruption to soft tissues such as ligaments. Instability
causes the back to become unable to successfully carry normal loads, which
can lead to permanent deformity, severe pain and in some cases catastrophic
neurological injuries. Most often the instability comes from a fracture
in one of the bony parts of the vertebra, specifically the vertebral body,
the lamina or the pedicles.
In the case of trauma, dislocations and fractures happen simultaneously
and can result in a very unstable spinal column. They can occur in any
region of the spine and are associated with a degree of neurological injury.
A surgeon needs to restore the mechanical stability of the spine to try
and prevent any more neurological injury, progressive deformity, or prolonged
incapacitating pain.
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Back pain in pregnancy
Introduction to back pain during pregnancy
For pregnant women, back pain during pregnancy is not a trivial matter.
If not addressed, it can have a negative impact on your daily lifestyle,
cause missed time from work, and make your delivery more difficult. Back
pain in the course of your pregnancy can also create problems that will
continue for an extended period after delivery.
Addressing back pain during pregnancy
While it is fairly common, back pain during pregnancy should definitely
not be accepted as just part of the process. To help make your pregnancy
as pleasant as possible and facilitate an easier delivery, back pain should
be always be addressed as quickly as possible and managed throughout your
pregnancy.
Low back pain of long duration (several weeks or months) during pregnancy
is a predictor for post partum back pain (pain after birth). For this
reason, pregnant women are encouraged to seek appropriate treatment for
back pain during pregnancy.
Likewise, any post partum pain that lasts longer than six to eight weeks
should be treated in order to avoid chronic or recurring back problems.
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Radiculopathy
Lumbar radiculopathy, which refers to pain in the lower extremities in
a dermatomal pattern. A dermatome is a specific area in the lower extremity
innervated by a specific lumbar nerve. This pain is caused by compression
of the roots of the spinal nerves in the lumbar region of the spine. Diagnosing
leg and back pain begins with a detailed patient history and examination.
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Scoliosis
Scoliosis is defined as a side-to-side deviation from the normal frontal
axis of the body. Although traditional, this definition is limited since
the deformity occurs in varying degrees in all three planes: back-front;
side-to-side; top-to-bottom. Scoliosis is a descriptive term and not a
diagnosis. As such, a search is made for the cause. In more than 80% of
the cases, a specific cause is not found and such cases are termed idiopathic,
i.e., of undetermined cause. This is particularly so among the type of
scoliosis seen in adolescent girls. Conditions known to cause spinal deformity
are congenital spinal column abnormalities, neurological disorders, genetic
conditions and a multitude of other causes. Scoliosis does not come from
carrying heavy things, athletic involvement, sleeping/standing postures,
or minor lower limb length inequality.
In managing AIS, the judgment of the surgeon and the participation of
informed patients and families are as important in determining treatment
outcome as surgical techniques. Decision-making in the management of AIS
remains complex despite the availability of data on natural history, prognosis
of different curve patterns, brace treatment factors, and surgical innovations.
The management of AIS includes several steps and treatment options:
· screening and early detection of deformity,
· observation of changes in deformity over time with informed judgment
regarding prognosis, orthotic and non-operative interventions,
· surgical planning and operating.
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Sciatica
This is a condition which causes pain down the back of one or both thighs.
Inflammation of the sciatic nerve (which is the largest nerve in the body-about
the diameter of your little finger) can be either constant or intermittent.
Success in solving this problem is directly correlated to the diagnosis.
Sciatica can be caused by a pinched nerve as it exits the low back spine,
or it can be caused by prostatic cancer. Odds are usually, that the cause
is some structural imbalance, but there are so many potential causes,
some serious and some benign, it is better to at least know that there
may be a grave cause to the symptoms.
This doesn't mean that you shouldn't immediately incorporate a
strategy to eliminate any structural imbalances. In most cases, this will
resolve the problem. If the problem doesn't respond to these basic
efforts, then professional assistance may be needed. The first effort
in relieving sciatic symptoms should be to review Hip Pain.
Trigger points can accumulate in the piriformis muscle forcing a contraction
and strangulation of the sciatic nerve. The tennis ball exercise should
be incorporated to help to relax the piriformis muscle. Stretching may
be beneficial, but that is more of a "try an see" exercise and
if there are no improvements with this approach, refer to Low Back Pain
to better understand the relationship between the sciatic nerve and the
low back spine. Seeking help from a chiropractor or orthopedist may be
indicated if the solution can't be found at home.
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