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Ankylosing spondylitis is a more rare form of arthritis that mainly affects the lower part of the spine and the sacroiliac joints. This inflammatory disease involves erosion of bone and increased bone formation in the spine, leading to bone fusion. This fusing makes the spine less flexible and can lead to a change to a hunched forward posture. Early signs of ankylosing spondylitis can include pain and stiffness in the lower back and hips, which is the part of the spine where the disease usually starts. Over time, it can spread up the spine or damage other joints in the body, and result in worsening symptoms or pain and stiffness in the shoulders, hands, rib cage, thighs, feet, or heels. In addition to the spine, ankylosing spondylitis can also affect the eyes; this eye condition is called uveitis, which is a type of eye inflammation associated with pain, blurred vision, and light sensitivity. While ankylosing spondylitis does not have a cure, there are several medications and conservative therapies that can assist with pain and swelling, including corticosteroid injections for the affected joint(s).
Degenerative Disc Disease
The spine consists of vertebrae, stacked on top of one another along with discs separating each bone. Degenerative disc disease is a condition that occurs when one or more of these discs begins to deteriorate. As the body ages, discs begin to lose fluid and dehydrate. The gel-like material wears out, losing its cushioning ability as the discs narrow and lose height. Once this cushion narrows, the nerve roots can get pinched, which can evolve into degenerative disc disease. The body responds by laying down bone to stabilize the spine, known as bone spurs, which can also cause pain for the patient. Degenerative disc disease can occur in the cervical (neck), thoracic (middle), or lumbar (lower) regions of the spine. Depending on the location of the affected discs, symptoms can vary. Many patients do not experience symptoms, but the condition can cause neck, upper, mid, and lower back pain, as well as numbness, tingling, or weakness in the legs. Nonsurgical treatment options such as medication, rest, exercise, and physical therapy may be recommended for those with no evidence of nerve root compression or muscle weakness. Additional conservative options may include steroidal injections, and where these treatments fail to provide relief, surgery is considered, in which a discectomy is performed to remove the affected disc(s).
Degenerative Joint Disease
Each joint has a smooth contact surface covering the bone called cartilage, which facilitates the fluid movement of the joint with reduced friction and stress. When operating without issue, this mechanism allows for a full range of motion. In early arthritis or joint degeneration, the cartilage surrounding the joint becomes yellow and opaque with localized areas of softening and roughening of the surfaces. As degeneration progresses, those soft areas become cracked and worn, exposing the bone under the cartilage so the joint is no longer covered and protected. If the cartilage wears away completely, it can result in bone rubbing on bone, which can become painful. Age is the leading factor of degenerative joint disease, resulting in wear-and-tear over time. The condition can occur in the cervical (neck), thoracic (middle), or lumbar (lower) regions of the spine. Symptoms of degenerative joint disease will depend on the location of the joint and what bone structures it affects, and can range from mild to severe. These symptoms can include pain or stiffness in the back, limited range of motion, loss of flexibility, and muscle spasms. In most cases, treatment for degenerative joint disease is non-surgical and can include physical therapy, pain medication, injections, and other modalities. Severe cases may warrant spine surgery.
Facet syndrome is a form of arthritis that affects the facet joints of the spine. Facet joints are located on the back of the spine and are responsible for connecting the vertebrae and providing stability and enabling joint movements. With facet syndrome, the cartilage in these joints breaks down, causing bone-on-bone friction. The condition can occur in the cervical (neck), thoracic (middle), or lumbar (lower) regions of the spine. Like other joints in the body, facet joints are susceptible to wear and tear and resulting degeneration. Disc degeneration can further progress facet syndrome; when disc degeneration causes loss of height between vertebrae, more force is placed on the facet joints and accelerates wear. Facet syndrome can result in symptoms including neck or back pain, pain and tenderness localized at the level of the affected facet joint, muscle spasms, changes in posture, or loss of motion, including the ability to bend backwards or move sideways. For mild symptoms, nonsurgical treatment includes activity modification to reduce flare-ups, physical therapy, or joint injections. Severe cases may warrant spine surgery.
Between each vertebrae in the spine is a structure called the intervertebral disc. An intervertebral disc is made up of 2 components: an outer, fibrous ring and a center, gel-like nucleus. A herniated disc occurs when part or all of the protective outer layer tears and some of the nucleus pulposus leaks out of the disc and onto a nearby nerve root or other surrounding structure. A herniation can occur in any disc in the cervical (neck), thoracic (middle), or lumbar (lower) regions of the spine. Depending on the location of the affected discs, symptoms can vary. Symptoms may include neck or back pain, stiffness or reduced range of motion, sensory changes such as tingling or numbness in the nerve that has been affected, loss of motion, and difficulty sitting or bending. However, if the damaged disc is not pressing on a sensitive structure, the patient may also remain symptom-free. Most pain from a herniated disc will resolve over a few weeks to a couple months with nonsurgical treatment and pain management. If the pain lasts longer or if the pain or damage is severe, spine surgery may be an option, which can include a laminectomy or discectomy in which part of all of the damaged disc is removed.
Sciatica refers to pain caused by irritation or compression of the sciatic nerve. This is the longest and thickest nerve in the body, which runs from the lower back through the hips, buttocks, and down the back of each leg. Pain from sciatica can range from a mild ache to severe and excruciating, and can be felt anywhere along the sciatic nerve – anywhere from the lower back, through the hips, buttocks, and each leg. This pain will usually worsen with movement and may result in the inability to move. Additional symptoms can include weakness, numbness, or a tingling sensation in the leg or foot. Sciatica usually only affects one side of the body at a time. The most common causes of sciatica are a herniated disc, a bone spur, and spinal stenosis. These conditions can all put pressure on a nerve root, which causes the inflammation and pain. In most cases, sciatica can be resolved with non-surgical treatments such as physical therapy or steroid injections. If conservative treatments fail to provide relief or the sciatica is accompanied by significant leg weakness or bowel or bladder changes, surgery may be recommended. Surgical options may include a discectomy or laminectomy, in which your surgeon would remove part of a bone or repair and/or replace a disc that is compressing the sciatic nerve.
Spinal stenosis occurs when your spinal canal starts to narrow, which can put pressure on the spinal cord and the nerves that travel through the spine. The narrowing is usually caused by arthritis of the spinal column and discs between the vertebrae. Spinal stenosis typically appears slowly over time, so symptoms may begin mildly and progress with the disease. Depending on which part of the spine the narrowing takes place, symptoms including pain, numbness, weakness, or tingling may occur in the lower back, legs, neck, shoulder, or arms. While some can be born with a narrower spinal canal, most cases are the result of aging and wear and tear on the spine. Other causes of spinal stenosis can include herniated discs, overgrowth of bone or bone spurs, and spinal injuries. For mild cases of stenosis, conservative treatment such as pain medication or physical therapy is recommended. Steroid injections can help reduce inflammation and relieve some of the pain. For more progressive cases, surgical options such as a laminectomy may be recommended to relieve the pressure on the spinal cord or affected nerve roots.
Your spinal cord runs through a canal in the center of your vertebral column. Nerve roots split from this cord and travel between the vertebrae to different parts of the body. When these nerve roots become pinched or damaged, the resulting symptoms are called radiculopathy. As these nerves provide sensation and motor control to different parts of the body, damage or interference can cause neurological problems like pain, weakness, numbness, or changes in reflexes. Due to the length and complexity of the spine, nerve roots are extremely susceptible to injury or damage. If anything – bone, tendon, muscle, or disc – compresses a nerve root, it can disrupt its function and cause neurological symptoms and pain. Causes of this disruption can be the result of conditions like a herniated disc, spinal stenosis, or degenerative disc or joint disease. Radiculopathy can occur in the cervical, thoracic, or lumbar regions of the spine, which has an effect on where symptoms occur. Non-surgical treatment options for radiculopathy may include medication or steroid injections. If symptoms aren’t relieved with conservative treatments, there are several surgical procedures that address the structures contributing to the pressure on the nerve.