Disease of the Cervical and Lumbar Spine

Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs). Cervical spondylosis is very common and worsens with age. More than 85 percent of people older than age 60 are affected by cervical spondylosis. Most people experience no symptoms from these problems. When symptoms do occur, nonsurgical treatments often are effective.

Symptoms

For most people, cervical spondylosis causes no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck. Sometimes, cervical spondylosis results in a narrowing of the space needed by the spinal cord and the nerve roots that pass through the spine to the rest of your body. If the spinal cord or nerve roots become pinched, you might experience:
• Tingling, numbness and weakness in your arms, hands, legs or feet
• Lack of coordination and difficulty walking
• Loss of bladder or bowel control

When to see a doctor

Seek medical attention if you notice a sudden onset of numbness or weakness, or loss of bladder or bowel control

Causes

As you age, the bones and cartilage that make up your backbone and neck gradually develop wear and tear. These changes can include:
• Dehydrated disks. Disks act like cushions between the vertebrae of your spine. By the age of 40, most people’s spinal disks begin drying out and shrinking, which allows more bone-on-bone contact between the vertebrae.
• Herniated disks. Age also affects the exterior of your spinal disks. Cracks often appear, leading to bulging (herniated) disks — which sometimes can press on the spinal cord and nerve roots.
• Bone spurs. Disk degeneration often results in the spine producing extra amounts of bone in a misguided effort to strengthen the spine. These bone spurs can sometimes pinch the spinal cord and nerve roots.
• Stiff ligaments. Ligaments are cords of tissue that connect bone to bone. Spinal ligaments can stiffen with age, making your neck less flexible.

Risk factors

• Age. Cervical spondylosis is a normal part of aging.
• Occupation. Jobs that involve repetitive neck motions, awkward positioning or a lot of overhead work put extra stress on your neck.
• Neck injuries. Previous neck injuries appear to increase the risk of cervical spondylosis.
• Genetic factors. Some individuals in certain families will experience more of these changes over time, while others will not.
• Smoking. Smoking has been linked to increased neck pain.

Complications

If your spinal cord or nerve roots become severely compressed as a result of cervical spondylosis, the damage can be permanent.
Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck.
Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can worsen over time.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

Types of spinal stenosis

The types of spinal stenosis are classified according to where on the spine the condition occurs. It’s possible to have more than one type. The two main types of spinal stenosis are:
• Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in your neck.
• Lumbar stenosis. In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of spinal stenosis.

Symptoms

Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the stenosis and which nerves are affected.

In the neck (cervical spine)
• Numbness or tingling in a hand, arm, foot or leg
• Weakness in a hand, arm, foot or leg
• Problems with walking and balance
• Neck pain
• In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence) In the lower back (lumbar spine)
• Numbness or tingling in a foot or leg
• Weakness in a foot or leg
• Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
• Back pain

When to see a doctor

See your doctor if you have any of the symptoms listed.

Risk factors

Most people with spinal stenosis are over the age of 50. Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. These include trauma, congenital spinal deformity such as scoliosis, and a genetic disease affecting bone and muscle development throughout the body. Spinal imaging can differentiate these causes.

Complications

Rarely, untreated severe spinal stenosis may progress and cause permanent:
• Numbness
• Weakness
• Balance problems
• Incontinence
• Paralysis

Causes

The backbone (spine) runs from your neck to your lower back. The bones of your spine form a spinal canal, which protects your spinal cord (nerves). Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to narrow the open space within the spine. Causes of spinal stenosis may include:
• Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
• Herniated disks. The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk’s exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves. • Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
• Tumors. Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
• Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.

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