Osteoporosis is a decrease in bone mass, more commonly seen in women during the post-menopausal period. The bone mass decrease includes both the mineral component (e.g., calcium and phosphorus) and the organic component (e.g., protein) of bone. About 15 million to 20 million people have osteoporosis, and among them, more than 500,000 suffer spinal fractures as a result each year. These fractures can occur with minimal trauma such as a fall to the ground, or no trauma at all.
Back pain is the most common symptom of osteoporosis. Back pain and other symptoms of osteoporosis – like infections, other metabolic bone diseases, and benign or malignant bone tumors – can mimic the symptoms of other conditions. That is why imaging evaluation is crucial in confirming a diagnosis of osteoporosis, such as:
Fortunately, most spinal fractures due to osteoporosis are successfully treated with just medication to control the pain, but the underlying osteoporosis should also be addressed. The treatment of osteoporosis itself is rapidly evolving.
Some of the therapies used to manage osteoporosis are:
May be necessary to control pain, in rare instances, to stabilize the structure of the spine, or decompress the nerve roots or spinal cord. New techniques to treat the problem of compressed vertebrae include:
Degeneration of the discs and the small joints of the spine (facet joints) is generally a normal part of the aging process.
Degeneration is detectable by x-ray, but may not cause any symptoms. However, in some individuals, it can cause significant back and/or leg pain. In patients with advanced degeneration, x-rays show marked narrowing of the discs as well as arthritic changes in the facet joints. The arthritic changes in the facet joints may cause narrowing of the space where spinal nerves are located, called stenosis. Stenosis can result in leg pain, or what many lay people refer to as "sciatica".
Usually effective in managing the symptoms of degenerative discs or facet joints, and includes:
May be required to alleviate pain associated with severe and progressive degenerative changes. Potential surgeries are:
As arthritis or disk degeneration and facet arthritis worsens, the spinal canal (the space which contains the spinal cord and nerve roots) can narrow—causing stenosis. During the narrowing, a large ligament (ligamentum flavum) that crosses the space between 2 vertebrae can shorten and become relatively thicker. The thicker ligament, the arthritis in the facet joint, and the narrowed disk space puts added pressure on the nerves in the spinal canal.
The constriction of the spinal canal, or stenosis, produces symptoms known as neurogenic claudication. The patient can have leg pain while walking and standing (and is usually relieved by sitting or lying down). The constriction around one or two nerves can cause leg pain known as radiculopathy. Worsening of pain varies with position, but may be relieved by lying down.
Pain from spinal stenosis must be differentiated from similar pain caused by circulatory problems, arthritis of the hips, or diabetic nerve problems through one or more of the following diagnostic tools:
Surgical decompression of the involved vertebrae allows patients to walk farther and stand longer without pain.
The hospital stay is generally shorter if spinal fusion is not performed and a bit longer if it is. In either case, particularly if a patient’s condition had debilitated rapidly preoperatively, a short stay in a rehab facility to regain strength and mobility may be needed. The actual details of post-discharge care, resumption of normal physical and athletic activities, driving, and the possible use of a brace will be provided by the patient's surgeon.
Herniated discs most commonly arise in patients ages 20 to 50 years, but can occur at all ages. In older patients, they may again be associated with arthritis and nerve root compression.
Typically, most people will have an occasional episode of low back pain not necessarily associated with a traumatic event and will subsequently develop nerve-related leg pain, commonly known as sciatica. If these symptoms don’t resolve in several weeks, a physician should be consulted to see if the pain is a result of a disc rupture or herniation. Discs rupture and herniate because of degeneration and tears in various parts of the disc. In addition to low back pain and sciatica, patients with a severely ruptured or herniated disc may experience loss of bladder or bowel function and progressive leg weakness.
If a patient has symptoms of a herniated or ruptured disk, a magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan should be performed to identify the abnormality.
Self-limited symptoms usually respond well to the following:
If 6 weeks to 3 months with non operative measures does not produce symptom improvement, or if leg pain or weakness persists or worsens, surgical treatment may be suggested. The most common procedure for this condition is a discectomy in which a small incision is made in the back and the herniated portion of the disc is removed. Relief of symptoms is often quite dramatic. Healthy patients can have this surgery in an outpatient setting, but occasionally the side effects of anesthesia and pain medication used postoperatively require admission to the hospital for a 1 to 2 days. After the surgery, some recovery is necessary, but gradual return to full activities is the rule. The time it takes to return to work and sports activities varies and should be discussed with the patient's surgeon.
Neck pain and stiffness frequently occur in the aging spine. This is due to arthritic changes in the joints and degenerated discs, often revealed through regular x-rays.
When neck pain is associated with pain and/or numbness or weakness in the shoulder, arm, or hand, further workup may be needed, as these symptoms indicate pressure on the spinal cord or one or more nerve roots. Severe spinal cord pressure in the neck may cause symptoms of arm and leg weakness, imbalance, and problems with the hand use, such as buttoning shirts, and handwriting. Evaluation includes the following diagnostic measures:
Initial treatment can consist of any of the following:
If the symptoms are significant and persistent after nonoperative measures and/or a significant neurological deficit is apparent, surgical treatment is often necessary.