Every part of the body ages. The spine which for most of our lifetime carries the weight of our body is subject to degenerative changes in varying form and degree. Owing partly to genetics, some spine manifest these changes earlier than we might expect it.
Disc pathology is the earliest form of degenerative spine problems. This is usually manifested as herniated discs or what we commonly call "slipped discs." This problem can happen in the young and old. Trauma may or may not be a predisposing problem. As our spine ages, it develops varying levels of instability in its intricate joint network. Our body reacts by forming bone spurs or what is known as "osteophytes." These bone spurs are attempts of our body to "auto-stabilize" our spine. In the process however some bone spurs grow in sensitive areas where it can cause irritation to the spinal cord and nerve roots.
Depending on what part of the spine is affected, degenerative changes in the spine is initially manifested as neck or low back pain usually related to physical activities. As the disease progresses, degenerative changes causes the central canal and the foramina of the spine to narrow in diameter. Narrowing of the canal and the foramina is called "stenosis." This condition heralds different symptoms listed below. Pain is the predominant symptom and it has varying presentations:
Neck/Back Pain - pain usually is axial or central in nature.
Usually related to certain positions and
physical activities. Rest usually relieves
this type of pain but can be progressively
recalcitrant in nature. This is usually
interpreted as mechanical pain which is
related to instability of the arcitecture of
Radicular Pain - refers to pain that radiates either to the
shoulder, arms and hands, or to the
buttocks, posterior thigh and legs. These
are very annoying pain that gives patients
a great deal of discomfort. They are
present even at rest and aggravated by
motion of the affected limbs. They are
usually brought about by irritation and
compression of the nerve roots.
Claudicant Pain - this type of pain is felt when walking.
Patient develops severe pain usually
on both legs after walking even just
short distances. Patient feels extreme
heaviness on both legs with pins and
needle sensations over the legs and the
feet. Patient feels gradual relief upon
sitting down for a rest for a couple of
minutes only to feel the symptom again
once he start to walk again. This is
usually seen advanced compression of
the cord itself.
Weakness - Weakness is usually hard to assess.
It might be related to progressing
debilitation of ageing. Once present
in younger patients, weakness is a
manifestation of severe and chronic
compression of both cord and roots.
Myelopathy - is a condition that pertains to a cervical
problem. It is manifested by clumsiness
of the hands, changes in hand writing,
weakness of the arms, and unsteady gait.
Immediate attention should be given to
Cauda Equina Syndrome - is a "surgical emergency." Patients would
usually experience severe leg pains with
sudden weakness of both lowers. There
would be an associated urinary or bowel
incontinence. This signifies severe cord
compression that necessitates immediate
Paralysis - is a rare consequence of degeneration.
It is usually the end stage of a long
neglect of symptoms of weakness and
pain leading to a slow progressive paralysis.
Sudden paralysis is usually related to
"cauda equina syndrome."
Deformity - is part of the progression of degeneration.
It is usually to compensatory posturing
of patients that give them comfort. Usually
patients will manifest listhing to one side or
a stooped position. Severe deformities are
usually related to adult scoliosis.
When evaluating degenerative disorders of the spine imaging exams are very important to assess degree of osseous and soft tissue affectation of the spine. Imaging exams also help in providing a very clear picture of central canal and foraminal compromise. Your spine specialists would normally order one or combination of all these labs to fully evaluate your spine and offer the best management.
Imaging - X-Rays
- CT Scans
This cross-sectional cuts shows the changes occurring in the central and neuro-foraminal canal of a normal and degenerated cervical spine. The herniation of the nucleus of the disc shows extrusion into the canal which compresses on both the spinal cord and its roots. The osteophytes growing around the vertebral body and the facets likewise contribute to the narrowing of the spaces available for the cord and roots. The resulting compromise of the neural elements causes severe inflammation that causes both pain and neurologic deficits such as weakness.
The cervical spine manifest degenerative changes as early as the third decade of life. This is because it is the most mobile of the spine segments. A- shows the normal cervical spine and its normal lordotic curvature, B- shows a cervical disc herniation with loss of lordosis, C- shows multiple disc herniations and osteophytic spur formations, D- shows multiple level degeneration and a kyphotic deformity. These degenerative changes produce different symptoms due to the compression of the spinal cord in the spinal canal and the nerve roots as it exits the cervical foramina.
The lumbar spine degenerates in the same manner as the cervical spine. It also usually starts with disc degeneration followed by osteophytic formation. The lumbar spine though less mobile than the cervical spine carries a bigger weight. Severe degeneration sometimes leads to an anterior slippage of one vertebra over another. This condition is called "spondylolisthesis." This condition causes severe canal and foraminal stenosis.