There are many causes of spine disorders; some common, some rare. The causes may be grouped into broad categories as outlined below.
The links in the text below connect to information about specific spine conditions provided by the American Academy of Orthopaedic Surgeons. This will give you useful background information and will help you to ask the right questions when you see us. To understand the basic way a spine is ‘built’ and to learn how it works, visit their website.
Herniation describes an abnormality of the intervertebral disc that is also known as a “slipped,” “ruptured” or “bulging” disc. This occurs when the inner core (nucleus pulposus) of the disc bulges out through the outer layer of ligaments that surround the disc (annulus fibrosis). This tear in the annulus fibrosis causes pain in the back at the point of herniation. If the protruding disc presses on a spinal nerve, the pain may spread to the area of the body that is served by that nerve like the leg.
Usually, the main symptom is sharp, acute pain. In some cases, there may be a previous history of localized low back pain, with pain also extending down the leg served by the affected nerve. This pain is usually described as a deep, sharp or burning, which gets worse as it moves down the affected leg. The onset of pain with a herniated disc may occur suddenly or it may be preceded by a tearing or snapping sensation in the spine, which may be attributed to a sudden rupture in the annulus fibrosis.
A patient with a herniated disc will usually complain of low back pain that radiates to the leg. They will often have a limitation in range of motion when asked to bend forward or lean backwards, and they may lean to one side as they try to bend forward. Patients will sometimes walk with a painful limp, flexing the affected leg so as not to put too much weight on the side of the body that hurts.
A straight leg raise test may be a positive indication of tension on the nerve root. Abnormalities in the strength and sensation of particular parts of the body may be examined for.
An MRI is the test of choice for diagnosis of a herniated disc, but a CT scan (CAT scan) also may be helpful to indicate where the source of pressure on the nerve root is located.
Treatment for the vast majority of patients with a herniated disc does not normally include surgery. Most patients will respond to conservative therapy, such as medication, rest and physical therapy.
Surgery is typically recommended only after conservative measures have failed to adequately relieve the symptoms within in a suitable timeframe. Rarely, in the case of severe nerve compression that is possibly causing irreversible damage, surgery may be recommended as a first line of treatment.
The primary element of conservative treatment is controlled physical activity. Usually treatment will begin with a modification of activity and then a gradual return to protected activities. Sitting, bending, lifting and twisting are not beneficial for this condition because they put a large amount of stress and pressure on the lumbar spine, which may increase the pressure on the affected nerve root. The appropriate use of medication is an important part of conservative treatment. This can include anti-inflammatories and specific analgesics your doctor may prescribe. Sometimes an anti-inflammatory or ‘cortisone’ spinal injection for the area of the affected nerve root to lessen swelling and irritation caused by the damaged disc is utilised.