1 Describe the prevalence and natural history of lumbar disc herniation. contrast the prevalence and natural history of lumbar disc herniation and low back pain. The lifetime prevalence of a symptomatic lumbar disc herniation in the adult population is approximately 2%. The natural history of sciatica secondary to lumbar disc herniation is spontaneous improvement in the majority of cases. Among patients with radiculopathy secondary to lumbar…

1 Is thoracic disc herniation a common clinical problem? No. The incidence of symptomatic thoracic disc herniation has been reported as 1 per million patients. It is estimated that 0.15%–4% of all symptomatic disc protrusions occur in the thoracic spine. The lower rate of symptomatic disc herniation in the thoracic region compared with the cervical and lumbar regions is attributed to the stability provided by the…

1 Define cervical spondylosis. how does this condition present in clinical practice? Cervical spondylosis is a nonspecific term that refers to age-related degenerative changes within the cervical spinal column. The degenerative process can affect the intervertebral discs, facet joints, uncovertebral joints, and associated soft tissue supporting structures. Often patients with cervical spondylosis have little or no pain. Positive radiographic findings in asymptomatic patients have been reported…

1 What factors play a role in the development of degenerative disorders of the spine? The prevalence and progression of spinal column degenerative changes are associated with increasing age, but remain asymptomatic in many individuals. Mechanical, traumatic, nutritional, biochemical, and genetic factors interact and contribute to the development of spinal degeneration. The relative importance of these factors varies among individuals and remains incompletely understood. Evidence suggests…

Definitions 1 Define spondylolysis. Spondylolysis is a unilateral or bilateral defect in the region of the pars interarticularis that may or may not be accompanied by vertebral displacement. The origin of the term spondylolysis is from the Greek words spondylo (vertebra) and lysis (break or defect). 2 Define spondylolisthesis. Spondylolisthesis refers to anterior displacement of the cranial vertebral body in relation to the subjacent vertebral body.…

General concepts 1 Why do patients with neuromuscular disorders develop spinal deformities? Neuromuscular spinal deformities develop in patients with underlying neuropathic or myopathic disorders due to trunk muscle weakness, spasticity, or spinal imbalance, which compromise the ability to maintain normal alignment of the spine and pelvis. Asymmetric spinal column loading of the immature spine leads to asymmetric vertebral body growth due to the Hueter-Volkmann principle, which…

1 What is idiopathic scoliosis? Idiopathic scoliosis is the most common type of scoliosis. At present it is uncertain whether this deformity represents a single disease entity or reflects a similar clinical expression of several different disease states. Idiopathic scoliosis is defined as a spinal deformity characterized by lateral bending and fixed rotation of the spine in the absence of a known cause. The criterion for…

Background 1 Why is the age of onset of scoliosis important? Growth and development of the spinal column, thorax, and lungs are interdependent. Deformities affecting the spine and thorax in the first decade of life adversely impact lung development and function. Long-term follow-up of patients with untreated scoliosis ( ) has shown increased mortality secondary to respiratory failure and cardiovascular disease in those with infantile scoliosis…

Evaluation 1 Discuss the epidemiology of back pain in children compared with adults. Traditionally, back pain in children was considered uncommon, and thought to be associated with a definable cause. Current data show that back pain is a frequent complaint in the pediatric population and that the probability of identifying a specific cause is low. Back pain is much less common before age 10, increases during…

General considerations 1 Why is the term failed back surgery syndrome considered controversial? Failed back surgery syndrome is an imprecise term used to refer to patients with unsatisfactory outcomes after spine surgery due to persistent or recurrent pain in the spine and/or extremities. This term does not identify a specific diagnosis responsible for persistent symptoms and implies that additional treatment will not provide benefit. Patients with…