Spine Problems as We Age
By Dr. Lloyd Maliner / January - February 2012
It is commonly said that there are two certainties in life: taxes and death. I want to suggest that there is a third: arthritis. The common type of arthritis, osteoarthritis, is not really a disease but simply the wear and tear of living on the joints, where two bones meet and move, such as elbows and knees. I often compare arthritis to rust on a hinge -- it develops over time, makes the surfaces irregular, and causes squeaking and stiffness.
Since the spine is flexible and composed of many bones, it contains many joints. There are three joints between each two vertebrae, and 25 of these joint levels from the head to the sacrum. There are many joints in the spine. No wonder almost everyone will develop some arthritic trouble in the back over time.
The most common spine problem that comes with age is the stiffness and occasional discomfort due to arthritis. An easy example is the trouble you have getting out of bed in the morning, requiring you to stretch your back. The longer you live, the stiffer and slower you will be in the morning.
The main factor that seems to determine an individual's severity of arthritis is genetics, but smoking, obesity and physical over-activity also play roles. The majority of people suffering from arthritic or age changes simply need encouragement and the occasional anti-inflammatory medication. However, more serious problems can develop due to arthritis, such as stenosis.
Stenosis refers to narrowing, usually boney, around the spinal cord or a nerve. This occurs when bone spurs, which are like rust deposits in our analogy, develop around the affected joint. With most joints in the body, bone spurs simply interfere with the joint movement, which is actually their purpose. This is helpful because the less the joint moves, the less irritation and pain. In fact, the old way to treat joint pain was to eliminate the joint, or fuse it. This works well for pain control, but try walking without a knee.
In the spine, lack of movement of the joints is not as much of a concern, but bone spurs can cause other problems. The real concern is that the spine contains and protects the spinal cord and nerves. Bone spurs can close off the space for these nervous structures, which is stenosis.
The effects of stenosis vary, depending on which nerves are being pinched and to what degree. The most common problem is stenosis in the low back, or lumbar spine. Lumbar stenosis causes discomfort in the back and legs with standing and walking. It is probably why you see people walking bent over while pushing grocery carts and having to sit down every five minutes. Lumbar stenosis is easily treated by surgery, but only needs to be treated when the person is tired of the discomfort.
This is not true of stenosis in the neck, or cervical spine. Cervical stenosis can be devastating because it pinches the actual spinal cord, which can lead to paralysis. Cervical stenosis can develop without real pain, just progressive numbness and clumsiness in the hands and feet, until the person can no longer walk. Significant cervical stenosis requires surgical treatment to prevent paralysis, even if the person does not feel that bad.
These are just some of the more common problems affecting the aging spine. Remember that most back problems are temporary. So don't panic, unless you are having some degree of paralysis. If you do have any sort of paralysis, seek medical help immediately.
Lloyd Maliner M.D. is a board-certified neurosurgeon who specializes in minimally invasive spine surgery at Broward Health Coral Springs Medical Center.
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