Degenerative

       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
                                           the spine.

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 
                                           this symptoms.

 

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
                                           decompressive surgery.

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
                                           - MRI 

        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.

Copyright UPMC Spine Specialists (2012) Manila, Philippines

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ACKNOWLEDGEMENTS :



Many illustrations in this Web Page were borrowed from open source Netter Anatomical Illustrations and the Sobotta Atlas of Human Anatomy.  However most of the original borrowed illustrations may not be recognized anymore.  Most of them were digitally modified and altered to serve the purposes of discussions and explanations contained within this web.



Other illustrations are originally drawn by the Webmaster.



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