Back and Neck Pain Disorders
The skilled physicians, neurosurgeons, nurses and therapists at Spine Center at Cushing Neuroscience Institute within North Shore-LIJ Health System provides state-of-the-art spinal care for patients with a wide spectrum of spinal conditions to help patients regain mobility and return to active, independent lives. The Spine Center treats the following back and neck pain disorders:
- Back and neck pain – originating from many causes
- Cervical radiculopathy – also known as sciatica, this pain originates along the sciatica nerve, the largest nerve in the entire body and the primary nerve of the leg
- Chordomas – tumors found more frequently in the spine's sacrum, the area that connects the spine to the pelvis
- Disc bulging/herniation/slipped disc (cervical, thoracic, lumbar) – discs are the pads that serve as cushions between the vertebrae of the spine
- Diskitis (cervical, thoracic, lumbar) – an uncommon condition that causes swelling and inflammation of the discs of the spine
- Kyphosis – curving of the spine that leads to a hunchback or slouching position
- Myelitis – a rare disorder of the spine that results in swelling and inflammation of the spinal cord
- Osteoarthritis of the spine – the most common form of arthritis that causes back and neck pain, swelling and reduced motion in your joints
- Osteoporosis of the spine – a loss of bone mass and destruction of bone tissue that makes bones more susceptible to breaking
- Scoliosis – a sideways curvature of the spine measuring 10 degrees or greater on an X-ray
- Spinal compression fractures – occurs when too much pressure is placed on a weakened vertebra and causes the front of the vertebra to crack and lose height
- Spinal cord tumors – tumors that originate in the spine as primary tumors are rare and usually benign
- Spinal deformities – such as curvature (scoliosis), humpback (kyphosis), saddle back (lordosis)
- Spinal malignancies – cancerous tumors that grow from the bone or disc are generally rare and slow growing
- Spinal stenosis – a narrow spinal canal resulting from an injury or disorders and diseases of the spine
- Spondylosis – caused by abnormal wear on the cartilage and bones of the neck
- Trauma of the spine – falls, accidents and whiplash are common causes of trauma of the spine that causes back and neck pain
- Vertebral artery disorders – atherosclerosis (hardening of the arteries due to buildup of plaque on the artery walls) is one of the most common vertebral artery disorders.
Spinal Disorder Types:
- Back and Neck Pain Disorders
Neck pain is pain that occurs in the area of the seven cervical vertebrae in the neck area. Because of its location and range of motion, the neck is often left unprotected and subject to injury.
Back and Neck Pain Symptoms:
Back pain symptoms may include the following:
- mild, dull, annoying pain
- persistent, severe, disabling pain in the lower back. Pain in the back can restrict mobility and interfere with normal functioning.
Pain symptoms in the back or neck area can come on suddenly and intensely (acute) or the pain can last for weeks, months, or even years (chronic). The pain can be continuous or intermittent.
Back and Neck Pain Causes:
There can be many underlying causes of back and neck pain, including any of the following:
- Overuse, strenuous activity, improper use or repetitive heavy lifting
- Trauma, injury or fractures
- Stress on the muscles and ligaments that support the spine, resulting in degeneration
- Tumor or bone spur
- Increased weight on the spine and pressure on the discs, as a result of obesity
- Poor muscle tone
- Muscle tension or spasm
- Sprain or strain
- Ligament or muscle tears
- Joint problems, such as arthritis
- Protruding or herniated (slipped) disc and pinched nerve
Congenital (present at birth) abnormalities
Herniated, Bulging or Slipped Disc Disorders
Discs are the pads that serve as cushions between the vertebrae of the spine and soften the impact of movement on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus). When a disc degenerates from aging or injury, the softer nucleus can rupture, or herniate. Some of the more common terms for this condition are herniated disc, bulging disc, slipped disc or pinched nerve.
Herniated, Bulging or Slipped Disc Symptoms:
Symptoms of a herniated, bulging or slipped disc vary, depending on where the disc has herniated and what nerve root it is pushing on. Common symptoms are:
- Intermittent or continuous back pain which may worsen with movement, coughing, sneezing, or standing for long periods of time)
- Spasm of the back muscles
- Sciatica – pain that starts near the back or buttock and travels down the leg to the calf or into the foot
- Muscle weakness in the legs
- Numbness in the leg or foot
- Decreased reflexes at the knee or ankle
- Changes in bladder or bowel function
Herniated, Bulging or Slipped Disc Causes:
- Aging – As we age, the disc may lose water and dry out. As this happens, the disc compresses. This may lead to the deterioration of the tough outer ring, allowing the nucleus (inside) of the ring to bulge out. This is considered a bulging disc.
- Disc Deterioration – As the disc continues to degenerate, or with continued stress on the spine, the internal matter may rupture and leak out. This is considered a ruptured or herniated disc. When the herniated disc pushes against a nerve root, it usually results in back or neck pain in the area of the body which that nerve supplies. This is what is known as a pinched nerve. For example, a pinched nerve in the neck (cervical) region will result in arm pain, while a pinched nerve in the lower back (lumbar) region results in leg pain (sciatica). This can cause back or neck pain, weakness, numbness or changes in sensation.
- Trauma – Occasionally, severe trauma can cause a normal disc to herniate. Trauma may also cause an already herniated disc to worsen.
Myelitis, otherwise known as transverse myelitis, is a rare disorder of the spine that results in swelling and inflammation of the spinal cord. This leads to problems with sensation and motor function. There is still much that is unknown about myelitis, a condition that can have many different symptoms. Some people have no symptoms of myelitis, while others may have pain in their bones and muscles, particularly in the back.
Osteoporosis, or porous bone, is a disease in which there is a loss of bone mass and destruction of bone tissue. This process causes weakening of the bones and makes them more likely to break. The bones most often affected are the hips, spine and wrists.
Although the exact medical cause for osteoporosis is unknown, a number of factors contribute to osteoporosis, including the following:
- Aging – Bones become less dense and weaker with age.
- Race – Caucasian and Asian women are at higher risk, although anyone may develop the disease.
- Body weight and bone structure – Individuals who weigh less and have small body frames. are more at risk for developing osteoporosis.
The following lifestyle factors may increase a person's risk of osteoporosis:
- Physical inactivity
- Excessive use of caffeine
- Excessive alcohol use
- Dietary calcium and vitamin D deficiency
- Certain medications
- Family history of bone disease
- Potentially no symptoms
- Pain in bones and muscles, particularly in the back
Sciatica, also known as lumbar radiculopathy, is a pain that originates along the sciatic nerve, which extends from the back of the pelvis down the back of the thigh. The sciatic nerve is the primary nerve of the leg and the largest nerve in the entire body.
Usually, sciatica is caused by a prolapsed disk in the spine that presses on the sciatic nerve. Sometimes, a cause cannot be identified. Common causes of sciatica may include the following:
- Blood clot
- Awkward sitting position
- Nerve disorders
The following are the most common symptoms of sciatica. However, each individual may experience symptoms differently.
- Lower back pain that radiates down the buttock and back of one thigh
- Pain that extends from the buttock down to the foot
- Numbness (in severe cases)
- Weakness (in severe cases)
Scoliosis is defined as a curvature of the spine measuring 10 degrees or greater on an X-ray. A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or sideways, curvature and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. Scoliosis is a type of spinal deformity and should not be confused with poor posture.
There are four common types of curve patterns seen in scoliosis:
- Thoracic curve – Ninety percent of the curves occur on the right side of the spine in the thoracic, or middle, segment of the vertebral column.
- Lumbar curve – Seventy percent of the curves occur on the left side of the vertebrae of the lower spine.
- Thoracolumbar curve – The largest scoliosis curve extends from the upper to lower spine. Eighty percent of the curves occur on the right side.
- Double major curve – These curves occur on the right and left side.
In the majority of cases the causes of scoliosis are unknown and are identified idiopathic scoliosis. In other cases, scoliosis may develop as a result of degeneration of the spinal discs, as seen with osteoporosis, or as a hereditary condition that tends to run in families.
The abnormal curves of the spine, or scoliosis, are classified according to their causes:
- Nonstructural Scoliosis (also called functional scoliosis) – In this condition, a structurally normal spine appears curved due to one or more underlying conditions (i.e., difference in leg length or an inflammatory condition). This type of scoliosis is generally temporary and is often relieved when the underlying condition is treated.
- Structural Scoliosis – The possible causes of structural scoliosis are numerous, including:
- Of unknown origin (idiopathic structural scoliosis)
- Disease (i.e., neuromuscular, metabolic, connective tissue or rheumatoid disease)
- Birth defect
- Abnormal growth or tumor
Although each individual may experience symptoms differently, these are the most common symptoms of scoliosis.
- Difference in shoulder height
- The head is not centered with the rest of the body
- Difference in hip height or position
- Difference in shoulder blade height or position
- When standing straight, difference in the way the arms hang beside the body
- When bending forward, the sides of the back appear different in height
Note that back pain, leg pain and changes in bowel and bladder habits are not commonly associated with idiopathic scoliosis. A person experiencing these types of symptoms requires further medical evaluation by a physician. The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your physician for a diagnosis.
- Spinal Cord Injury
The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body. Each nerve that comes out of the spinal cord is responsible for a different area of the body and communication back and forth to the brain actions, reactions, sensation and more.
Spinal Cord Injury Causes:
Acute spinal cord injury (SCI) is due to a traumatic injury that can either result in a bruise (also called a contusion), a partial tear or a complete tear (transection) in the spinal cord.
There are many causes of spinal cord injury. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following:
- Birth injuries, which usually affect the spinal cord in the neck area
- Motor vehicle accidents (where the person is either riding as a passenger in the car or is struck as a pedestrian)
- Sports injuries
- Diving accidents
- Trampoline accidents
- Penetrating injuries that pierce the cord, such as gunshots and stab wounds, may also cause damage.
Types of Spinal Cord Injury:
Spinal cord injury can be divided into two main types of injury:
- Complete spinal cord injury – There is no function below the level of the injury (sensation and movement), and both sides of the body are equally affected. Complete injuries can occur at any level of the spinal cord.
- Incomplete spinal cord injury – There is some function below the level of the injury. There may be movement in one limb more than the other, feeling in parts of the body or more function on one side of the body than the other. Incomplete injuries can occur at any level of the spinal cord.
Spinal Cord Injury Symptoms:
Possible symptoms of spinal cord injury include:
- Muscle weakness or paralysis in the trunk, arms or legs
- Loss of feeling in the trunk, arms or legs
- Muscle spasticity
- Breathing problems
- Problems with heart rate and blood pressure
- Digestive problems
- Loss of bowel and bladder function
- Sexual dysfunction
- Spinal Stenosis
In people with spinal stenosis, the spine is narrowed in one or more of these three parts:
- The space at the center of the spine
- The canals where nerves branch out from the spine
- The space between vertebrae (the bones of the spine)
This narrowing puts pressure on the spinal cord and nerves and can cause pain. Spinal stenosis is most common in men and women over 50 years old. Younger people who were born with a narrow spinal canal or who injure their spines may also get spinal stenosis.
Spinal Stenosis Causes:
Spinal stenosis is the result of numerous factors:
- Aging – Changes that occur in the spine as people get older are the most common cause of spinal stenosis. As people get older, the bands of tissue that support the spine may get thick and hard. The bones and joints may get bigger and the surfaces of the bones may bulge out (bone spurs).
- Arthritis – In some cases, arthritis, a degenerative condition, can cause spinal stenosis. Two forms of arthritis may affect the spine: osteoarthritis and rheumatoid arthritis.
- Osteoarthritis is the most common form of arthritis, occurring most often in middle-aged and older individuals. It may involve many joints in the body.
- Rheumatoid arthritis affects most people at a younger age than osteoarthritis and causes swelling of the soft tissues of the joints. It can also affect internal organs and cause severe damage to the body's systems, especially to joints. It is not a common cause of spinal stenosis.
- Inherited conditions – Some people are born with conditions that cause spinal stenosis, such as a small spinal canal.
- Other causes of spinal stenosis are:
- Tumors of the spine
- Paget's disease (a disease that affects the bones)
- Too much fluoride in the body
- Calcium deposits on the ligaments that run along the spine
Spinal Stenosis Symptoms:
There may be no symptoms of spinal stenosis, or symptoms may appear slowly and get worse over time. Signs of spinal stenosis include:
- Pain in the neck or back
- Numbness, weakness, cramping or pain in the arms or legs
- Pain going down the leg
- Foot problems
- Always consult your physician for a diagnosis
One type of spinal stenosis, cauda equine syndrome, is very serious. This type occurs when there is pressure on nerves in the lower back. Symptoms may include:
- Loss of control of the bowel or bladder
- Problems having sex
- Pain, weakness or loss of feeling in one or both legs
- Spinal Tumors
Tumors that originate in the spine (primary tumors) are rare. They can be either benign (non-cancerous) or malignant (cancerous) and are caused by out-of-control growth among cells that reside in the spinal column or neural tissues. Some spinal tumors are the result of cancer that has spread from other parts of the body (secondary or metastatic tumors). Secondary spinal tumors are, by nature, malignant as they have arisen from cancerous tumors elsewhere in the body.
Types of Spinal Tumors:
The common types of benign and malignant spinal tumors.
- Benign Spinal Tumors:
- Osteochondroma is a slow growing tumor of the cartilage that usually affects adolescents. An uncommon tumor, osteochondromas are usually found in the posterior (rear) spine.
- Osteoid osteoma is a small bone tumor (less than 2 cm). It usually affects adolescents, causes night pain and may result in spinal deformity.
- Osteoblastoma affects children and adolescents. These tumors can be large, aggressive and painful, sometimes causing spinal deformity and paralysis.
- Aneurysmal bone cysts (ABCs) typically cause pain and swelling and usually affects children and adolescents. These tumors can be large and quite vascular.
- Giant cell tumor is known to affect children, adolescents and young adults. These tumors can be found at the cervical, thoracic, or lumbar segments of the spine, but are more common in the sacrum.
- Hemangioma occurs most often in the thoracic spine. These tumors affect adults and are known to be progressive vascular masses that can cause vertebral collapse and paraparesis (slight paralysis).
Malignant Spinal Tumors:
- Plasmacytoma presents in middle aged and older adults. These tumors are common in the pedicle and vertebral body and may cause paraparesis (slight paralysis).
- Ewing's sarcoma is an aggressive tumor affecting adolescents and young adults. In some cases, it may metastasize.
- Lymphoma may present in one or more vertebral bodies in middle aged or older adults. Sometimes the lymphatic system is involved.
- Chondrosarcoma is a tumor affecting spinal cartilage in middle-aged adults. It grows slowly but can be dangerous. Usually, aggressive medical intervention is required.
- Osteosarcoma is bone cancer found in adolescents and middle-aged adults. These tumors may metastasize and require aggressive medical therapy.
- Chordoma is usually seen in adults. Although chordoma can affect other parts of the spine, it involves the sacrum 50 percent of the time. These tumors often require aggressive medical therapy.
Spinal tumors are also classified by the part of the spine where they are located. From the neck down to the point where the spinal column joins with the pelvis, these classifications are
Spinal Tumor Symptoms:
Back pain is the primary symptom of a spinal tumor. Other symptoms include:
- Paraparesis (slight paralysis)
- Spinal deformity (e.g. scoliosis, kyphosis)
Please note that neck or back pain does not always indicate tumor presence. However, early medical intervention is always warranted, if spine pain does not resolve or if other neurologic symptoms are experienced.
Spinal Tumor Causes:
Causes of primary spinal tumors are largely unknown. However, some causes may be:
- Exposure to radiation or cancer-causing chemicals.
- Secondary spinal tumors are the result of the spread of cancer from elsewhere in the body.
Spondylosis is caused by abnormal wear on the cartilage and bones of the neck (cervical vertebrae) with degeneration and mineral deposits in the cushions between the vertebrae (cervical discs). Cervical spondylosis results from chronic degeneration of the cervical spine, including the cushions between the neck vertebrae (cervical discs) and joints between the bones of the cervical spine. There may be abnormal growths or spurs on the vertebrae (the bones of the spine).
These accumulated changes caused by degeneration can gradually compress one or more of the nerve roots. This can lead to increasing pain in the neck and arm, weakness, and changes in sensation. In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs, as well.
Common causes of spondylosis are:
- Previous neck injury – which may have occurred several years prior
- Aging – As one ages the incidence of cervical spondylosis increases
- Some people have no symptoms, while others may have pain in bones and muscles, particularly in the back
Whiplash is an injury to the neck caused by the neck bending forcibly forward and then backward or vice versa. The injury usually involves the muscles, discs, nerves and tendons in the neck.
Most whiplash injuries are the result of a collision that includes sudden acceleration or deceleration. Many whiplash injuries occur when a person is involved in a rear-end automobile collision or as a result of a sports injury, particularly contact sports.
Symptoms of whiplash may include:
- Potentially no symptoms
- Pain in bones and muscles, particularly in the back
- Neck stiffness
- Shoulder, low back or neck pain
- Pain in the arm and/or hand
- Numbness in the arm and/or hand
- Ringing in the ears
- Blurred vision
- Concentration or memory problems
Spinal Disorders Diagnosis:
In addition to a complete medical history and physical examination, the Spine Center uses additional diagnostic studies to get a better understanding of what may be wrong. These studies may include:
- Bone Densitometry (bone density test) – Measurement of the mass of bone in relation to its volume to determine the risk of developing osteoporosis
- Computed Tomography Scan (CT or CAT scan) – Diagnostic imaging that uses a combination of x-rays and computer technology to produce cross-sectional images of the body (often called slices), both horizontally and vertically. A CT scans detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
- Electromyogram (EMG) – A test that evaluates nerve and muscle function
- Magnetic Resonance Imaging (MRI) – Diagnostic imaging that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body
- Myelogram – A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-ray. A myelogram is very good at showing the distribution and position of the nerves and spinal cord and is helpful at detecting compression of these structures.
- Radionuclide Bone Scan – A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient's blood stream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
- X-ray – A diagnostic test that uses invisible electromagnetic energy beams to produce images on film of internal tissues, bones and organs.
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