Why do so many people suffer from low back pain?

Have you ever asked, "Why do so many people suffer from low back pain?" The answer involves a brief overview of the lumbar spine. Although the entire spine is involved in everyday activities of rest and movement, the low back can be vulnerable to many pain-provoking disorders. Simple sprains and strains from overexertion, a herniated disc from a slip and fall, degenerative disc disease or spinal stenosis from normal aging, and other disorders can cause low back pain.

To help you understand back pain, the following brief and illustrated anatomy lesson is provided.

What Is the Lumbar Spine?

The lumbar spine (low back) is the third major region of the spine; it is below the cervical spine and thoracic spine. Most people have five bones (vertebrae) in the lumbar spine, although it is not unusual to have six. Each vertebra is stacked on top of the other and between each vertebra is a gel-like cushion called an intervertebral disc. The discs help to absorb pressure, distribute stress, and keep the vertebrae from grinding against each other.

Ligaments and Tendons: Connective Lumbar Spine Soft Tissues

The vertebrae and discs are held together by groups of ligaments . Ligaments connect bone to bone, whereas tendons connect muscle to bone. In the spine, tendons connect muscles to the vertebrae. The ligaments and tendons help to stabilize the spine and guard against excessive movement in any one direction.

Lumbar Spine Joints

The spine also has joints that are similar to knees, elbows, and other joints. The spinal joints are called facet joints 

The facet joints have been described as finger-like, and they link the vertebrae together. The facet joints are located at the posterior area of the spinal column (on the back side of the spinal column).

In addition, the facet joints help to make the spine flexible and enable you to bend forward, backward, and side to side.

The lumbar spine has several distinguishing characteristics:

·         The lower the vertebra is in the spinal column, the more weight it must bear. The five vertebrae of the lumbar spine (L1-L5) are the biggest unfused vertebrae in the spinal column, enabling them to support the weight of the entire torso.

·         The lumbar spine's lowest two spinal segments, L4-L5 and L5-S1, which include the vertebrae and discs, bear the most weight and are therefore the most prone to degradation and injury.

·         The lumbar spine meets the sacrum at the lumbosacral joint (L5-S1). This joint allows for considerable rotation, so that the pelvis and hips may swing when walking and running.

·         The spinal cord travels from the base of the skull through the spinal column and ends at about T12-L1 - where the thoracic spine meets the lumbar spine. At that point numerous nerve roots from the spinal cord continue down and branch out, forming the "cauda equina," named for its resemblance to a horse's tail. These nerves extend to the lower extremities (buttocks, legs and feet). Because the spinal cord does not run through the lumbar spine, it is quite rare that a lower back problem would result in spinal cord damage or paralysis.

Lumbar Intervertebral Segment

Physicians usually explain a patient's pathology by focusing on one intervertebral segment, or spinal segment. The lumbar spine has 5 intervertebral segments, termed lumbar segment 1 through 5 (e.g. L1, L2, L3, L4, and L5).

Each lumbar spine segment is comprised of:

·         Two vertebrae, such as L4-L5, stacked vertically with an intervertebral disc between them. A healthy disc is cushiony, with a lot of water, and has a sponge-like substance. It acts like a shock absorber in the spine, allowing flexibility and providing protection from jarring movements.

·         The two adjacent vertebrae are connected in the back of the spine by two small joints called facet joints. The facet joints of the lumbar spine allow movement to bend and twist the low back in all directions.

·         There are nerves that branch off from the spinal column at each level of the spine. They pass through small holes in the back of the lower spine. They then connect together to form the sciatic nerve, which travels into the legs down the back of each thigh and into the calves and feet.

Doctors usually talk about a patient's lumbar disc problem, or nerve or other lower back problem, as the level that includes two vertebrae and the disc between them, such as L3-L4 or L4-L5. If the disc at the very bottom of the spine is affected, that segment is called the lumbosacral joint L5-S1

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Spinal Cord Injury Treatment in India - Understanding Spinal Cord Injury

Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back and forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures or dislocates your vertebrae, the bone disks that make up your spine. Most injuries don't cut through your spinal cord. Instead, they cause damage when pieces of vertebrae tear into cord tissue or press down on the nerve parts that carry signals.

Spinal cord injuries can be complete or incomplete. With a complete spinal cord injury, the cord can't send signals below the level of the injury. As a result, you are paralyzed below the injury. With an incomplete injury, you have some movement and sensation below the injury.

A spinal cord injury is a medical emergency. Immediate treatment can reduce long-term effects. Treatments may include medicines, braces or traction to stabilize the spine, and surgery. Later treatment usually includes medicines and rehabilitation therapy. Mobility aids and assistive devices may help you to get around and do some daily tasks.

Each patient's injury is unique. Some patients require surgery to stabilise the spine, correct a gross misalignment, or to remove tissue causing cord or nerve compression. Spinal stabilisation often helps to prevent further damage.  Some patients may be placed in traction and the spine allowed to heal naturally.  Every injury is unique as is the course of post injury treatment that follows.

Spinal Cord Shock

When a spinal cord injury is caused due to trauma, the body goes into a state known as spinal shock. While spinal shock begins within a few minutes of the injury, it make take several hours before the full effects occur. During spinal shock the nervous system is unable to transmit signals, some of which may return once spinal shock has subsided, the time spinal shock lasts for is approximately 4-6 weeks following the injury. In some rare cases spinal cord shock can last for several more months.  The loss of these signals will effect the persons movement, sensation and how well the body’s systems function. Often the persons loss of movement and sensation below the level of the spinal cord injury may appear complete soon after the injury. This may mask the real extent of the damage. Usually, over the first few weeks the some of body systems adjust to the effects of the injury and their function improves. Therefore, during this time and the early stage of ANY new injury it is unlikely that an accurate prediction of any recovery or permanent paralysis can be made.


Surgery

Depending on the circumstances, when surgery is required, it may be performed within 8 hours following injury. Surgery may be considered if the spinal cord is compressed and when the spine requires stabilization. The surgeon decides the procedure that will provide the greatest benefit for the patient.

Different tissue and bony structures including vertebrae misaligned from the force of injury, a herniated disc, or a haematoma can cause spinal cord compression. An unstable spine may require spinal instrumentation and fusion to build in support.

Spinal instrumentation and fusion can be used to provide permanent stability to the spinal column. These procedures correct, join, and solidify the level where a spinal element has been damaged or removed .

Instrumentation uses medically designed hardware such as rods, bars, wires and screws. Instrumentation is combined with fusion (bone grafts) to permanently join two or more vertebrae.

Healing Broken Bones Without Surgery

Surgery isn't the only way to repair broken bones in the neck and back a more conservative and less invasive approach is to allow the bones to heal naturally with the help of halo traction where needed.  This approach may mean up to two months complete bed rest.
 

Recovery

Once the patient is stabilised, care and treatment focuses on supportive care and rehabilitation. Family members, nurses, or specially trained carers give supportive care. This care might include helping the patient bathe, dress, change positions to prevent bedsores, and other assistance.

Rehabilitation often includes physical therapy, occupational therapy, and counselling for emotional support. Each program is designed to meet the patient's unique needs. 

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The Advantage of Laminoplasty spine Surgery – Stenosis , Herniated Disc , Spondylosis , Tumor Treatment in India

Laminoplasty

Laminoplasty or laminaplasty is a term that refers to a surgical procedure performed to relieve spinal cord and/or nerve root compression.  To help you understand, let’s separate laminaplasty into two; lamina and plasty.

• Lamina - Located at the back of the spine, the lamina are thin bony plates between each facet joint in the cervical (neck), thoracic (mid back), and lumbar (low back) spine.  The laminar plates are part of the bony wall that covers and protects the spinal canal.  Within the spinal canal are the spinal cord and nerve rootlets.

• Plasty means to surgically repair.

Your spinous processes are bones that project off the back of your spine.  You can feel the end of most of your spinous processes by moving your hand up or down your spine.

Purpose

During laminaplasty, the lamina is cut in such a way that it opens like a door, and takes pressure (decompresses) off the spinal cord and nerve roots.  Your neurosurgeon uses small pieces of bone or metal plate as a wedge to hold the lamina in position during healing.

Causes of spinal cord and/or nerve root compression includes:

• Cervical spinal stenosis
• Cervical herniated disc
• Cervical radiculopathy
• Degenerative disc disease
• Lumbar herniated disc
• Lumbar spinal stenosis
• Spondylosis
• Spondylolisthesis
• Tumor, infection (uncommon)\

Laminoplasty aims at decompressing the spinal cord and the spinal nerves, by hinging open the vertebrae posteriorly. The lamina (flat arch on the backside of the vertebral body) is cut open on one side and grooved on the other side to keep it hinged to the main body of the vertebra. This creates more room for the spinal cord and nerves. Any compressing structure like a herniated or fragmented disc, or bony spurs, thickened ligament etc are also removed in this procedure.

The advantage of this procedure is that the stability of the spine is maintained as the amount of bone and muscle tissue that is removed is very less, and any fusion surgery of the spine is avoided.

How is the surgery performed?

This surgery is performed by sedating the patient under general anesthesia and making him lie on his stomach. The head is kept slightly bent with the help of Mayfield clamp to straighten the skin folds on the neck. A midline incision is made on the back of the neck corresponding to the affected spinal segment. The skin is cut open and the muscles are separated to view the involved vertebrae.

The lamina are cut through their thickness longitudinally on one side and grooved on the other side to keep it hinged to the vertebral body. The posterior part of the vertebra is swung open like a door. Small wedges made of bone are placed in the opened space of the door. The door of the vertebrae swings shut, and the wedges stop it from closing all the way. The spinal cord and the nerve roots rest comfortably behind the door. Since this increases the space in the spinal canal, it decompresses the spinal cord with immediate relief of symptoms. Any presence of herniated disc, thickened ligament or facet joint and osteophytes are identified and removed.

PostOperative Recovery and Rehabilitation

The person is usually up and about on the same day after surgery and is discharged in one or two days later. The Physical therapist advises certain exercises of the neck to maintain the flexibility and strength of the neck muscles before the patient is discharged. Certain ergonomics advice regarding neck movements is also given.

The patient is able to return to his daily activities wearing a soft cervical collar within a few days. The collar is discarded after some time.

Our network hospitals have the most advanced spine surgery facilities. The spine surgeons here use minimally invasive and computer guided techniques in spine surgery. In a Minimally Invasive spine surgery the surgeon makes a few small incisions unlike the open surgery where a single large incision is made. Minimally Invasive spine surgery has several important benefits for the patients. If you have been advised spine surgery your first choice should be the latest minimally invasive technique developed by our world best hospitals in India. Most advanced Technology like Intra Operative MRI, Brain Suite and Computer Assisted Navigation System are deployed by highly trained surgeons for accurate and safe Spine Surgeries through a small incision.

Why should you choose to get Indian hospitals offer the best spinal surgery treatment in India at affordable prices. MedWorld india associated best spine surgery hospitals in India have the latest technology and infrastructure to offer the most advanced spine surgery at low cost.

Salient features of these hospitals are:

• Comprehensive management of spine disorder from birth defects to degeneration of tumor and trauma.
• Dedicated team of International trained and vastly experienced Spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.
• Expert evaluation of spinal problems by dedicated team of experienced spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.
• Latest Generation Diagnostic and Imaging facilities including dynamic digital X rays, Spiral CT scanning , MRI and Electrophysiology unit all under one roof.
• Physiotherapy and Rehabilitation by experts after the surgery help you regain functional abilities quickly helping in vastly improved overall results.

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