Spinal Disorders

A lumbar disc herniation occurs when the soft inner core (nucleus pulposus) of an intervertebral disc pushes through its outer ring (annulus fibrosus) and compresses a nearby nerve root. It is most common at the L4-L5 and L5-S1 levels and is a frequent cause of sciatica — pain radiating from the lower back into the leg.

A cervical disc herniation occurs when a disc in the neck region protrudes and compresses a nerve root or the spinal cord. It is most common at the C5-C6 and C6-C7 levels and typically causes pain radiating into the arm, with numbness and weakness.

Lumbar spinal stenosis is narrowing of the spinal canal or nerve-root canals in the lower back. It most often develops from degenerative (age-related) causes and is characterized by leg pain that worsens with walking and eases with rest (neurogenic claudication).

Cervical disc herniation is displacement of the inner disc material (nucleus pulposus) through the outer annulus, compressing a nerve root or the spinal cord in the neck. It most often occurs at C5-C6 and C6-C7, causing arm pain, numbness and weakness (radiculopathy), and in severe cases spinal cord compression (myelopathy).

Spondylolisthesis is forward slippage of one vertebral body over the one below it, most often at L4-L5 and L5-S1. In children it is usually due to a pars defect (isthmic), while in adults it is degenerative. It can cause low-back pain, leg pain and difficulty walking, although many low-grade cases are asymptomatic.

OPLL is ossification (bone formation) of the posterior longitudinal ligament of the spine. It most often affects the cervical (neck) region and can narrow the spinal canal over time, causing spinal cord compression (myelopathy). It is more common in people of Asian descent and is a slowly progressive disease, often asymptomatic at first.

Adult spinal deformity (ASD) is a three-dimensional curvature of the spine in adults: sideways curvature (scoliosis), forward stooping (kyphosis) and loss of the lower-back curve (lordosis). It most often develops on an age-related degenerative background, causing back pain, a forward-leaning posture and imbalance. The concept of sagittal balance is central to treatment.

Osteoporotic vertebral compression fractures are collapse fractures occurring in osteoporotic bone after minimal trauma or spontaneously. They are most common in postmenopausal women and at the thoracolumbar junction, causing sudden back pain and height loss. Most cases heal with conservative treatment.

Intramedullary tumors are rare tumors that arise within the spinal cord tissue and make up a small fraction of all spinal tumors. In adults the most common types are ependymoma and astrocytoma. They cause slowly progressive pain, weakness and sensory loss; the mainstay of treatment is microsurgical resection.

Chiari malformation is a congenital anomaly in which the lower part of the cerebellum (cerebellar tonsils), and sometimes the brainstem, descends through the large opening at the skull base (foramen magnum) into the spinal canal. By disrupting cerebrospinal fluid circulation it can lead to syringomyelia and hydrocephalus; symptomatic cases are treated with surgical decompression.

Syringomyelia is a chronic, progressive condition characterized by a fluid-filled cystic cavity (a syrinx) within the spinal cord. Its most common cause is Chiari malformation. Its hallmark is dissociated sensory loss, in which pain and temperature sensation are lost; treatment targets the underlying cause.

Spinal metastases are secondary tumors formed when a primary cancer elsewhere in the body spreads to the spine. They arise most often from lung, breast and prostate cancers; the main features are progressive back pain, neurological deficit and pathological fracture.