What are spine disorders?
Spine disorders include conditions such as acute and chronic low back pain, herniated disc, spondylolysis & spondylolisthesis (slipped vertebra), scoliosis, and stenosis.
Acute Low Back Pain is defined as low back pain present for up to six weeks. It may be experienced as aching, burning, stabbing, sharp or dull, well-defined, or vague. The intensity may range from mild to severe and may fluctuate. The pain may radiate into one or both buttocks or even into the thigh/hip area. Low back pain is considered chronic if it has been present for more than three months.
Herniated disc: The spine is made up of a series of connected bones called "vertebrae." The disc is a combination of strong connective tissues which hold one vertebra to the next and acts as a cushion between the vertebrae. The disc is made of a tough outer layer called the "annulus fibrosus" and a gel-like center called the "nucleus pulposus." As you get older, the center of the disc may start to lose water content, making the disc less effective as a cushion. This may cause a displacement of the disc's center (called a herniated or ruptured disc) through a crack in the outer layer. Most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist. A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling, or weakness of the leg called "sciatica." Sciatica affects about 1-2% of all people, usually between the ages of 30 and 50.
Spondylolysis & Spondylolisthesis: In about 5% of the adult population, there is a developmental crack in one of the vertebrae, usually at the point at which the lower (lumbar) part of the spine joins the tailbone (sacrum). It may develop as a stress fracture. Because of the constant forces the low back experiences, this fracture does not usually heal as normal bone. This type of fracture (called a spondylolysis) is simply a crack in part of the vertebra and may cause no problem at all. However, sometimes the cracked vertebra does slip forward over the vertebra below it. This is known as adult isthmic spondylolisthesis.
Stenosis: The vertebrae are the bones that make up the spine. The spinal canal runs through the vertebrae and, in the lower (or lumbar) spine, contains the nerves supplying sensation and strength to the legs. Between the vertebrae are the intervertebral discs and the spinal facet joints. The discs become less spongy and less fluid-filled with age. This can result in reduced disc height and bulging of the hardened disc into the spinal canal. The bones and ligaments of the spinal facet joints can thicken and enlarge (because of arthritis) also pushing into the spinal canal. These changes cause narrowing of the lumbar spinal canal which is known as spinal stenosis.
Scoliosis: Scoliosis refers to a curvature in the spine. Scoliosis curves can be C-shaped or S-shaped. Often times they go undetected since a scoliosis curve in many people is quite harmless and of no clinical consequence. They are painless and are not a cause of breathing problems or heart failure as is sometimes believed. Scoliosis begins in the early teens or younger, but the curve undergoes its greatest increase in size only during the growth spurt. The risk of it progressing after growth ends is uncommon and only of concern in certain situations1.
What are the available treatments for spinal disorders?
Nonsurgical treatments for spinal disorders include medications such as anti-inflammatory drugs, muscle relaxants, and narcotics, physical therapy, structured exercise programs, epidural and trigger-point injections, and surgery.
The spine program includes both surgeons and physiatrists, however currently the program is more focused on research involving surgery.
Some of the common surgery procedures for spinal disorders include:
Decompression
Decompression is simply to remove pressure. If a nerve or nerves are under pressure it may indicate a diagnosis of disc herniation or spinal stenosis. In decompression surgery, bone or soft tissue that may be pressing on the nerves is removed. Laminectomy is removal of bone, discectomy is removal of disc, and flavectomy is removal of ligamentum flavum. Partial removal of lamina (laminoplasty) is often possible which will maintain spinal stability and limit the need for a fusion.
Microdiscectomy
The discs are the cushions between each of the vertebrae. When a disc herniates it escapes from its normal position and will pinch the nerve next to it. Treatment removes that portion of the disc that is herniated in order to decompress that nerve. A small incision is needed and removal of a very small amount of bone required to see the nerve root and herniated disc. A microscope is used for magnification and light, allowing for a minimally invasive approach2.
Fusion
Occasionally back pain may be caused by an area of instability in the spine. Instability can be caused by spondylolisthesis, scoliosis, or advanced degeneration of a spinal level. Movement of this spinal level is painful and fusion will join these two vertebrae together in order to eliminate all movement. Often, a fusion in combination with a decompression is performed and rarely a fusion by itself. To help get the bones to fuse - rods, screws or cages are used with bone graft. Occasionally bone graft is taken from the hip or just locally from the area of the decompression.
Current Research Projects
The Spine research Program currently has a number of studies that fall into three broad categories: surgical predictors of outcome, patient predictors of outcome, and Investigational Device Exemption (IDE) studies. Whereas investigator-initiated studies focus on surgical and/or patient predictors of outcome and are funded either internally or externally with grant funding, IDE studies are industry-sponsored contracts for clinical trials that investigate new medical devices for use in spine surgery.
For many of the studies, the spine program utilizes the NEBH Spine Registry and the NEBH Spine Quality of Life (QOL) Registry. These registries contain information from physician and patients' self-report measures to provide a full picture of the patient's quality of life and well-being. These measures evaluate physical, social and emotional well-being using a range of standardized and validated tools. These databases allow for the generation and investigation of multiple research questions. Some of our current investigator-initiated studies focus on:
- Estimating the prevalence and risk factors of dural tears.
- Utility of EMG Threshold testing of pedicle screws during posterior instrumented lumbar spine surgery.
- Developing and validating a ct assessment system after lumbar fusion surgery
- A pilot trial to evaluate the impact of helping others on healing after spine surgery
- A study of changes in appraisal in spine patients before and after operative and nonoperative interventions
Some of our current IDE studies focus on:
- A device to repair anular tear
- A structural allograft ring for use in patients with degenerative cervical disc disease
- A comparison of the eXtreme Lateral Interbody Fusion (XLIF®) approach to other types of open anterior and/or posterior surgery
References
Spine.org - spine conditions and treatments. Consumer Health Spine Conditions And Treatments.
Accessed 6/19/2008.
Sunnybrook Health Sciences Center - Spine Program Web page. http://www.sunnybrook.ca/content/?page=2588.
Accessed 6/19/08.