Spinal Conditions and Their Diagnosis Explained
Whatever your age, general health or fitness levels, you may suffer from neck or back pain or other symptoms from an underlying spinal condition. Spinal conditions can have a serious impact on mobility and quality of life. In this article we describe three common spinal conditions and their implications. If you are concerned about any symptoms you have, please do contact Dr James Laban’s excellent and personable team to schedule an appointment. You will be able to discuss your problem with Dr Laban and, after appropriate investigation, he will offer tailor-made advice about the diagnosis and treatment options for your spinal conditions.
The spine is made up of a column of bones called vertebrae which are separated from each other by intervertebral discs. This vertebral column has a bony canal through which the spinal cord runs, carrying all the electrical information from the brain to the arms, body and legs. The intervertebral discs which separate the vertebrae act as shock absorbers and are made up of a tough fibrous outer layer (annulus fibrosus) and a gelatinous inner core (nucleus pulposus).
The term “slipped disc” can be a bit misleading as the whole disc does not move. If the outer layer (annulus fibrosus) develops an area of weakness or tear, some of the inner gel-like material (nucleus pulposus) can bulge or leak out; a “slipped disc”. The term “slipped disc” is used interchangeably with bulging disc, herniated disc, disc protrusion and prolapsed disc. There is not one single correct phrase.
In younger people, most discs are well hydrated and the outer layer securely encases the inner gel. However, as discs get older and degenerate they become less hydrated and flatter and less efficient at shock absorption (disc degeneration). The outer layer of annulus fibrosus becomes more brittle and more likely to tear and can allow some of the inner gel leak out or bulge. If the discs sustain a sudden high-pressure load, for example from heavy lifting, twisting or straining, this can also cause disc protrusion.
The leakage of the nucleus pulposus gel can press on nearby nerves and irritate them causing pain. Whilst this most commonly occurs in the lower back or lumbar region, it also often occurs in the neck or cervical region.
Sciatica refers to a pain which radiates from the lower spine, through the buttocks and down the legs. This pain can range from fairly mild pain to excruciating debilitating pain. Most patients feel pain radiating from the lower back running down the back of the leg (although sometimes pain is felt on the front of the leg as well) and most people find it hard to get comfortable in any one position for more than 10 minutes. You might also experience tingling, pins and needles, or numbness. If you have pain in both legs or weakness in your legs or feet, numbness in your buttocks or perineum, or a change in bladder and bowel function you should seek immediate neurosurgical opinion.
Sciatica is a very common condition: most people have an 80-90% chance of experiencing back pain in their lifetime and 2-3% of these patients will go on to experience sciatica. Sciatica is most commonly due to irritation and/or compression of the lumbar (lower back) nerves by a “slipped disc”. The disc most commonly bulges or herniates to one side pressing on a lumbar nerve root as it begins to exits the spinal canal triggering sciatica down that leg.
Spondylolisthesis is simply when a bone in the spine (vertebra) slips out of place, usually forwards relative the one below it. Most commonly this is due to arthritis wear-and-tear changes. It is also often seen due to a stress fractures through a vertebra known as pars defects. These are thought to most commonly occur in childhood but usually do not cause significant symptoms until many years later. Some people are born with a defective vertebra and again this may not be identified until much later in life. Spondylolisthesis can cause common symptoms including:
- lower back pain
- pain and/or weakness in one or both legs or thighs
- a tingling sensation that radiates from lower back down to the legs
- tenderness or stiffness in the back
- tight hamstring and buttock muscles
- difficulty walking or running.
There are many ways to treat spondylolisthesis. Initial treatment regime may be simply avoiding straining including heavy lifting, twisting or jerking movements or sports which exacerbate the symptoms. This can give your back a chance to get back to your normal followed by targeted multimodal non-invasive therapy including physiotherapy with core strengthening. For some patients, injections could be considered, for others, surgery may be the best option.
Diagnosis of Spinal Conditions
Optimal treatment relies on accurate diagnosis to identify the exact underlying cause of spinal symptoms. Diagnostic imaging technology has evolved to the point where we are able to produce high resolution images of the spinal column, intervertebral discs and nerves and pinpoint precisely where an issue has arisen.
MRI (magnetic resonance imaging) is generally recognised as the gold standard investigation for spinal pathology in most circumstances. CT scans and X-Rays can produce excellent images of broken, fractured or misaligned bones. However, CT scans and X-Rays cannot display soft tissues, such as discs or nerves, as clearly as MRI. Specialised X-rays, termed EOS imaging, can be very useful for spinal deformity such as scoliosis. SPECT-CT (single photon emission computed tomography-CT) combines CT imaging with a very low dose of radioactive tracer and can be used to diagnose or localise excess activity as seen in active arthritis or degenerate disc disease.
Sometimes electrical tests such as nerve conduction studies and electromyography can be useful to determine the source of symptoms particularly if they are caused by a peripheral nerve problem such as generalised neuropathy from diabetes or compression as seen in carpal tunnel syndrome or ulnar nerve entrapment at the elbow. These often produce symptoms also seen in spinal conditions and may co-exist with spinal pathology.
Combining these and other diagnostic tests can aid accurate diagnosis to optimise treatment and improve outcomes.
Contact Dr Laban
If you are concerned about any symptoms you have involving back or neck pain, do contact our friendly team to book an appointment with Dr James Laban. Dr Laban sees patients with all types of back pain related problems and conditions. Even though back pain is common, there can be underlying issues that you may not be aware of. If your back pain and related symptoms are getting in the way of life and not resolving then it is important to get an expert opinion.
Dr Laban is a fellow of the Royal Australasian College of Surgeons and of Royal College of Surgeons of England and has trained, worked, published and presented nationally and internationally. Dr Laban works out of his North Shore, Northern Beaches and Central Coast consulting rooms. We are open to talk to you between the hours of 8:00am 5:00pm, Monday to Friday. Call us on 02 8320 0577 today.