The intervertebral discs are complex structures that consist of a thick outer ring of fibrous cartilage termed the annulus fibrosus, which surrounds a more gelatinous core known as the nucleus pulposus.
The gelatinous core can breakthrough the outer fibrous layer leading to compression of adjacent nerves. It also causes severe acute irritation and inflammation. Inflammation and compression both contribute to the pain.
Because the walls of the discs are so densely supplied with nerve fibers, a tear in the wall can also result in excruciating pain, weakness, numbness, or alterations in sensation.
Degenerative Disc Disease:
Due to aging process, intervertebral discs start to deteriorate and degenerate. Small fissures and tears develop in the outer layer while inner gelatinous layer hardens. This process leads to discs losing height and elasticity.
Therefore, spaces between the vertebrae become narrow and tight. Combined with spine arthritis, the spine loses its natural healthy shape and nerves become “pinched”.
Spinal stenosis happens when the space inside the backbone is too small. This can occur due to facet joint arthritis and ligamentum Flavum thickening; a ligament that holds the vertebra together.
Some people with spinal stenosis may develop no symptoms. Others may experience pain, tingling, numbness and muscle weakness especially with walking. Hallmark of this condition is pain relief with forward flexion.
It is a degenerative spine disorder that can make everyday activities like walking or bending forward extremely painful and can be associated with stiffness.
The diagnosis is given when an imaging study such as a x-ray or MRI image of the spine from a side view reveals the displacement of one vertebral level compared to the surrounding levels.
If the vertebral level is shifting forward then it may pinch an exiting nerve and cause discomfort in the distribution of that nerve. If the slippage is not severe, there may not be any symptoms except vague chronic low back pain if any.
The most common location for Spondylolisthesis is in the lumbar region of the spine. Other causes include trauma or fractures, in this case the vertebra may begin to move out of position if a stress fracture weakens the bone and prevents it from maintaining the correct alignment.
Initial treatment is conservative and there is evidence to suggest that lumbar epidural cortisone injections may be beneficial if a nerve is pinched due to forward slippage of the vertebra. Come in for a visit to discuss a specific treatment plan.
Skeletal Deformities – such as scoliosis is congenital whereas some like kyphosis or lordosis can be due to poor posture and genetics.
Discomfort in the lower back can result from such deformities as they alter weight distribution and put more stress on soft tissues like muscles, ligaments and nerves.