DEGENERATIVE LUMBAR SPINE

DEGENERATIVE LUMBAR SPINE2019-01-15T15:38:51+00:00

Back pain is very common and normally improves within a few weeks or months. Pain in the lower back (lumbago) is particularly common, although it can be felt anywhere along the spine – from the neck down to the hips.

CAUSES OF BACK PAIN

Often it’s not possible to identify the cause of back pain. Doctors call this “non-specific” back pain. Sometimes the pain may be a result of an injury such as a sprain or strain, but often it occurs for no apparent reason. It’s very rarely caused by anything serious. Occasionally back pain can be due to a medical condition such as:

These conditions tend to cause additional symptoms – such as numbness, weakness or a tingling sensation – and they’re treated differently to non-specific back pain.

A slipped disc occurs when the circle of connective tissue surrounding the disc breaks down, allowing the soft, inner gel-like part of the disc to bulge out. The damaged disc can put pressure on the whole spinal cord or on a single nerve root, where a nerve leaves the spinal cord. This means a slipped disc can cause pain in the area of the protruding disc and also in the area of the body controlled by the nerve that the disc is pressing on.

It’s not always clear what causes a disc to break down, but age is a common factor in many cases. As you get older, your spinal discs start to lose their water content, making them less flexible and more likely to split (rupture). Smoking can also be associated with a slipped disc because it causes the discs to lose their natural flexibility.

Other factors that can put increased pressure and strain on your spine include:

bending awkwardly
heavy or awkward lifting
sitting for long periods, particularly when driving
being overweight or obese
weight-bearing sports, such as weightlifting
severely injuring your back, such as during a fall or car accident
These situations can weaken the disc tissue and sometimes lead to a slipped disc.

Sciatica is the name given to any sort of pain caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet. The pain of sciatica is usually felt in the buttocks and legs. Most people find it goes away naturally within a few weeks, although some cases can last for a year or more.

In the vast majority of cases sciatica is caused by a slipped disc. A slipped disc occurs when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves. It’s not always clear what causes the damage, although as you get older your discs become less flexible and more likely to rupture.

Less common causes include:

spinal stenosis – narrowing of the nerve passages in the spine
spondylolisthesis – when a vertebra slips out of position
a spinal injury or infection
a growth within the spine – such as a tumour
cauda equina syndrome – a rare but serious condition caused by compressed and damaged nerves in the spinal cord

Spinal stenosis is an abnormal narrowing (stenosis) of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. Symptoms include pain, numbness, paraesthesia, and loss of motor control. The location of the stenosis determines which area of the body is affected.

With spinal stenosis, the spinal canal is narrowed at the vertebral canal, which is a foramen between the vertebrae where the nerve roots pass through.

There are several types of spinal stenosis, with lumbar stenosis and cervical stenosis being the most frequent. While lumbar spinal stenosis is more common, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord whereas the lumbar spinal stenosis involves compression of the cauda equina.

Cauda equina syndrome (CES) is a serious neurologic condition in which damage to the cauda equina causes loss of function of the lumbar plexus (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord. CES is a lower motor neuron lesion.

Signs and symptoms

Severe back pain
Bladder and bowel dysfunction
Sciatica-type pain on one side or both sides, although pain may be wholly absent
Weakness of the muscles of the lower legs (often paraplegia)
Achilles (ankle) reflex absent on both sides
Sexual dysfunction
Absent anal reflex and bulbocavernosus reflex
Gait disturbance

Causes
After the conus medullaris, the canal contains a mass of nerves (the cauda equina or “horse-tail”) that branches off the lower end of the spinal cord and contains the nerve roots from L1-5 and S1-5. The nerve roots from L4-S4 join in the sacral plexus which affects the sciatic nerve, which travels caudally (toward the feet). Compression, trauma or other damage to this region of the spinal canal can result in cauda equina syndrome.

The symptoms may also appear as a temporary side-effect of a sacral extra-dural injection:

Tumors and lesions
Any lesion which compresses or disturbs the function of the cauda equina may disable the nerves although the most common is a central disc prolapse. Metastatic disease may also be a cause.

Trauma
Direct trauma can also cause cauda equina syndrome. Most common causes include iatrogenic lumbar punctures, burst fractures resulting in posterior migration of fragments of the vertebral body, severe disc herniations, spinal anaesthesia involving trauma from catheters and high local anaesthetic concentrations around the cauda equina, penetrating trauma such as knife wounds or ballistic trauma.

Spinal stenosis
CES can be caused by lumbar spinal stenosis, which is when the diameter of the spinal canal narrows. This could be the result of a degenerative process of the spine (such as osteoarthritis) or a developmental defect which is present at birth. In the most severe cases of spondylolisthesis cauda equina syndrome can result.

Inflammatory conditions
Chronic spinal inflammatory conditions such as Paget disease, neurosarcoidosis, chronic inflammatory demyelinating polyneuropathy, ankylosing spondylitis and chronic tuberculosis can cause it. This is due to the spinal canal narrowing that these kind of syndromes can produce.

Risk factors
No set risk factors have been clearly defined for CES at this point in time. Individuals most at risk for disc herniation are the most likely to develop CES. Race has little influence with the notable exception that African Americans appear slightly less likely to develop CES than other groups; similarly, men are slightly more likely to develop CES than women. Middle age also appears to be a notable risk factor, as those populations are more likely to develop a herniated disc; heavy lifting can also be inferred as a risk factor for CES.

For more information on the degenerative lumbar spine please do not hesitate to get in touch with Mr Torrie through our appointments page.

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