Spine Conditions

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Intro to three spine conditions: scoliosis, herniated discs, cauda equina syndrome (CES)

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  • These statistics are from the ACA – American Chiropratic Association
  • In America, approximately 10% of women and 5% of men have scoliosis. It is unknown why scoliosis is more prevalent in females.Idiopathic scoliosis typically presents itself at ages 9 – 15, during the onset of puberty.The fourth classification is degenerative scoliosis also known as adult onset scoliosis, which is rare. It’s caused by a gradual deterioration of the facet joints in people over the age of 65.
  • Signs of scoliosis include uneven shoulders, uneven hips, and a curve in the spine. Scoliosis sometimes leads to low self-esteem and depression due to the irregular appearance of the spine.
  • Over time, the intervertebral discs can “dry out”. This means that the nucleus loses water and collagen while the annulus loses elasticity. In addition to drying out, excess pressure on the spine causes the disc to compress until it ruptures, leading to a bulged or herniated disc.
  • Improper posture and habitual incorrect body mechanics stress the lumbar and cervical regions of the spine. This affects the spine’s normal ability to carry the body's weight and results in pressure on the vertebrae measuring several hundred lbs per square inch.Car/sports accidents: Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury.Carrying extra body weight (especially in the stomach area) puts additional strain on the lower back. But being overweight often also means being in poor physical condition, with weaker muscles and less flexibility.Smoking cigarettes or using other forms of tobacco releases nicotine and additional toxins into the body, which can keep intervertebral discs from getting the proper oxygen and nutrients from blood that they need to stay healthy.Men are slightly more likely to develop herniated discs than women because of working in jobs that require heavy lifting, playing sports such as rugby, etc.
  • Medications are short-term pain relievers.NSAID’s such as naproxen, ibuprofen, aspirin. Opiods such as Percocet.Cortisone is injected into the space around the spinal cord to reduce the inflammation and swelling of the disc herniation, thereby relieving irritation of the adjacent nerves.Microdiscectomy uses a special microscope to view the disc and nerves. This view allows the surgeon to make a smaller cut, causing less damage to surrounding tissue. This procedure removes the part of the disc that is herniated and is pushing into the spinal canal.
  • CES is a neurological disorder that results from a spine condition, such as stenosis.Men are slightly more likely to develop CES because men are more prone to herniated discs. Mainly affects middle-aged people.Refers to the normal anatomy of the end of the spinal cord in the low back where it divides into many bundles of nerve tracts resembling a horse's tail. These nerves send and receive messages to and from the lower limbs and pelvic organs.
  • Difficult to diagnose because symptoms are similar to other spine conditions. Caudaequina syndrome most commonly results from a massive disc herniation in the lumbar region.Spinal stenosis - an abnormal narrowing of the spinal canalIschemia (iskeemia) - a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolismIt is caused by any condition that results in direct irritation or pinching of the nerves at the end of the spinal cord. These include abnormal growths (tumor or cancer) adjacent to the lower spinal cord, localized infection near the spinal cord (epidural abscess), and localized bleeding (epidural hematoma) causing pressure on the spinal cord in the low back.
  • Once the diagnosis of CES is made, and the etiology established, urgent surgery is usually the treatment of choice. The goal is to reverse the symptoms of neural dysfunction. Left untreated, CES can result in permanent paralysis and incontinence.Following surgery, drug therapy coupled with intermittent self-catheterization can help lead to slow, but steady recovery of bladder and bowel function.
  • Although some spine conditions are genetic and/or come with age, there are certain things you can do to decrease your risks for the developing the other types.
  • Spine Conditions

    1. 1. 07/22/13 Spine Conditions
    2. 2. Overview  Statistics  Scoliosis - description, treatments  Herniated disc - description, causes, treatments  Cauda Equina Syndrome - description, causes, treatments  Tips
    3. 3. Statistics  Back pain is the #1 cause of disability worldwide  Second most common reason for visits to the doctor’s office  About half of working Americans admit to BP per year  An estimated 80% of the population will experience BP at some point in their lives 80% of Americans exp. BP
    4. 4. Scoliosis: Description  Skoliosis (Greek) = obliquity, bending  Sideways abnormal curvature (S or C-shaped)  Occurs more often in females (Ratio = 2:1)  Classifications: Type Description Dist . Idiopathi c Unknown cause, genetic association (gene CHD7). Runs in families. 65% Congenit al Present at birth. Malformation typically occurs in utero (weeks 3 – 6). 15% Magnitude of curve (Cobb A
    5. 5. Scoliosis: Complications  While most cases are mild, severe scoliosis can be disabling.  Reduces the space within the chest, affecting lung function, thereby leading to difficulty in breathing. Also causes back & chest pain.  Heart damage: rib cage presses against heart  inefficient pumping
    6. 6. Scoliosis: Treatment  Depending on severity, an orthopedist will decide whether treatment is necessary (using an X-ray, MRI, or CT)  Treatments:Type Description Braces Angles of 20°-45° Only effective in young, growing patients and are meant to hold the spine in place. Prevents further progression of the curve. Surgery Angles of 45°-50° Spinal fusion connects two vertebrae together so they can’t move
    7. 7. Herniated Disc: Description  Between each vertebrae of the spine is a cushiony, fibrocartilage disc that serves as shock absorber for reducing impact from movements and lends flexibility to the spine.  A herniation occurs when the jelly-like material from the center of the disc (nucleus pulposus) squishes out from a tear in the tough outer ring (annulus fibrosus).
    8. 8. Herniated Disc: Causes / Risks  Occur mainly in cervical or lumbar regions  Causes are widespread: - age-related wear and tear (degeneration) - lifting heavy objects with back, not legs - back injuries (car and sports accidents) - being overweight
    9. 9. Herniated Disc: Treatments  Diagnosis: imaging tests and nerve tests  Treatments: Type Description Examples Medica tion Medication does not cure a herniated disc but can reduce inflammation & pain. NSAID’s, opioids Muscle relaxants Cortisone injections Anti- depressants Surger y Either the protruding portion is Microdisectom y Spinal fusion
    10. 10. Cauda Equina Syndrome (CES)  Cauda equina (Latin) = horse’s tail  Bundle of nerves in the lumbar spine  CES = compression of these nerves  Symptoms include: Symptom Description Bladder/bowel dysfunction Loss of control & weakness in muscles causing urinary / bowel retention and incontinence. Low back pain (LBP) Sharp, aching pain in the lumbar region Sciatica / Motor weakness Reduced sensation in lower limbs and impaired reflexes in extremities. Compressed sciatic nerve leads to pain in buttocks, legs, and feet.
    11. 11. Cauda Equina Syndrome (CES)  Causes: Compressive Non-compressive Massive disc herniation in L1– L5, S1–S2 Ischemia Spinal stenosis Infection or inflammatory condition Spinal neoplasm (tumor/cancer) Fracture (rare)
    12. 12. Cauda Equina Syndrome (CES)  Rare but serious condition  Requires emergency surgery (ASAP) - within 48 hours of onset of symptoms - decrease chance of permanent damage to nerves  Surgical decompression: - remove material pressing on nerves - reverse neural dysfunction  Post-op self-catheterization & drug therapy - recovery of bladder/sphincter function - if infection  antibiotics
    13. 13. Tips  Healthy diet  Don’t smoke  Exercise  Stretch, esp. prior to exercising  Proper posture  Use knees to lift heavy objects  Don’t ignore back pain, see a doctor
    14. 14. References  http://www.acatoday.org/level2_css.cfm?T1ID=13& T2ID=68  http://www.mayoclinic.com/health/scoliosis/DS0019 4/DSECTION=alternative-medicine  http://orthoinfo.aaos.org/topic.cfm?topic=a00534  http://www.mayoclinic.com/health/herniated- disk/DS00893/DSECTION=treatments-and-drugs  http://nemsi.uchc.edu/clinical_services/spine/back/c onditions.html#scoliosis  http://www.spine-health.com/conditions/lower-back- pain/cauda-equina-syndrome  http://www.aans.org/en/Patient%20Information/Con

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