Spine & Discs

Spinal Diseases

Spinal diseases are widespread and can affect anyone, regardless of age or lifestyle. From acute injuries like herniated discs or fractures to chronic, degenerative diseases of the spine and discs that develop over time, these conditions can cause significant discomfort and greatly reduce the quality of life for those affected.

Poor posture or congenital conditions such as scoliosis can also lead to impairments. This article provides a comprehensive overview of the most common spinal diseases, their causes, symptoms, and various treatment approaches.

What are spinal diseases?

Spinal diseases involve changes in the structure and function of the spine. The spine consists of 33 vertebrae, connected by intervertebral discs and ligaments. These diseases can affect entire regions of the spine (cervical, thoracic, lumbar spine, sacrum, and coccyx) or specific structures, such as vertebral bodies, spinal nerves, ligaments, or tendons.

What types of spinal diseases are there?

The most common spinal diseases include herniated discs, scoliosis, degenerative changes, and spinal fractures. The incidence of a herniated disc is about 5 to 20 cases per 1,000 adults annually, occurring most frequently in people between the ages of 30 and 60, with men being more often affected than women. With a prevalence of 2-3%, an estimated 160,000 to 240,000 people in Switzerland may be affected by scoliosis, although most cases are mild and do not require intervention.

Common Spinal Disorders

• Herniated Disc: A herniated disc occurs when the annulus, the outer layer of a disc, tears or is damaged, allowing the soft inner core to protrude. The protruding core may press on the nerve roots in the spinal canal near the vertebrae.
• Degenerative Disc Disease: As people age, discs lose fluid and elasticity, leading to pain and limited movement. A common sign of spinal wear is spondylosis, causing disc and joint wear that can lead to bone spurs (osteophytes) and eventual stiffening. Spondylarthrosis, also known as facet joint arthritis, is another degenerative spine condition where cartilage in the small vertebral joints (facet joints) wears down.
• Diffuse Idiopathic Skeletal Hyperostosis (DISH): This condition causes calcification and ossification of ligaments along the spine, potentially leading to stiffening.
• Spinal Stenosis: Narrowing of the spinal canal, which houses the spinal cord and nerve roots, can result in pain, numbness, and weakness.
• Spondylolisthesis (Vertebral Slippage): A slipping vertebra occurs when one vertebra shifts forward over the one below it. This shift can cause pain and spinal instability, and in severe cases, nerve damage.
• Nerve Root Compression: Various spinal conditions can compress nerve roots. For example, arthritis in the vertebral joints can create bone growths that compress the nerve roots.
• Vertebral Compression Fracture: A compression fracture of a vertebra occurs when the bone is compressed, losing height and often forming a wedge shape.

Other Important Spinal Disorders

• Scoliosis: Scoliosis is a sideways curvature of the spine, often accompanied by vertebral rotation. Instead of running straight, the spine forms an S- or C-shaped curve. Scoliosis typically appears during adolescence when the spine grows rapidly.
• Tethered Cord Syndrome: Normally, the spinal cord moves freely within the spinal canal, allowing it to adapt during growth, bending, and stretching. In tethered cord syndrome, the spinal cord is fixed at the lower end or another point within the canal, preventing free movement. This tension can stretch nerve fibers and cause neurological impairments.
• Schmorl's Nodes: Schmorl's nodes are small indentations where disc tissue pushes into the vertebral bodies, caused by a weakened cartilage layer on the top and bottom vertebral plates. When the cartilage is weakened, pressure from the disc’s core can cause it to break through the plate and enter the vertebra.
• Syringomyelia: Syringomyelia is a rare neurological condition where fluid-filled cysts (syrinxes) form within the spinal cord. These cysts can damage the spinal cord and surrounding nerve fibers.
• Disc Bulge: A disc bulge, or disc protrusion, is when the outer fibrous ring (annulus fibrosus) of a disc extends outward, causing the disc to protrude between the vertebrae.
• Ankylosing Spondylitis (Bechterew's Disease): This chronic inflammatory condition primarily affects the spine and the sacroiliac joint (SIJ). It leads to progressive stiffening, typically starting in the lower back and spreading upward.
• Rheumatoid Arthritis: Although primarily a joint disease, rheumatoid arthritis can also affect the spine, leading to stiffness and reduced mobility.

Rare and Severe Spinal Disorders

• Vertebral Body Metastases
• Spinal Cord Metastases
• Vertebral Hemangioma
• Spinal Cord Tumor
• Vertebral Malformation
• Spinal Bone Cyst
• Myelomalacia
• Vertebral Tumors
• Spinal Mass Lesion
• Tarlov Cyst
• Hyperlordosis
• Hyperkyphosis
• Bone Island in the Spine
• Bone Marrow Edema of the Spine

What are the Causes of Spinal Disorders?

The causes of spinal disorders are varied. One of the most common factors is the natural aging process, during which the intervertebral discs wear out over time and lose elasticity.

Injuries from falls, accidents, or sports can also lead to spinal disorders. Additionally, genetic factors play a role, especially in conditions like scoliosis.

Another significant factor is excessive strain on the spine, which may result from physical labor, excess weight, or poor posture.

• Aging: The natural aging process leads to wear and tear on the spine. A common age-related condition is osteoporosis, which reduces bone density, making vertebrae more brittle and prone to fractures. The intervertebral discs also deteriorate with age.
• Injuries: Accidents, falls, or sports injuries can damage the spine. For example, a vertebral body or arch can fracture due to a forceful impact, such as a fall or car accident.
• Overuse: Excessive spinal strain from heavy physical labor, excess weight, or poor posture can accelerate spinal and disc wear.
• Excess Weight: Additional weight strains the spine, accelerating the wear of facet joints (facet joint osteoarthritis), leading to pain and restricted mobility.
• Genetics: Some spinal diseases have a genetic component and can be congenital, such as scoliosis or Scheuermann's disease, a growth disorder of the vertebral bodies that can cause spinal deformity.
• Vertebral Fractures: Severe vertebral fractures may cause spinal instability, which could require surgical fusion (spondylodesis).
• Tumors: Primary tumors originating in the spine are rare, but metastases — secondary growths from tumors in other body regions that spread to the spine — are more common.

What Are Common Symptoms of Spinal Disorders?

Spinal disorders can cause a range of symptoms, which vary depending on the type and severity of the condition. The most common symptom is back pain, which can range from a mild ache to severe, sharp pain.

Limited mobility and stiffness in the spine are also frequent signs. In some cases, numbness, tingling, or muscle weakness in the arms or legs may occur. These symptoms can significantly affect daily activities and quality of life.

Here are the most common symptoms of spinal disorders:

Sensory and motor deficits

• Back pain
• Neck pain
• Limited range of motion
• Radiating pain (e.g., sciatica due to a herniated disc in the lumbar spine)
• Stiffness of the spine
• Sensory disturbances

Neurological symptoms

• Numbness
• Tingling (paresthesias)
• Muscle weakness (paresis)
• Signs of paralysis (plegia)
• Reflex disturbances
• Dizziness
• Coordination disorders
• Gait disturbances

Additional symptoms

• Changes in posture, e.g., increased curvature of the spine (kyphosis or lordosis)
• Muscle tension in response to pain
• Bladder or bowel dysfunction

How are spinal diseases diagnosed?

The diagnosis of spinal diseases involves a thorough examination and assessment of symptoms through several steps. This includes a comprehensive medical history, a physical examination to assess the mobility of the spine, and imaging techniques such as X-rays, MRI, or CT scans.

Medical History and Physical Examination

• Medical History: A detailed medical history is taken, considering the patient's history, including the type, duration, and intensity of pain, possible triggers, previous injuries or illnesses, and family medical history.
• Physical Examination: During a comprehensive examination, an orthopedist or neurologist assesses posture, mobility, muscle strength, and reflexes. Additionally, specific tests such as the Spurling test or the Lasègue test may be conducted to identify nerve damage or instabilities.

Imaging Procedures

• X-ray: Displays bony structures and can reveal fractures, deformities, signs of wear (osteoarthritis), or indications of inflammation. CT (Computed Tomography): Provides precise images of bones and can be helpful for questions regarding bone structure, fractures, or bony changes.
• MRI (Magnetic Resonance Imaging): An MRI is particularly well-suited for detecting herniated discs, disc protrusions, as well as degeneration and tears of the discs. It can also effectively illustrate nerve compressions, inflammation, or injuries to the spinal cord and nerve roots. Furthermore, an MRI is sensitive to inflammatory changes in the spine, such as spondylodiscitis (inflammation of the vertebrae and intervertebral disc) or rheumatological diseases. Tumors and infections in the spinal area, such as osteomyelitis, can also be detected early with MRI. Additionally, MRI is the method of choice for diagnosing and monitoring multiple sclerosis, which can also affect the spine.

Neurological Examinations

• Clinical Neurological Examination: Assesses the function of nerves and the spinal cord, for example, through reflexes, sensitivity tests (touch, pain, temperature), and evaluation of muscle strength and coordination.
• Electrophysiological Examinations: Measurement of nerve conduction velocity (NCV) and electrical activities in the muscles (electromyography, EMG) can help localize and quantify nerve damage and its extent.

Laboratory Investigations

• Blood Test: Can be performed if there is suspicion of inflammatory diseases (e.g., rheumatoid factor, inflammatory markers) or infections (e.g., leukocytes).
• Cerebrospinal Fluid Examination (Lumbar Puncture): In rare cases, an examination of the cerebrospinal fluid (CSF) may be necessary to rule out inflammation or infections of the central nervous system.

Further Investigations

• Bone Density Measurement (Osteodensitometry): Bone density can be measured when osteoporosis is suspected. The most common method is DXA measurement, which assesses bone mineral content (BMC) and bone mineral density (BMD) in the lumbar spine and femoral neck. Additionally, quantitative computed tomography (QCT) or quantitative ultrasound (QUS) may be used (the latter primarily for screening purposes).
• Myelography: Myelography involves examining the spinal canal and nerve roots. A contrast agent is injected into the cerebrospinal fluid (the space surrounding the spinal cord and nerve roots). Subsequently, X-rays or a computed tomography (CT) scan are performed to detect possible constrictions or other abnormalities in the spinal canal. Nowadays, it is less frequently used, as more modern techniques like magnetic resonance imaging (MRI) typically provide more informative and less invasive results.
• Discography: In a discography, a contrast agent is injected directly into the nucleus of a disc under X-ray control. X-ray images or CT scans are then taken. Discography is an invasive procedure and is used less frequently nowadays than in the past. Modern imaging techniques such as MRI and CT often provide sufficient information about the condition of the discs.

What Treatment Options Are Available for Spinal Disorders?

Pathological changes in the spine should be treated not only to reduce pain but also to prevent further complications.

Typically, conservative therapy is attempted first, focusing on pain reduction, improving function, and preventing additional damage. Conservative methods include medication, physical therapy, and injections. However, in some cases, surgery may be necessary to stabilize the spine or repair damaged tissue.

Conservative Therapy for Spinal Disorders

Orthopedics and physical therapy are usually the first points of contact for the conservative treatment of spinal disorders. This includes pain relievers to alleviate pain and inflammation, the application of heat or cold therapy to relax the muscles, and the execution of physical therapy exercises to strengthen the muscles and improve the mobility of the spine and musculoskeletal system.

Spinal Surgery

In some cases, surgery may be necessary to treat spinal diseases, which involves removing damaged or degenerated discs and replacing them with implants. In severe cases of scoliosis, surgery may be required to realign the spine and correct the curvature.

The most commonly used techniques include:

• Microdiscectomy for the removal of herniated discs
• Decompression of the spinal canal in patients with spinal canal stenosis
• Spinal fusion (spondylodesis), for example, after fractures, in degenerative diseases, or in cases of scoliosis
• Kyphoplasty/vertebroplasty for stabilizing vertebral fractures, especially in older patients with osteoporosis

Prevention of Spinal Diseases

While it is not possible to completely prevent all spinal diseases, especially those that are genetically predisposed or caused by age-related wear and tear, there are certainly ways to reduce the risk of certain conditions and keep the spine healthy for as long as possible:

• Maintain an upright posture while sitting, standing, and lifting
• Avoid prolonged sitting
• Use ergonomic office equipment and aids at the workplace
• Strengthen abdominal and back muscles
• Stretch muscles regularly
• Avoid being overweight
• Follow a balanced diet and engage in regular physical activity
• Lift heavy objects correctly (bend your knees and keep your back straight)
• Ensure adequate intake of calcium and vitamin D to maintain bone density and prevent osteoporosis

Conclusion

Spinal diseases can pose a significant burden and greatly impair quality of life. To avoid complications, it is important to detect changes in the spine early and treat them accordingly.

Many spinal conditions can be prevented or at least slowed down by maintaining a healthy lifestyle with regular exercise and a balanced diet. Strengthening the back and abdominal muscles, as well as avoiding excess weight and poor posture, are particularly important.

Experiencing back pain or concerned about your spine? Secure your MRI scan now to identify any potential changes in your spine as early as possible.