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Thoracic Pain

Spondylosis

Spondylosis, or disc degeneration, is sometimes referred to as osteoarthritis. It describes bony overgrowths (osteophytes), predominantly along the anterior, lateral, and less commonly the posterior aspects of the superior and inferior margins of the vertebral bodies. This dynamic process increases with, and is perhaps inevitable with age.

 

What causes spondylosis?

There is no specific cause of spondylosis and this condition appears to be a natural part of the aging process. Prior injuries or surgery to the spine may increase the risk of developing spondylosis.

 

What are some symptoms of spondylosis?

There are a number of symptoms of spondylosis that may occur with other spinal conditions. The nature of the symptoms varies depending on the location of the spondylosis.

Spondylosis affecting the cervical spine may cause:

  • Neck pain that may radiate to, or be felt in, the arms or the shoulders

  • Weakness or loss of sensations in the shoulders, arms and occasionally the legs

  • Stiffness in the neck that worsens over time

  • Problems with balance

  • Reduced or hyper reflexes

  • Headaches that tend to originate in the back of the head

  • Bladder and bowel control problems

 

Spondylosis affecting the lumbar spine is more elusive and is usually asymptomatic, with no diagnostic or prognostic significance. Given the frequency and size of lumbar osteophytes, they have long been thought to cause back pain. This has led to many studies. These studies reveal that there is no greater frequency of signs or symptoms among individuals with osteophytes than among those without osteophytes.

 

 

 

Compression Fracture

"Excruciating pain in my back after a fall…" You may suffer from a compression fracture.

A compression fracture is a common fracture of the spine. It implies that the vertebral body has suffered a crush or wedging injury. The vertebral body is the block of bone that makes up the spinal column. Each vertebral body is separated from the other with a disc. When an external force is applied to the spine, such as from a fall or carrying of a sudden heavy weight, the forces may exceed the ability of the bone within the vertebral body to support the load. This may cause the front part of the vertebral body to crush forming a wedge shape. This is known as a compression fracture.

The compression fracture may range from mild to severe in terms of severity. A mild compression fracture causes minimal pain, minimal deformity and is often treated with time and activity modification. A severe compression fracture may be such that the spinal cord or nerve roots are involved, as they are draped over the sudden angulation of the spine. This may cause severe pain, a hunched forward deformity and rarely neurologic deficit from spinal cord compression.

 

How is it diagnosed?

A compression fracture is usually diagnosed by the history, physical exam, x-rays, CT scan or MRI. MRI scan can also rule out disc herniation and nerve roots involvement along with a compression fracture.

 

Treatment

The majority of mild to moderate compression fractures is treated with immobilization in a brace or corset. Bracing helps to reduce acute pain by immobilizing the fracture. It also helps to reduce the eventual loss in height and in angulation from the fracture. Neck compression fractures may be immobilized using a rigid collar and/or a soft collar. Pain medications may help lessen the pain of a compression fracture. Spinal surgery is rarely indicated for patients with compression fractures.

Kyphoplasty or Vertebroplasty are newer minimally invasive procedures performed to stabilize vertebral compression fractures and reduce pain.

 

Recovery

Most patients can expect to make a full recovery from their compression fractures. Typically, braces are worn for six to twelve weeks followed by three to six weeks of physical therapy and exercise. This is to help regain strength of the trunk muscles and to increase endurance of the trunk musculature. Overall strength, aerobic capacity and flexibility are also helped by physical therapy. Most patients can return to a normal exercise program six months after suffering their compression fracture. Regular exercise is one of the activities recommended to help prevent compression fractures in the future.

 

 

 

 

 

 

Scoliosis

"I have back pain. My spine is curved."

We all have curves in our spines, but scoliosis causes the spine to curve in the wrong direction. It is commonly associated with pain. It causes sideways curves, and those are different from the spine's normal curves. If you were to look at your spine from the side, you would see that it curves out at your neck, in at your mid-back, and out again at your low back. Your back is supposed to have those curves. However, if you look at your spine from behind, you should not see any curves at all. When there are sideways curves in the spine, that is scoliosis. The curves can look like an 'S' or a 'C.'

 

How is scoliosis diagnosed?

Scoliosis is generally found in children, but adults can have it, too. This typically happens when scoliosis is not detected during childhood or the disease progresses aggressively. The diagnosis of scoliosis is made by a careful physical exam and an x-ray to evaluate the magnitude of the curve.

 

How is scoliosis treated?

The majority of patients are observed at regular intervals (usually every 4 to 6 months) by a physical exam and a low radiation x-ray. Bracing is the usual treatment choice for adolescents. Those who have or develop significant curves may become candidates for surgery. If scoliosis associated with pain, pain medications and interventional pain procedures (i.e. spine injections) may be very helpful to provide a relief. Scoliosis is nothing to be scared or ashamed of. With the proper treatment, scoliosis does not have to define your life.

 

 

 

 

Herniated Disc

The human spine is comprised of 24 vertebrae separated from each other by discs that serve as shock absorbers and provide flexibility of the spine. In addition, they serve to allow adequate space for spinal nerves to exit, providing sensation and movement to all parts of the body.

The disc is composed of a thick, tough outer annulus fibrosus - constraining ring primarily composed of collagen and a soft inner core known as the nucleus pulposus which consists of a proteoglycan. A tear in the annulus may cause the nucleus to rupture. If the nucleus pours out through the tear in the annulus, the disc is said to be herniated. Nuclear material, which is displaced into the spinal canal, is associated with a significant inflammatory response. The vertebrae between which the disc lies may press against each other and against the nerves that extend from either side of the vertebra. Compression of a motor nerve results in weakness, and compression of a sensory nerve results in numbness. In this instance, one may experience both back pain from the herniation or tear of the annulus, as well as pain from that part of the body served by the nerve. Radicular pain results from inflammation or compression of the nerve, explaining the lack of correlation between the actual size of a disc herniation with that of clinical symptoms.

 

What are some symptoms of a herniated disc?

Patients usually feel pain in the lower back and pain or numbness in the legs. The classic presentation of a herniated disc includes the complaint of sciatica (an intractable radiating pain), with associated objective neurological findings of weakness, reflex change or dermatomal numbness.