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X-rays are very good at detecting new fractures, spondylosis, spinal deformities such as scoliosis, kyphosis, spondylolysis and spondylolisthesis ( instability ) .
CT is most useful when bony abnormality is suspected. Common conditions where CT scan is done are spine fractures, facet arthrosis, spondylosis, spondylolisthesis, pars fractures (spondylolysis) and high BMI patients where quality of x-rays are suboptimal.
MRI is the modality of choice for most  spinal conditions. It uses strong magnetic field to create images of the spine. It is very good for looking at the soft tissue structures of the spine such as nerves, spinal cord and intervertebral disc. The best thing about MRI is that it does not involve radiation as its safe for most patients .
MRI is not advised for patients with medical implants such as pacemaker devices, aneurysm clips in the brain, metallic bodies in the eye, Stainless Steel implants.
Yes, Myelogram can be performed on a patient who cannot undergo MRI.
A Myelogram involves the injection of dye into the spinal fluid surrounding the spinal cord and nerves. Erect and dynamic X rays or a CT are then performed. Myelograms detect narrowing around the spinal cord and nerve roots.
Dual energy X-Ray Absorptiometry (DEXA scan) is the test that measures bone density. It measures the bone quality of the patient and compares it to a normal person.
Bone scan can detect the relative biologic activity of a bone lesion. Is advised to screen the skeletal system for metastatic disease, spinal column for metastatic tumour, primary bone tumour, disc  space infection, or vertebral osteomyelitis.
Spine pain can arise from multiple structures like Vertebral body , facet joints , intervertebral discs, muscles ,ligaments, nerves, spinal cord.
Acute back pain (< 6 weeks) occurs in accident injuries, high impact injuries such as sports, heavy weight lifting, violent twisting injury to spine. The vertebra may fracture, joints may be dislodged causing painful stiffness. Herniated discs pinch the nerve roots to cause radiating pain to the leg.
Chronic back pain ( > 6 weeks ) results by overuse injuries, repetitive motions that strain the muscles,  degenerative changes in the discs, vertebral joints, nerve root compression, changes in musculoskeletal alignment.
The commonest cause of low back pain is often referred  to as  simple or mechanical low back pain. This is diagnosed in the absence of any other identifiable cause. It is often of short duration and comes on after certain activities usually in the young adult population. Pain usually lasts for few days and then subsides .
X-ray is the simplest form of investigation. Easy to perform in the out patient clinic. X rays are  usually performed in standing and bending positions.
As  a person gets older the spongy intervertebral discs loses its  water content in it and become stiffer and non-elastic . This can be the source of back pain ( Discogenic low back pain ) .This is usually associated with arthritis of the facet joints as well.
No, not all people with degenerative disc disease get back pain. Recent evidence suggest that the main factor leading to degenerative disc disease is genetic. By the age of 50 years 90% of MRI scans will demonstrate degenerative discs.
Over weight, lack of exercise and muscle conditioning ,smoking, prolonged driving in bad roads are some of the risk factors for degenerative disc disease.
Pain is made worse by sitting, activities involving forward bending, coughing, sneezing, straining. All of these activities increases the pressure in the disc. Pain from the disc may give rise to protective spasm of the lower back muscle, which can worsen the symptoms.
The mainstay of treatment for degenerative disc disease is non-operative. Medications, physiotherapy- core trunk stability exercises, yoga helps to reduce the pain and stiffness.
When non-operative treatment modalities have failed ,surgery can be considered.
Degeneration of facet joints is facet joint arthrosis. The commonest cause is degenerative disc disease.  As the intervertebral disc degenerates it can lose height and more load is transmitted through the facet joints. This results in accelerated wear causing arthritis .
Pain is made worse by activities that stress the joints such as bending backwards, standing, reaching upwards, walking down stairs .
Usually non-operative measures such as medications, physiotherapy programs, core trunk stability exercises, pilates, yoga are the main stay of treatment. Radiologically guided injections of small quantities of local anaesthetic and steroids into the facet can be done in case where other modalities are ineffective to control the pain. It is important to start exercising the spine to strengthen the muscles to help share the load going across the joints and therefore reduce the pain.
It refers to pain caused by degenerative changes in the spine ( usually a combination of both degenerative disc and facet joint disease). It is treated as for degenerative disc disease and facet joint degeneration.
A Spondylolysis is a defect in the pars interarticularis part of the vertebra. It is present in around 5% of the population and is asymptomatic. It can be a development problem during childhood and adolescence, activities that involve hyperextension of the spine  such as high diving, trampolining, gymnastics, cricket fast bowling, wrestling, weight lifting. It can cause low back pain of a similar nature to facet joint pain.
Slipping of one vertebra over the other is called Spondylolisthesis. This causes segmental instability . Causes include degenerative changes, traumatic, spondylolysis. The spinal canal can become markedly narrowed and cause compression of the nerves leading to pain. The treatment depends on the cause and on the patient’s symptoms. Decompression and fusion procedures can improve low back pain in spondylolisthesis.
Spondylitis means inflammation of the spine. Occurs in conditions such as rheumatoid arthritis and ankylosing spondylitis.
The term “Sciatica” refers to the shooting pain that is felt going down from the back to the leg. It is usually caused by acute disc prolapse or due to spinal canal stenosis.
As the intervertebral disc undergoes normal aging process, the stiff outer fibrous layer can crack and a small volume of central jelly like disc material can escape through the defect that cause inflammation and can press on the spinal nerves in the spinal canal. Both the inflammation and the mechanical compression of the nerve root can act to irritate the nerve resulting in leg pain, numbness and weakness.
95% of lumbar disc herniations occur at L4/5 and L5/S1 levels.
Surgery for a disc herniation is indicated in cauda equina syndrome, progressive neurological deterioration,  severe pain , Instability , failure to improve with conservative management.
Cauda equina syndrome is a very rare but serious spine emergency. It consists of a combination of low back pain, pain in one or both legs, numbness and / or weakness in the legs, numbness in the genitals and/ or bottom region and urinary and / or rectal symptoms. ( Inability to pass urine is the most important symptom). Surgery needs to be performed in diagnosed cases within 48 hrs to retain bowel & bladder function.
Spinal stenosis is a condition in which there is narrowing of the spinal canal and therefore a reduction in space for the nerves. It is usually due to degenerative changes in the spine that have occurred over many years. The intervertebral disc can be thought of as a car tyre-over time it deflates and bulges. As a result the height is lost at the front of the spine and the facet joints at the back of the spine start to take more load. Facet joint degeneration then occurs and the joints and ligaments can enlarge. The ligaments at the back of the spine tend to buckle inward as the disc height is reduced and they become lax. Narrowing of the spinal canal and space for the nerves then occurs due to a combination of the disc bulge, facet enlargement and ligament buckling causing leg symptoms.
Dr Kiran Kumar Lingutla is available for consultation at Yashoda Hospital Mon - Sat 9.30 am to 5.30 pm and Tenet Diagnostics HUB Mon - Sat 6.00 pm to 9.00 pm
Cervical spondylosis (arthritis), nerve compression due to disc prolapse, cervical instability, whiplash injury, spinal trauma, infection, tumours, inflammatory conditions like ankylosing spondylitis and rheumatoid arthritis.
Stress, shoulder problems, brachial plexitis, dystonia, thoracic outlet syndrome, cardiac problems, head and neck infections and tumours.
This is the normal ageing process and occurs in exactly the same way as in the lower back. It is often termed Cervical Spondylosis. During the normal ageing process, the intervertebral disc loses water content and becomes stiffer and rigid. The disc over time degenerates and bulges. As this occurs, the height is lost at the front of the spine and the facet joints at the back of the spine start to take more load. Facet joint wear and tear (arthritis) then occurs. Predominantly its genetic in origin. Patients with degenerative disc disease in the low back will often have it in the neck and vice versa.

Treatment usually involves non-operative measures such as medications, physiotherapy programmes, core stability exercises, pilates, yoga. Intermediate options are spine injections like facet joint injections and trigger point injections. In carefully selected patients, Surgery can improve pain and function in up to 70% of patients if a focal cause can be identified accurately preoperatively.
It is radiating pain caused by nerve root compression in the cervical spine due to disc herniation, degenerative cervical spondylosis, nerve root irritation. Usually presents with occipital headache, trapezial or interscapular pain,axial  neck pain, unilateral arm pain, dermatomal numbness and tingling, weakness.There will be a gradual decline in hand function.  Most patients improve with non-operative management with awareness and education of condition, medications, physiotherapy and injections. Surgery is indicated in progressive and significant neurologicaldeficits and in failed non-operative modalities.
Cervical myelopathy is a common degenerative condition caused by prolongedcompression on the cervical spinal cord by conditions like degenerative cervical spondylosis, congenital stenosis, ossified posterior longitudinal ligament, tumour, epidural abscess, trauma.Symptoms are characterised by weakness and clumsiness in hands, gait imbalance,loss of grip function and reduction in fine motor activity like writing and buttoning up shirt/blouse .Bowel/bladder dysfunction can occur in chronic cases . Non- operative treatment modalities are indicated in patients with mild disease with no functional impairment. Surgical decompression and stabilisation is indicated in patients with significant functional impairment. The main objective of surgery is to retain existing function.
Whiplash refers to pain in the neck region caused after the specific mechanism of hyperflexion and hyperextension usually during motor vehicle accidents. Commonly occurs in young adults aged between 20 and 40 years. The symptoms include neck pain and stiffness, headache, pain in the shoulder or between the shoulder blades, pain and numbness in the arm, difficulty in concentrating, irritability, sleep disturbance and fatigue. There is no diagnostic test for whiplash. It is a self-limiting condition with a favourable prognosis for most patients.
The spinal muscles help to support the spine. A strong muscle helps to protect the joints underneath it. Strong and flexible spinal muscles help to reduce the load going through the spine itself. People with weak spinal muscles are more prone to injury. People with back pain have reflex wasting of the spinal muscles and this makes them more prone to injury, setting up a vicious cycle. 

The only way of breaking this cycle is to strengthen the muscles, stabilising the spine. The best way to treat soft tissue injuries is by early rehabilitation. This improves circulation and tissue remodelling, helping tissues to heal faster. The old concept of long periods of bed rest has been shown to actually make people worse.
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