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About Spine Center

Scoliosis

Scoliosis

Definition

Scoliosis is a curving of the spine. The spine curves away from the middle or sideways.

Alternative Names

Spinal curvature; Kyphoscoliosis

Causes

There are three general causes of scoliosis:

  • Congenital (present at birth) scoliosis is due to a problem with the formation of the spine bones (vertebrae) or fused ribs during development in the womb.
  • Neuromuscular scoliosis is caused by problems such as poor muscle control or muscle weakness, or paralysis due to diseases such as cerebral palsy, muscular dystrophy, spina bifida, and polio.
  • Idiopathic scoliosis is scoliosis of unknown cause. It appears in a previously straight spine.

Idiopathic scoliosis in adolescents is the most common type. Some people may be prone to curving of the spine. Most cases occur in girls. Curves generally worsen during growth spurts. Scoliosis in infants and young children are less common, and commonly affect boys and girls equally.

Scoliosis may be suspected when one shoulder appears to be higher than the other, or the pelvis appears to be tilted. Untrained observers usually can't notice the curving.

Routine scoliosis screening is now done in middle and junior high schools. Many cases, which previously would have gone undetected until they were more advanced, are now being caught at an early stage.

There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if irritation results. The greater the initial curve of the spine, the greater the chance the scoliosis will get worse after growth is complete. Severe scoliosis (curves in the spine greater than 100 degrees) can cause breathing problems.

Symptoms

  • Backache or low-back pain
  • Fatigue
  • Shoulders or hips appear uneven
  • Spine curves abnormally to the side (laterally)

Note: Kyphoscoliosis also involves abnormal front to back curvature, with a "rounded back" appearance. See kyphosis.

Exams and Tests

The health care provider will perform a physical exam, which includes a forward bending test that will help the doctor define the curve. The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. The health care provider will perform a neurologic exam to look for any changes in strength, sensation, or reflexes.

Tests may include:

  • Scoliometer measurements (a device for measuring the curvature of the spine)
  • Spine x-rays (taken from the front and the side)
  • MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray )

Treatment

Treatment depends on the cause of the scoliosis, the size and location of the curve, and how much more growing the patient is expected to do. Most cases of adolescent idiopathic scoliosis (less than 20 degrees) require no treatment, but should be checked often, about every 6 months.

As curves get worse (above 25 to 30 degrees in a child who is still growing), bracing is usually recommended to help slow the progression of the curve. There are many different kinds of braces used. The Boston Brace, Wilmington Brace, Milwaukee Brace, and Charleston Brace are named for the centers where they were developed.

Each brace looks different. There are different ways of using each type properly. The selection of a brace and the manner in which it is used depends on many factors, including the specific characteristics of the curve. The exact brace will be decided on by the patient and health care provider.

A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis.

Curves of 40 degrees or greater usually require surgery because curves this large have a high risk of getting worse even after bone growth stops. Surgery involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is done through a cut in the back, on the abdomen, or beneath the ribs. A brace may be required to stabilize the spine after surgery.

The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important for adjustment to the limitations of treatment.

Physical therapists and orthotists (orthopedic appliance specialists) can help explain the treatments and make sure the brace fits comfortably.

Outlook (Prognosis)

The outcome depends on the cause, location, and severity of the curve. The greater the curve, the greater the chance the curve will get worse after growth has stopped.

Mild cases treated with bracing alone do very well. People with these kinds of conditions tend not to have long-term problems, except maybe an increased rate of low back pain when they get older. People with surgically corrected idiopathic scoliosis also do very well and can lead active, healthy lives.

Patients with neuromuscular scoliosis have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.

Babies with congenital scoliosis have a wide variety of underlying birth defects. Management of this disease is difficult and often requires many surgeries.

Possible Complications

  • Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace)
  • Failure of the bone to join together (very rare in idiopathic scoliosis)
  • Low back arthritis and pain as an adult
  • Respiratory problems from severe curve
  • Spinal cord or nerve damage from surgery or severe, uncorrected curve
  • Spine infection after surgery

When to Contact a Medical Professional

Call your health care provider if you suspect your child may have scoliosis.

References

Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38(4):497-509, vi.

Review Date: 2/27/2008
Reviewed By: Rachel A. Lewis, MD, FAAP, Columbia University Pediatric Faculty Practice, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Spinal Surgery

Spinal surgery - lumbar

Definition

Lumbar spinal surgery is used to correct problems with the spinal bones (vertebrae), disks, or nerves of the lower back (lumbar spine).

Alternative Names

Lumbar spinal surgery

Description

The spine consists of bones (vertebrae) separated by soft cushions (disks). Pressure on the nerves that branch off the spinal cord can produce pain, numbness, tingling, or weakness.

Lumbar spinal surgery is done while you are under general anesthesia (unconscious and pain-free). A surgical cut is made over the area of the problem. The bone that curves around and covers the spinal cord and the tissue that presses on the nerve or spinal cord are removed.

The hole through which the nerve passes may be widened to prevent further pressure on the nerve. Sometimes, spinal fusion is necessary to stabilize the area.

Why the Procedure is Performed

Symptoms of lumbar spine problems that may require surgery at some point include:

  • Pain that extends (radiates) from the back to the buttocks or back of thigh
  • Pain that interferes with daily activities
  • Weakness of legs or feet
  • Numbness of legs, feet, or toes
  • Loss of bowel or bladder control

It's important to not that patients with spinal pain in the neck or back are usually treated conservatively before surgery is considered. This includes bedrest, anti-inflammatory medications, physical therapy, braces, and exercise. Maintaining good health, muscle strength, and body posture with appropriate rest and exercise help prevent unnecessary strain on the spine and muscles.

Risks

Risks for any anesthesia include the following:

  • Reactions to medications
  • Problems breathing
Risks for any surgery include the following:
  • Bleeding
  • Infection
Additional risks of spinal surgery include the following:
  • Nerve damage leading to paralysis
  • Blood clots
  • Muscle weakness
  • Loss of bowel or bladder control

Outlook (Prognosis)

The outcome depends on what is causing the problem.

Recovery

How long you must stay in the hospital depends on the type of spinal surgery performed. Some people only say overnight, while others must stay in much longer.

You will be encouraged to walk the first or second day after surgery to reduce the risk of blood clots (deep venous thrombosis).

Complete recovery takes about 5 weeks. Heavy work is not recommended until several months after surgery or not at all.


Review Date: 5/12/2008
Reviewed By: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, subspecialty Foot and Ankle, Camden Bone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Lower Back Pain

Back pain - low

Definition

Pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like your mid or upper back, a hernia in the groin, or a problem in the testicles or ovaries.

You may feel a variety of symptoms if you've hurt your back. You may have a tingling or burning sensation, a dull aching, or sharp pain. You also may experience weakness in your legs or feet.

It won't necessarily be one event that actually causes your pain. You may have been doing many things improperly -- like standing, sitting, or lifting -- for a long time. Then suddenly, one simple movement, like reaching for something in the shower or bending from your waist, leads to the feeling of pain.

Alternative Names

Backache; Low back pain; Lumbar pain; Pain - back

Considerations

If you are like most people, you will have at least one backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body's weight.

Low back pain is the #2 reason that Americans see their doctor -- second only to colds and flus. Many back-related injuries happen at work. But you can change that. There are many things you can do to lower your chances of getting back pain.

Most back problems will get better on their own. The key is to know when you need to seek medical help and when self-care measures alone will allow you to get better.

Low back pain may be acute (short-term), lasting less than one month, or chronic (long-term, continuous, ongoing), lasting longer than three months. While getting acute back pain more than once is common, continuous long-term pain is not.

Causes

You'll usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident. But prior to that moment in time, the structures in your back may be losing strength or integrity.

The specific structure in your back responsible for your pain is hardly ever identified. Whether identified or not, there are several possible sources of low back pain:

  • Aortic aneurysm
  • Degeneration of the disks
  • Kidney problems, such as infections or stones
  • Muscle spasm (very tense muscles that remain contracted)
  • Other medical conditions like fibromyalgia
  • Poor alignment of the vertebrae
  • Ruptured or herniated disk
  • Small fractures to the spine from osteoporosis
  • Spinal stenosis (narrowing of the spinal canal)
  • Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens
  • Strain or tears to the muscles or ligaments supporting the back

Low back pain from any cause usually involves spasms of the large, supportive muscles alongside the spine. The muscle spasm and stiffness accompanying back pain can feel particularly uncomfortable.

You are at particular risk for low back pain if you:

  • Are over age 30
  • Are pregnant
  • Feel stressed or depressed
  • Have a low pain threshold
  • Have arthritis or osteoporosis
  • Have bad posture
  • Smoke, don't exercise, or are overweight
  • Work in construction or another job requiring heavy lifting, lots of bending and twisting, or whole body vibration (like truck driving or using a sandblaster)
Back pain from organs in the pelvis or elsewhere include:
  • Bladder infection
  • Endometriosis
  • Kidney stone
  • Ovarian cancer
  • Ovarian cysts
  • Testicular torsion (twisted testicle)

Home Care

Many people will feel better within one week after the start of back pain. After another 4-6 weeks, the back pain will likely be completely gone. To get better quickly, take the right steps when you first get pain.

A common misconception about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is NOT recommended.

If you have no indication of a serious underlying cause for your back pain (like loss of bowel or bladder control, weakness, weight loss, or fever), then you should reduce physical activity only for the first couple of days. Gradually resume your usual activities after that. Here are some tips for how to handle pain early on:

  • Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
  • Apply heat or ice to the painful area. Try ice for the first 48-72 hours, then use heat after that.
  • Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).

While sleeping, try lying in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.

Do not perform activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins. After 2-3 weeks, you should gradually resume exercise.

Begin with light cardiovascular training. Walking, riding a stationary bicycle, and swimming are great examples. Such aerobic activities can help blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.

Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after an injury can make your pain worse. A physical therapist can help you determine when to begin stretching and strengthening exercises and how to do so.

AVOID the following exercises during initial recovery unless your doctor or physical therapist says it is okay:

  • Jogging
  • Football
  • Golf
  • Ballet
  • Weight lifting
  • Leg lifts when lying on your stomach
  • Sit-ups with straight legs (rather than bent knees)

When to Contact a Medical Professional

Call 911 if you have lost bowel or bladder control. Otherwise, call your doctor if you have:

  • Unexplained fever with back pain.
  • Back pain after a severe blow or fall.
  • Redness or swelling on the back or spine.
  • Pain traveling down your legs below the knee.
  • Weakness or numbness in your buttocks, thigh, leg, or pelvis.
  • Burning with urination or blood in your urine.
  • Worse pain when you lie down or pain that awakens you at night.
  • Very sharp pain.
  • Uncontrollable loss of urine or stool (incontinence).

Also call if:

  • You have been losing weight unintentionally
  • You use steroids or intravenous drugs.
  • You have never had or been evaluated for back pain before.
  • You have had back pain before but this episode is distinctly different.
  • This episode of back pain has lasted longer than 4 weeks.

If any of these symptoms are present, your doctor will carefully check for any sign of infection (like meningitis, abscess, or urinary tract infection), ruptured disk, spinal stenosis, hernia, cancer, kidney stone, twisted testicle, or other serious problem.

What to Expect at Your Office Visit

When you first see your doctor, you will be asked questions about your back pain, including how often it occurs and how severe it is. Your doctor will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches.

Questions will include:

  • Is your pain on one side only or both sides?
  • What does the pain feel like? Is it dull, sharp, throbbing, or burning?
  • Is this the first time you have had back pain?
  • When did the pain begin? Did it start suddenly?
  • Did you have a particular injury or accident?
  • What were you doing just before the pain began? Were you lifting or bending? Sitting at your computer? Driving a long distance?
  • If you have had back pain before, is this pain similar or different? In what way is it different?
  • Do you know the cause of previous episodes of back pain?
  • How long does each episode of back pain usually last?
  • Do you feel the pain anywhere other than your back, like your hip, thigh, leg or feet?
  • Do you have any numbness or tingling? Any weakness or loss of function in your leg or elsewhere?
  • What makes the pain worse? Lifting, twisting, standing, or sitting for long periods of time?
  • What makes you feel better?
  • Are there any other symptoms present? Weight loss? Fever? Change in urination? Change in bowel habits?

During the physical exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:

  • Sit, stand, and walk. While walking, your doctor may ask you to try walking on your toes and then your heels.
  • Bend forward, backward, and sideways.
  • Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

Most people with back pain recover within four to six weeks. Therefore, your doctor will probably not order any tests during the first visit. However, if you have any of the symptoms or circumstances below, your doctor may order imaging tests even at this initial exam:

  • Pain that has lasted longer than one month
  • Numbness
  • Muscle weakness
  • Accident or injury
  • Fever
  • If you are over 65
  • You have had cancer or have a strong family history of cancer
  • Weight loss

In these cases, the doctor is looking for a tumor, infection, fracture, or serious nerve disorder. The symptoms above are clues that one of these conditions may be present. The presence of a tumor, infection, fracture, or serious nerve disorder change how your back pain is treated.

Tests that might be ordered include an x-ray, myelogram (an x-ray or CT scan of the spine after dye has been injected into the spinal column), CT of the lower spine, or MRI of the lower spine.

Hospitalization, traction, or spinal surgery should only be considered if nerve damage is present or the condition fails to heal after a prolonged period.

Many people benefit from physical therapy. Your doctor will determine if you need to see a physical therapist and can refer you to one in your area. The physical therapist will begin by using methods to reduce your pain. Then, the therapist will teach you ways to prevent getting back pain again.

If your pain lasts longer than one month, your primary care doctor may send you to see either an orthopedist (bone specialist) or neurologist (nerve specialist).

Prevention

Exercise is important for preventing future back pain. Through exercise you can:

  • Improve your posture
  • Strengthen your back and improve flexibility
  • Lose weight
  • Avoid falls

A complete exercise program should include aerobic activity (like walking, swimming, or riding a stationary bicycle) as well as stretching and strength training.

To prevent back pain, it is also very important to learn to lift and bend properly. Follow these tips:

  • If an object is too heavy or awkward, get help.
  • Spread your feet apart to give a wide base of support.
  • Stand as close to the object you are lifting as possible.
  • Bend at your knees, not at your waist.
  • Tighten your stomach muscles as you lift the object up or lower it down.
  • Hold the object as close to your body as you can.
  • Lift using your leg muscles.
  • As you stand up with the object, DO NOT bend forward.
  • DO NOT twist while you are bending for the object, lifting it up, or carrying it.

Other measures to take to prevent back pain include:

  • Avoid standing for long periods of time. If you must for your work, try using a stool. Alternate resting each foot on it.
  • DO NOT wear high heels. Use cushioned soles when walking.
  • When sitting for work, especially if using a computer, make sure that your chair has a straight back with adjustable seat and back, armrests, and a swivel seat.
  • Use a stool under your feet while sitting so that your knees are higher than your hips.
  • Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.
  • If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don't lift heavy objects just after a ride.
  • Quit smoking.
  • Lose weight.
  • Learn to relax. Try methods like yoga, tai chi, or massage.

References

US Preventative Services Task Force. Primary Care Interventions to Prevent Low Back Pain: Brief Evidence Update. Rockville, MD: Agency for Healthcare Research and Quality; February 2004.

Anema JR, Steenstra IA, Bongers PM, de Vet HC, Knol DL, Loisel P, van Mechelen W. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine. 2007;32:291-298.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.


Review Date: 5/5/2008
Reviewed By: Andrew L. Chen, MD, MS, Orthopedic Surgery and Sports Medicine, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Osteoporosis

Osteoporosis

Definition

Osteoporosis is the thinning of bone tissue and loss of bone density over time.

Alternative Names

Thin bones

Causes

Osteoporosis is the most common type of bone disease. An estimated 10 million Americans have osteoporosis, as well as another 18 million who have low bone mass, or osteopenia, which may eventually lead to osteoporosis if not treated.

Researchers estimate that about 1 out of 5 American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine).

Osteoporosis occurs when the body fails to form enough new bone, when too much old bone is reabsorbed by the body, or both.

Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

As you age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. This can result in brittle, fragile bones that are more prone to fractures, even without injury.

Usually, the loss occurs gradually over years. Many times, a person will have a fracture before becoming aware that the disease is present. By the time this occurs, the disease is in its advanced stages and damage is severe.

The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women, especially those over age 50, get osteoporosis more often than men.

Other causes include:

  • Being confined to a bed
  • Cushing syndrome
  • Excess corticosteroid levels due to ongoing use of medicines for asthma, certain forms of arthritis or skin diseases, and COPD.
  • Hyperthyroidism
  • Hyperparathyroidism
  • Rheumatoid arthritis and other inflammatory conditions

White women, especially those with a family history of osteoporosis, have a greater-than-average risk of developing osteoporosis. Other risk factors include:

  • Absence of menstrual periods (amenorrhea)
  • Drinking large amount of alcohol
  • Early menopause
  • Eating disorders
  • Family history of osteoporosis
  • Low body weight
  • Smoking
  • Too little calcium in the diet
  • Use of certain medications, including steroids and antiseizure drugs

Symptoms

There are no symptoms in the early stages of the disease.

Symptoms occurring late in the disease include:

  • Bone pain or tenderness
  • Fractures with little or no trauma
  • Loss of height over time
  • Low back pain due to fractures of the spinal bones
  • Neck pain due to fractures of the spinal bones
  • Stooped posture

Exams and Tests

Bone mineral density testing (specifically a densitometry or DEXA scan) measures how much bone you have. This test has become the gold standard for osteoporosis evaluation. For specific information on such testing, see bone density test.

A spine CT can show loss of bone mineral density. Quantitative computed tomography (QCT) can evaluate bone density. However, it is not as available and is more expensive than a DEXA scan.

In severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis.

You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age.

Treatment

The goals of osteoporosis treatment are to:

  • Control pain from the disease
  • Slow down or stop bone loss
  • Prevent bone fractures with medicines that strengthen bone
  • Minimize the risk of falls that might cause fractures

There are several different treatments for osteoporosis, including a variety of medications.

BISPHOSPHONATES

Bisphosphonates are a type of drug used for both the prevention and treatment of osteoporosis in postmenopausal women. Several bisphosphonates are approved for the treatment of osteoporosis in the United States, including alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Most are taken by mouth, usually once a week or once a month. Bisphosphonates given through a vein (intravenously) are taken less often.

CALCITONIN

Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection. The main side effects are nasal irritation from the spray form and nausea from the injectable form.

While calcitonin slows bone loss and reduces the risk of fractures, it appears to be less effective than bisphosphonates.

HORMONE REPLACEMENT THERAPY

Estrogens are still used to prevent osteoporosis but are not approved to treat a woman who has already been diagnosed with the condition.

Sometimes, if estrogen has helped a woman, and she cannot take other options for preventing or treating osteoporosis, the doctor may recommend she continue using hormone therapy. If you are considering taking hormone therapy to prevent osteoporosis, discuss the risks with your doctor.

Over the past decade, several major studies evaluated the health benefits and the risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes, and blood clots. Evidence from these studies raised concerns for an increased risk for stroke, heart disease, breast cancer, and blood clots, depending on several factors that include the types of hormones used

Some women may still wish to consider hormone therapy for short-term treatment of menopausal symptoms. The key is to weigh the risks associated with taking hormone therapy against a particular woman's risk of heart disease or osteoporosis without taking hormone therapy. Other factors to consider include:

  • A woman's age
  • The age menopause started
  • The dose of hormone therapy being considered
  • Prior hormone replacement therapy taken in the past
  • Quality of life issues

Every woman is different. Your doctor should be aware of your entire medical history when considering hormone therapy.

PARATHYROID HORMONE

Teriparatide (Forteo) is approved in the United States for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. The medicine is given through daily shots underneath the skin. You can give yourself the shots at home.

RALOXIFENE

Raloxifene (Evista) is used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. However, it does not appear to prevent other fractures, including those in the hip. It may have protective effects against heart disease and breast cancer, though more studies are needed.

The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

EXERCISE

Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Some of the recommended exercises include:

  • Weight-bearing exercises -- walking, jogging, playing tennis, dancing
  • Resistance exercises -- free weights, weight machines, stretch bands
  • Balance exercises -- tai chi, yoga
  • Riding stationary bicycles
  • Using rowing machines
  • Walking
  • Jogging

Avoid any exercise that presents a risk of falling.

DIET

Get at least 1,200 milligrams per day of calcium, and 800 - 1,000 international units of vitamin D3. Vitamin D helps your body absorb calcium.Your doctor may recommend a supplement to give you the calcium and vitamin D you need.

Follow a diet that provides the proper amount of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

High-calcium foods include:

  • Cheese
  • Ice cream
  • Leafy green vegetables, such as spinach and collard greens
  • Low-fat milk
  • Salmon
  • Sardines (with the bones)
  • Tofu
  • Yogurt

STOP UNHEALTHY HABITS

Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

PREVENT FALLS

It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good. Other ways to prevent falling include:

  • Avoiding walking alone on icy days
  • Using bars in the bathtub, when needed
  • Wearing well-fitting shoes

MONITORING

Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1-2 years. However, such monitoring is controversial and expensive.

Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

RELATED SURGERIES

There are no surgeries for treating osteoporosis itself. However, a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebra from becoming fractured by strengthening the bones in your spinal column.

The procedure involves injecting a fast-hardening glue into the areas that are fractured or weak. A similar procedure, called kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)

Outlook (Prognosis)

Some persons with osteoporosis become severely disabled as a result of weakened bones. Hip fractures leave about half of patients unable to walk independently. This is one of the major reasons people are admitted to nursing homes.

Although osteoporosis is debilitating, it does not affect life expectancy.

Possible Complications

  • Compression fractures of the spine
  • Disability caused by severely weakened bones
  • Hip and wrist fractures
  • Loss of ability to walk due to hip fractures

When to Contact a Medical Professional

Call your health care provider if you have symptoms of osteoporosis or if you wish to be screened for the condition.

Prevention

Calcium is essential for building and maintaining healthy bone. Vitamin D is also needed because it helps your body absorb calcium. Following a healthy, well-balanced diet can help you get these and other important nutrients throughout life.

Other tips for prevention:

  • Avoid drinking excess alcohol
  • Don't smoke
  • Get regular exercise

A number of medications are approved for the prevention of osteoporosis.

References

Cranney A, Papaioannou A, Zytaruk N, et al. Clinical Guidelines Committee of Osteoporosis Canada. Parathyroid hormone for the treatment of osteoporosis: a systematic review. CMAJ. 2006 Jul 4;175(1):52-9.

Gass M, Dawson-Hughes B. Preventing osteoporosis-related fractures: an overview. Am J Med. 2006 Apr;119(4 Suppl 1):S3-S11. Review.

Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society. Menopause. July/August 2008;15(4)584-602.

Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause. 2006 May-Jun;13(3):340-67.

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Feb. 2008. Accessed July 23, 2008. Available online at https://www.nof.org/professionals/Clinicians_Guide.htm


Review Date: 8/4/2008
Reviewed By: Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Kyphosis

Kyphosis

Definition

Kyphosis is a curving of the spine that causes a bowing of the back, which leads to a hunchback or slouching posture.

Alternative Names

Scheuermann's disease; Roundback; Hunchback; Postural kyphosis

Causes

Kyphosis is a spinal deformity. It can be caused by:

  • Degenerative disease (such as arthritis)
  • Developmental problems
  • Trauma

Kyphosis can occur at any age, although it is rare at birth.

Adolescent kyphosis, also known as Scheuermann's disease, is caused by the wedging together of several bones of the spine (vertebrae) in a row. The cause of Scheuermann's disease is unknown.

In adults, kyphosis can be a result of:

  • Fractures caused by osteoporosis (osteoporotic compression fractures)
  • Slipping of one vertebra forward on another (spondylolisthesis)

Other causes of kyphosis include:

  • Certain endocrine diseases
  • Connective tissue disorders
  • Disk degeneration
  • Infection (such as tuberculosis)
  • Muscular dystrophy
  • Neurofibromatosis
  • Paget's disease
  • Polio
  • Spina bifida
  • Tumors

Kyphosis can also be seen with scoliosis. Each cause has its own risk factors.

Symptoms

  • Difficulty breathing (in severe cases)
  • Fatigue
  • Mild back pain
  • Round back appearance
  • Tenderness and stiffness in the spine

Exams and Tests

Physical examination by a health care provider confirms the abnormal curve of the spine. The doctor will also look for any nervous system (neurological) changes (weakness, paralysis, or changes in sensation) below the curve.

Other tests may include:

  • Spine x-ray
  • Pulmonary function tests (if kyphosis affects breathing)
  • MRI (if there may be a tumor, infection, or neurological symptoms)

Treatment

Treatment depends on the cause of the disorder:

  • Congenital kyphosis requires corrective surgery at an early age.
  • Scheuermann's disease is treated with a brace and physical therapy. Occasionally surgery is needed for large (greater than 60 degrees), painful curves.
  • Multiple compression fractures from osteoporosis can be left alone if there are no nervous system problems or pain. However, the osteoporosis needs to be treated to help prevent future fractures. For debilitating deformity or pain, surgery is an option.
  • Kyphosis caused by infection or tumor needs to be treated more aggressively, often with surgery and medications.

Treatment for other types of kyphosis depends on the cause. Surgery may be necessary if neurological symptoms develop.

Outlook (Prognosis)

Adolescents with Scheuermann's disease tend do well even if they need surgery, and the disease stops once they stop growing. If the kyphosis is due to degenerative joint disease or multiple compression fractures, surgery is needed to correct the defect and improve pain.

Possible Complications

  • Decreased lung capacity
  • Disabling back pain
  • Neurological symptoms including leg weakness or paralysis
  • Round back deformity

Prevention

Treating and preventing osteoporosis can prevent many cases of kyphosis in the elderly. Early diagnosis and bracing of Scheuermann's disease can reduce the need for surgery, but there is no way to prevent the disease.

References

Shelton YA. Scoliosis and kyphosis in adolescents: diagnosis and management. Adolesc Med State Art Rev. 2007;18:121-139.


Review Date: 7/17/2008
Reviewed By: Andrew L Chen, MD, MS, Orthopedist, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Spinal Stenosis

Spinal stenosis

Definition

Spinal stenosis is a narrowing of the lumbar (back) or cervical (neck) spinal canal, which causes compression of the nerve roots.

Causes

Spinal stenosis mainly affects middle-aged or elderly people. It may be caused by osteoarthritis or Paget's disease or by an injury that causes pressure on the nerve roots or the spinal cord itself.

Symptoms

  • Back pain that spreads to the legs
  • Difficulty or imbalance when walking
  • Leg pain
  • Neck pain
  • Numbness in the buttocks, thighs or calves, that is worse with standing, walking, or exercise
  • Pain in the buttocks, thighs, or calves that is worse with walking or exercise
  • Weakness of the legs

Exams and Tests

Neurological examination confirms leg weakness and decreased sensation in the legs.

  • EMG may show neurological changes.
  • Spinal MRI or spinal CT scan shows spinal stenosis.
  • X-ray of the spine shows degenerative changes and narrowed spinal canal.

Treatment

Generally, conservative management is encouraged. This involves the use of anti-inflammatory medications, other pain relievers, and possibly steroid injections. If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves.

Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

Outlook (Prognosis)

If the nerve roots can be successfully relieved of pressure, the symptoms will not worsen and may improve.

Possible Complications

Injury can occur to the legs or feet due to lack of sensation. Infections may get worse because pain related to them may not be felt. Changes caused by nerve compression may be permanent, even if the pressure is relieved.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of spinal stenosis.


Review Date: 5/12/2008
Reviewed By: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, subspecialty Foot and Ankle, Camden Bone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Herniated Disk

Herniated nucleus pulposus

Definition

A herniated nucleus pulposus is a slipped disk along the spinal cord. The condition occurs when all or part of the soft center of a spinal disk is forced through a weakened part of the disk.

Alternative Names

Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk

Causes

The bones (vertebrae) of the spinal column run down the back, connecting the skull to the pelvis. These bones protect nerves that come out of the brain and travel down the back and to the entire body. The spinal vertebrae are separated by disks filled with a soft, gelatinous substance, which provide cushioning to the spinal column. These disks may herniate (move out of place) or rupture from trauma or strain.

The spinal column is divided into several segments -- the cervical spine (the neck), the thoracic spine (the part of the back behind the chest), the lumbar spine (lower back), and sacral spine (the part connected to the pelvis that does not move).

Radiculopathy refers to any disease affecting the spinal nerve roots. A herniated disk is one cause of radiculopathy (sciatica).

Most herniation takes place in the lower back (lumbar area) of the spine. Lumbar disk herniation occurs 15 times more often than cervical (neck) disk herniation, and it is one of the most common causes of lower back pain. The cervical disks are affected 8% of the time and the upper-to-mid-back (thoracic) disks only 1 - 2% of the time.

Nerve roots (large nerves that branch out from the spinal cord) may become compressed resulting in neurological symptoms, such as sensory or motor changes.

Disk herniation occurs more frequently in middle aged and older men, especially those involved in strenuous physical activity. Other risk factors include any congenital conditions that affect the size of the lumbar spinal canal.

Symptoms

SYMPTOMS OF HERNIATED LUMBAR DISK

  • Muscle spasm
  • Muscle weakness or atrophy in later stages
  • Pain radiating to the buttocks, legs, and feet
  • Pain made worse with coughing, straining, or laughing
  • Severe low back pain
  • Tingling or numbness in legs or feet

SYMPTOMS OF HERNIATED CERVICAL DISK

  • Arm muscle weakness
  • Deep pain near or over the shoulder blades on the affected side
  • Neck pain, especially in the back and sides
  • Increased pain when bending the neck or turning head to the side
  • Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest
  • Pain made worse with coughing, straining, or laughing
  • Spasm of the neck muscles

Exams and Tests

A physical examination and history of pain may be all that is needed to diagnose a herniated disk. A neurological examination will evaluate muscle reflexes, sensation, and muscle strength. Often, examination of the spine will reveal a decrease in the spinal curvature in the affected area.

Leg pain that occurs when you sit down on an exam table and lift your leg straight up usually suggests a herniated lumbar disk.

A foraminal compression test of Spurling is done to diagnose cervical radiculopathy. For this test, you will bend your head forward and to the sides while the health care provider provides slight downward pressure to the top of the head. Increased pain or numbness during this test is usually indicative of cervical radiculopathy.

DIAGNOSTIC TESTS

  • EMG may be done to determine the exact nerve root(s) that is (are) involved.
  • Nerve conduction velocity test may also be done.
  • Myelogram may be done to determine the size and location of disk herniation.
  • Spine MRI or spine CT will show spinal canal compression by the herniated disk.
  • Spine x-ray may be done to rule out other causes of back or neck pain. However, it is not possible to diagnosis herniated disk by spinal x-ray alone.

Treatment

The main treatment for a herniated disk is a short period of rest with pain and anti-inflammatory medications, followed by physical therapy. Most people who follow these treatments will recover and return to their normal activities. A small number of people need to have further treatment, which may include steroid injections or surgery.

MEDICATIONS

Nonsteroidal anti-inflammatory medications (NSAIDs) and narcotic pain killers will be given to people with a sudden herniated disk caused by some sort of injury (such as a car accident or lifting a very heavy object) that is immediately followed by severe pain in the back and leg.

If the patient has back spasms, muscle relaxants are usually given. On rare occasions, steroids may be given either by pill or directly into the blood through an IV.

NSAIDs are used for long-term pain control, but narcotics may be given if the pain does not respond to anti-inflammatory drugs.

LIFESTYLE CHANGES

Any extra weight being carried by an individual, especially up front in the stomach area, will make back pain worse. Diet and exercise are crucial to improving back pain in overweight patients.

Physical therapy is important for nearly everyone with disk disease. Therapists will tell you how to properly lift, dress, walk, and perform other activities. They will also work on strengthening the muscles of the abdomen and lower back to help support the spine. Flexibility of the spine and legs is taught in many therapy programs.

Some health care providers recommend the use of back braces to help support the spine. However, overuse of these devices can weaken the abdominal and back muscles leading to a worsening of the problem. Weight belts can be helpful in preventing injuries in those whose work requires lifting of heavy objects.

INJECTIONS

Steroid injections into the back in the area of the herniated disk can help control pain for several months. Such injections reduce swelling around the disk and relieve many symptoms. Spinal injections are usually done on an outpatient basis using x-ray or fluoroscopy to identify the area where the injection is needed.

SURGERY

Surgery may be an option for the few patients whose symptoms persist despite other treatments.

Diskectomy removes a protruding disk. This procedure requires general anesthesia (asleep and no pain) and 2-3 day hospital stay. You will be encouraged to walk the first day after surgery to reduce the risk of blood clots.

Complete recovery takes several weeks. If more than one disk needs to be taken out or if there are other problems in the back besides a herniated disk, more extensive surgery may be needed. This may require a much longer recovery period.

Other surgical options include microdiskectomy, a procedure removing fragments of nucleated disk through a very small opening.

Chemonucleolysis involves the injection of an enzyme (called chymopapain) into the herniated disk to dissolve the protruding gelatinous substance. This procedure may be an alternative to diskectomy in certain situations.

Outlook (Prognosis)

Most people will improve with conservative treatment. A small percentage may continue to have chronic back pain even after treatment.

It may take several months to a year or more to resume all activities without pain or strain to the back. People with certain occupations that involve heavy lifting or back strain may need to change job activities to avoid recurrent back injury.

Possible Complications

  • Long-term back pain
  • Loss of movement or sensation in the legs or feet
  • Loss of bowel and bladder function
  • Permanent spinal cord injury (very rare)

When to Contact a Medical Professional

Call your health care provider if persistent, severe back pain develops, especially if you have any numbness, loss of movement, weakness, or bowel or bladder changes.

Prevention

Safe work and play practices, proper lifting techniques, and weight control may help to prevent back injury in some people.


Review Date: 5/12/2008
Reviewed By: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, subspecialty Foot and Ankle, Camden Bone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Spinal Tumor

Spinal tumor

Definition

A spinal tumor is a growth of cells (mass) in or surrounding the spinal cord.

Alternative Names

Tumor - spinal cord

Causes

Any type of tumor may occur in the spine, including:

  • Leukemia
  • Lymphoma
  • Myeloma

A small number of spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other gliomas.

Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metatastasis) are called secondary spinal tumors.

The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects. A spinal tumor is much less common than a primary brain tumor.

Spinal tumors can occur:

  • Inside the cord (intramedullary)
  • In the membranes (meninges) covering the spinal cord (extramedullary - intradural)
  • Between the meninges and bones of the spine (extradural)

Or, tumors may extend from other locations. Most spinal tumors are extradural.

As it grows, the tumor can affect the:

  • Blood vessels
  • Bones of the spine
  • Meninges
  • Nerve roots
  • Spinal cord cells

It may press on (compress) the spinal cord or nerve roots (similar to spinal cord trauma), invade normal cells, or block blood vessels and lead to a lack of oxygen (ischemia).

Symptoms

The symptoms depend on the location, type of tumor, and your general health. Tumors that have spread to the spine from another site (metastatic tumors) often progress quickly. Primary tumors often progress slowly over weeks to years.

Tumors in the spinal cord (intramedullary) usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord (extramedullary) may grow for a long time before causing nerve damage.

Symptoms may include:

  • Abnormal sensations, loss of sensation:
    • Especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg)
    • May worsen
  • Back pain:
    • Gets worse over time
    • In any area -- middle or low back are most common
    • Is usually severe and not relieved by pain medication
    • Is worse when lying down
    • Is worse with strain, cough, sneeze
    • May extend to the hip, leg, or feet (or arms), or all extremities
    • May stay in the spine
  • Cold sensation of the legs, cool fingers or hands, or coolness of other areas
  • Fecal incontinence
  • Inability to keep from leaking urine (urinary incontinence)
  • Muscle contractions or spasms (fasciculations)
  • Muscle function loss
  • Muscle weakness (decreased muscle strength not due to exercise):
    • Causes falls
    • Especially in the legs
    • Makes walking difficult
    • May get worse (progressive)

Exams and Tests

A nervous system (neurologic) examination may find the location of the tumor.

The health care provider may also find the following during an exam:

  • Abnormal reflexes
  • Increased muscle tone
  • Loss of pain and temperature sensation
  • Tenderness in the spine

These tests may confirm spinal tumor:

  • Antidiuretic hormone (ADH) test
  • Cerebrospinal fluid (CSF) examination
  • Cytology (cell studies) of CSF
  • Myelogram
  • Spinal CT
  • Spine MRI or lumbosacral spine MRI
  • Spine x-ray

Treatment

The goal of treatment is to reduce or prevent nerve damage from pressure on (compression of) the spinal cord.

Treatment should given quickly. The faster symptoms develop, the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be taken seriously.

Treatments include:

  • Corticosteroids (dexamethasone) may be given to reduce inflammation and swelling.
  • Surgery may be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, part of the tumor may be removed to relieve pressure on the spinal cord.
  • Radiation therapy may be used with, or instead of, surgery.
  • Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended in some cases.
  • Physical therapy may be needed to improve muscle strength and the ability to function independently.

Support Groups

You can ease the stress of illness by joining a support group whose members share common experiences and problems.

Outlook (Prognosis)

The outcome varies depending on the tumor. Early diagnosis and treatment usually leads to a better outcome.

Nerve damage often continues, even after surgery. Although permanent disability is likely, treatment may delay major disability and death.

Possible Complications

  • Incontinence
  • Life-threatening spinal cord compression
  • Loss of sensation
  • Paralysis
  • Permanent damage to nerves, disability from nerve damage

When to Contact a Medical Professional

Call your health care provider if you have a history of cancer and develop severe back pain that is sudden or gets worse.

Go to the emergency room or call the local emergency number (such as 911) if you develop new symptoms, or your symptoms get worse during the treatment of a spinal tumor.

References

DeAngelis LM. Tumors of the central nervous system and intracranial hypertension and hypotension. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 199.


Review Date: 9/22/2008
Reviewed By: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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