Chennai Spine Foundation is a registered non-governmental organisation (NGO) and non-profit organization (NPO) to support and guide children and adult patients with spinal problems to access appropriate care for improved quality of life.
Low back pain is extremely common problem that most of us will experience at some point in their life time. About 8 in 10 people have one or more episodes of low back pain. In most cases, it is not due to a serious disease or serious back problem, and the exact cause of the pain is not clear. This is called nonspecific lower back pain. The usual advice is to keep active and do normal activities as much as possible. Painkillers can help until the pain eases. In most cases, the pain disappears within six weeks but may come back (recur) from time to time. Persistent (chronic) pain develops in some cases and further treatment may then be needed.
Low back pain symptoms range from sharp and stabbing to a dull ache. The pains can be constant or intermittent and positional. Acute low back pain can appear suddenly after injury.Most of low back pain resolves on its own and is often non-specific muscular origin from strain injury. A common cause of a sprain or strain is excessive physical demand on the spine’s ligaments or muscles due to combination of poor posture and prolonged sitting. Muscular back pain settles with course of physiotherapy concentrating on stretching and strengthening exercises for back muscles. Good posture care and ergonomics session will prevent recurrent episodes of muscular back ache.
Chronic low back often involves a disc problem, joint problem, or an irritated nerve root. Some ageing conditions that cause low back pain are Disc degeneration, Disc bulge, Disc Herniation (slipped disc), Sciatica, Spinal Stenosis (Spinal Canal Narrowing), Facet joint arthritis, Spondylolisthesis (Slipped Vertebra) and Sacroiliac Joint Dysfunction. If not treated on time, lower back pain can get severe affecting your daily living activities and quality of life.
Less common serious causes of back pain include infection (Spondylodiscitis), inflammation (Ankylosing Spondylitis, Rheumatoid arthritis), fracture, cauda equine syndrome and cancer (Primary/Metastasis) of the spine. There are symptoms and signs of back pain that indicate underlying serious spine condition. Knowing to spot those serious red flag symptoms will help early evaluation and treatment of the serious problem. Those red flag symptoms include constant and unrelenting back pain with any of following wide range symptoms and associated conditions
Some symptoms can come on suddenly while others can ramp up gradually. There are several conditions that can bring on these so-called red flags. Urgent spine specialist consultation is recommended if your back pain is of serious nature.
Your neck is made up of vertebrae that extend from the skull to the upper torso. Cervical discs absorb shock between the bones.
The bones, ligaments, and muscles of your neck support your head and allow for motion. Any abnormalities, inflammation, or injury can cause neck pain or stiffness.
Many people experience neck pain or stiffness occasionally. In many cases, it’s due to poor posture or overuse. Sometimes, neck pain is caused by injury from a fall, contact sports, or whiplash.
Most of the time, neck pain isn’t a serious condition and can be relieved within a few days. This is usually because of muscular strain due to activities and behaviors such as poor neck posture, working at a desk for too long with flexed head posture, sleeping with your neck in a bad position and jerking your neck during exercise. Good physiotherapy and neck posture care sessions are all needed to resolve acute attack and minimize recurrent episodes of neck pain.
But in some cases, neck pain can indicate serious illness and require a spine specialist care. If you have neck pain that continues for more than a week, is severe, or is accompanied by other red flag symptoms, seek specialist attention immediately. Red flag symptoms are indicators of underlying serious spine illness such as disc bulge, spinal canal stenosis, infection, fracture, cancer, and rheumatoid arthritis and birth anomalies. Those red flag symptoms include constant neck pain, pain that radiates down your arms or legs, numbness or weakness of arms or legs, inability to move your arms or hands, inability to touch your chin to your chest, bladder or bowel dysfunction, and difficulty in balancing.
A disc bulge or herniation refers to a problem with one of the rubbery shock absorbing cushions (discs) that sit between the individual bones (vertebrae) that stack to make your spine.
A spinal disc has a soft, jellylike center (nucleus) encased in a tougher, rubbery exterior (annulus). A bulging disc is a condition in which the nucleus (inner portion) of a spinal disc remains contained within the annulus fibrosus (outer portion), unlike a herniated disc in which the nucleus leaks out of the disc. Sometimes called a slipped disc or a ruptured disc, a herniated disk occurs when some of the nucleus pushes out through a tear in the annulus.
Most herniated disks occur in the lower back, although they can also occur in the neck. Signs and symptoms depend on where the disc is situated and whether the disc is pressing on a nerve. They usually affect one side of the body.
Natural history is that 70-80% of the disc herniation symptoms will resolve spontaneously in 6-12 weeks with non-operative treatment. Only those who have persistent symptoms beyond 2-3 months affecting their daily activities and quality of life will need disc removal surgery. Disc removal surgery (Discectomy) can be done as minimally invasive surgery with microscope or endoscope.
Any degeneration of the vertebrae or disc, trauma, or fracture can cause spondylolisthesis. This occurs when one of the spinal bones (vertebra) slips forward onto the bone directly beneath it (falling out of alignment). Ageing related degenerative spondylolysthesis usually happens in the lower (lumbar) spine.
Symptoms of Slipped Vertebrae can include persistent lower back pain, lower back tenderness, and radiating pain to thigh/leg, leg heaviness on standing/walking, stiffness in the back or legs, or numbness/weakness of legs/feet. Depending on the severity of the slip, symptoms intensity can vary from mild to severe affecting daily activities of life. Early spine specialist consultation for prompt diagnosis can be useful as delay can complicate the condition. First line of treatment includes simple analgesics, brace, exercises and physiotherapy. If non-operative treatment fails then surgery in the form of spinal fusion will provide long term pain/symptom relief to improve the quality of life.
Lumbar spinal stenosis is a narrowing of the spinal canal or open spaces in the spine, compressing the nerves travelling through the lower back (lumbar spine) into the legs. While it may affect younger patients, due to developmental causes or disc bulge, it is more often an ageing related degenerative condition that affects people who are typically age 60 and older.
Narrowing of the spinal canal usually occurs slowly, over many years or decades. The discs become less spongy with aging, resulting in loss of disk height, and may cause bulging of the hardened disk into the spinal canal. Bone spurs may also occur and ligaments may thicken. All of these can contribute to narrowing of the central canal and may or may not produce symptoms. Symptoms may be due to inflammation, compression of the nerve(s) or both.
Cervical discs are the cushions between the vertebrae in the upper back and neck. Herniation of the disc occurs when the gelatinous inner disc material, the nucleus pulpous, ruptures, or herniates, through the outer cervical disc wall.The causes may be due to ageing related degeneration of the disc, genetic problems, tobacoo use, poor neck posture, any sudden jarring movement, or any sudden stress that can damage the disk. Cervical disc herniation is usually seen in 30- to 50-year-olds
Cervical disc herniation is a common cause of neck and upper body pain. Pain may feel dull or sharp in the neck, between the shoulder blades, and may radiate (travel) downward into the arms, hands and fingers. Sensations of numbness and tingling are typical symptoms, and some patients report muscle spasms. Certain positions and movement can aggravate and intensify pain. In some patients, a cervical herniated disc can cause spinal cord compression where disc material pushes on the spinal cord. This is a much more serious condition and may require a more prompt. Spinal cord compression symptoms include awkward or stumbling gait, difficulty with fine motor skills in the hands and arms, and tingling or “shock” type feelings down the torso or into the legs.
Natural history is that 70-80% of the disc herniation symptoms will resolve spontaneously in 6-12 weeks with non-operative treatment. Only those who have persistent symptoms beyond 2-3 months affecting their daily activities and quality of life will need disc removal surgery.
Cervical myelopathy is a neck condition that arises when the spinal cord in the cervical spine region (neck) becomes compressed—or squeeze. Most common cause is the wear-and-tear (degenerative) changes that occur in the spine as we age. These degenerative changes in the discs are often called arthritis or spondylosis. The degenerative cervical myelopathy condition commonly occurs in patients over the age of 50. There are other non-age related conditions that can cause cervical myelopathy and they include rheumatoid arthritis infection (TB/bacterial), cancer, injury (traumatic disc herniation) and spinal cord abnormality/tumors.
Because the spinal cord carries nerve impulses to many regions in the body, patients with cervical myelopathy can experience a wide variety of symptoms. Weakness and numbness in the hands and arms, loss of balance and coordination, and neck pain/stiffness can all result when the normal flow of nerve impulses through the spinal cord is interrupted. Typical symptoms include gait imbalance or clumsiness of hands i.e. loss of fine motor skills with difficulty in handwriting, buttoning clothes, picking up coins, or feeding yourself. Severe spinal cord compression can cause paralysis and loss of bladder/bowel control (incontinence).
Cervical myelopathy is a progressive condition and can get worst over time. Non-operative treatment is the first line management for condition with static symptoms. Decompressive cervical spine surgery is recommended for worsening symptoms or cases presenting with severe spinal cord compression. Timely decompressive surgery before the development of paralysis or bladder/bowel incontinence is beneficial.
A spinal cord injury is damage to the spinal cord. It’s an extremely serious type of physical trauma that’s likely to have a lasting and significant impact on most aspects of daily life. The spinal cord is a bundle of nerves and other tissue that the vertebrae of the spine contains and protects. The vertebrae are the bones stacked on top of each other that make up the spine. The spine contains many nerves, and extends from the brain’s base down the back, ending close to the buttocks. The spinal cord is responsible for sending messages from the brain to all parts of the body. It also sends messages from the body to the brain. We’re able to perceive pain and move our limbs because of messages sent through the spinal cord.
If the spinal cord sustains an injury, some or all of these impulses may not be able to “get through.” The result is a complete or total loss of sensation and mobility below the injury. A spinal cord injury closer to the neck (cervical spine) will typically cause paralysis of all four limbs (quadriplegia) and injury in the mid or lower back (thoracic or lumbar spine) will cause paralysis of lower limbs (paraplegia)
Spinal cord injuries are generally caused by a direct trauma, for example a fall down stairs, sporting injury or road traffic accident, where a force to the spine causes the bone to break and impacts on the spinal cord. Other conditions that can cause spinal cord injury include cancer, osteoporosis, spine/spinal cord tumours, infection, inflammation of spine/spinal cord, spinal stenosis (narrowing of spinal canal space) and blood clot in spinal canal (haematoma).
Everybody with a spinal cord injury will experience slightly different symptoms, depending on the part of the spine that been injured and common symptoms include:
Spinal cord injury can be complete or incomplete. People with a complete spinal cord injury cannot move or feel anything at or below the area where the trauma occurred. Those with an incomplete spinal cord injury may have some sensation and movement below the level of the injury. Research suggests that people with an incomplete spinal cord injury have a higher chance of recovering from a loss of motor and sensory function in the affected limbs than those with a complete spinal cord injury.
Treatment and recovery time depend on the type of spinal cord injury that the person has sustained. Surgery is a standard treatment for spinal cord injuries. Surgery may involve the removal of objects compressing the spinal cord nerves, such as herniated disks, fractured vertebrae, or bone fragments.
Timely surgical intervention in the form of decompression (relieve pressure off spinal cord) and stabilisation of the spine will provide best chance for the recovery. After a spinal cord injury and initial surgical/medical management, you’ll need spinal cord injury rehabilitation to optimize recovery and adapt to a new way of life.
A spinal infection is a rare, but often serious, form of disease that occurs when bacteria, fungi, or viruses invade the spinal tissues. These foreign agents can attack pretty much any part of the spine that you can image. This includes the vertebrae, spinal discs, spinal canal, meninges and even the spinal cord.
Spinal infections may arise spontaneously or as a secondary condition, such as after an invasive medical procedure. Infections in the spine may affect different structures, such as the vertebral column bones (Osteomyelitis),intervertebral disc space (Discitis) and the spinal canal (Epidural Abscess). Certain factors increase your risk of developing spinal infections. Those risk factors include
Tuberculous infection of spine (Potts Disease) is very common, usually haematogenous (through blood stream) spread from lungs or other site of infection. 15% of patients with TB will present with spine infection.
Spine infection will present as constant back pain with associated symptoms of fever, chills, rigor, cough or unexplained weight loss. Back pain can be severe and may not relieve with rest or lying. Night pain is indicator of serious spine infection. If infection is severe then damage tof spinal nerves and spinal cord can present with numbness /weakness of limbs, bowel/bladder incontinence or paralysis.
Early diagnosis and timely management is all what needed for complete cure or clearance of the spine infection. Identification of the organism is essential, and this can be accomplished through keyhole surgery or computed tomography-guided biopsy sampling of the vertebra or disc space. Blood cultures, preferably taken during a fever spike, can also help identify the pathogen involved in the spinal infection. Proper identification of the pathogen (organism or bacteria) is necessary to narrow the antibiotic treatment regimen.
Spinal infections often require long-term intravenous organism specific antibiotic or antifungal therapy to clear the infection. Surgery in the form of abscess drainage, debridement, decompression and stabilisation will be required if there is instability of spine and patient presents with neurological deficit.
Metastatic spinal tumors (cancer) are those that have spread to the spine from other areas of the body. If a tumor is able to spread, this usually means it is malignant. Between 30 and 70 percent of cancer patients develop metastatic spine cancer during the course of their disease. Lung, prostate, thyroid, kidney and breast cancers are the five most common cancers that tend to spread to the spine.
Metastatic spine cancer present as back or neck pain depending on which part of spine is affected. Mid back (Thoracic) region is the most common site. Back pain is constant and may not relieve with painkillers or rest. Night pain is indicator of serious spine problem. If cancer destroys the spinal/vertebral column then spinal nerves/roots and spinal cord can be under pressure and present as neurological problems including radiating pain down arms/legs, numbness/weakness of arms/legs, bowel/bladder incontinence or paralysis.
Timely diagnosis and treatment is needed to relieve pain, improve neurological function and quality of life. Treatment strategy for spinal cancer and spinal tumors will differ based on the tumor type, aggressiveness and many other factors. Management can be palliative or curative and is best devised through multi-disciplinary team approach involving oncologist, pathologist, radiotherapist and surgeon. Spine surgery in form of surgical decompression and stabilisation of spine is recommended in patients presenting with neurological deficit and instability of spine. Post spine surgery radiotherapy and chemotherapy will be recommended depending on cancer type.
Primary spinal tumors are those that originate in the spine. They are relatively rare, typically benign (noncancerous) and represent a small percentage of spinal tumors. Malignant tumors (Osteosarcoma, Ewings, Chondrosarcoma) may also originate in the spine but are extremely rare.
A primary spinal tumor is a serious issue and can cause pain, paralysis, or even neurological problems. Back pain is constant and may not relieve with painkillers or rest. Night pain is indicator of serious spine problem. If cancer destroys the spinal/vertebral column then spinal nerves/roots and spinal cord can be under pressure and present as neurological problems including radiating pain down arms/legs, numbness/weakness of arms/legs, bowel/bladder incontinence or paralysis.The condition if neglected can be even life-threatening too.
Timely diagnosis and treatment is needed to relieve pain, improve neurological function and quality of life. Treatment strategy for primary spinal tumous will differ based on the tumor type, aggressiveness and many other factors. Management is best devised through multi-disciplinary team approach involving oncologist, pathologist, radiotherapist and surgeon. Spine surgery can be palliative or curative and take form of excision of tumour, decompression/debulking, complete removal of tumor (enbloc, removal in toto), reconstruction and stabilisation. Pre or/ post spine surgery radiotherapy and chemotherapy will be recommended malignant spine cancer type.
This is rare spinal condition (syndrome) that happens when the nerve roots of the cauda equina (collection of nerves at the end of the spinal cord) are compressed. It can disrupt the sensory and motor functions of the lower extremities and bladder. These nerves send and receive messages to and from the pelvic organs and lower limbs. It’s a medical emergency that needs urgent spinal surgical intervention.
Exact symptoms and their severity depend on which nerve root(s) are affected and the degree to which they are compressed.
This condition is a serious medical condition and can lead to permanent paralysis and bowel/bladder incontinence if not timely managed. Timely surgical intervention (with in 24-48 hrs of onset of urinary symptoms) in the form of decompression and disc removal surgery gives best chance for neurological recovery.