Degenerative or Congenital

Degenerative spinal disorders are sometimes due to the process of normal aging and/or wear and tear. Just like mechanical devices, human bodies are subject to wear and tear from use.  However, unlike machinery, the hu­man body has the ability to heal or attempt to repair a problem.

At birth, the structural integrity of a person's spine, heart, lungs or any other organ system is at its peak for development through the years.  During mid-life, early microscopic changes begin to appear that indicate the spine is aging.  The spine does not deteriorate just be­ cause it ages. Wear and tear also play important roles.

Ailments such as arthritis, spinal stenosis, or osteoporosis do not develop overnight.  Degenerative diseases may take many years to develop. These dis­ orders may be associated with past injuries, abuse, body structure, or congenital problems.

Arthritis (arth-rye-tis) affects approximately 80% of people over the age of 55 in the United States. Injury, a weakened immune system, and/or heredity can trigger the onset of arthritis.  Although there are hun­dreds of types of arthritis, the symptoms are similar..: inflammation, joint pain, and a progressive deteriora tion of joint surfaces over time.

The joints may actually lose their normal con­ tour, excessive amounts of fluid may build up inside the joint along with floating pieces of debris. This disease may be found in any of the spine's joints, those parts which enable the body to bend and twist.

Part of the problem may be the body's response to arthritis, which is to manufacture extra bone to stop joint movement.  The extra bone is called a bony over­ growth or bone spurs. 

In medical terminology, the extra bone is called osteophytes (os-tea-oh-fights).  Osteophytes may be found in areas affected by arthritis such as disc or joint spaces where cartilage has deteriorated.

Since the facet joints are in close proximity to the neuroforamen through which the nerve roots exit, the arthritic  bone spurs may cause nerve impingement. Sensory symptoms include pain, numbness, burning, and pins and needles in the extremities below the affected nerve.  Motor symptoms (muscle) include muscle spasm, cramping, weakness, and/or loss of muscular control of a body part. The body's production of osteophytes is really a futile attempt to stop the motion of the arthritic joint and deal with the degenerative  process. It never completely works. The evidence of bony deposits can be found on an x-ray.

Osteoarthritis (os-tea-oh-arth-rye-tis) is the degenerative form of arthritis.  Osteoarthritis is a pro­gressive joint disease associated with aging.  Many elderly people have some degree of osteoarthritis. It might be found  in the knees, hips, or any other joint.

In the spine, osteoarthritis can affect the facet joints, which enable the body to bend and twist.  As these joints deteriorate, cartilage may become inflamed and start to fray like a well used rag.  The fraying process may cause pieces of cartilage to break away from the joint surfaces. The cartilage fragments might begin to float in the joint's lubricating fluid.

As the joints are stripped of their cartilage, the once smooth,  slick surfaces designed for friction-free movement are lost. Joint bones may begin to rub to­ gether creating friction while trying to work.  The nerve structures in the joint become sensitized, irritated, and may result in inflammation and pain.

Osteoarthritis may trigger the formation of osteophytes (os-tea-oh-fights).  These bony  spurs are the body's way of dealing with the disease.

In the spine, the bony spurs may cause disc space to narrow. When this happens, the associated vertebral disc may collapse, compromising its integrity.

Rheumatoid Arthritis (RA) (room-a-toyed arth-rye-tis) is a progressive form of arthritis that can be painfully destructive. This disorder may cause the interior tissue of joints to swell and thicken. Over time, the affected joint(s) disintegrate, resulting in deformity. RA may appear during early middle age and is more common in women than men.

The symptoms may include fatigue, weakness, a poor appetite, fever, and anemia. Upon rising, joints are usually stiff, swollen, and tender. Medication is available to relieve the pain and to reduce inflammation, but a key is regular exercise to keep joints moving and functioning. Passive forms of physical therapy may be help­ ful to increase joint mobility.

Ankylosis (an-key-low-sis) is a progressive spi­nal disease that may cause the spine to gradually lose its flexibility and stiffen.   It may be  found to  affect patients with arthritis and/or osteoarthritis.

Spinal Stenosis  (sten-oh-sis) is a narrowing of the spinal canal and/or neuroforamen (windows) where the nerves exit the spinal canal.  This disorder is associated with aging. Some people are predisposed to spinal stenosis genetically or it may be due to con­ genital problems.  The disease can be easily explained by translating its meaning from Greek. Spinal denotes the spine and stenosis means the narrowing of a normally larger opening.

When the neuroforamen (windows) are partially or completely closed and/or clogged with debris, the spinal nerves become compressed and/or trapped.  The symptoms of spinal stenosis may include numbness, weakness, burning sensations, tingling, and pins and needles  in the  involved  extremity,  such  as the  leg.

Spinal stenosis could be compared to wearing a pair of shoes that are a half size too small.  The feet (nerves) react to the pressure by swelling (nerve inflammation), which makes the shoe even tighter. The pain (nerve compression) from wearing the small shoes can make walking difficult or impossible.

Patients with spinal stenosis have found the pain may ease when bending forward or sitting.  This may happen because bending forward creates more vertebral space, which may temporarily relieve nerve com­ pression.

Although spinal stenosis may affect any part of the spine, it seems to be more prevalent in the lumbar region.  Pain may be felt in the buttocks, thighs, and/or calves when walking and/or standing.

Cervical spinal stenosis can affect the upper ex­ tremities and back. If severe enough, it could affect everything from the neck down. The patient's symptoms for spinal stenosis are often confirmed by either aCT scan or MRI.    If absolutely  necessary, a surgical procedure termed a foraminotomy  (for-aye-men-ott-toe-me) can be per­ formed, which enlarges the size of the window to help relieve nerve compression

Foramina! Stenosis  (for-aye-men-al   sten­ oh-sis) is associated with spinal stenosis, but is singled out because it primarily effects one or more vertebral foramen (window).

Normally, nerve roots have enough room to eas­ily slip through the foramen.   However, with age and disease, the windows (neuroforamen) may become clogged with debris. The nerves can become trapped and compressed.

The symptoms of foramina! stenosis may include numbness, weakness, burning sensations, tingling, and pins and needles in the involved extremity, such as the leg.  Not every stenosis is critical, but if spinal stenosis is ignored, nerves may die, which could result in a loss of function. The functional loss could involve the ability to feel (sensory) and/or move (motor).

If conservative forms of treatment are unsuccessful, surgery is an option.  The procedure is called a foraminotomy.

Degenerative  Disc Disease  affects the vertebral discs.  As each disc is placed under constant pressure during spinal flexion and extension, the discs absorb the stress created by movement. With age and motion, some disc wear and tear will naturally occur.

When the spine is x-rayed, the spaces between the vertebrae may appear narrowed indicative of de­ generative disc disease. Discs that have become thin, or that have collapsed, can cause the vertebral space to narrow.

In addition, loss of disc moisture is simply one of many biochemical  changes associated with aging.  A similar chemical  change occurs as a tire ages.  As the tire loses its resilence, its original form may be compro­ mised. The disc may shrink in size, wrinkle and/or even crack. Pieces of the disc may break away (i.e. creating fragments) and cause nerve irritation.

This could cause vertebral structures to compress causing the neuroforamen (window) to be reduced in size. The compressed nerves react by swelling and sig­ naling pain. 

The neuroforamen could be compared to the brakes on a car.  In this scenario, the vertebral discs are the brake pads, which act as a cushion between the foot pedal (top vertebral body) and the wheel (bottom vertebral body).    With age, abuse, and/or wear and tear, the brake pads may become thin or may even dis­ integrate.  What happens?  The brakes squeal (pain) when used, or may not stop the car.   Either way, the driver of the car will probably feel the effects of the faulty brakes.

People maintain their cars for dependability. A normal amount of wear and tear is expected and ac­ceptable. The same is true of the spine. In most cases, as a person ages the physical demands placed on the body decrease.  Today, through proper nutrition, con­ sistent exercise, and prevention, the body can be in good shape at any age.

Osteoporosis  (os-tea-oh-pour-oh-sis) is known as the silent degenerative disease.   The dis­ease is labeled silent because in the early stages, the patient may be symptom free.   However, as the disease progresses, bones gradually begin to resemble a well used sponge: thin and porous (full of holes).  Bone mass and density is lost. 

Osteoporosis can affect any bone in the body, rendering bones extremely susceptible to fracture. It might be said that osteoporosis occurs when the body makes more calcium withdrawals than deposits, result­ ing in bankrupt bones.

When osteoporosis affects the spine, the symp­ toms may include chronic pain, loss of mobility, and an alteration of physical appearance. Patients may appear frail, bent over, and shorter.

Chronic pain may result from spinal muscles forced to take on the load once handled by the spine. Daily chores such as making the bed, removing a turkey from the oven, or even embracing a loved one could cause vertebrae to break.

Deformities may develop as the spinal bones become more porous and weakened.  The breakdown of bone can eventually lead to compression and crush fractures, as well as a hunched back. Due to the loss of bone strength, spinal fractures may occur spontane­ ously without reason.   The patient's weight alone can cause vertebrae to collapse. The associated nerves may become impinged, compressed, and/or destroyed.

As vertebrae collapse, height can be lost and internal organs may be forced out of their normal posi­ tions.  Osteoporosis can be an insidious disease, which may eventually cause the patient's general health to deteriorate.

Although osteoporosis is a normal part of aging for both women and men, the key is to know the risks and reduce them.    There are factors that accelerate the progression of the disease.  Smoking, alcoholism, heavy use of laxatives, stress, diabetes, menopause, inactivity, and unhealthy dieting are examples.

Women smokers produce lower levels of estro­ gen.  In addition, the smoking habit interferes with the absorption of calcium (Vitamin D), which is necessary for strong bones.  Alcoholics, women or men, generally have less bone mass because calcium absorption is hindered.

The estrogen hormone is primarily responsible for maintaining sufficient calcium in the skeletal system. Stress can be an undermining  factor because it may stimulate the adrenal (a-dree-nal) hormones, which could cause calcium to be passed during urination.

Women are more prone to osteoporosis than most men because, to begin with, a woman's bones are smaller, containing less mass.  Estrogen levels are usually effected during the menopause. In addition, women have a longer life expectancy than men and therefore may have more time to develop the disease.

Fortunately, today there is a simple and painless test termed a Bone Density Scan.  This test measures the density of bone. If signs of osteoporo­ sis are found, medication can be prescribed to help con­ trol the disease. Treatment is easily administered. The medication is available either orally (by pill) or in nasal spray form. Plus, the medication has proven beneficial in some cases by preventing spontaneous fracture(s).

Since it takes years for bone to gain (or regain) strength, treatment is sometimes started when the pa­ tient is in the 60's. Later when the patient is older, the chances of a minor fall causing a broken hip or rib is minimized.

Besides medication, exercise is especially impor­ tant at any age for several reasons. Physical activity can stimulate bones to become denser, good blood cir­ culation nourishes bone, and healthy hormone levels can be maintained.

Weight bearing and resistance exercises, such as walking, build strong bones.  However, before start­ ing any exercise regimen, the reader should first check with a physician.

Spinal Tumors are rare. The physician will be primarily interested  in determining the cause of the tumor and relieving  any associated pain.

For example, if the patient's primary condition is breast or lung cancer, it is possible for the cancer to metastasize (ma-taz-ta-size, or spread) to the spine. The physician is always concerned if there is a past history of cancer coupled with a new history of back pain. The past and present histories may be related.

Tumors may occur in anyone without a history of disease. Fortunately,  not all tumors are malignant.