07/22/13

Spine Condition

s

Overview Statistics Scoliosis - description, treatments Herniated disc - description, causes, treatments Cauda Equina Syndrome - description, causes, treatments Tips

Statistics Back pain is the #1

cause of disability worldwide

Second most common reason for visits to the doctor’s office

About half of working Americans admit to BP per year

Most cases of back pain are mechanical

An estimated 80% of the population will experience BP at some point in their lives

80% of Americans exp. BP

Scoliosis: Description

Skoliosis (Greek) = obliquity, bending Sideways abnormal curvature (S or C-

shaped) Occurs more often in females (Ratio =

2:1) Classifications:

Type Description Dist.

Idiopathic

Unknown cause, genetic association (gene CHD7). Runs in families.

65%

Congenital

Present at birth. Malformation typically occurs in utero (weeks 3 – 6).

15%

Secondary

Result of a neuromuscular condition (e.g. cerebral palsy). Typically occurs during adolescent growth spurt.

10%

Magnitude of curve (Cobb Angle)

Scoliosis: Complications

While most cases are mild, severe scoliosis can be disabling.

Reduces the space within the chest, affecting lung function, thereby leading to difficulty in breathing. Also causes back & chest pain.

Heart damage: rib cage presses against heart inefficient pumping

Scoliosis: Treatment Depending on severity, an orthopedist

will decide whether treatment is necessary (using an X-ray, MRI, or CT)

Treatments:Type Description

Braces

Angles of 20°-45°

Only effective in young, growing patients and are meant to hold the spine in place. Prevents further progression of the curve.

Surgery

Angles of 45°-50°

Spinal fusion connects two vertebrae together so they can’t move independently. Uses metal rods and screws to hold the spine straight.

Herniated Disc: Description

Between each vertebrae of the spine is a cushiony, fibrocartilage disc that serves as shock absorber for reducing impact from movements and lends flexibility to the spine.

A herniation occurs when the jelly-like material from the center of the disc (nucleus pulposus) squishes out from a tear in the tough outer ring (annulus fibrosus).

May create pressure against one or more of the spinal nerves numbness/tingling (paresthesia), pain or weakness in the area of the body to which the nerve travels.

Herniated Disc: Causes / Risks

Occur mainly in cervical or lumbar regions

Causes are widespread: - age-related wear and tear (degeneration) - lifting heavy objects with back, not legs - back injuries (car and sports accidents) - being overweight - sedentary lifestyle - improper posture - smoking (2.7X more likely)

Herniated Disc: Treatments

Diagnosis: imaging tests and nerve tests Treatments:

Type Description

Examples

Medication

Medication does not cure a herniated disc but can reduce inflammation & pain.

NSAID’s, opioids Muscle relaxants

Cortisone injections Anti-depressants

Surgery

Either the protruding portion is removed or the entire disc is removed depending on severity.

Microdisectomy

Spinal fusion

Artificial disc replacement (ADR)

Cauda Equina Syndrome (CES)

Cauda equina (Latin) = horse’s tail Bundle of nerves in the lumbar spine CES = compression of these nerves Symptoms include:

Symptom Description

Bladder/bowel dysfunction

Loss of control & weakness in muscles causing urinary / bowel retention and incontinence.

Low back pain (LBP)

Sharp, aching pain in the lumbar region

Sciatica / Motor weakness

Reduced sensation in lower limbs and impaired reflexes in extremities. Compressed sciatic nerve leads to pain in buttocks, legs, and feet.

Paralysis If symptoms are ignored, permanent loss of sensation could result paraplegia, sexual dysfunction, etc.

Cauda Equina Syndrome (CES)

Causes:Compressive Non-compressive

Massive disc herniation in L1–L5, S1–S2

Ischemia

Spinal stenosis Infection or inflammatory condition

Spinal neoplasm (tumor/cancer)

Fracture (rare)

Cauda Equina Syndrome (CES)

Rare but serious condition Requires emergency surgery (ASAP) - within 48 hours of onset of symptoms - decrease chance of permanent damage to nerves Surgical decompression: - remove material pressing on nerves - reverse neural dysfunction Post-op self-catheterization & drug therapy - recovery of bladder/sphincter function - if infection antibiotics

Tips Healthy diet Don’t smoke Exercise Stretch, esp. prior to exercising Proper posture Use knees to lift heavy objects Don’t ignore back pain, see a doctor

References http://www.acatoday.org/level2_css.cfm?T1ID=

13&T2ID=68 http://www.mayoclinic.com/health/scoliosis/DS

00194/DSECTION=alternative-medicine http://orthoinfo.aaos.org/topic.cfm?topic=a005

34 http://www.mayoclinic.com/health/herniated-di

sk/DS00893/DSECTION=treatments-and-drugs http://

nemsi.uchc.edu/clinical_services/spine/back/conditions.html#scoliosis

http://www.spine-health.com/conditions/lower-back-pain/cauda-equina-syndrome

http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Cauda%20Equina%20Syndrome.aspx

http://www.columbianeurosurgery.org/conditions/cauda-equina-syndrome/