What you need to know about the spine

Spinal motion segment is the term used to designate the functional unit of the spine to define abnormalities in the kinematic properties of the spinal column.

The PDS is made up of two vertebrae, which are connected to each other by a disc, ligaments, and muscles (the intervertebral disc is of particular importance, allowing it to absorb loads and shocks). Facet joints allow a certain range of motion between the vertebrae. In the lateral sections of the vertebral segment, blood vessels and nerve roots pass through the foraminal openings. The motor properties of the spine depend on the activity of many SMS.

Disturbances in the function of the SMS may be in the form of instability or in the form of a blockade. With segmental instability, conditions arise for an excessive range of movements, which can lead to pain and often compression of nerve formations. With a blockade of a segment, a sharp decrease in movements between the vertebrae occurs. But at the same time, there is an increase in the range of movements in adjacent segments, which is a compensatory reaction of the spine and allows you to maintain the necessary range of movements in the spine. That is, in both cases, instability of the PDS appears. From a biomechanical point of view, instability of the SMS means the loss of the segment’s ability to maintain the physiological position of the vertebrae in relation to each other, that is, excessive displacement of the overlying vertebra in the horizontal and lateral directions relative to the underlying vertebra. Instability of the SDS can be caused by both pathological processes in the intervertebral disc and facet joints, may be due to weakness of the musculo-ligamentous apparatus of various origins. Most often, instability is caused by degenerative changes in the disc - a decrease in the height of the disc and the shock-absorbing functions of the disc leads to an increase in the amplitude of movements in the overlying segment (discogenic instability). An S-shaped dynamic deformation of the affected area of the spine occurs and, accordingly, an excessive load on the facet joints and ligaments. The muscular system is of great importance in the development of instability, as well-developed back muscles (especially deep ones) make it possible to compensate for excess mobility during instability. But prolonged pain syndrome leads to the fact that a person begins to limit both the volume and amplitude of movements of the torso, which ultimately leads to muscle wasting and further progression of instability. A person makes movements along a trajectory that allows him to avoid painful manifestations and, over time, a pathological motor stereotype of movements. Accordingly, muscles that are not involved in movement become flabby, tone decreases and muscle strength also decreases. Long-term instability leads not only to changes in the muscles, but also leads to the formation of bone growths along the edges of the vertebrae (osteophytes) - this is also its a kind of compensatory reaction of the body, in order to increase the area of the vertebral body. Osteophytes are sometimes directed into the spinal canal and then conditions arise for spinal stenosis and compression of the spinal cord and roots. There are several types of spinal instability: post-traumatic, degenerative, postoperative, dysplastic. According to localization, instability can be in the cervical region, in the lumbar spine. Instability in the thoracic region practically does not occur due to the anatomical rigidity of this part of the spine.

Spinal sections:

In medical terminology, for brevity, the Latin letter “C” - C1 - C7 is used to designate the cervical vertebrae, the Latin letter “Th” - Th1 - Th12 is used to designate the thoracic vertebrae, and the lumbar vertebrae are designated the letter “L” - L1 - L5.

Cervical spine (7 vertebrae) This is the uppermost section of the spinal column. It is distinguished by its special mobility, which provides such variety and freedom of head movement. The two upper cervical vertebrae, with the beautiful names atlas and axis, have an anatomical structure that is different from the structure of all other vertebrae. Thanks to the presence of these vertebrae, a person can turn and tilt his head. By the way, all mammals have 7 cervical vertebrae, even the giraffe.
Thoracic region (12 vertebrae) 12 pairs of ribs are attached to this region. The thoracic spine is involved in the formation of the posterior wall of the chest, which is the container for vital organs. In this regard, the thoracic spine is inactive.
Lumbar (5 vertebrae) This section consists of the most massive vertebrae, since they bear the heaviest load. Some people have a sixth lumbar vertebra. Doctors call this phenomenon lumbalization. But in most cases, such an anomaly has no clinical significance. 8-10 vertebrae fuse to form the sacrum and coccyx.
Sacrum (5 vertebrae)
Coccyx (4-5 vertebrae)

Causes of displacement of the lumbar vertebrae

There are several reasons for displacement of the lumbar vertebrae:

Intrauterine defect in the development of the sacrum or lumbar vertebral arches. This type manifests itself in childhood and, as a rule, does not reach the third degree of displacement;
Spondylolysis is the cause in 67% of cases. This pathological phenomenon is characterized by a defect in the interarticular part of the vertebral arches. It appears in older age groups, more often in men;
Congenital instability of displaced vertebrae instability of displaced vertebrae;
Spondylolisthesis as a result of involutional changes. Does not reach pronounced stages;
Displacement of the vertebrae resulting from injury. Can be of any degree;
Vertebral displacement as an outcome of systemic pathology of the supporting system.

Predisposing factors in the development of vertebral displacement are heavy physical activity, frequent injury to the lumbar region, single heavy impact, poor development of the back muscles, hormonal imbalances, and cases of the disease in the family.

Osteochondrosis?

Synonyms: radiculitis, salt deposits. Between the bodies of two adjacent vertebrae there is an intervertebral disc that performs 3 functions: shock absorption, holding adjacent vertebrae, ensuring mobility of the vertebral bodies. With osteochondrosis, the intervertebral disc loses its elasticity, becomes less durable, and therefore cannot perform its functions. Salts are deposited at the junctions of the vertebrae, bone growths appear, which, together with the discs, can shift and compress the nerve roots. This causes pain.

Manifestations of osteochondrosis are herniated intervertebral discs. A lumbar hernia causes pain in the back, buttocks, sacrum, and can spread to the legs. If you have any of these symptoms, it is necessary to undergo an examination, which includes not only x-rays, but also magnetic resonance imaging (MRI). When determining treatment tactics, we rely on MRI data. If an MRI reveals a disc herniation, the patient is most often frightened by this “terrible” diagnosis - not surgery! It must be said that for surgery for a herniated disc at the lumbar level, good reasons are needed. The patient makes the final decision after consultation with a neurosurgeon - vertebrologist.

A disc herniation causes severe pain, even with slight exertion, which interferes with life and work. If the patient wants to significantly improve the quality of his life, he will choose surgical treatment that will permanently rid him of this disease.

Another question arises: Where to have surgery? What to look for when choosing a medical institution?

To successfully perform an operation, in addition to the knowledge and skills of the surgeon, you need appropriate equipment in the operating room (Electro-optical converter (EOC) - a special X-ray unit, a powerful operating microscope, a special set of microsurgical instruments). The operating rooms in our clinic meet all these requirements and are fully equipped with everything necessary for spinal surgery.

A question that people leading an active lifestyle ask: How many days will the hospital stay take in case of surgery? Before surgery – from 2 to 5 days. After surgery – up to two weeks. The patient gets up on the second day and is discharged after the stitches are removed. He is offered a special rehabilitation program that will allow him to recover as soon as possible and return to an active lifestyle.

Symptoms of displacement of the lumbar vertebrae

The first and most striking symptom of vertebral displacement is pain localized directly at the site of the pathological process. Pain intensifies during periods of prolonged standing or sitting without changing body position. In this case, the pain can be of a varied nature. Sometimes the onset of the disease is manifested by pain in the legs, which is typical for the young contingent of patients.

Symptoms that are detected during an objective examination of the patient are also important:

the superior vertebra protrudes significantly compared to the underlying one;
the muscles that straighten the spinal column are tense (symptom of “reins”);
the sacrum is in a horizontal position;
pathological kyphosis is detected above the site of pathological lordosis;
the height of the lumbar region is reduced;
as a result of a significant forward displacement of the torso, a kind of transverse skin fold is formed on the abdomen;
characterized by a gait similar to that of a tightrope walker;
the “flat back” symptom is detected when the patient is in an inclined position;
atrophic gluteal muscles are characteristic of late stages of the disease;
the abdominal aorta is palpated without indentations into the abdominal cavity;
“proud pelvis” is characteristic of advanced spondylolisthesis.

When the cauda equina is involved in the pathological process, the following symptoms occur:

"Crawling of goosebumps" on the legs. It occurs very often at rest, with stress on the legs. More often with unstable displacement of the vertebrae;
increased sensitivity in the legs;
areflexia;
pronounced symptoms of tension;
atrophy of the muscles of the lower extremities, most often the calf muscles are affected;
paresis (not common);
the patient takes a forced position to reduce the pain impulse;
Sometimes there is a lack of sensitivity in the skin of the feet. At the same time, the skin is cold and pale;
Sometimes there may be a problem with potency. This is typical for unstable vertebral displacement;
neurogenic intermittent claudication.

Spinal injuries

Spinal injuries are very common and extremely dangerous, as spinal injuries cause injury to the spinal cord, which can lead to paralysis. Injuries to the cervical spine are varied: damage to the ligamentous apparatus, subluxations and dislocations of the vertebrae, and their fractures. Many experts do not consider injuries to the ligamentous apparatus to be serious, since they do not detect pathology on X-rays. The patient only has neck pain. Therefore, they either put a soft collar on him or let him go with the parting words: in 2 weeks everything will pass! However, our experience shows that such damage must be taken seriously. Lack of treatment often leads to serious complications: pain increases significantly, and intervertebral disc herniation may occur.

Subluxations and dislocations of the vertebrae are a very serious problem. In this case, the spinal cord and its roots suffer to one degree or another. In this situation, active actions of the surgeon are required. The goal is to eliminate compression of the nerve structures (spinal cord and its roots) and restore the correct anatomical relationship in the cervical spine between bone and nerve structures (eliminate dislocation). To restore the supporting function of the spine, during the operation the dislocation is reduced, and then special plates are implanted to fix the unstable part.

Diagnostics

Diagnosis of instability of segments of various parts of the spine is based on the patient’s complaints, medical history, examination, neurological status, and the results of instrumental research methods. The presence of deformities, range of motion in various parts of the spine, the presence of functional blocks, muscle spasms, and increased pain during certain movements are assessed. Of the instrumental research methods, radiography is primarily used, both standard and a more informative study - radiography with functional tests. A displacement of the vertebra forward or backward by more than 2-3 mm when performing radiography with forward bending and extension is a sign of spinal instability. But radiography allows visualizing changes only in bone structures and, if necessary, diagnosing morphological changes in soft tissues (cartilage, ligaments, muscles, nerve structures) tomography (CT or MRI) is required. MRI is the most reliable diagnostic method for diagnosing such changes in the spine as spinal canal stenosis, disc herniation, root compression, etc. If it is necessary to identify liquor-dynamic disorders, myelography can be performed. The use of EMG is necessary in the presence of compression of peripheral nerves. Laboratory diagnostics are prescribed if it is necessary to differentiate from systemic infectious or oncological diseases. Diagnostics allows you to determine both the diagnosis and treatment tactics (conservative and surgical).

Cervical vertebrae fractures

This is a common injury. Especially among athletes. In case of a fracture of the cervical vertebrae, surgery is always required. You need to act as quickly as possible, since the spinal cord is damaged, and this entails serious problems (loss of sensitivity and loss of motor function are possible).

Separately, it is necessary to highlight injuries to the upper cervical spine. These include damage to the first two vertebrae. They are different in structure from the others and require a special approach to treatment. In order for the fragments to heal correctly, a special device is used - a Halo-device, which allows you to fix the fragments in the desired position.

Complications

Often, the stability of the vertebrae can be a signal of the development of a disease such as osteochondrosis. At the initial stage, it may practically not manifest itself - however, as the pathology progresses, even one unsuccessful movement or a slightly more intense load than usual can cause severe pain. Due to the mobility of the vertebrae, the development of osteochondrosis occurs much faster and will ultimately lead to complications in the form of arthrosis of the intervertebral joints. Due to instability of the vertebrae, the load on the muscles and ligaments is significantly increased, which leads to impaired muscle tone and the appearance of pain symptoms when sitting for long periods and trying to perform simple movements. In the absence of proper treatment, pathology can lead to the following consequences:

MRI of the spine

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More details

neurological disorders;
restriction of movements;
spasms;
headaches accompanied by nausea and weakness (with damage to the cervical vertebrae);
development of spondylosis.

Trauma to the thoracic and lumbar spine

Unlike the cervical region, vertebral dislocations in their pure form do not occur in these regions.

There are fractures and fracture-dislocations.

There are stable and unstable fractures.

Bones and ligaments that provide mobility protect the spinal cord from injury. When, due to a fracture, these structures no longer protect the spinal cord or nerve roots from damage or irritation during stress, the fracture is considered unstable.

Unstable fractures are subject to mandatory surgical treatment, while stable ones can be treated conservatively.

Types of instability, their causes

Instability of the thoracic or cervical vertebrae can be caused by various reasons. In accordance with them, it is customary to distinguish the following types:

post-traumatic - appears due to dislocations or fractures of the vertebrae;
degenerative - appears due to the development of degenerative processes in the spine against the background of other diseases;
postoperative - appears due to excessive load on the spine during rehabilitation after surgery;
dysplastic - appears as a result of pathological processes in the connective tissue of the vertebrae, their joints and ligaments.

Treatment tactics

After all the necessary examinations, treatment tactics are selected.

If conservative (non-surgical) treatment is possible, a corset is selected for the patient, and primary rehabilitation is carried out (the abdominal and back muscles need to be strengthened).

If a decision is made to undergo surgery, the doctor will determine the type of surgical treatment. You can read more about this in the section “For persons with medical education.”

Thanks to reliable and proven methods, the experience of surgeons, as well as modern technologies, patients recover quickly.

Herniated disc

Hernial protrusion is caused by the destruction of the fibrous ring of the disc, which, under the weight of the overlying vertebrae, is flattened and extends beyond its anatomical boundaries. Hernias are detected during examination for osteochondrosis and are its complication. Hernias, like protrusions, often develop asymptomatically and may not manifest themselves in any way. Otherwise, patients complain of dull pain at the location of the hernia. It increases with walking and standing, and goes away after resting in a lying position. If a nerve root near the disc is pinched, the pain is difficult to endure because it resembles an electric shock and is sharply shooting, piercing in nature. In the area of innervation of the pinched nerve, numbness and muscle weakness are possible.