The Encyclopedia of the Back and Spine Systems and Disorders (Facts on File Library of Health and Living)

369 Pages·2007·2.7 MB·English

by  Mary Harwell Sayler

THE ENCYCLOPEDIA OF
THE BACK AND SPINE
SYSTEMS AND DISORDERS
Mary Harwell Sayler
with
Arya Nick Shamie, M.D.
Director, UCLA Comprehensive Spine Center
VA Wadsworth Medical Center
Assistant Professor of Orthopaedic Surgery and Neurosurgery
UCLA School of Medicine
i-xiv_back&spine-fm.indd i 8/7/07 3:38:58 PM
The Encyclopedia of the Back and Spine Systems and Disorders
Copyright © 2007 by Mary Harwell Sayler
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means,
electronic or mechanical, including photocopying, recording, or by any information storage or retrieval
systems, without permission in writing from the publisher. For information contact:
Facts On File, Inc.
An imprint of Infobase Publishing
132 West 31st Street
New York NY 10001
Library of Congress Cataloging-in-Publication Data
Sayler, Mary Harwell.
The encyclopedia of the back and spine systems and disorders /
Mary Harwell Sayler with Arya Nick Shamie.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-8160-6678-0 (hc : alk. paper) 1. Back—Diseases—Encyclopedias.
2. Spine—Diseases—Encyclopedias. I. Shamie, Arya Nick. II. Title.
III. Title: Back and spine systems and disorders.
RD768.S6277 2007
617.5′64—dc22 2006035678
Facts On File books are available at special discounts when purchased in bulk quantities for businesses,
associations, institutions, or sales promotions. Please call our Special Sales Department in New York at
[phone] or [phone].
You can fi nd Facts On File on the World Wide Web at http://www.factsonfi le.com
Text and cover design by Cathy Rincon
Printed in the United States of America
VB Hermitage 10 9 8 7 6 5 4 3 2 1
This book is printed on acid-free paper.
i-xiv_back&spine-fm.indd ii 8/7/07 3:38:58 PM
Dedicated to Backbone
for Bob
The spine defines us:
fish, amphibian,
reptile, bird,
or mammal
crawling,
crouching,
reaching
toward upright.
Uptight or loosely
woven, we struggle
to correct each
complication
of age or accident
we’ve fallen
heir to
in this relentless art
of balancing our act.
i-xiv_back&spine-fm.indd iii 8/7/07 3:38:58 PM
CONTENTS
Foreword v
Preface vi
Acknowledgments xi
Introduction xi
Entries A–Z 1
Appendix I: National and International Organizations
for the Back and Spine 321
Appendix II: Related Organizations 323
Appendix III: Other Relevant Web Sites 327
Appendix IV: Internet Journals and Magazines 328
Bibliography 329
Index 31
About the Authors 354
i-xiv_back&spine-fm.indd iv 8/7/07 3:38:58 PM
FOREWORD
ack pain and neck pain are very common dis- phy of the muscles and other problems associated
Borders that affect 90 percent of the adult popu- with immobility.
lation sometime in their life span. The good news Typically, pain in the spine is caused by inflam-
is that only 10 percent of these disorders require mation that stimulates pain receptors in the area.
any treatment, and most will get better spontane- Therefore, medications that block inflammation will
ously within weeks after the onset of symptoms. also help pain. For instance, the class of medication
Of the patients who need treatment, only 10 per- called NSAIDs, or nonsteroidal anti-inflammatory
cent will require surgical treatment (1 percent of drugs, are generally safe and not habit-forming but
all patients). Most will be treated with medica- should be taken with food to minimize risks of gas-
tions, physical therapy, and/or injections. trointestinal upset. In some cases, especially with
Despite the generally good outcome after the larger doses and prolonged use, these medications
onset of back and neck pain, the disorder can can cause a peptic ulcer. The first sign of this condi-
be quite debilitating. When severe pain occurs, tion is pain in the stomach area that may or may
patients desperately seek any treatment that may not be relieved by ingesting food. If these symp-
help, but many of the advertised treatments lack toms develop, you should immediately stop the
any sound evidence that they work. The patient medication and consult your physician.
takes herbal medications, gets a massage to relieve Steroids (a form of hormone) can also be pre-
“knots of muscles,” or uses traction that promises scribed to cut down inflammation. Steroids are
to get rid of pain. The interesting fact is that, in generally more effective than NSAIDs in treat-
most cases, if patients just waited four to six weeks, ing inflammation but have more side effects. The
the pain would disappear on its own! Unproven steroids can be given either by mouth (with more
treatments also take money out of a patient’s systemic effects) or via direct injection of a small
pocket because insurance companies do not cover amount at the site of the inflammation or injury.
the costs. Some treatments can even be harmful Physical therapy offers another treatment pre-
to patients or worsen their symptoms. The bottom scribed during the acute phase of the disease. This
line is, use common sense or ask a professional to therapy may include exercise, ultrasound heating
help you decide which treatments to invest in. of sore muscles, and/or massage treatments to ease
The most common initial treatments offered to muscles “knotted” by contraction. There is contro-
patients are bed rest for a maximum of one to two versy over whether this treatment modality actu-
days, anti-inflammatory medications or injections ally works, probably because of non-standardized
including steroids, some form of exercise or physi- treatments or variations in the success rate. Physi-
cal therapy, and/or pain medication including nar- cal therapy theoretically helps patients by stretch-
cotics like codeine. Bed rest for more than one to ing then strengthening muscles around the spine,
two days is not advised, because it can cause atro- which ultimately takes the pressure off the spinal
v
i-xiv_back&spine-fm.indd v 8/7/07 3:38:58 PM
vi The Encyclopedia of the Back and Spine Systems and Disorders
joints. Not to be regarded as a quick fix, physical the disc space that is degenerated. Since the device
therapy should be continued in a regimented fash- has a built-in mechanical joint, it theoretically pre-
ion even after the pain has subsided to prevent a serves the motion in the disc space. This prevents
recurrence of symptoms. the extra stress that may occur in adjacent discs so
If none of the above treatments helps to allevi- may prevent adjacent level disease. However, disc
ate symptoms, then surgical intervention is consid- replacement devices require a stable spine, so spi-
ered. A subgroup of patients do need some form of nal instability precludes their use. Currently, disc
treatment, but before talking about that, a review replacement is approved only for the lumbar spine,
of spine anatomy will help to explain the three but cervical spine disc replacement is under clini-
main categories of spine disease: degenerative disc cal trials and will soon be available.
disease (DDD), stenosis, and instability. Since the discs in the spine are in front of the
The spinal column consists of bony vertebrae nerves, disc replacement does not adequately
stacked on top of each other from the neck to the address stenosis or narrowing around the nerves,
tail bone. Between each of these vertebrae there is especially if stenosis is caused by structures in the
a cushion known as the intervertebral “disc.” These back of the spine. Stenosis causes pressure on the
discs have a jelly core, much like a jelly doughnut, nerves and, hence, can result in nerve pain (radic-
and the jelly withstands much of the force that is ulopathy or sciatica.) DDD often causes stenosis
transmitted through the vertebrae. The jelly dries up in its late form. As the discs degenerate, the joints
as we age, and this leads to normal aging or degen- in the back of the spine called the facet joints see
eration in the spine, a process known as DDD. more stress and enlarge or hypertrophy. Nerves
As this cushion dries up and the vertebrae settle exit through holes (foramina) in front of the facet
on top of one another, pain ensues. This is much joints at every level of the spinal column. Enlarged
like the degeneration of the hips and knees that facets can cause stenosis in these holes and, hence,
we have been treating for years with hip and knee cause nerve pain. When facet disease is promi-
replacement. The treatment of the degeneration nent, just addressing the disc in the front with a
in the spine, however, is more complex. First of disc replacement will not treat the symptoms.
all, the spine has many discs that can degenerate Therefore, stenosis is typically addressed from the
together, and the challenge comes in treating the back of the spine to free up nerves in the foramina.
correct level that is the source of the pain. Secondly, The exception to this rule is in the cervical spine
we did not have a good way to replace degenera- (neck) where most of the early stenosis occurs
tive discs safely until recently. Fusion has been the from a disc herniation or bone spurs in front of
mainstay of treatment for degenerative discs. The the spine. If a facet is much enlarged and part of
logic behind this treatment is that, if the degen- it has to be removed to decompress the nerves, the
erated cushion causes pain in adjacent vertebrae, patient’s spine also has to be fused. The two facets
fusing the two vertebrae together should get rid of act as the posterior (back) stabilizers of the spine,
the patient’s pain. The fusion treatment has been while the disc is the anterior (front) stabilizer. This
only partially successful though, because after two configuration is present in most levels of the spinal
vertebrae are fused together, the stresses are trans- column.
ferred to the levels above and below this fused level, Traditionally, stenosis is treated with a lami-
and this may result in more rapid degeneration of nectomy (and partial facet removal). Lamina form
those adjacent levels. In rare cases, the degenera- the posterior arch of the spine, which is removed
tion or other disease processes can cause instabil- in order to decompress the nerves in the center of
ity of the spine. When this occurs, one vertebra the spinal column. Through this posterior opening
slides on top of another, putting the nerves passing the foramina are also accessed and decompressed
through them at risk. In the case of instability, we using special tools. Laminectomy is a safe proce-
have no choice but to fuse the vertebrae. dure and can significantly improve a debilitating
Disc replacement is a new alternative to fusion condition. Laminectomy is not, however, without
for DDD. A disc replacement device is implanted in its potential limitations and complications.
i-xiv_back&spine-fm.indd vi 8/7/07 3:38:58 PM
Foreword vii
A new alternative to a laminectomy is a proce- able to perform surgeries through small skin inci-
dure performed while the patient is awake. This sions. This translates to more accurate surgeries
procedure does not require bone removal but and quicker recovery for patients.
accomplishes decompression indirectly by implan- With the rapid advancement in technology, it is
tation of a device called the X Stop. When the ste- imperative that physicians and patients alike are
notic patient bends forward, the foramina in the educated in the best treatment (not necessarily
back of the spine enlarge and free the nerve from always the newest) modality for their condition. This
pressure. X Stop is implanted in the back of the textbook is an attempt to help readers understand
spine between the spinous processes at the level the often complex spinal conditions. Understanding
where the problem exists, thus functionally open- the nomenclature will possibly aid in understand-
ing the foramina. ing the processes and treatments available for the
The field of spine surgery is evolving rapidly. common condition of spine-related pain.
With the advent of new technology and surgical
techniques, patients are being treated more effec- —Arya Nick Shamie, M.D.
tively and safely. This advancement is possible only Director, UCLA Comprehensive Spine Center
through continued efforts of scientists in various VA Wadsworth Medical Center
disciplines and their interdisciplinary collabora- Assistant Professor of Orthopaedic Surgery
tion. MRI has tremendously advanced the diagno- and Neurosurgery
sis of spinal disease in the last 20 years. With live UCLA School of Medicine
X-ray now available in the operating room, we are www.espinecare.com
i-xiv_back&spine-fm.indd vii 8/7/07 3:38:59 PM
PREFACE
lmost anywhere you go, you will find a Remembering the adage, “You are what you eat,”
Acountry overly populated with aching backs. I like to think there is more to me than mozzarella,
Undoubtedly, this sad fact helped the Bone and but a one-ounce slice of my favorite part-skim
Joint Decade (2000–10) become an international brand gives 20 percent of the daily requirement
event. Yet, despite the global momentum toward of calcium needed by most adults. The question is
universal back pain, books on the subject often whether I need that much or more. Do you, even
focus on such specialized treatments as trigger if the calcium comes with 8 percent fat and 5 per-
point therapy or microsurgery. Or the spine of a cent cholesterol squeezing through the creamery?
book might cover the aging spine. Would 6 percent calcium in two tablespoons of fat-
Although my own back heatedly objects to the free, cholesterol-free sour cream be a better choice
inflammation typically associated with aging, I for you, or would 0 percent fat and 2 percent cho-
wanted a book to consider a wide range of spine- lesterol warrant a cup of fat-free yogurt with 40
related topics, including ample options for treating percent of your daily calcium need?
various levels of pain. I also wanted a broader view Such mathematical questions might be directed
of the back to help me and, I hope, you to avoid pre- to a cardiologist or other specialist who assesses
ventable problems, make informed decisions about your level of cholesterol and its effects on your
our vertebral health, and remain upright inhabit- heart and veins. To evaluate your overall food pat-
ants of our own bodies. terns, however, a nutritionist can address your
What, for example, should be considered before individual tastes, habits, weight, activities, family
you flex muscles that have begun to conform to history, symptoms, and unique nutritional needs
an ergonomic chair? Would certain exercises before planning the best course of meals and snacks
strengthen your spine without weakening a disc? for you. As a registered dietitian, a nutritionist
Could information about the anatomy and func- can also separate the fat everyone needs from the
tion of your neck and back help to show you what amount you personally require to store fat-soluble
has happened and, thereby, clarify what to do? vitamins, lubricate joints, and transport hormones
Do all natural treatments naturally assure throughout your body. Too much fat, of course, is
safe usage? Are herbal remedies strong enough literally overkill, but, in moderation, a fatty layer
to assuage your night-time pain? Will anything of protection can shield and cushion your bones in
restore collagen, rebuild bone, or keep your carti- wintry weather—or in a fall.
lage from wearing out? What medical tests might To help you keep your balance, a healthful diet
provide you with a clearer picture? And how much includes energizing carbohydrates and muscle-
should you heed ongoing word fights over food? building protein. As a general rule, well-balanced
With conflicting advice to confuse this very per- meals tip the scales toward fresh fruit, vegetables,
sonal issue, do you need more calcium or less? and whole grains with dairy and meat products
viii
i-xiv_back&spine-fm.indd viii 8/7/07 3:38:59 PM
Preface ix
dished lightly on the side. Since the optimum of your vertebrae can affect your entire body. This
amounts of proteins, carbohydrates, and fats fluc- viewpoint may lead an osteopath to educate you
tuate from person to person, a nutritionist can about self-care and disease prevention.
determine the percentages appropriate for you. If A D.O. might also choose a medical specialty
any changes occur in your health or habits though, similar to the ones pursued by a medical doctor
your nutritional needs will change too. (M.D.). Although a D.O. and an M.D. both adhere
As yet another variable, the level of stress you to the Hippocratic oath, “First, do no harm,” they
experience today will seldom be the same a week may have slightly different interpretations of what
or a month from now. If tension builds, so will this rule means. For example, a D.O. may see your
muscle tightness, thereby restricting blood flow symptoms as an indication of some disorder in
and causing muscle cramps. Back pain may then your defense system, which, when set right, could
arise with a new slew of questions. For example, evoke a natural response of healing. Despite a
would a good massage help your muscles to relax belief in the healing mechanisms inherent in the
and, if so, what type would be best for you? Do you body, a D.O. can still prescribe medication as, of
need kneading? Or would pressing pressure points course, an M.D. can. Prior to writing prescriptions
release those bundles of nerves? A licensed mas- or practicing medicine though, both types of phy-
sage therapist can explain the styles and purpose sicians must pass their state licensing exams. Both
of each stroke, but if you’re worried about having a can then opt to continue their studies to obtain
stroke, ask your doctor about the elevation in blood certification in such specialized areas as pediatrics,
pressure a massage conceivably could cause. or the spinal care of infants, children, and teens.
Questions about the minimal risks of a stroke As another specialist of the musculoskeletal
might also go to your osteopath or chiropractor, system, a rheumatologist treats autoimmune dis-
especially if your cervical spine needs to be realigned. orders and conditions of the spine, such as juvenile
Both specialists have been trained to manipulate arthritis, ankylosing spondylitis, or rheumatoid
neck and back vertebrae to treat musculoskeletal arthritis. Similarly, an orthopedic specialist treats
complaints. However, differences between these disorders of muscles, bones, joints, and connec-
medical professionals occur not only in their train- tive tissue, such as tendons and ligaments. How-
ing but also in the theory behind each approach to ever, a rheumatologist generally concentrates on
treatment. A chiropractor, for example, may focus soft tissue as an underlying indicator of back pain,
on the nerves involved in adjusting your tendons whereas an orthopedist often focuses on the hard
and joints. After taking your medical history and, matter in matters of bone fracture, injuries, and
possibly, X-rays, a chiropractor might treat your abnormalities in bone growth.
neck or backache with spinal manipulation, mas- To treat spinal cord injuries and spinal nerve
sage, ultrasound, acupressure, trigger point therapy, involvement, a D.O. or M.D. may decide to special-
or a combination of those options. An instrument ize in neurology, or, to repair structural problems,
such as an Activator might also be used, but more a physician may elect surgery. With numerous
likely, you will be given hands-on treatment. If poor procedures available, surgeons usually avoid any
postural habits, stress, or injury have caused your invasive course of action unless an identifiable
spine to lose its natural curves, your vertebrae may condition shows a particular procedure to be the
need a well-planned series of adjustments to get best choice. If so, minimally invasive surgery can
back in shape. often be used to speed recovery, thereby enabling
A doctor of osteopathy (D.O., or osteopath) you to resume your normal activities or begin
performs similar treatments but with the under- therapy more quickly.
standing that proper alignment of the spine allows The type of therapy depends, of course, on what
a body to function better. Because your spinal you need. For instance, physical therapy usu-
column houses the nervous system that controls ally addresses larger groups of muscles to get you
your bodily functions, the condition and position mobile again. Occupational therapy aids smaller
i-xiv_back&spine-fm.indd ix 8/7/07 3:38:59 PM