Degenerative back diseases
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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There are many types of degenerative diseases that affect the back.
Degenerative joint disease occurs when joints begin to wear and tear. The spine consists of vertebrae that sit on top of each other. Vertebrae are separated from each other by rubbery discs in the front and true joints- facet joints- in the back.
Discs serve a cushioning and shock absorbing function while the facet joints permit the twisting rotation movements. Facet joints allow movement of the spine.
As facet cartilage deteriorates, osteoarthritis develops.
In degenerative joint disease (also called osteoarthritis), the shiny, smooth cartilage that lines the joint wears away, leaving bone rubbing against bone.
Degeneration of the rubbery discs and joints in the spine is called spondylosis.
Spondylosis can be noted on x-rays of the spine as a narrowing of the disc space between the vertebrae. It is deterioration of disc tissue that predisposes the disc to herniation and localized lumbar pain in patients.
Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized pain. The degenerative back pain is treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.
Another degenerative back problem is disc herniation.
Disk herniation occurs when a spinal disk begins to bulge. Herniated or ruptured disks are a common cause of chronic lower back pain in adults. Torn or bulging disks can compress the spinal cord or nerves leaving the back.
Disc bulge or protrusion results when the disc bulges out from between two vertebrae without rupturing its surrounding capsule, the annulus fibrosis.
Disc prolapse or extrusion results when the inner jelly-like central part of the disc (nucleus pulposis), leaks into the outermost fibers of the surrounding envelope, the annulus fibrosis.
A herniated disc can cause compression against a nerve, producing radicular pain.
Radicular pain is also called sciatica. The pain may radiate into the buttock or down the leg, and may be accompanied by a sensation of numbness or tingling in the leg.
A common degenerative spine disorder is spinal stenosis.
Narrowing (stenosis) of the spinal canal is caused by calcium build-up in ligaments, degenerative joint disease or disk disease. Any of these problems alone or in combination can lead to pressure on the spinal cord or a nearby nerve, causing pain. Many conditions can cause spinal stenosis and these include infection, tumors, trauma, herniated disc, arthritis, thickening of ligaments, growth of bone spurs, and disc degeneration.
Spinal stenosis occurs as intervertebral discs lose moisture and volume with age, which decreases disc space height but may cause increased disc diameter.
This causes pressure on the sciatic nerve roots and cord before their exit from the foramina. It may mimic vascular disease by simulating intermittent claudication. The disorder occurs in middle-aged or elderly patients.
Spondylolisthesis is a relatively common condition in which one vertebra slides forward on another. It may result from a number of causes, including trauma to the spine or osteoarthritis (wear and tear) of the spine, or it may have been acquired from birth. When fracture in the bones at the back of the vertebrae is also present, the condition is called spondylolysis. In both situations, the spinal cord or nerves leaving the cord can be compressed, causing pain in the back or legs.
It may be asymptomatic or there may be back pain and stiffness. Treatment depends on the severity of the condition and the symptoms. This may range from simple exercises and physical therapy to spinal fusion to stabilize the spine.
Sciatica is due to inflammation of the sciatic nerve. Pain is experienced along the sciatic nerve, from the lower back down through the buttocks and along the back of the leg.
It may occur with or without lower back pain. It is most commonly caused by peripheral nerve root compression from intervertebral disk protrusion.
Compression may due to disk protrusion, tumor, or bony abnormalities (eg, osteoarthritis, spondylolisthesis). The nerves can also be compressed outside the vertebral column, in the pelvis or buttocks.
By itself, osteoporosis is painless, but it increases the risk of fracture of the hip, wrist and vertebrae. The fracture itself or the resulting abnormal curvature of the spine or pressure on nerves may be a source of pain.
In osteoporosis, a disease that commonly affects postmenopausal women leads to fragile bones. Although osteoporosis, by itself, doesn’t cause pain, it increases the risk of fracture. Vertebral fractures may be extremely painful and debilitating.
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