Back problems: By Dr Harold Gunatillake
Web Site:www.Doctorharold.com
Transcript:
There is no human being having not experienced back pain during one’s lifetime. Everybody gets one.
They may last for a few weeks and then subside and forget till you get the next bout.
So, some back problems get better by doing nothing, or temporizing measures like heat therapy, application of anti-inflammatory gels, physiotherapy, chiropracty, herbal therapy, yoga and so on. Some get better with such temporizing measures, but others unfortunately need surgical invention for relief.
Most back aches are due to strains of the soft tissues in your back, caused by straining your ligaments, or and muscles columns called erector-spinae muscles, that supports and give stability to your back. Doctors label them as ‘Lumbo-sacral strains in the lower back
Temporizing measures mentioned are sufficient, in such soft tissue strains.
With age, some people get chronic backaches due to degeneration of intervertebral discs that cushion the bones, or the bones themselves undergoing softening referred to as osteoporosis.
The spine or the vertebral column usually consists of 33 vertebrae, placed in series, and connected by ligaments and intervertebral discs.
There are 7 neck or cervical bones that can move in all directions, on top of chest or thoracic bones that form a fixed cage with the ribs and the sternum in front, which protects your internal organs such as the heart lungs, wind pipes, gullet and so on.
Then in your lower spine -the lumbar region there are five bones, quite strong, solid, and mobile to move your torso in all directions. Good golfers seem to have a very mobile lower back.
These lumbar vertebrae are supported on 5 sacral bones that are not mobile.
So, the mobility for everyday functions are limited to the neck bones and lower back lumbar vertebral bones.
What are the common progressive lower back pains that need early attention by specialists?
As one ages, you may get severe backache due to softening or demineralization of the vertebra. This condition is referred as osteoporosis. This is more common among females due to hormone deficiencies or imbalance
In the United States, 10 million people have osteoporosis (80% of those are women), and 34 million are at risk for developing the disease due to low bone density. Osteoporosis is a public health issue because the disease contributes to 1.5 million fractures (broken bones), including 350,000 hip fractures annually.
It is known that if you were athletic during your school days, that favors to have strong bones right through your life.,
In most cases, they may not know they have osteoporosis until a complication, when the bones collapse with minor injuries related to a fall, bending, or twisting or even after a sneeze,
As the bones of the spine lose their mineralization and strength, they can collapse, causing a hunched-over appearance, often referred to as a “dowager hump.”
All women over the age of 65 who have risk factors must have bone density testing.
Spinal stenosis
This is a condition due to degenerative changes in the spine as one ages.
The spinal canal is about 14 mm in diameter. When it constricts to 12 mm due to bone growth resulting from degeneration of the vertebrae, will result in early spinal stenosis. As I said it is a natural process of aging and some may not get any symptoms at all.
As you get older as mentioned, the vertebral bones undergo a process of degeneration. This is called spondylosis.
In addition to narrowing of the spinal canal the opening in front of the vertebral joints called intervertebral foramen, also can get narrowed due to spurs projecting into the openings, causing pressure on the nerves arising from the spinal cord.
Such constrictions of the nerves give rise to pins and needles, or numbness in the periphery such as the lower limbs. Sometimes the shooting pain down the back of your lower limb is referred to as sciatica.
If the condition is progressive, meaning that your symptoms get worse, you need to see a spine specialist with much experience in the surgical procedures.
You need to have a CT scan of the spine to reveal degree of damage due to the degenerative changes.
Your specialist will decide whether you need minimal surgery or more involved surgery. He will also try cortisone injections into the areas of inflammation and that may give you temporary relief.
They are decompression of the stenosed area of the spine by carefully removing the degenerated bone growths that are causing the pressure on the spine. Also, you may need fusion of the spine with plates and screws.
If your back problem does not get better by palliative methods, you need to see a specialist early without delaying for years. Delay can cause damage to the nerve blood supply, and the operative procedures may not be successful.
Maintaining your body weight is important to prevent spinal stenosis.
Good posture in standing, walking, and sitting are important
If the spinal cord is involved due to stenosis of the canal is referred as myelopathy
Spine surgery is all about anatomy. Understanding of spine problems is all about understanding anatomy
5% are born with narrow spinal canal
Diameter of the spinal canal from front to back is 14mm. 12 cm or less, is relative spinal stenosis
When it is 10mm it is absolute spinal stenosis
In the cervical spine stenosis, it can occur in the canal or where the nerves come out of the foramina. Initially the hands may not work properly and may have trouble buttoning your shirt. Trouble in handwriting.
When the spinal cord is compressed in the cervical spine due to cervical spondylosis and disc degeneration, gives a different set of symptoms. You get numbness and tingling in the distribution of the nerve in the upper extremities.
In the lumbar region you can have weakness and numbness in your legs
Indications for surgery are:
Weakness is progressive and severe
Pain is significant and disabling
Loss of power of bladder control
Operation approach could be through front of the spine or back of the spine or side of the spine
Spondylolisthesis- This is a situation where the fourth lumbar vertebra slips over the 5th lumbar vertebra. This can cause pressure on the spinal cord and cause stenosis. In such a situation the surgeons fuse the two bones together to prevent further slipping.
Decompression takes pressure off the spine and may have a fusion if spine is unstable before or after operation
Conclusions:
If your symptoms are progressing with no relief from palliative methods described earlier, you need to see an orthopedic surgeon specialized in spine surgery
Hope this was useful,
Thank you and stay safe
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