Saturday, September 17, 2011

Degenerative Disorders of the Spine

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 (Photos of a Human Spinal Cord)

Degenerative Disorders of the Spine

          People in their 30’s or older are more subject to Degenerative disk disease (DDD), due to aging. Inheriting a variation gene for the cartilage intermediate layer protein (CILP) may increase a person’s chances for lumbar disk disease. As biochemical and biomechanical changes occur, disease begins. The different pathologic problems that have been found in Degenerative disk disease are: disk protrusion, spondylolysis, subluxation (spondylolisthesis), degeneration of vertebrae, and spinal stenosis (Heuther, S., E., & McCance, K., L., 2008).
          Spondylolysis is the developmental defect of the spine involving the lamina or neural arch of the vertebra (Heuther, S., E., & McCance, K., L., 2008). The lumbar section of the spine is mostly affected in between the superior and inferior articular facets. Heredity is a major factor because spondylolysis is associated with an incrased incidence of other congenital spinal defects. The symptoms that occur are pain in the lower back and in the lower limb (Heuther, S., E., & McCance, K., L., 2008).
         Spondylolisthesis happens when a vertebra slides forward in relation to he vertebra below and may include a fracture of the pars interarticularis, which happens at the L5-S1 (Heuther, S., E., & McCance, K., L., 2008). The amount of slip the vertebra does is graded from 1 to 4, based on less slip to more slip. Grades 1 and 2 are mostly just managed symptomactically and nonsurgically. Grades 3 and 4 require decompression, stabilization, and sometimes both (Heuther, S., E., & McCance, K., L., 2008).
         Spinal stenosis is a narrowing of the spinal canal that causes pressure on the spinal nerves or cord and can be congenital or acquired (more common) and associated with trauma or arthritis (Heuther, S., E., & McCance, K., L., 2008). The lumbar and cervical spine are the most affected areas in spinal stenosis. Acquired conditions can be: bulging disk, facet hypertrophy, or a thick ossified posterior longitudinal ligament. Symptoms include: pain, numbness, and tingling in the legs. For people with chroninc symptoms and those who don’t respond to medical management, surgical decompression is in order.
         Lower back pain affects the area between the lower rib cage and gluteal muscles and often radiates into the thighs (Heuther, S., E., & McCance, K., L., 2008). Most cases there is no exact diagnosis but the things that can be involved in causing the pain are: tumors, disk prolaps, bursitis, synovitis, rising venous and tissue pressure, abnormal bone pressures, problems with spinal mobility, inflammation caused by infection, bony factures, or ligamentous sprains to pain referred from viscera or the posterior peritoneum (Heuther, S., E., & McCance, K., L., 2008). Some of the most common causes of low back pain is lumbar disk herniation, degenerative disk disease, spondylolysis, spondylolisthesis, and spinal stenosis. The treatment for low back pain can be diagnosed based on physical exampination, electromyelograhy, CT with or without myelography, MRI, nerve conduction studies, diskography, and epidurography (Heuther, S., E., & McCance, K., L., 2008). Most people’s conditions improve wit bed rest, analgesic medications, exercise, physical therapy, and education (Heuther, S., E., & McCance, K., L., 2008). Also anti-inflammatory and muscle relaxant medications can be given to relieve pain from lower back. Aerobic exercises are also an effective treatment.
        Herniated intervertebral disk is a protrusion of part of the nucleus pulposus through a tear in the posterior rim of the annulus fibrous (the fibrous capsule enclosing the genlatinour center of a disk) (Heuther, S., E., & McCance, K., L., 2008). The rupture of an intervertebral disk is usually caused by trauma, degenerative disk disease, or both (Heuther, S., E., & McCance, K., L., 2008). In a herniated disk, the ligament and posterior capsule of the disk are usually torn, allowing the gelatinous material (the nucleus pulposus) to extrude and compress the nerve root (Heuther, S., E., & McCance, K., L., 2008). Large amounts of extruded nucleus pulposus or complete disk herniation may compress the spinal cord (Heuther, S., E., & McCance, K., L., 2008). The location and size of the herniation into the spinal canal, together with the amount of space in the canal, determine the clinical manifestations associated with the injury. A herniated disk in the lumbosacral area is associated with pain that radiates along the sciatic nerve course over the buttock and into the calf or ankle. Pain happens with straining, for example: coughing and sneezing, and usually on straight leg raising. The diagnosis of a herniated intervertebral disk is made throught the history and physical examination, spinal x-ray films, electromyelography, CT scan, MRI, myelography, discography, and nerve conduction studies (Heuther, S., E., & McCance, K., L., 2008). Different therapies are available. The approach without surgery involves: no traction, bed rest, heat and ice to the affected areas, and an effective anti-inflammatory analgesic regimen. The surgical approach is used if there is severe compression (weakness or decreased deep tedon, bladder, or bowel reflexes) or if the non-surgical attempts are unsuccessful (Heuther, S., E., & McCance, K., L., 2008).


Huether, S.E., Mccane, K.I. (2008). Understanding Pathophysiology (4th edition). St Louis, MI: Mosby Inc.