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Twin Cities Spine Center treats an array of spinal conditions. To learn more about a particular disorder, click on the educational links below.
A burst fracture is caused by flexion and an axial load and has vertebral compression with a bony fragment in the spinal canal. In about 1/2 of the cases there is spinal cord damage with complete or partial paralysis.
Treatment:
The treatment depends on the presence of spinal cord damage and the amount of angulation (kyphosis) present.
These disorders are defined as abnormal vertebral development occurring prior to birth. These malformations may be classified in several ways including the area of the spine involved (cervical/neck, thoracic/mid back or lumbar/low back), the pattern of the deformity (scoliosis, kyphosis or lordosis) or the type of abnormal development.
Failures of a portion of the spine to divide into separate vertebrae or incomplete formation of the vertebrae are two major types of congenital spine deformities.
What causes these disorders?
Most deformities have no known cause and are called idiopathic. In rare cases it is an inherited disorder.
How are these deformities detected?
These disorders are often discovered when an x-ray is taken for other health concerns. Deformity may also be discovered because the patient has a head tilt, uneven shoulders, an uneven waistline or shoulders not centered above the pelvis.
Treatment:
Treatment depends on the kind of deformity, the severity of the disorder, the age of the patient and the potential for the deformity to worsen. Treatment includes observation for cure progression, bracing to slow curve progression or surgery (spinal fusion) to stop curve progression.
Back to topIntervertebral discs are cushions between the vertebrae. They act as shock absorbers that cushion the spine and allow the vertebrae to rock back and forth with motion. The discs are composed of a spongy center and a covering called the annulus. As a part of the normal aging process, the discs can degenerate. As this degeneration occurs, the disc becomes more susceptible to injury. These injuries may include tears to the annulus and/or bulging or herniation of the disc. All these injuries can compress nerves or nerve roots causing pain. This degeneration is most commonly found in the low back (lumbar spine) followed by the neck (cervical spine). However, DDD can occur in any area of the spine.
What are the symptoms of degenerative disc disease?
Symptoms include pain in the affected area of the spine or pain and/or numbness in the arms or legs depending on the affected area. DDD is diagnosed by physical examination and x-rays or other diagnostic tests.
Treatment:
Most patients find relief with non-surgical treatments. The most important of these is a program of physical therapy. Trunk strengthening exercises, which tone the back and abdominal muscles, can help support weakened spines and decrease pain. Good posture and body mechanics will help reduce pain and further degeneration of the spine. A physical therapist often helps patients begin a program, which can be continued at home. Braces are sometimes ordered to provide additional support and relief.
Non-steroidal anti-inflammatory drugs (NSAIDS), such as Ibuprofen, are helpful in pain reduction. Occasional mild narcotics may provide some relief. Occasionally patients receive steroid injections into the spine for pain relief.
Surgical options are available for patients who do not respond to non-surgical treatments. This may involve removal of the disc (discectomy), decompression of the nerves, or spinal fusion.
Back to topFractures of the spine may occur due to a fall from a height, a blow on the head or shoulders, (usually with the spine flexed), automobile accidents, or sports such as horseback riding or gymnastics.
Forcible flexion is the common injury, but flexion may be accompanied by compression bending or rotation.
Types of fractures include:
Compression Fracture:
Compression fractures of the vertebrae,involve a collapse of the vertebrae. One or more vertebra may be affected. Causes of these fractures may include osteoporosis (the most common cause), tumor or trauma to the back.
Seat Belt Fractures:
These fractures occur in an automobile accident with a lap seat belt and may involve either bone or ligament injury.
Fracture Dislocation:
Fracture dislocations occur with high force injuries of (auto accidents, falls) and are often accompanied by spinal cord damage and paralysis. In addition, there is severe bony injury with an unstable spine.
Burst Fracture:
A burst fracture involves compression of the vertebrae and the presence of bony fragments in the spinal canal. In about 1/2 of the cases there is spinal cord damage with complete or partial paralysis.
Treatment:
The treatment depends on the number of levels involved; the area of the spine involved the presence of spinal cord damage, the amount of angulation (_kyphosis_) present and the condition of the bone i.e. osteoporosis. Casting or bracing is used without cord damage and minimal kyphosis. Surgery is necessary when there is cord damage and/or for larger degrees of kyphosis. Surgical treatment involves spinal fusion which allows maximum cord recovery and aids rehabilitation.
Back to topIntervertebral discs are located between each vertebral body in the spine. They act as shock absorbers between each vertebra and allow a small amount of motion between any two vertebrae. Discs consist of two parts, a hard outer layer and a soft central core.
A tear or break in the outer layer may allow leakage of the soft central portion into the spinal canal causing irritation or pressure on the spinal cord or nerve roots at that level. This is called a disc herniation or ruptured disc.
Herniated discs can occur at any level in the spine but occur more frequently in the lumbar (low back) area. The next most common area is in the cervical (neck) spine region, followed by the thoracic (mid back) spine area.
What causes herniated discs?
A disc herniation can occur due to an injury. Discs can degenerate as a part of the normal aging process. As discs continue to degenerate they become more susceptible to injury.
What are the symptoms of a herniated disc?
Symptoms may include neck or back pain, arm or leg pain, arm or leg numbness, and/or loss of bowel or bladder control. The symptoms vary depending on the amount of herniation and the level in the spine where it occurs.
Treatment:
Most patients find relief from non-surgical treatments such as physical therapy, activity modification, and non-steroidal antiinflammatory medications. If the disc herniation is more severe, surgery may be required. A discectomy, where the portion of the disc compressing the nerve is removed, is the most common surgical procedure used to treat herniated disc.
Back to topKyphosis is defined as the backward bending of the spine. When this natural curve (primarily in the thoracic or midback area is increased and there are specific structural changes in the vertebrae this curvature may be diagnosed as Scheuermann’s Kyphosis. This disorder was named for the physician who recognized the wedging and irregular edges on the vertebrae.
What causes kyphosis?
As with other curvatures of the spine, the cause of this curvature is unknown. In some cases there may be a familial occurrence.
How is kyphosis detected?
This disorder can be detected by the visible presence of deformity, aching back pain or increased lumbar lordosis (swayback). The diagnosis is confirmed by obtaining an x-ray
Treatment:
Treatment is determined by the patient’s age, the severity of the curvature and the symptoms. Non-operative treatment may include bracing and physical therapy, in cases of more severe curvature or in adults, a spinal fusion is used to correct the curvature.
Back to topLordosis is defined as an increase of the normal inward curvature of the lumbar spine. It also may be referred to as swayback.
What causes lordosis?
As with other curvatures of the spine, the cause of this curvature is unknown. In some cases there may be a familial occurrence. In some cases a loss of lumbar lordosis may occur as a result of a failed spinal fusion.
How is lordosis detected?
This disorder can be detected by the visible presence of deformity, aching back pain or increased lumbar lordosis (swayback). The diagnosis is confirmed by obtaining an x-ray.
Treatment:
Treatment is determined by the patient’s age, the severity of the curvature and the symptoms. Non-operative treatment may include bracing and physical therapy, in cases of more severe curvature or in adults, a spinal fusion is used to correct the curvature.
Back to topRisk Factors:
Cause:
Unknown and can be related to ligaments, discs, joints, muscles or any combination. Disorders such as: Degenerative Disc Disease, Ankylosing Spondylitis, Herniated Disc, Lumbar Strain, Spondylolisis or Spinal
Treatment:
Goal of Treatment:
Continued low back pain which lasts longer than three months is diagnosed as chronic low back pain and is addressed differently than acute low back pain.
Emergency exam is needed for:
Treatment of unrelenting low back pain and changes in neurological function will be determined by the physician after clinical exam and diagnostic tests (x-rays, CT's, MRI's, labs) to determine the cause of the problem.
Surgery may be needed to treat the symptoms:
Seat Belt Fractures occur in an automobile accident with a lap seat belt and may involve either bone or ligament injury.
Fracture Dislocation:
Fracture dislocations occur with high force injuries of (auto accidents, falls) and are often accompanied by spinal cord damage and paralysis. In addition, there is severe bony injury with an unstable spine.
Treatment:
Treatment, which is usually surgical, fuses and stabilizes the spine to allow maximum cord recovery and aid rehabilitation.
Back to topYou need to know...:
Osteoporosis:
Goal:
Maximize the level of peak bone mass and minimize the rate of bone loss.
Bone is constantly being "remodeled". During the first 30-35 years of life bone is being built (formation) faster than it is being broken down (resorption). After this approximate age each person will reach their PEAK BONE MASS and the process will gradually start to reverse.
Know the Risk Factors:
Treatment:
How can YOU intervene?
A disorder named for the physician that recognized wedging and irregular edges of vertebrae on x-ray.
An increase in the "normal" thoracic kyphosis (20-50°) with the specific structural changes in the vertebrae is often referred to as Scheuermann's Kyphosis.
Cause:
Symptoms:
Treatment:
Determined by patient's age and severity of deformity and symptoms.
Non-operative - Milwaukee Brace
Operative - Spinal Fusion
What does the normal spine look like?
When looking directly at the back, the normal spine is in a straight alignment. When viewed from the side, the spine has three normal curves.
What is scoliosis?
When looking at the back, scoliosis is an abnormal side to side curvature of the spine. In a person with severe scoliosis, the spine can resemble and “S” or “C” shape.
Are there other abnormal curves of the spine?
What causes scoliosis?
Most curves, about 80%, have no known cause and are called idiopathic. Some curves are inherited while others are the result of an accident or disease. During the teenage years, scoliosis is more common in girls than boys.
How is scoliosis detected?
Treatment:
Treatment depends on the severity of the curve and the child's age. The earlier scoliosis is detected, the more treatment options are available. All changes from the normal spinal curves should be checked by a physician. Physical examination should include assessing the child's back and possible x-rays. There are currently three types of treatment for scoliosis.
Can scoliosis be prevented?
No, but early detection and treatment are important in preventing long term effects of scoliosis on other body systems. In 80-95% of scoliosis patients, surgery may be avoided if treatment is started when the abnormal spinal curve is small and while the child is still growing.
Do adults have scoliosis?
There are two types of scoliosis which occur in adults. Scoliosis can develop as a result of osteoporosis or arthritis, or it can begin after bone growth has stopped. More commonly, scoliosis begins in childhood but the curves continue to progress in adulthood, despite various treatments. Potential problems for adults with scoliosis include back pain, increased stress to the heart and disabling lung disease. Many adults undergo surgery to prevent further complications and deterioration of these body systems. Research studies are being conducted to study the cause of scoliosis and to find the best treatment approach.
Back to topSpinal stenosis refers to the narrowing of the spinal canal. This is most often a condition that develops as a person ages, although in rare circumstances it is present at birth. This condition can also be caused by arthritic changes, injury or surgery. Diagnosis of spinal stenosis is confirmed through testing such as MRI, CT scan or Myelogram.
What are the effects of spinal stenosis?
When the spinal canal becomes narrowed, the nerves which pass through can be compressed. This may cause them to become inflamed which can cause pain in the low back, or one or both legs. Symptoms may also include pain in the legs which occurs after walking and is relieved by rest and/or a feeling of coldness, weakness, numbness or cramping in the legs. The onset of these symptoms may be slow or sudden.
Treatment:
Treatment of this condition depends on the number of vertebrae involved, the amount of pain and the condition of the patient’s general health. Non-surgical treatments include use of the non-steroidal anti-inflammatory medication, physical therapy, spine education programs, rest and the application of ice. Epidural steroid injections into the epidural space of the spine may reduce inflammation and pain. Surgical treatment involves removing the bone compressing the spinal cord or nerves and allowing them to move freely. If this bone removal makes the spine less stable, a spinal fusion may be done to immobilize the area.
Back to topSpondylolisthesis is defined as the forward displacement of one vertebrae over another usually the fifth lumbar on the sacrum or the fourth lumbar vertebrae on the fifth. Symptoms may involve back or leg pain. Some people experience changes in their posture or gait pattern or changes in motion or sensation of the legs.
What causes spondylolisthesis?
A fracture, break or defect of the pars interarticularis, also known as spondylolysis often leads to spondylolisthesis. This defect may be present at birth, occur as the vertebrae develops, or as the result of degeneration or injury. This defect in the pars occurs in 5-8% of the population due to unknown causes.
Treatment:
What treatments are available for spondylolisthesis? Treatment depends on the amount of slippage, severity of symptoms and age at the time of diagnosis. Non-surgical treatments include activity modification, brace or cast application, physical therapy, non-steroidal anti-inflammatory medication and periodic monitoring of symptoms or slippage. Surgery may be indicated if there is no response to the non-surgical treatments, there is progressive or severe slippage, development of muscle weakness or changes in bowel or bladder function. Spinal fusion of the affected area is the most common surgery performed.
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