Introduction
Due to the modern lifestyle with its lack of movement and the resulting weakening of rump muscles a lot of people suffer from a lot of back problems. Many technical and “colloquial” terms are used with the development of degenerative diseases of spinal disks and vertebral joints or the narrowing of the spinal canal. They shall be explained in the following section.
Popular lore for “lumbago” is “lower back pain” or often also “sciatica“. The local pain is often associated with considerable movement restriction, locked up vertebral joints, and concomitant muscle tension.
True sciatica, however, is accompanied by leg pain – either as lumbosciatica when pain radiates from the lower back into the leg or as sciatica when pain is merely in the leg.
The degenerative back disease starts mostly with degenerative changes of the spinal disks – they lose their function as shock-absorber and subsequent osseous changes of the upper and lower surfaces of the vertebral bodies (spondylosis) may occur. Your doctor may speak of an activated osteochondrosis if severe muscle tension and edemas at the upper and lower surfaces of the vertebral bodies (detectable in MRI images) coexist.
Spinal Disc Problems
If symptoms stem from the spinal disks (synonym: intervertebral disk, discuss intervertebrally) this is called “discogenic” pain or disease and there are a lot of technical terms associated with the respective pathological states of the disk.
The disks consist of a fibrous ring (synonym: annulus fibrosis) and a gel-like nucleus (synonym: nucleus pulposus). The fibrous ring forms the firm outer wrapping and the nucleus provides the required elasticity.
Mostly degeneration starts with a loss of liquid of the nucleus pulposus and a subsequent height reduction of the intervertebral space (the space between the adjacent vertebral bodies). This is called osteochondrosis.
Shifting of disk material is mostly associated with osteochondrosis and there are again a couple of different technical terms.
Mostly the first thing that happens is a tearing of the fibrous ring (rupture of the annulus fibrosis). Subsequently more or less of the gel-like nucleus may make its way through this rupture into the spinal canal.
If only a small part “creeps” through the fissure your doctor will speak of a disk protrusion – he may also divide into different grades of severity. All protrusions have in common, that the rupture of the annulus is limited and a great part of the function of the fibrous ring is still maintained.
If the rupture is complete, more of the disk material will shift into the spinal canal and eventually pinch nerve roots. Your doctor will call this a slipped disk (synonyms: disk prolapse, herniated disk, disk herniation).
A special form of a herniated disk is the sequestered disk or disk sequestration. The nucleus pulposus shifts completely into the spinal canal without further connection to the original disk.
This condition may be an indication for disk surgery (nucleosome or discectomy) if conservative care proved inefficient.
The term nucleosome seems more appropriate than discectomy, as only the material from the nucleus pulposus that pinches the nerve root will be removed whereas the fibrous ring will remain untouched.
The most tissue-preserving surgical option for the nucleosome is the endoscopic technique that is successfully carried out in the APEX SPINE Center for many years. As opposed to other surgeons we are able to treat all herniated discs endoscopically!
Refer also to scientific publications.
Facet Joint Arthrosis
If symptoms stem from degenerative changes of the small pairs of vertebral joints (synonym: facet joints) your doctor will speak of spondylarthrosis, facet joint arthrosis, a facet syndrome, or facet joint syndrome.
These arthroses of the vertebral joints are – with advanced state of disease – the most common cause for the development of a narrowing of the spinal canal (synonym: spinal stenosis, spinal canal stenosis)
Spinal Stenosis
In its pronounced form – where more than one segment is affected (definition according to Junghans: at least one pair of vertebral bodies with all its adjacent structures), it is also called a multisegmental bottleneck syndrome of the spinal canal.
Other causes for this quite frequent but often unrecognized condition are:
- undue stresses from sports activities or physical work
- an inherent narrowness of the spinal canal (congenital stenosis)
Spinal stenosis can never be diagnosed merely from the evaluation of magnetic resonance images, but radiologic findings must always be directly correlated to prevailing symptoms.
It should be mentioned that the size of the spinal cord as well as the susceptibility of the dura differ individually.
Together this makes precise diagnosing a challenging task that requires extensive experience of a specialized physician.
Therapy of spinal stenosis:
Advanced stenosis with the clinical picture of a claudication spinal (significant limitation of walking distance that is associated with pain) is often an indication for surgery. Conservative care with injections, physiotherapy, and electrotherapy mostly fail.
With our tissue-preserving surgery technique (microscopic decompression of the spinal canal) we are able to discharge patients home a few days after the intervention and – after short out-patient rehabilitation – to reintegrate them into daily life very soon.
Vertebral Slippage
A special form of spinal stenosis is the slipped vertebra (spondylolisthesis or listhesis). This form of spine disease is also facultatively associated with a more or less pronounced segmental instability. This means that the affected vertebra tends to slip out of the proper position onto the bone below it.
It must be differentiated between:
- a true spondylolisthesis which comes along with an inherent spondylolysis (defect in the connection between vertebrae)
- pseudospondylolisthesis.
This disease results from an inherent malposition and a concomitant degeneration of the vertebral joints.
There are different scales to quantify the degree of slippage. Most used is the Meyerding scale with a range from I to IV. The complete slippage of the vertebra out of its position is called spondyloptosis.
Therapy: If surgery is indicated we are often able to prevent so-called transpedicular reposition spondylodesis! This is a fusion surgery with a simultaneous reposition of the slipped vertebra. With our special microscopic decompression of the spinal canal, the facet joints will mostly remain intact and the fusion hence not necessary.
Degenerative Lumbar Scoliosis
This degenerative sideways curvature of the spine with a concomitant twisting of the vertebrae is due to present stenoses and increasing static disturbances.
The development of scoliosis may have different origins:
- degenerative (due to tear and wear )
- inherent or idiopathic (infantile or juvenile)
- traumatic
- metabolic
Progressive degenerative lumbar scoliosis is a common cause for severe back problems from the 4th or 5th decade of life.
Second most often – apart from degenerative scoliosis – is the idiopathic form. That means scoliosis develops without apparent cause in early childhood (infantile form) or adolescence (juvenile form). Also, congenital scoliosis is quite frequent.
Often scoliosis is quite well compensated for with good rump musculature and there may be only little symptoms over many years. Especially in the lumbar spine, scoliosis tends to worsen from the 4th or 5th decade of life. The degree of curvature increases which can be quantified with the so-called Cobb angle.
If the apex of scoliosis is in the thoracic spine, disease progress is mostly slower and less severe as more stability is provided from the surrounding musculature.
Therapy:
We look at all causes of the spine and examine the functional faults and deficits that lead to or led to your spine hurting. We always look at the muscle function of the spine and correct that and any related mobility issues with each and every spinal joint applicable. We are very successful at treating spinal conditions. Many times results are immediate right off the treatment table.