Medical Conditions
Idioms such as ‘to show some backbone’, ‘to have someone’s back’ or ‘a pat on the back’ show just how important the spine for people. The spine is symbolic of walking upright and evolutionary progress. It is also a point of reference for negative feelings when, for example, you ‘have someone breathing down your neck’ or ‘a weight on your shoulders’. For many people, back symptoms mean less enjoyment of life and restrictions on every day activities. Back disorders are often associated with pain and in more severe cases with sensory or motor deficits such as neurological disorders or paralysis. We would like to give you a brief overview of the most common diseases of the spine. This information is not comprehensive, however. It cannot and should not replace a personal discussion with your treating doctor.
Common Diseases and Symptoms of the Spine
Lumbago in specialist medical language is described as acute, sudden onset pain in the lumbar spine. This pain attack usually resolves itself after a short period.
Neurogenic claudication refers to a pain-related limping walk and often means that those affected cannot walk as far. It is caused by a narrowing of the spinal canal in the lumbar spine or lower back (lumbar spinal stenosis) which leads to irritation of the nerves. Characteristic of lumbar spinal stenosis and consequently also for neurogenic claudication is that the symptoms improve with forward bending postures such as when walking uphill or riding a bicycle. Another form of claudication is intermittent claudication, which, although it also leads to pain in the legs and limping, is caused by peripheral arterial occlusive disease (PAOD). These two medical conditions should be differentiated from one another so that the right therapy can be selected.
Radicular pain is pain that starts from inflamed or compressed nerve roots on the spine, caused by disc herniation, for example, but which radiates out to the limbs. In some cases the pain in the areas supplied by the particular nerves is even worse than at the inflamed site itself. Neurological deficits such as numbness in the legs or functional disorders such as paralysis may also develop.
The external fibrous ring of the disc can become brittle or torn, meaning that it can no longer adequately contain the gel-like core. If the disc is overloaded because of excess weight, long periods spent sitting or lifting heavy loads, the gel-like core can bulge outwards (disc protrusion). If it escapes the fibrous ring, this leads to disc herniation (disc prolapse). The disc tissue that escapes then presses on the spinal cord and can cause pain or motor and/or sensory deficits.
Spinal canal stenosis describes a narrowing of the spinal canal which places pressure on the spinal cord. This narrowing can have different causes such as disc herniation, spondylolisthesis or cancer.
Spinal canal stenosis is often experienced as pain. Many patients report that their symptoms improve when they bend forwards, such as when riding a bicycle or when shopping if they lean on the shopping trolley. The forward bending increases the distance between the spinous processes which relieves the pressure on the compressed nerve fibres. If the stenosis is severe, neurological disorders may also develop.
So that the spine can support the body and still remain flexible, it is made up of individual vertebral bodies. The vertebral bodies are stacked vertically on top of one another, like the links in a chain. With spondylolisthesis, a vertebral body slips out of this organised structure. It usually slips a little forward towards the abdominal wall. Spondylolisthesis can be congenital or may be the result of wear or injury. Spondylolisthesis does not always cause problems but it is often associated with back pain. In some cases the vertebral body slips so far forwards that it compresses or even squashes the nerves.
Spinal deformities are general malformations and abnormal curves of the spine. These deformities can be a kyphotic deformity, or round back, a lordotic deformity, when the spine curves inward too much such as that seen with saddle back, scoliosis or combinations of these. The individual manifestations can in turn be divided into different forms and described by different causes.
If you look at the spine from the back, it normally runs straight from the head to the pelvis. With scoliosis, however, there are one or more curves with the spine curving to the side and in some cases it is twisted on itself. This reduces mobility. Why such a curve develops in children is not known in many cases. In adults scoliosis is caused by degeneration of the discs. Mild scoliosis is often not noticed at all. If the curve increases, however, the shoulders and pelvis appear crooked. A pronounced curve to the side stresses the spine and can lead to signs of wear and therefore to back pain.
The individual vertebrae in the spinal column are made up of the vertebral body, the spinous process and the vertebral arch. Like all other bones in the body, these structures can also break (fracture) – whether due to a fall or an accident or as bone density decreases with age (osteoporosis or thinning bones). Bone fractures can heal again. Only if the fracture is unstable can parts of the bone or bone splinters jeopardise the spinal cord or the nerves.
The posterior longitudinal ligament is located in the spinal canal and is attached to the back of the vertebral bodies and the discs. It restricts forward bending of the spine and stabilises the spine together with the anterior longitudinal ligament, which runs along the front of the vertebral bodies. If the posterior longitudinal ligament ossifies it can cause pain, restricted movement and narrowing or spinal canal stenosis.
As a result of excessive mechanical strain, such as caused by long periods spent standing or sitting and a lack of movement or even deformities such as scoliosis, degenerative changes can develop on the vertebral body endplates. The cartilage and bone tissue becomes hard and bony growths (spondylophytes) form on the endplates. This can lead to progressive degeneration, disc herniation, deformities or stenosis.
If a fracture or surgical separation of bones does not fully heal after 6 months but instead remains mobile, this is called pseudoarthrosis. Along with an unnatural movement, persistent pain and restricted mobility can also develop.
Spondylodiscitis is an inflammation of the vertebral bodies and discs, usually caused by bacteria. If only the vertebral bodies are affected, this is referred to as spondylitis. The most common pathogen is the bacterium Staphylococcus aureus. Along with acute back pain, the pain can also radiate to the stomach or hips. If the inflammation is not treated, the infection can spread to the spinal cord and the brain or throughout the bloodstream, leading to meningitis or blood poisoning.
The sacroiliac joints (SIJ) connect the upper and lower halves of the body. More precisely, these joints connect the iliac bone, the largest part of the pelvis, with the sacral bone. The sacral bone forms the base of the spine. The entire weight of the upper body rests on this bone. Although the sacroiliac joints are true joints, they have little movement because the pelvis is surrounded by strong ligaments. Nevertheless, the sacroiliac joints, like all other joints, can cause pain and other problems: the joint surfaces can wear, become inflamed or painfully frozen (SIJ syndrome).
The facet joints are small joints that are located between the joint processes on the vertebral arch of neighbouring vertebrae and are responsible for the movement of the spinal column. If these joints become worn because of degenerative processes, it can cause pain known as facet syndrome.
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