SPINE (BACKBONE)

The main purpose of spine is weight transmission and protect the spinal cord.

The spinal cord consists of:       

  • Bones ( Vertebrae)
  • Muscles and ligaments surrounding and connect the bones
  • Spinal cord containing the nerves which supply the whole body.

THE BONES (VERTEBRAE):

They form the basic structure of the spine. The vertebrae are separated by cushions (disc) which help in movements between the bones and also absorb shock.

The disc (cushion) is a jelly like structure (nucleus palposus) inside with a fibrous capsule (annulus fibrosus) to surround and encapsulate it inside.

The weight bearing and hence the pressure in disc increased as we go down in the spine. The pressure in the disc increases while leaning forward, lifting heavy weights, lateral bending and twisting movements of the spine. All this activities are hence to be avoided to protect the disc, and hence early degenerative changes of the spine.

The weight transmitting occurs through the disc in front and facets behind.

   

SPINAL CANAL:

It is the passage formed within the bones of spine (vertebral) to protect the spinal cord and cover it.

SPINAL CORD:

It is a sac containing the nerves to supply the whole of lower body. The most common

SPINAL PROBLEMS: 

  • Low Back Pain
  • Neck Pain (Cervical Spondylosis)
  • Disc Prolapse
  • Spinal Fractures

LOW BACK PAIN:

The most common complain of an orthopedic OPD. The causes of this can be classified into:

1)         Simple Back Strain:          
           
This generally follows a muscular activity like lifting heavy weight, bad posture and fall from a height.
The complains are for a short duration and usually respond well to rest and gradual back exercises.
Mostly seen in patients having bad posture causing Thoracic Kyphosis.

2)         Sudden Acute Backpain with Sciatica
            Young less than 20 years:     Infection
                                                            Spondylolisthiasis

20years - 40 years:     Acute disc prolapse – generally there is a positive history of heavy weight lifting, motor vehicular accident, fall from a height.

More than 40 years:              Osteoporotic compression fractures
                                                Metastatic bone disease.

 

3)         Intermittent Low Backpain after Exersion:
            Here the patient complains of low back pain on exercises and relief with rest. Past history of similar symptoms or acute sciatica.

           The causes can be:     

      • Facet Arthropathy
      • Disc Prolapse
      • Vertebral Instability
      • Ankylosing Spondylitis
      • Chronic Infection

 

4)         Back pain with Claudication:
The patient typically complains of low back pain. Patient can walk for sometime but later has to stop or sit to relieve the pain in both lower limbs. In later cases, patient may not be able to stand straight. He may also experience weakness in both lower limb, heaviness of legs or sensory deficit in form of tingling numbness.

These are features of canal stenosis

5)       Severe and constraint pain localized to a particular site:
                           
                         Spinal Fractures
                         Pagets Disease
                         Spinal Tumor
                         Infection

   

NECK PAIN:

The most common called as Cervical Spondylosis/ Computer Necks.

Cervical Spondylosis involves all abnormality arising from disc prolapse.

Stages of disc prolapse :

 

 

Normal disc.  
Increasing Protrusion of the disc and finally sequestrated.
 

Clinical features: 

Generally greater than 40years.
                               Chronic neck pain and stiffness
                               Worse in the morning.

This pain may radiate in one or both arms accompanied with numbness in the hands, weakness in the hands. It may be associated with giddiness.


MRI Showing disc prolapse
 

         

                                                                                                            

Treatment      : 
Analgesics (Pain Killers)

  • Heat Fomentation
  • Neck Exercises
  • Intermittent cervical traction
  • Collor - only in acute cases for a short time
  • Operation - It is indicated only when there is a deficit disc prolapse or excessive degenerative changes where in conservative line of treatment fails to give relief.                                

Operation in form of:

  • Laminectomy
  • Discectomy
  • Laminectomy with discectomy.
  • Discectomy with Spinal Fusion
  • Disc Replacements.
 

LUMBAR DISC PROLAPSE

Most common problem encountered in low back.

Clinical features:

Man greater than 50 years.
Complaining of heaviness, numbness, parasthesia, in thighs and legs after standing or walking for 5-10 minutes and relieved with sitting, squatting or leaning/stooping against a wall.                                                                          
  Patient prefers walking uphill than downhill.
                               

Treatment:    

  • Conservative in form of bedrest,
  • Gradual mobilization,
  • Back exercises,
  • Muscle relaxants and pain killers.   

Operation:     When conservative treatment fails operative treatment in form of

  • Microlumbar Discectomy,
  • Fenestrations,
  • Wide Laminectomy,
  • Disc Replacements.
  • Spinal fusion.

Text Box: Normal Lumbar spine
 
Text Box: Herniated Lumbar Disc
 

SPINAL FRACTURES.

Cause :   Following motor Vehicular accidents and Tumors.

Management:

If the fracture is causing less than 25% of vertebral compression, no neurological deficit,
and a stable spine is maintained and conservative treatment can be taken in form of
braces and bed rest.

If the spine become unstable or with neurological deficit like weakness or
numbness – surgical treatment is advised in form of screws ,  plates , rods  etc.

 

 

 

 

 

   
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