Common Conditions

Sacroiliac (SI) joint pain is felt in the low back and buttocks. The pain is caused by damage or injury to the joint between the spine and hip. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem. Accurate diagnosis is important to determine the source of pain. Physical therapy, stretching exercises, pain medication, and joint injections are used first to manage the symptoms. Surgery to fuse the joint and stop painful motion may be recommended.

The SI joints are located between the iliac bones and the sacrum, connecting the spine to the hips. The two joints provide support and stability, and play a major role in absorbing impact when walking and lifting. From the back, the SI joints are located below the waist where two dimples are visible. Strong ligaments and muscles support the SI joints. There is a very small amount of motion in the joint for normal body flexibility. As we age our bones become arthritic and ligaments stiffen. When the cartilage wears down, the bones may rub together causing pain. The SI joint is a synovial joint filled with fluid. This type of joint has free nerve endings that can cause chronic pain if the joint degenerates or does not move properly.

Spondylosis is common and usually not serious, although it can be quite painful. Most patients with spondylosis don't need spine surgery. It's s a degenerative condition that may worsen as a person grows older, and can affect any region of the spine:

• Cervical (neck)
• Thoracic (upper, mid back)
• Lumbar (low back)
• Lumbosacral (low back/sacrum)

Spondylosis can affect the spine’s intervertebral discs (eg, degenerative disc disease) and facet joints. As people grow older, normal age-related cellular changes, coupled with the effects of daily wear and tear can cause or contribute to discs losing normal shape, size, and height. These structural alterations may reduce the amount of space (disc space) between vertebral bodies and subsequently affect normal movement of the facet joints. Bone spurs (osteophytes) develop, which can pinch a spinal nerve root and cause inflammation and pain.

Adjacent segment disease (ASD) is a spinal disorder that may develop after spinal fusion (eg, instrumentation, bone graft). Although ASD is widely known to be a potential complication of spinal fusion, it can also be caused by natural degenerative changes that occur in the spine due to aging. ASD is also known as adjacent segment syndrome, transitional syndrome, and adjacent segment degeneration.

Adult scoliosis occurs when the spine curves abnormally to the left or right. The majority of scoliosis cases are termed idiopathic, meaning of undetermined cause. Although scoliosis is usually considered a disorder affecting adolescents, it is also found in adults.

Adult scoliosis is more often caused by:

1. Progression of the disease from childhood such as when scoliosis is not treated early or goes unnoticed during childhood. The scoliotic curves may be thoracic, lumbar, or both.
2. The asymmetric degeneration of spinal elements. Disorders such as degenerative disc disease and compression fractures (eg, osteoporosis) may cause changes in the height of vertebral bodies and their shape. A region of the spine may begin to lose its symmetry—meaning, each side is vertically straight—and bend to the left or right.
3.  A combination of numbers 1 and 2.

Back pain is one of the most common reasons people self-treat and seek medical care. It will affect approximately three in four adults during their lifetime. When we speak about “back pain” we mean pain that originates in the spine anywhere between the upper and lower back.

Degenerative disc disease (DDD) is typically associated with aging. As you age, your discs, like other joints in the body, can degenerate (break down) and become problematic: That's a natural part of growing older as your body deals with years of strain, overuse, and maybe even misuse. However, DDD can occur in people as young as 20, so sadly, youth doesn't always protect you from this disc-related spinal condition. In fact, some patients may inherit a prematurely aging spine.

Degenerative disc disease involves the intervertebral discs. Those are the pillow-like cushions between your vertebrae in your spine. They help your back carry weight and allow complex motions of the spine while maintaining stability. As you age, the discs can lose flexibility, elasticity, and shock absorbing characteristics. They also become thinner as they dehydrate. When all that happens, the discs change from a supple state that allows fluid movement to a stiff and rigid state that restricts your movement and causes pain.

Lumbar spinal stenosis is a common cause of low back, buttock and leg pain in adults 50 years and older. This condition is caused by nerve compression and symptoms may include tingling, numbness and weakness. Leg symptoms are sometimes described as sciatica or lumbar radiculopathy.

The cervical spine is a marvelous and complex structure. It is capable of supporting a head weighing 15 or more pounds while moving in several directions. No other region of the spine has such freedom of movement. This combination however, complexity and mobility, make the neck susceptible to pain and injury.

Sciatica is a lumbar spine condition that won't stay in the spine. It's a pain in the butt...literally.

Sciatica starts in the lower back. Nerve roots in the lumbosacral spine eventually come together and turn into the sciatic nerve in the buttocks. Sciatica happens when these nerve roots become compressed, often from a herniated disc or a narrowing of the spinal canal called stenosis.

This nerve impingement causes pain that radiates from the lower back along the sciatic nerve. Sciatica is a type of lumbar radiculopathy; a condition described as pain and/or sensations (eg numbness, tingling) that travels downward into one or both legs. Pain is the hallmark sciatic symptom and classic sciatica radiates below the knee.

Typically, sciatica causes pain, numbness and/or tingling in one side of the lower back and the associated left or right leg. The sciatic nerve has several smaller nerves that branch off from the main nerve and enable movement and feeling (motor and sensory functions) in the thighs, knees, calves, ankles, feet, and toes.

Spondylolisthesis occurs when one vertebra slips forward over the vertebra below it. The term is pronounced spondy-low-lis-thesis and is derived from the Greek language: spondylo means vertebra and listhesis means to slip. There are several types or causes of spondylolisthesis; a few are listed below.

• Congenital spondylolisthesis means the disorder is present at birth.
• Isthmic spondylolisthesis occurs when a defect, such as a fracture occurs in a bony supporting vertebral structure at the back of the spine.
• Degenerative spondylolisthesis is more common and is often associated with degenerative disc disease, wherein the discs (eg, due to the effects of growing older) lose hydration and resilency.

A clue to answering this question is found in the meaning of each word. Spinal refers to the spine. Stenosis is a medical term used to describe a condition where a normal-size opening has become narrow. Spinal stenosis may affect the cervical (neck), thoracic (chest), or lumbar (lower back) spines. The most commonly area affected is the lumbar spine followed by the cervical spine.

Spinal infections can be classified by the anatomical location involved: the vertebral column, intervertebral disc space, the spinal canal and adjacent soft tissues. Infection may be caused by bacteria or fungal organisms and can occur after surgery. Most postoperative infections occur between three days and three months after surgery.

Vertebral osteomyelitis is the most common form of vertebral infection. It can develop from direct open spinal trauma, infections in surrounding areas and from bacteria that spreads to a vertebra from the blood.