SPONDYLOSIS

  • Cervical spondylosis is the most common progressive disease in the ageing cervical spine. Seen in 95% of the people by 65 years. It can present with neck or hand pain, weakness in the hand or fingers. Severe compression on the spinal cord due to a disc prolapse can give rise to myelopathic features which can cause leg weakness and imbalance while walking.
  • Evaluation of a patient involves a thorough clinical examination, MR imaging of the cervical (neck) spine.
  • Management approaches to cervical disc problems involves pain medications, isometric neck exercises, physiotherapy as part of conservative management
  • Surgery is advised in case of progressive symptoms which do not remit with conservative treatment, hand weakness, severe spinal cord compression.
  • The type of surgery is decided based on the clinical findings in the patient which are correlated with MR imaging findings.

Low back-ache

  • symptom of Lumbar disc herniation: acute or gradual
  • after trauma or without an inciting event
  • most common 3rd and 4th decade

Chief Complaints

  • Pain, radiating from the back or buttock into the leg
  • Numbness and weakness
  • Sharp, lancinating, shooting/radiating pain down the leg posteriorly below the knee
  • Coughing - increase intrathecal pressure - increase pain
  • Sitting position, driving - increase intra-discal pressure - increase pain

Evaluation: Involves a thorough clinical evaluation based on patient symptoms, evaluation in the form of MRI of the lower back. Severe symptoms may need further neurological tests.

Management:

  • Reports indicate that 40-50% of patients are symptom-free within 1 week
  • Initial treatment of lumbar disc disease with pain includes bed-rest, pain medications. Physiotherapy is initiated once intensity of pain reduces.
  • Surgery is indicated in patient
  1. With increasing, unremitting pain even after prolonged treatment.
  2. Leg weakness
  3. Symptoms of bladder or bowel involvement