Spine Surgery

Spine Disorders

Spine Disorders

The spine is a complex structure of bones, nerves, cartilage and other tissues – and ripe for difficulties. The fibrous discs that separate the vertebral bones comprising the spinal column may deteriorate from age and wear. They may bulge or even extrude the gel-like material that makes up each vertebrae’s nucleus. The bones themselves may degenerate. The nerves that run through the spinal canal may become pinched. Although rare, tumors – benign or malignant – may develop within the spine. The key role of nerves that make up the spinal cord make the spine an area of concern for neurosurgeons. PRH’s neurosurgeons, with strong experience with minimally invasive, microsurgical techniques to restore or repair spinal problems, work closely with spine specialists in Orthopedics and interventional radiologists in Radiology-Imaging. Interventional radiologists use minimally invasive vertebroplasty and kyphoplasty techniques to reconstruct compressed discs.

Spine Disorders Overview:

Spine Anatomy

The spine consists of 33 bones called the vertebrae, stacked atop one another and separated by flat, round fibrous intervertebral discs that cushion them like shock absorbers. The discs, filled with jelly-like material called nucleus pulposus, are held in place by ligaments.

Lamina, or arch-like protrusions on each vertebra, form the hollow spinal column that houses and protects the spinal cord, the superhighway of the central nervous system that carries nerve impulses from the brain to the body’s diverse parts. At each vertebral level, nerves branch out from the spinal cord, carrying the signals that make the body function. Cerebrospinal fluid (CSF) circulates around the spinal cord, nourishing and protecting it.

Altogether, the spine encompasses seven cervical vertebrae (the neck), 12 thoracic vertebrae (upper back, behind the ribcage), five lumbar vertebrae (lower back), five sacral vertebrae (part of the pelvis, and fused together) and four coccyx vertebrae (also fused together to form the tailbone).

It’s estimated that 8 out of 10 Americans experience back problems at some point in their lives – and that most of them recover without any serious medical intervention. Muscle and ligament strains, even bulges and herniations in discs usually resolve themselves in a matter of days or weeks with a program of rest, pain-killing medications and perhaps rehabilitative exercise. A small percentage don’t, and necessitate intervention.

A Glossary of Spinal Disorders

  • Degenerative Disc Disease – Flexible, fibrous pads that account for about a quarter of the length of the spine, the intervertebral discs serve as shock absorbers for the vertebra. Aging and wear can lead to instability and inflammation of a disc. Effects can vary but can include narrowing of the discs, development of bone ridges on a vertebra and bulging or protrusions of a disc’s interior nucleus pulposus. While the vertebra can account for some back problems, a disc is far more likely to be a source of trouble.
  • Disc Herniation – When placed under undue stress, an intervertebral disc may rupture, or herniate, extruding its nucleus pulposus to the point that it presses against a nerve to cause pain. Herniation of a lumbar vertebra is often the source of the sharp, sciatic pain that shoots down a leg. In the cervical spine, a herniation may provoke dull or sharp pain in the neck, between the shoulder blades, or radiated down an arm to cause pain or tingling in the hand.

    Sometimes a stressed disc won’t herniate but will simply bulge – even then pressing against a nerve and stimulating pain. Most bulges and herniations diminish over a period of weeks but some extrusions assume a mushroom shape, with the head trapped outside the disc, requiring intervention.
  • Bone Spurs - Similar effects may result from bone spurs, growths of bone extending from the vertebrae that press against nerves and generate radiating pain, tingling and numbness.
  • Stenosis – Narrowing of the spinal canal can compress the spinal cord, creating pain-inducing pressure on the nerves within the spinal cord bundle. This narrowing of the spinal canal reflects the disc degeneration and thickening of the bones and ligaments that occurs with age. Stenosis can enhance the growth of bone spurs on the vertebra.
  • Compression Fractures – The body’s bones are constantly adding and removing calcium, building up bone mass faster than it’s lost before age 30, then, after that age, shifting to pattern of losing mass faster than it’s added. This is osteoporosis, the disease of brittle bones. When a vertebral bone loses enough mass, it can collapse – a compression fracture. This problem can often be dealt with by surgery or by the interventional radiology technique of vertebroplasty.
  • Spinal Tumors – Like brain tumors, spinal tumors may be benign (meningiomas), malignant (gliomas) and metastatic (spread from other parts of the body). Spinal tumors grow within or surrounding the spinal column and spinal cord. They represent only a small proportion of the primary tumors that affect the central nervous system – brain tumors account for as many as 90 percent.

Symptoms

The symptoms of disc or vertebral problems will depend on the location of the issue. A herniation, bone spur or stenosis in the cervical vertebrae may cause pain in the neck or arms, tingling or weakness in the hands, unsteady gait and lack of coordination. A problem in the lumbar vertebrae will likely cause similar symptoms in the lower back, legs and feet. A spinal tumor may cause similar problems, as well as increased sensitivity to pain, heat and cold, loss of bowel or bladder function and varying degrees of paralysis in parts of the body.

Diagnosis

Depending on the suspected problem, your neurosurgeon might seek tests including CT scanning to define the shape and size of the spinal canal and its contents, electromylogram and nerve conduction tests to assess electrical activity in the nervous system, MRI scanning to depict the spinal cord and nerve roots and a mylogram to visualize pressure in spinal cord and nerves from bulging or herniated discs, bone spurs or tumors.

Treatment Options

For most spinal problems, a conservative, nonsurgical approach is likely to be the first line of treatment. Pain management, physiatry and physical therapy seek to resolve the symptoms without more serious intervention.

If conservative treatments prove unsuccessful, surgery might be considered, especially if the problems progress in severity.

Surgical treatments for a degenerated or herniated disc problem might take the form of:

  • Discectomy – Complete or partial removal of a degenerated disc.
  • Laminectomy – Removal of most of a vertebra’s bony arch, or lamina.
  • Laminotomy – Creation of an opening in a lamina to relieve pressure on a nerve.
  • Spinal Fusion – The grafting on bone onto the spine to join together two or more vertebrae. Screws and rods (“instrumentation”) may be utilized for additional strength.
  • Artifical Disc Implantation – Replacement of a diseased disc with an artificial disc of plastic and chrome plates.

Patients with disc compression fractures, in which the vertebral discs have collapsed due to loss of bone mass, may be treatable with vertebroplasty, the injection of a medical cement into the disc’s bone fragments to stabilize them and end their microscopic, pain-causing shifting. A variation called kyphoplasty uses an inflatable medical balloon to create a larger space for the infusion of cement.

To read more on treatment options at Portsmouth Regional Hospital, visit our spine surgery page.

Spinal Tumors

Depending on the location and nature of a primary spinal tumor, surgical treatment might involve complete removal of the tumor from the nerves and fusing the vertebra. For a tumor that shows no symptoms and does not appear to be progressing, a treatment of watchful waiting might be appropriate. Some tumors respond well to chemotherapy or radiation therapy. In patients with metastatic malignancies, treatment is aimed primarily at relieving pain and preserving neurological function.

For More Information:

American Association of Neurological Surgeons
www.aans.org

National Institutes of Health
www.nih.gov