Cervical Spondylosis - Causes, Symptoms, Tests and Diagnosis

Did you know that as a person grows old, the back experiences wearing away? Yes. As you get older, the bones and other parts of your back may come to a point that becomes damage due to the wear and tear it constantly goes through. Cervical Spondylosis being one of the effects of constant degeneration.

Cervical Spondylosis, a common degenerative disorder of the spine, specifically affects the neck. It is a condition that affects both males and females who are usually ages 40 and above. Cervical osteoarthritis, another name for the specified spondylosis, appears earlier in men than in women.

What causes cervical spondylosis? As mentioned earlier, age related wear and tear is the primary cause for this condition. Ligaments become too weak or too stiff; discs lose its ability to act as cushions, and bone start to form abnormal spurs. Other factors that may cause this condition are past neck or spine injuries and severe arthritis.

How can you tell if the pain you are feeling is due to cervical spondylosis? The signs and symptoms of this condition are as follows:

• Pain on the neck, arm, or chest area.


• Neck becomes stiff or painful.


• Arms and hands become weak or numb.


• Feet, legs, arms, or hands get the tingling or pinprick feeling.


• Difficulty with coordinating your movements.


• Having abnormal reflexes.

If you have these symptoms and you go to your doctor, you can expect that different assessments will be done to confirm if you have cervical sponylosis. These include:

• Your doctor will have to assess your neck flexibility. Spondylosis affects one's range of motion. The doctor will have tilt your and rotate your head and neck towards different directions.


• Another is checking if your nerves in the spine have been affected or compressed. Your reflexes will be checked to see if your arms and legs feel the sensation and if your nerves are able to generate reactions.


• X-ray can be used to check if there are any abnormalities like bone spurs. In this case, spinal or neck X-rays are used.


• Injecting a special dye into the spinal canal and then generating images using CT scans or X-rays to see there are affected areas on spine is called Myelogram.


• MRI or CT scans are like X-rays but produces clearer images. It will help aid your doctor in finding out the severity of the damage to you cervical area.

Cervical spondylosis can be a bit scary especially if you are not informed about the condition very well. Just remember, if you have the symptoms, immediately consult a doctor so that she or he could diagnose you properly and provide a treatment plan to help you with the condition.

Selective Endoscopic Discectomy: Extremely Minimally Invasive Surgery

TRANSFORAMINAL SELECTIVE ENDOSCOPIC DISCECTOMY: extremely minimally invasive surgical treatment for lower back and leg pain.

While 95% of people who sustain an injury to their lower back will recover with a combination of conservative treatment and preventative measures there is a small group of patients who fail to respond to these measures.

This article is meant for those patients who remain unhappy with their symptoms and have been advised by their treating physicians that they would have to live with their present symptomatology or undergo extensive spinal surgery. The following information is about SELECTIVE ENDOSCOPIC DISCECTOMY an alternative procedure for those patients who do not want to live with chronic pain, undergo extensive spinal surgery and do not want to have general anesthesia.

The typical patient frequently presents several months or more after having sustained an injury to the lower back with no previous history of any back problems. Initial treatment from the general practitioner, chiropractor or emergency room physician might include that the patient take anti-inflammatory medication, analgesics, muscle relaxants, limit activities and receive physiotherapy. When the patient's problem did not resolve the patient may have been sent to an orthopedic or neurosurgical specialist who scheduled the patient for an MRI scan that may have revealed one or multiple disc bulges, disc protrusions or disc herniations. The patient may have been provided with additional treatment in the form of a lower back brace and a series of epidural cortisone injections along with specific trunk/abdominal/lower back stabilization exercises or Pilates exercises. While the patient may have noticed some partial improvement with any or all of the above measures he or she may have significant residual lower back pain and radicular pain into one or both of the legs. At that point the patient may have been told that surgical intervention would be necessary in the form of either a micro lumbar laminectomy or a Metrx discectomy under general anesthesia or if the problem was more extensive that a spinal fusion or disc replacement surgery might be indicated.

At that point after thorough review of the patient's history and performing a complete physical examination and discussing the patient's MRI scan I might find that the patient could be a candidate for the SELECTIVE ENDOSCOPIC DISCECTOMY procedure if the patient was found to have either a contained lumbar disc protrusion or lumbar disc herniation unassociated with elements of severe arthritic changes. At that point we would recommend to the patient that additional confirmatory testing be performed in the form of a provocative discogram to determine the exact disc that is causing the residual pain and then follow the discogram with a SELECTIVE ENDOSCOPIC DISCECTOMY procedure.

A discogram is an X-ray study performed under flouroscopic control in an outpatient surgical center using local anesthesia. A needle is placed in the center of the abnormal disk and in an adjoining normal disc and a solution consisting of X-ray contrast dye mixed with indigo Carmine blue dye is injected into these discs. Since the patient is awake as the dye causes increasing pressure in the center of the disc most likely this will reproduce the patient symptoms in the back and/or leg pain and also define the abnormal anatomy of the damage disc on the floroscope. If the patient's symptoms are reproduced by this discogram it is considered a positive concordant discogram and the patient can then be treated with the SELECTIVE ENDOSCOPIC DISCECTOMY either immediately or at a later time if insurance authorization is required.

The SELECTIVE ENDOSCOPIC DISCECTOMY procedure is then performed under local anesthesia with the patient awake and in the prone position on special pillows. A small needle is inserted into the disc space after local anesthesia has been administered. A 7mm (1/4inch) skin incision is made and a spine arthroscope is slipped into the abnormal disc. Under fluoroscopic control, the micro-instruments (mini forceps, mini curettes, and mini cutters-shavers) and the laser probe are used for removal of only the damaged disc material. The laser is used for further removal and shrinkage of the disc for the purpose of disc decompression and tightening up of the annulus. The procedure takes about 30 minutes to an hour per disc, on the average. The amount of disc removed and shrinkage by the laser varies, but includes only the herniated and damaged portion. The supporting structure of the disc is not affected. Upon completion, the probe is removed and a small Band-Aid is applied over the needle incision. Since the patient is awake during the procedure frequently they are interested in watching the monitor as we remove the damage disc material.

After surgery the patient is sent home and advised to use ice packs on the lower back and take mild oral analgesics and rest for few days. Many patients are able to resume work within a few days. The patient are advised prior to the procedure that if the preoperative pain was primarily lower back that in excess of 86% good and excellent results should be expected. If the patient's pain was back and leg pain good and excellent results should approach 92%.

Most of the time the patient's return to the office one week later feeling much improved and wanting to know why this procedure was not performed on them earlier and why the procedure works. We believe that this technique is successful because the abnormal portion of the disc that is creating internal pressure against the annulus and nerve root is removed, the fissures in the annulus that allow leakage of disc fluid and material are sealed and tighten up and the constant flow of irrigating saline through the endoscope washes out the irritating damaged metabolites( prostaglandins, histamines,and substance P & X). No deep tissue is cut and generally no bone has to be removed.

The following patients are not candidates for selective endoscopic discectomy:

1. The rare patient than has a disk that has become a fully extruded and migrated up into the spinal canal.

2. The patient has extensive spinal stenosis will need an extensive amount of bone removed which is better done with open surgery.

3. The patient has extensive spinal instability and requires a spinal fusion that must be done with an open procedure.

For those patients who are afraid of having extensive spinal surgery and have been told that they will have to live with their lower back pain, SELECTIVE ENDOSCOPIC DISCECTOMY is an exciting successful minimally invasive surgical alternative procedure that it is performed under local anesthesia and has a very high rate of patient satisfaction. For further information see www.back-surgery-online.com.

Correcting Forward Head Posture

Forward head posture is a common postural dysfunction today. It occurs when the head is habitually held in front of the body's midline so that its weight is not properly balanced over the spine and shoulders.

The body works best when it is aligned. The muscles of the neck as well as the cervical spine, with its joints and discs, are designed to support the weight of the head, but only when it is centered over the shoulders. When the head moves forward, the pressure exerted on the spine, and the shoulder and neck muscles increases drastically as they have to work harder to hold the head up.

Forward head posture results in and is perpetuated by a muscle imbalance. How does it all start? Modern culture involves a lot of sitting. We sit in school, in the office, in front of the TV and when commuting. It is typical, particularly when driving, looking at a computer screen or using a small electronic device, to crane your head forward to bring it closer to what you're looking at. Many people do this unconsciously (you're likely doing it right now). After a length of time, the body adapts to this posture. Muscles in the upper back become overstretched and weak, while muscles in the chest become short and tight. The upper trapezius, the portion of the muscle in the neck, can become chronically tight from working overtime to hold the head upright when in a forward position. The brain learns this pattern of tension and automatically sends signals for the pectorals and upper trapezius to contract, and the upper back and shoulders are pulled forward.

Forward head may also be caused by an unbalanced workout routine. Gym buffs who spend more time on their chests than their upper backs often end up with the postural dysfunction.

The chronic muscle tension associated with forward head can lead to the development of knots and spasms. It also puts the spine at risk, since the joints and discs of the cervical spine become compressed as vertebral angles change.

Correcting Forward Head Posture

To restore the head to proper alignment, a two-pronged approach works best. First, correct muscle imbalances. Second, increase posture awareness and use ergonomic aides, if necessary, to encourage proper posture.

Correcting the muscle imbalances involved in forward head means restoring flexibility to chest muscles and strengthening the upper back muscles, particularly the middle trapezius. See the video at http://www.youtube.com/watch?v=7l2TLBkFnP0 to learn a simple chest stretch and back exercise that, repeated a number of times a day, will help prepare your body for alignment.

Being aware of your head position is a crucial part of reversing the harmful muscle memory you've developed. You may find it necessary to readjust the way you do things like send a text, surf the
web or read a book. One easy way to encourage your head to stay upright is to keep things at eye level. When using an iPhone or similar device, hold it up to eye level, keeping the shoulders low and loose. Adjust your computer screen so that you can easily see it without craning forward. For book reading, consider investing in a book holder. This will prevent fatigue on your arms and hands from holding a book high for long periods of time.

Forward head posture can wreak havoc on your spine and muscles. Simple exercises and ergonomic changes to your daily activities may suffice to correct this condition. Massage therapy, physical therapy and myofascial release are treatments that can help in cases of advanced postural distortion.

Spinal Fusion Often Not Best Option For Spinal Stenosis Patients

Characterized by the narrowing of the spinal canal and impingement of nerves, spinal stenosis can be severely painful and debilitating. Stenosis can be caused by vertebral bone spurs, disc herniation or ligament overgrowth in the spine.

Stenosis of the upper spine segment in the neck is called cervical stenosis; it causes intense localized pain at the area of nerve compression and refers pain, numbness, tingling and/or weakness into the arm. In the lumbar spine, the condition often leads to sciatica. If nerve damage, paralysis or loss bladder and bowel function are imminent, surgery will be performed to treat this condition.

Not all surgeries are created equal. Be sure you know your options before agreeing to a surgical procedure.

Fusion Vs. Laminectomy

By far, spinal fusion is the most popular procedure prescribed for people with stenosis. This procedure entails the use of a bone graft or other device that is placed between two or more vertebrae to fuse them together into one rigid segment. The fusion is often reinforced with multiple pieces of hardware.

Medical researchers have expressed a great deal of concern about the increasing number of spinal fusion procedures in the last 15 years, particularly among Medicare patients. Some speculate that high reimbursements for the procedures coupled with kickbacks to surgeons from hardware device companies like Medtronics rather than the patients' best interests are responsible for the choice to perform the procedure.

A 2010 study sought to analyze trends of spinal fusion procedures while comparing this type of surgery to another, laminectomy, in the treatment of older Medicare patients with spinal stenosis. The study reports that the rate of complex spinal fusions - those involving fusion of more than two vertebrae or entailing both posterior and anterior approaches - performed between 2002 and 2007 increased 15-fold. Rates of laminectomy procedures decreased during this time.

Laminectomy, or surgical decompression, involves the removal of a piece of the posterior vertebra that covers spinal nerves. During a laminectomy, bone spurs or spinal disc segments impinging nerves are removed as well. The procedure widens the spinal canal, aiming to relieve painful pressure on nerves.

The study results showed that the rate of life-threatening complications was 2.3% among laminectomy patients and 5.6% for complex fusion patients. Rehospitalization rates within 30 days of the procedure were 7.8% for laminectomy recipients and 13% for complex fusion recipients. Complex fusions cost nearly 4 times more than laminectomies ($80,888 compared to $23,724). See more on the study at http://www.ncbi.nlm.nih.gov/pubmed/20371784.

Another study sought to compare the cost-effectiveness of both procedures for stenosis patients. Some cases of stenosis cannot be treated with laminectomy, particularly those that involve vertebral slipping (spondylolisthesis). Researchers compared the cost-effectiveness of laminectomy for regular stenosis to that of fusion for stenosis with vertebral slipping. Cost-effectiveness was measured in quality-adjusted life-years (QALY). Laminectomy cost $77,000 per QALY gained, compared to $115,000 for fusions. In the U.S., procedures are considered cost-effective up to $100,000 per QALY. See more on the study at http://annals.org/article.aspx?articleid=744151.

Despite the low cost-effectiveness, it is important to note that the above study also showed fusion for stenosis patients with spondylolisthesis to yield significantly greater health improvements than nonoperative care.

The decision to have surgery should not be an easy one. It is important for both patients and health professionals to ensure that conservative treatments have been rigorously pursued, if possible, and that surgery is a necessary last resort. For those with stenosis without vertebral slipping, laminectomy appears to be the best surgical option. Inform yourself about all your options before having surgery.

Scoliosis of the Spine - A New Perspective

Scoliosis of the spine is equally complex and confusing to doctors and patients alike. Over 80% of case have an unknown cause (idiopathic) and generally affects adolescent girls who may experience rapid spinal curvature increases by as much as 20 degrees per month during large growth spurts. Until recently, relatively ineffective spinal bracing and high-invasive spinal fusion surgery have been a patient's only treatment options.

The work we are doing is based on the fact that scoliosis is not just a spinal curvature, but involves abnormal spinal curves in the neck, as well as hip rotation. Active scoliosis patients always present with forward head posture and loss of cervical lordosis (seen on x-ray). There is also abnormal biomechanical mal-position of the head and neck. Therefore before the lateral scoliotic curvature can be corrected the cervical lordosis in the sagittal plane must be re-established. After which the lateral curve (Cobb angle) is reduced. These results are achieved with a combination of specific spinal adjustments done with instruments, specific rehabilitative procedures including proprioceptive neuromuscular re-education, muscle and ligament rehab and vibration therapy. The scoliotic spine compresses and rotates three dimensionally; therefore it must be de-rotated, and de-compressed in order to correct. We use, among other things, vibration platforms and a vibration scoliosis traction chair as well as specific bracing to pull the Cobb angle back into proper alignment.

Scoliosis is the body's natural and innate response to the loss of mechanical function provided by the normal curves of the spine. When these curves disappear, the body re-inserts them in another dimension. If scoliosis has a "cause," then it can only be described as the laws of physics.

Scoliosis is caused by a dysponesis (miscommunication) between the motor-sensory input/output from the upper trunk to the lower. This is in turn caused by a unilateral (one-sided) impairment of the spino-cerebellar loop, which is located in the area between the occiput and the first cervical vertebra. Supporting this theory is the fact that 100% of scoliosis patients have a problem with proprioception (orientation of the

body in time and space), and 100% of scoliosis patients have a loss of the curve in their neck, resulting in forward head posture.

Exercise rehabilitation therapy is mandatory to reverse the scoliosis. Without patient compliance, no amount of care can help. It is necessary to retrain the postural muscles of the body. Vibratory stimulation overrides the body's proprioceptive signals and mechanoreceptors, thus facilitating retraining of the postural muscles.

Cobb angles over 30 degrees cannot be reduced in the same manner as Cobb angles under 30 degrees. The muscles contract more on the convexity of the curve, rather than the concavity, as is the case with angles under 30 degrees. Normal laws of biomechanics do not apply in patients with Cobb angles of more than 30 degrees! One component is universally lacking in nearly all forms of scoliosis treatment today: the effect of the cervical spine in determining spinal pathology, gait, stance, and overall posture. The head controls all components of the spine below it, much like how the engine controls the direction of a train. Without regard for which direction the locomotive is heading in, how is it possible to control the boxcars behind it? The very first aspect that must be addressed in scoliosis correction is the cervical spine; specifically, correcting the forward head posture by restoring the curve and the normal ranges of motion in the neck, especially between the occiput (C0) and the atlas (C1).

This is why lateral cervical views in neutral, flexion, and extension are necessary. Follow-up x-rays should be performed roughly every three months as objective proof of improvement; should the patient's progress plateau or regress, additional rehabilitation or alterations to the protocol may be required. Obviously thoracic views are necessary to measure the Cobb angle, but stay away from full-spine views! The rate of distortion is too high to allow for consistency and accuracy when comparing measurements between pre-and post-x-rays. It is also important to evaluate the curve in the low back, and rotation in the hips with lateral and A-P lumbar x-rays, and correct any deviation from normal that is found.

Dr Brian T Dovorany

Dr Clayton J Stitzel

Do You Need An MRI For Back Pain?

Given the difficulty of diagnosing back pain, patients are often eager to try every available diagnostic method. There is a popular idea among pain patients that MRI scans are a necessary part of diagnosis. For many reasons, this is a misconception.

The MRI

Magnetic resonance imaging (MRI) scans use a large magnet to surround the patient with a magnetic field that excites the water molecules in his or her body. MRI films capture the image of these excited molecules and end up with an accurate, detailed picture of the patient's spinal anatomy. MRIs are more thorough than X-rays, which mainly show bones. MRIs show softer tissues, such as discs, nerves, muscles and ligaments as well as bones.

This kind of imaging test is a great advance in diagnostic science, allowing medical professionals to detect disc abnormalities, nerve obstruction, tumors and infections. However, for the typical back pain patient, MRIs may not be especially useful.

"Normal Abnormalities"

Some in the medical community have dubbed certain changes within the spine "normal abnormalities." This particularly applies to disc degeneration. Spinal discs wear with age and use. A variety of studies reporting the findings of spinal MRI scans have included people without back pain. Findings have varied, but disc degeneration was detected by scans in an average of about 30% of asymptomatic people. This means that an MRI may show a problem, but that the problem may not be causing your pain.

Uses

MRIs are very proficient at detecting disc and nerve abnormalities, but for most people, the cause of pain lies elsewhere. At least 80% of the population suffers from lower back pain at some point; for about 5%, the pain is caused by a disc problem with nerve impingement. MRIs also detect tumors and infections around the spine, but these are even rarer than nerve and disc problems. The type of pain you feel and the correlating symptoms you have should help to confirm or rule out discogenic pain, nerve impingement, spinal tumors or infections. Most commonly, the cause of back pain is muscle or ligament strain. This can take anywhere from days to a few months to heal with conservative treatment.

Cost

Nobody wants to sacrifice their health to save a few bucks, but the limited usefulness of the MRI combined with its cost can be taken together as reason enough not to rush into it. You can expect a scan to cost around $2,000, but much more or slightly less depending on where you live. Insurance companies don't always offer full reimbursements for MRIs.

MRIs are best reserved for people whose pain is not resolved by months of conservative treatment and those who immediately represent severe symptoms associated with nerve impingement, tumor or infection. If the medical professionals treating you don't order a scan right off the bat, it doesn't mean they aren't doing their jobs. If all they do is give you pain pills, however, it does mean they aren't doing their jobs. Diagnosis of back pain should involve a physical exam, questions about your medical history and, if no cause is apparent to the doctor, a trip to the physical therapist for a muscle balance check and to the chiropractor for alignment testing.

MRIs aren't needed by everyone, or even most people with back pain. As long as your doctor is taking other steps to understand the source of your pain, you don't need to rush the MRI.

Natural Therapies for Low Back Pain

Low back pain is something that plagues hundreds and thousands of people, in the United States alone. Low back pain can make it difficult to walk, stand or sit for long periods of time, cause pain and complications in other parts of the body and make it difficult to get everyday or work related tasks completed. Luckily, there are a lot of natural therapies to help reduce low back pain when the alternatives like surgery or prescription pain pills are not the desired form of treatment. Take the next few minutes to learn about these various nature therapies for the treatment of low back pain, or at least the reduction in the pain.

Seeing a chiropractor is a great natural remedy or therapy to deal with low back pain as they are experts in the spine and how it can cause pain disorders in the low back or worsen back pain caused by problems other than spine issues. A chiropractor can uses various techniques to help loosen the various joints in the back that are causing pain due to repetitive stress, improper back support or traumatic event. These causes often result in a tissue injury that restricts the joints from being able to move properly. This inability to have a full range of motion puts stress on other parts of the body, like the lower back for example, which causes pain. When the chiropractor manipulates those joints they are helping to restore the mobility of the joints.

Aside from just manipulating or adjusting the spine and joints affected, they generally also make recommendations to your diet and the vitamins and minerals you are taking in. They might also recommend various exercises you can do at home to prevent further pain and injury.

Another alternative, natural therapy for low back pain is soft tissue manipulation or mobilization. This type of therapy is generally performed by a physical therapist, but can also be done by a properly trained massage therapist who you can usually get a referral for through your chiropractor, if they feel it may be beneficial to your particular cause of low back pain. This method involves using the hands to move the soft tissues in such a way that the affected muscle becomes loosened and the natural and proper muscle balance is restored, eliminating stress and overuse in the wrong areas. The physical therapist will also give you a variety of exercises you can do at home to enhance the therapy you receive from them.

While there are still many other alternative, natural therapy methods to help alleviate low back pain, the last one we'll discuss here is acupuncture. While, like most types of therapies, acupuncture does not work for everyone, but because it can be beneficial on a number of levels it doesn't hurt to try it out. Acupuncture is the process in which a professional inserts needles into specific areas of the back in order to unblock the natural pathways in which energy flows through the body. When it works, acupuncture reduces the pain and helps increase your ability to be more active.