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Your Spine/Back

Anatomy of the Spine

The normal anatomy of the spine is usually described by dividing up the spine into three major sections: the cervical, the thoracic and the lumbar spine. Below the lumbar spine is a bone called the sacrum, which is part of the pelvis.

Each section is made up of individual bones called vertebrae. There are seven cervical vertebrae, 12 thoracic vertebrae, and five lumbar vertebrae.

An individual vertebra is made up of several parts. The body of the vertebra is the primary area of weight bearing and provides a resting place for the fibrous discs that separate each of the vertebrae. The lamina covers the spinal canal, the large hole in the center of the vertebra through which the spinal nerves pass. The spinous process is the bone you can feel when running your hands down your back. The paired transverse processes are oriented 90 degrees to the spinous process and provide attachment for back muscles.

There are four facet joints associated with each vertebra. A pair that face upward and another pair that face downward. These interlock with the adjacent vertebrae and provide stability to the spine.

The vertebrae are separated by intervertebral discs that act as cushions between the bones. Each disc is made up of two parts. The hard, tough outer layer called the annulus surrounds a mushy, moist center termed the nucleus. When a disc herniates or ruptures, the soft nucleus spurts out through a tear in the annulus, and can compress a nerve root. The nucleus can squirt out on either side of the disc or in some cases both sides. The amount of pain associated with a disc rupture often depends upon the amount of nucleus that breaks through the annulus, and whether it compresses a nerve. To help alleviate the pain, a laminotomy/microdiscetomy may be performed.

Herniated discs

To alleviate the pain of a ruptured or herniated intervetebral disc (see Spinal Anatomy), a laminotomy/microdiscetomy may be performed. This surgical procedure is carried out in two steps beginning with the laminotomy. Lamina is the Latin name given to the bone protecting the spinal canal, and otomy means opening or hole. The laminotomy simply opens up the spinal canal in order to visualize the pinched nerve root.

Once this is accomplished, the second procedure, the microdiscetomy, is performed. A high powered stereoscopic microscope is used to provide illumination and magnification to allow the nerve and surrounding structures to be visualized clearly through an incision less than one inch long. The nerve root is carefully protected with a specialized retractor, and protruding disc fragments, along with any remaining loose or degenerated disc material, are then removed. The small hole left in the annulus will regenerate in four to six weeks and fill in with new disc material.

Osteoporosis

Detection with Bone Mineral Density Testing

There has been much recognition of osteoporosis as a women's health problem, but five million American men are also affected. Even teenagers are not immune, particularly girls. Osteoporosis causes the bones to weaken and fracture under the slightest stress. If detected early, it can be prevented and treated before significant bone loss occurs. Bone tissue can be affected by age, heredity, unhealthy habits, diet, sex hormones, physical inactivity and certain medications.

Osteoporosis can be a complication of any chronic disease involving the lungs, liver, kidneys, GI tract, hormones, and rheumatoid arthritis. Bone loss can occur as a result of long-term use of steroids, thyroid hormone, some anti-convulsant drugs and chemotherapies.

Low levels of sex hormones are the major cause of osteoporosis. Men with low testosterone levels can be treated with replacement therapy.

Women who complete menopause or suffer loss of menstrual periods should investigate the possibility of bone loss with a BMD test. The BMD test is quick, painless, similar to x-ray, and can predict fracture risk.

Unhealthy habits such as smoking and excessive alcohol intake are known risk factors. A regular regimen of improved physical activity, especially weight-bearing exercise or the use of resistance machines, can prevent or slow the inevitable loss of bone with aging.

It is important to tell your doctor if you detect any loss of height, have sudden back pain or suffer a fracture with little trauma. A medical workup would include a complete medical history, x-rays and blood and urine test. Your doctor can order a bone mineral density (BMD) test at OSC to detect low bone density.

Men and women who have risk factors should take calcium and, in some instances, Vitamin D, as a preventative measure. Additional treatments for osteoporosis now include calcitonin, which comes in a nasal spray, and bisphosphonate alendronate (Fosamax). Estrogen is the first line of defense against osteoporosis and the decision whether or not to take estrogen should be carefully considered with your doctor, who can recommend a specific program of treatment.

Scoliosis

What is Scoliosis? And How is it Treated?

Everyone's spine has curves. These curves produce the normal rounding of the shoulder and the sway of the lower back.

A spine with scoliosis has abnormal curves with a rotational deformity. This means that the spine turns on its axis like a corkscrew. Compare the more subtle curve of the normal spine to the severe curvature of the scoliotic spine.

Scoliosis is a curvature of the spine that may have its onset in infancy but is most frequently seen in adolescence. It is more common in females by a 2:1 ratio. However, when curves in excess of 30 degrees are evaluated, females are more frequently affected by a ration of approximately 8-10:1.

The cause of the most common form of scoliosis — idiopathic scoliosis — is unknown, but there are certainly hereditary factors that are present.

Scoliosis causes shoulder, trunk and waistline asymmetry. In mild forms, the condition may be barely noticed; whereas in severe forms there is significant disfigurement, back pain and postural fatigue, and it may be associated with heart failure. Fortunately the majority of scoliosis cases need only close follow-up to watch for worsening of the curve. Some cases require more aggressive treatment, which could include surgery.

Orthopedic surgeons are best qualified to evaluate and treat deforming spinal conditions like scoliosis. However, a good resource for further information is:

The National Scoliosis Foundation
5 Cabot Place
Stoughton, MA 02072
Phone: (617) 341-6333
Fax: (617) 341-8333
Email: scoliosis@aol.com

Non-Operative Treatment

The non-operative treatment of scoliosis involves observing the deformity with examinations and repeated x-rays. Under certain circumstances, when spinal growth remains, a brace may be used in combination with follow-up x-rays. Physical therapy exercises have not been shown to be effective treatment for scoliosis.

Why Surgery?

Surgical treatment of scoliosis may be indicated for any of the following reasons: To prevent further progression of the curve, to control the curve when brace treatment has failed, to improve an undesired cosmetic appearance or for reasons of discomfort or postural fatigue.

Surgical Treatment of Scoliosis

The most common surgical treatment for scoliosis is a spine fusion using special stainless steel rods, hooks, and a bone graft. The rods are attached to the spine with hooks and the curved portion of the spine is carefully straightened. Then, small strips of bone graft are placed over the spine to fuse it in a straight position. As the bone graft heals over the next several months, the spine becomes solid and will not curve again. But the part of the spine that has not been fused will still be flexible, and allow nearly normal overall movement.

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