Spinal Osteoarthritis

What is Osteoarthritis of the Spine?

As people age, the cartilage in the spine wears down and deteriorates. Cartilage is the smooth, stretchy tissue that protects and lubricates the joints in the spine for ease in movement. The intervertebral discs in the spine are made mostly of water and can dehydrate with increasing age. Increased pressure is placed on the discs and facet joints of the spine causing the symptoms of osteoarthritis.

Post Laminectomy Syndrome

Symptoms

A classic symptom of spinal osteoarthritis is lower back pain. The pain in this part may be more intense upon awakening and after long periods of sitting in one position. As the disease progresses other discomforts may be noticed such as:

  • Weakness, numbness, or tingling in the legs or arms
  • Range of motion becomes limited
  • Tenderness in the joints
  • Joints become stiff with position changes becoming difficult.

Causes

Several factors may cause OA. Aging is one of the primary reasons for the deterioration of the cartilage, but there are others, such as:

  • Working in a job that place continued stress on the spine
  • Defects of the cartilage in the spinal column at birth
  • Female
  • Excessive body weight

Treatment

Treatment for OA of the spine consists of pain relief and ways to increase mobility. There is no cure for the disease, but OA of the spine can be managed by working with your doctor on the best treatment options. Many cases can be controlled using a combination of different treatments. Over-the-counter medications containing acetaminophen, ibuprofen, or naproxen sodium may be used to alleviate pain. The common side effects of these medications can include stomach upset, bleeding and possible organ damage. Always discuss with a physician on how to safely use these medications. Other treatment options may include:

  • Acupuncture for osteoarthritis of the spine
  • Low impact exercise program
  • Cortisone injections to reduce inflammation
  • Physical or occupational therapy

The progression of OA of the spine is treatable with help from a medical provider. Significant pain reduction and increased mobility are possible when treatment options are combined and monitored for success. Communicating changes and discussing all possible treatment options with a physician is the best way to control OA of the spine successfully.

Causes of Bursitis

Bursitis is a very painful condition that occurs when a bursa is inflamed. Bursae are the small fluid-filled sac-like cavities around joints. Bursa serve as cushions between the joint bones and the muscles and tendons close to the joints. Their purpose is to reduce friction when the joint is moving. Anyone can develop this condition, so understanding its causes is important.

Healthy bursae and bursitis

Which Joints are Most Susceptible to Bursitis?

There are some joints more susceptible to developing bursitis than others. They include:

  • Shoulder
  • Elbow
  • Hip
  • Knee
  • Heel
  • Base of the big toe

Bursitis is temporarily debilitating. For example, bursitis in shoulder is very painful and reduces the range of the shoulder joint’s movement.

Bursitis in hip and elbow joints

Bursitis hip pain is experienced on the outside of the hip joint at the upper thigh. There is a hip bursa between the hip bone and the tendon that passes over the hip’s bony prominence. Since the hip tendon moves with each step a person takes, the pain is usually intense when doing something as normal as walking.

The same kind of pain and limitations of movement are experienced in other joints, like bursitis knee and bursitis foot. No matter where bursitis occurs, the joint is swollen and red, and is painful and warm to the touch.

What Causes Bursitis?

The causes of chronic bursitis are the following:

  • repetitive movements, i.e. lifting items at work, playing sports, leaning on elbows at a desk, etc.
  • joint overuse
  • injury
  • inflammatory disease, like gout or rheumatoid arthritis
  • infection
  • certain behaviors, like not stretching before exercise or the way a person walks
  • joint abnormalities
  • surgery.

Elbow joint pain caused by bursitis

Some people may experience bursitis once and never have it again. Other people have repeated episodes. A lot has to do with the specific bursitis causes. A patient can change behaviors to lessen repetitive movements but cannot eliminate rheumatoid arthritis or an inherited joint abnormality.

Bursitis versus Arthritis

A common question is: Can bursitis cause arthritis? The short answer is, “No.” Arthritis is a joint inflammation with deterioration of the bone and cartilage. Rheumatoid arthritis, in particular, affects the synovial membrane (lining) in the joint. Joint damage from arthritis is one of the bursitis causes.

However, bursitis is an inflammation of the bursa and not of bone, cartilage or other joint tissues. Therefore, bursitis does not cause arthritis.

Treating Bursitis

In many cases, bursitis is easily treated by the patient. They include avoiding the repetitive activity that caused the bursitis until the bursa heals, applying hot and cold compresses and taking anti-inflammatory (NSAIDs) medications. Resting the joint experiencing the pain and using braces or splints to limit movement are also recommended.

Injections into the injured joint

However, in some cases, a physician may need to inject more powerful corticosteroids directly into the joint for maximum pain relief. The physician may also order physical therapy or occupational therapy. If the bursitis is due to infection, antibiotics are prescribed.

In rare cases, a bursectomy is performed. It is a surgical procedure to remove an infected bursa. In most cases, bursitis improves within days or weeks, though it can take longer. The key is to begin treating it as soon as possible.

Discogenic Back Pain

Discogenic Back Pain

Discogenic back pain is a condition in which the discs in the spine deteriorate, producing pain. Pain can occur in any area of the spine. The pain can be persistent or sporadic and is usually experienced in the lower or upper back.

What is Discogenic Back Pain?

The spinal column is made up of a series of bones called vertebra. Between each of the vertebra is a spinal disc that serves as a shock absorber and stops two vertebra from rubbing together. The round disc consists of two parts. The outer portion (annulus) is made of tough collagen fiber and is connected to each vertebra bone. It surrounds a core (nucleus) made up of a network of protein fibers that are suspended in a gel-like material.

The gel-like core does not have nerves. The outer ring-shaped annulus does. When the discs deteriorate or are damaged, inflammation and pain ensues. Most discogenic pain occurs in the lower back (lumbar spine), but it can occur anywhere along the spine. The second common area for this kind of pain is in the neck or upper back. 
One of the puzzling facts about discogenic pain is that, though it is believed to be related to disc degeneration, degeneration does not always cause pain. Medical research is ongoing.

What are the Symptoms?

There is no one set of discogenic back pain symptoms. The symptoms vary from person to person, including pain intensity that ranges from mild to intense.

Discogenic Back Pain

Discogenic low back pain symptoms include:

  • Persistent pain in the back and not in the arm or leg.
  • Pain when the spine is compressed, i.e. bending, sitting, twisting, etc.
  • Pain is fully or partially relieved when lying down.
  • Pain may be felt in the back of the thigh but does not extend into the lower leg.

Discogenic upper back pain symptoms include:

  • Pain in the neck when the head is tilted or turned.
  • Pain in the neck when the head is held in the same position for a period of time.
  • Muscle spasms in the neck.
  • Pain extending down the arm from the neck.

Pain can start suddenly due to something like an injury, or it can start gradually and get progressively worse, usually due to aging.

What are the Causes?

There are several possible causes of disc-related pain. One type of discogenic disorder is called Internal Disc Disruption (IDD). Discogenic back pain internal disc disruption refers to pain caused when a spinal disc tears or cracks, allowing the core tissue to connect with the annulus. A process occurs in which annular nerves are irritated by inflammatory proteins from the nucleus that are released as a result of the tear, leading to an inflammatory response. Not all annular tears or fissures cause pain though.

Other causes of disc issues that lead to pain include:

  • Aging – aging can cause discs to dry out and shrink or get thinner, or to weaken through normal wear and tear; these events place stress on the disc annulus which in turn leads to tears or cracks.
  • Too much pressure is placed on the spine, and the disc’s outer ring, which has nerves, is damaged.
  • Collapsing or misaligned discs place pressure on nerve roots close to the spine.
  • Genetics alters disc composition, making them dry out faster than normal and hurting the ability of the spine to carry an even load; the disc is eventually torn over time.
  • Vertebra edges deteriorate, releasing inflammatory chemicals that increase the speed of disc degeneration.
  • Disease leads to disc deterioration.

How is the Condition Diagnosed?

Clinical diagnosis of discogenic low back pain begins with the physician doing a physical examination and obtaining a medical history. An MRI (magnetic resonance imaging) is ordered first in most cases, or the physician may choose to order a CT (computerized tomography) scan.

The goal is to pinpoint the pain’s source. It may be necessary to order an invasive test like a discogram. A dye is injected into the disc or discs, so they are visible on a fluoroscope monitor and on an x-ray film. However, this method of diagnosis is only used when other methods fail to identify the specific discs causing pain.

What are the Common Treatments?

Discogenic back pain treatment always begins with conservative methods first. The goal is to reduce the amount of inflammation around the nerves to relieve pain. Treatments include:

  • medications, non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, steroids
  • physical therapy, i.e. ultrasound, massage, exercises, etc.
  • applying ice and heat
  • an injection of an anesthetic and corticosteroid medications (epidural nerve block) while using x-ray guidance
  • lifestyle changes, i.e. losing weight, reducing stress, adjusting posture throughout the day, etc.

Surgical treatments are only considered as a last resort for discogenic back pain. They include a spinal fusion and replacement of the deteriorated disc with a moveable implant. However, there are new surgical and non-surgical treatments options being tested all the time.

The good news is that most people can get relief from back pain. Consult with a physician to learn the best customized treatment options for a particular situation.

Osteoporosis

osteoporosis

Anyone can develop the disease called osteoporosis. The National Osteoporosis Foundation statistics indicate it is a common disease that afflicts nearly 10 million people in the United States. Another 44 million have low bone density, a precursor to developing full blown osteoporosis. The following sections give an overview of the “silent disease” that frequently makes its presence known only after someone breaks a bone.

What is Osteoporosis?

Osteoporosis is a disease in which the bones become thin and porous. The low bone mass makes them susceptible to fractures. Bone is living tissue that is mostly soft collagen, a protein, and hard calcium phosphate, a mineral. The soft collagen inside the bone is mesh-like.

Through the young adult years, the bones regenerate, as old bone is removed (resorption) and new bone is added (formation). The mesh structure inside the bone is strong. Until the age of 30, the rate of formation exceeds the rate of resorption, so the bones get larger and denser.

After the age of 30, the process flips, with old bone being removed at a faster rate than new bone is formed. Low bone mass develops, along with structural deterioration of the bone tissue. The mesh structure weakens, and bones get brittle.

Here are a few facts about osteoporosis:

  • Women and men can develop the disease.
  • Osteoporosis can occur in any bone in the body.
  • People with osteoporosis are at high risk of experiencing fractures in the spine, hips, wrists and pelvic area.
  • Women are more susceptible to developing osteoporosis because they have smaller bones and lose bone faster than men do after menopause.
  • The greatest bone density change in the bones of women occurs 5-7 years after menopause.
  • Due to osteoporosis, one out of every two women over 50 years old will break a bone.
  • Due to osteoporosis, one out of every four men over 50 years old will break a bone.

Osteoporosis is called the “silent disease” because people often do not know they have the disease until they break a bone, or there is an obvious change in posture due to weakened vertebrae.

Symptoms

In its early stages, osteoporosis usually does not display any symptoms, or the symptoms are not taken seriously. Osteoporosis symptoms include:

  • Developing a stooped posture in which the shoulders and head are bent forward; severely stooped posture is called kyphosis.
  • Experiencing a spinal deformity of any kind.
  • Losing height due to spinal compression as vertebra develop tiny fractures.
  • Developing back pain due to collapsed or fractured vertebra.
  • Experiencing a bone fracture that happens easily.

Osteoporosis accounts for approximately 1.5 million bone fractures each year. For people with osteoporosis, the fracture can be result of a mild event, like bumping into something or exerting light force. A fall may lead to a broken hip. For people with advanced osteoporosis, simply sneezing or standing up can cause bones to break.

Causes

The slowing and eventual reversal of the bone regeneration process causes osteoporosis. Aging is the number one cause of osteoporosis. However, there are other factors that contribute to the rate of progression and severity of the disease.

Osteoporosis

In addition to the normal aging process, osteoporosis causes include:

  • Diet over a lifetime that is low in vitamin D and calcium.
  • Failure to increase calcium intake as the body becomes less efficient at absorbing calcium during the aging process.
  • Using certain medications, like anticonvulsants and glucocorticoids.
  • Lack of exercise.
  • Anorexia nervosa, an eating disorder that deprives the body of nutrients.
  • Excessive alcohol use.
  • Smoking.
  • Hormonal imbalances, particular low estrogen or testosterone levels, the absence of menstrual periods, thyroid issues, etc.
  • Gastrointestinal surgery in which part of the stomach or intestines were removed, limiting the ability to fully absorb nutrients like calcium.

Besides aging, there are a number of osteoporosis risk factors that a person has no control over. The factors that research shows increases the chances of developing osteoporosis include:

  • Gender – women have a greater risk than men due to smaller bones and hormonal changes after menopause.
  • Ethnicity – Asian and Caucasian women have the highest risk among women, followed by African American and Hispanic women.
  • Body size – Smaller boned people, especially women, are at high risk.
  • Heredity – Research indicates a strong genetic component. increasing the risk of developing osteoporosis, i.e. people with low bone mass, parent or sibling broke a hip, etc.
  • Disease – Certain diseases, like rheumatoid arthritis and Celiac disease, can contribute to osteoporosis.

Understanding the risk factors provides guidance on how to prevent osteoporosis.

  • Get an adequate supply of calcium and vitamin D at each stage of life, recognizing that needs change as a person ages or during events like pregnancy.
  • Get an adequate supply of protein, needed for bone building.
  • Eat a nutrient balanced diet over a lifetime, reducing sodium intake because sodium interferes with calcium absorption.
  • Exercise regularly and include weight-bearing and resistance exercises like walking, jogging, tennis, weight training, swimming, etc.
  • Limit alcohol intake.
  • Quit smoking.
  • Have regular checkups that include assessing bone loss due to medications.
  • Maintain a healthy weight.
  • Take steps to prevent falls that could lead to bone fractures, like getting rid of throw rugs and wearing sturdy shoes.

Diagnosis

There are several tests available today that are used to diagnose osteoporosis. The Bone-density or bone mineral density (BMD) test is the most commonly used diagnostic test for measuring bone health. A central DXA (dual-energy x-ray absorptiometry) machine is used to take pictures of the inside of bones. This machine uses a very low dose of radiation, and the preferred test is to measure bone density of the lower spine and hip.

The results are expressed as a T-score. The lover the T-score, the lower the bone density.

The BND test can detect bone density before a patient experiences a fracture. It can determine whether osteoporosis exists and its severity. Periodic tests can determine the rate of bone loss. They are also used during treatments to assess the impact of treatments.

The bone density test is painless, noninvasive and only takes about 15 minutes.

Treatment

An osteoporosis treatment plan requires a comprehensive program that includes dietary changes, exercises and medications. The dietary changes include increasing calcium and vitamin D intake, and ensuring a balanced diet is consumed on a daily basis. Doing exercises that do not overly strain the bones, but will work to strengthen bones, is important. They include dancing, stair climbing, using light weights or elastic exercise brands, fast walking on a treadmill and using elliptical training equipment. The amount of impact the person can tolerate is determined by the stage of osteoporosis.

Medications are prescribed when the risk of developing osteoporosis is fairly high, or there is a high risk of breaking a bone within the next decade due to weakening bones. There are several medications prescribed to treat osteoporosis. Most of them are bisphosphonates, like Alendronate (Fosomax), Ibandronate (Boniva), Risedronate (Actonel, Atelvia) and Zoledronic acid (Reclast). Sometimes hormone replacement therapies are used – estrogen for women and testosterone for men.

However, if common medications cannot be tolerated well, there are two drugs that are delivered as an injection for osteoporosis. One is Denosumab (Prolia) which is delivered as an injection every six months. The other is Teriparatide (Forteo) which is a daily injection given for two years, followed by another osteoporosis drug to encourage continued bone growth.

Sometimes, people are diagnosed with osteopenia, which is bone loss that has not reach the osteoporosis stage. Changing the diet and exercising can significantly slow the rate of bone loss. Right now there is really no way to reverse bone loss, so it is crucial to take the necessary steps to save as much bone as possible.

Degenerative Disc Disease

Degenerative Spinal Disc Disease Degenerative Disc Disease

Aging can lead to the development of a variety of medical conditions, and degenerative disc disease is one of them. Technically, it is not a disease. It is an age-related condition that develops due to wear and tear on spinal discs over a period of time, and may become painful. Injuries and other factors can influence the rate and severity of the natural degeneration process. The following sections provide an overview of the disease, including symptoms, causes and treatments.

What is Degenerative Disc Disease?

The spinal column has spongey discs between the spinal bones. The discs serve as cushions that absorb the force of movement and pressure placed on the spine. Each disc has two parts. One is the annulus fibrosus, a tough outer layer that contains shallow nerves. The disc interior, called the nucleus pulposus, is best described as a soft, jelly-like substance that is filled with proteins. People experience pain when the outer or inner sections of the disc are damaged or deteriorate, impacting the nerves in and around the spine.

Symptoms

The back is made up of three major sections, called the cervical (neck), thoracic (middle) and lumbar (lower back) areas. When the discs degenerate, the symptoms can vary from person to person. Though any disc can degenerate, most people experience pain or stiffness in the neck or lower back.

Pain, numbness, tingling and weakness are four major symptoms that can occur individually or in some combination when one or more spinal discs deteriorate. Symptoms include the following:

  • Pain in the cervical area – Neck pain remains isolated in the neck.
  • Radiating pain in the neck area – Pain from degenerative disc disease in neck radiates to the hands and arms.
  • Pain in the lower back worsens while sitting – Sitting places significantly more pressure on the lower spine.
  • Radiating pain in the lower back, thighs and buttocks – Pain radiates from the lower back into other areas.
  • Weakness in leg muscles – Muscles weaken due to damaged nerve roots.
  • Pain that varies – Pain can vary in that it may come and go; last a few days or remain unrelenting; worsen during certain movements like twisting and bending; improve during certain movements like walking or changing positions; and range from mild to severe and disabling.

While any spinal disc can deteriorate, lumbar and cervical degenerative disc disease are the most common.

Pain is the most common symptom of disc disease due to degeneration. The causes of pain include:

  • A tear in the annulus fibrosis reaches the nerves on the periphery.
  • A crack in the annulus fibrosis allows the soft core to bulge and affect nearby nerves or cause a disc to slip out of place.
  • The inner section of the disc leaks its inflammatory proteins, and they make contact with a nerve root that becomes inflamed and shoots pain down the leg or armor into the legs.
  • The inner section of the disc leaks its inflammatory proteins, and they make contact with the nerves in the annulus fibrosis.
  • Loss of water in the disc leads to bones in the spine making contact, irritating surrounding tissues.
  • Damaged disc leads to spine instability, which causes painful /muscle spasms as the body attempts to stabilize.

Though most people will develop degenerative disc disease due to again, not everyone experiences pain.

Causes

Though it is called an age-related disease, there are actually several possible factors that determine the rate at which the discs deteriorate and the severity of deterioration.

  • Age – Spinal discs are 80 percent water at birth, but they dry out over the decades, losing their resiliency.
  • Everyday movements – Repetitive movements, like a lot of lifting, can cause wear and tear on the discs.
  • Sports – Intense movements can cause tears in the annulus fibrosus.
  • Injuries – Injuries at work, car accidents, slip and falls at work or home and participating in athletic activities can damage discs.
  • Genetics – There are ongoing studies also exploring whether genetics make some people more likely to developing symptomatic disc disease.
  • Lifestyle – Activities like smoking and factors like obesity can accelerate or intensify the normal degenerative process.

Only the outermost layer of spinal discs have blood vessels, so damaged spinal discs are not able to repair themselves.

Diagnosis

Degenerative disc disease pain lowers the quality of life and drives people to seek medical attention. The physician will:

  • obtain a medical history;
  • document a detailed description of the symptoms experienced;
  • ask patients to perform certain movements, like twisting and sitting, to pinpoint the problem area;
  • check for pain associated with the application of pressure to certain back areas;
  • check for indications of muscle weakness;
  • check for nerve functioning by testing reflexes and response to hot and cold stimuli.

Conventional X-rays can detect damage in the bones of the spine. However, since discs are soft tissue, imaging scans are necessary. They include an MRI (magnetic resonance imaging) or CT scan (computed tomography scan). Since most people experience some level of disc degeneration during their lifetime, the scan alone is not enough to determine the source of pain.

Treatment

Non-Surgical Treatments

Surgical treatments are a last resort treatment when non-surgical treatments do not relieve pain. Non-surgical treatments include:

  • taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS), acetaminophen or muscle relaxants;
  • taking prescription pain relievers to reduce inflammation and/or relieve muscle spasms;
  • getting one or more shots, called facet joint injections, of powerful steroid medication to reduce inflammation and swelling;
  • attending physical therapy sessions designed to strengthen supporting muscles from the neck to the lower back;
  • doing gentle, low impact exercises, including walking and stretching, also designed to strengthen back muscles and decompress the spine;
  • losing weight and/or quitting smoking;
  • getting massages to relieve muscle tension;
  • using heat and cold therapy.

Surgical Treatments

The physician will likely recommend a combination of non-surgical treatments. In some cases, surgery is needed when all other treatments fail to reduce the pain or other symptoms after a few months, or the condition becomes a disability. A lumbar or cervical degenerative disc disease disability makes it difficult to work, perform daily activities and enjoy life. There are two basic types of surgeries.

  1. Minimally invasive surgery

There is a variety of minimally invasive surgical procedures, including spinal stabilization procedures that do not require large incisions. They include procedures like the facet thermal ablation to deaden nerves causing pain and the posterior cervical fusion which requires only a small incision in the back of the neck to fuse adjacent vertebrae for greater stability.

  1. Invasive surgery requiring open spine procedures

Open spine surgery is the most invasive type of surgery and is only used in extreme cases. The most common procedure is the open spine fusion in which two or more vertebrae are permanently fused. A spinal fusion requires large incisions and significant surgical procedures to remove degenerated discs and stabilize the spine with hardware.

Living with chronic pain is debilitating. When back pain interferes with daily activities, it is time to see a spine specialist. There are many options for treatment, so there is no reason to live with pain that has a good chance of responding to treatments.

Pinched Spinal Nerve

Pinched Spinal Nerve (Cervical Radiculopathy)

When there is an occurrence, which causes pain in the neck, shoulders, arm or upper body, in general, the diagnosis could be pinched spinal nerve. The pain experienced is compression in the nerves leading off the neck to the upper body. The reason is, most often, due to the aging process or to a sudden injury.

Symptoms of a Pinched Spinal Cord Nerve

Patients often describe a sharp or burning type of pain coming from the neck when they move their head from side to side. The pain usually decreases when patients place their hands on top of their head. The pain may affect the shoulder and arm affected by the damaged nerve. Those symptoms may include:

  • Loss of control or sensation in the affected arm.
  • A “pins and needles” sensation in the affected area.
  • Weakness to the affected extremity.

Causes of Pinched Nerve

Aging or an injury to the cervical spine is the most frequently seen reasons for pinched nerve pain.

The aging of the spinal cord, or degenerative discs, are discs that have stiffened and have started to bulge. As aging occurs the discs lose water and height and begin to deteriorate. When this process occurs the vertebrae of the spine move closer together, the body responds to this process and forms more bone or “spurs” causing even further damage to the spine.

Patients that do bending and lifting may experience a herniated disc. When the disc becomes worn or injured, the center may press through the disc placing pressure on the nerve root and causing pain.

Doctor’s Examination

The doctor’s examination for spinal stenosis pinched nerve will include a history, physical examination, and tests if needed. After completing a physical history of a patient’s general health and physical activity, the doctor will do a physical exam including the following:

  • Full examination of movement in the neck, shoulders, and arms.
  • Examine for muscle weakness, change in reflexes, or loss of sensation.
  • Check for pain during the examination of the range of motion of the neck or arm.

The doctor may order a cervical radiculopathy test to assist in a diagnosis. Some of the tests ordered may include:

  • Computed Topography Scan or (CT) Scan to check for the possibility of bone spurs in the spinal column.
  • Magnetic Resonance Imaging or (MRI) scan. These scans will confirm damage to the soft tissue areas of the spine.
  • X-Rays to examine the alignment of the spinal cord and any possible damage to the vertebrae or discs.

Treatments

Treatments for cervical neck pain include non-surgical and surgical procedures. Most patients report improvement with non-surgical treatment over time. Some non-surgical treatments include:

  • Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen, and naproxin sodium.
  • Oral steroids to decrease inflammation and pain at the affected nerve.

Physical therapy may help determine the exercises needed to decrease pain and prevent further injury to the cervical spine. Therapy along with a cervical neck collar may be necessary to improve severe symptoms. In some particular cases, steroid injections may be prescribed to decrease the inflammation along the spine to help assist in mobility and improvement in the recovery process.

Surgical treatment may be needed when all areas of non-surgical treatment have been unsuccessful. The surgery required depends on the area affected and the specific location of the affected nerve root.

Migraine Headaches

migraine headache

When asked what is a migraine headache, those who have never experienced one may be tempted to think that it is just a particularly bad headache. However, a migraine can be completely debilitating and last for days. These headaches are unique in their symptoms, triggers and treatments. Thus, understanding whether or not one is dealing with a common tension headache or with a migraine is vital in understanding how to care for the symptoms.

Symptoms

Migraine symptoms are generally described as coming in four stages. For some people, these stages may come so close together that they are impossible to distinguish. Others may completely skip one or two phases.

  1. The first stage is known as the prodrome, and it includes certain symptoms that tell the individual that a migraine is coming soon. For example, the individual may start feeling stiff or may have food cravings. He or she may also experience a mood shift.
  2. The second stage is the aura. Most often, the aura is a visual disturbance, such as halos or flashing lights. It could also include a change in movement or speech.
  3. The main phase is the attack. Severe pain, which may be throbbing, occurs throughout the head. The individual may have worsened symptoms with loud noises or bright lights.
  4. After the attack, the post-drome phase leads to significant sleepiness and could also include weakness and some confusion.

Causes

It is often difficult to say what causes a migraine. However, genetics seem to play a part in many cases. In addition, migraines tend to occur more in teens and young adults rather than in older adults. Women are more apt than men to struggle with them because hormonal changes and hormone replacement therapy can be powerful migraine headache triggers.

Types of Migraine Headaches

As already described, migraines can occur in many ways, and each of these ways constitutes a type of migraine. For example, migraines may be described as being chronic if they occur more than half the days of each month or vestibular if they cause dizziness. However, the two most classic types of migraines are migraines with an aura and migraines without an aura.

Diagnosis

A migraine headache diagnosis often relies greatly on one’s description of symptoms as well as on the past medical record and family history. The doctor will also perform a complete physical and neurological examination. Some other tests that may be necessary before diagnosis is complete include blood tests, an MRI or CT scan and a spinal tap and are often used to rule out other conditions with similar symptoms.

Treatment

The best treatment for an individual will depend on the frequency and severity of the attacks. Many times, over-the-counter or prescription pain relievers, such as ibuprofen or triptans are used. Anti-nausea medications may be important for controlling this unwelcome symptom.

Additionally, all treatments should include preventative techniques for avoiding triggers as well as lifestyle changes, such as increasing gentle exercise and getting enough sleep. Many alternative treatments, including massage and acupuncture, are also gaining in popularity for chronic migraines.

When migraines become debilitating or when they are occurring more frequently than not, they must be treated professionally. A doctor can provide the right combination of prescription medications, lifestyle remedies and possibly even alternative remedies to create a full-bodied treatment plan that offers the best hope for relief. Plus, he or she can also provide ways to prevent migraines, reduce triggers and learn to cope with the symptoms.

Trigeminal Neuralgia

Occipital Neuralgia

Trigeminal neuralgia (TN or TGN), sometimes called Tic Douloureux, is chronic and debilitating facial pain which reduces one’s ability to concentrate, think or act. However, with the help of a health care provider who specializes in neurology, this type of pain can be successfully managed to help individuals cope with this ongoing condition. Although it does not generally go away altogether, the pain can certainly be decreased, allowing individuals to continue to take part fully in their lives.

What Is Trigeminal Neuralgia?

This facial pain affects the fifth cranial nerve, and it can affect any of the three branches of this important nerve. The first branch is the ophthalmic branch, which runs to the eyes and eyelids. The second is the maxillary branch, which runs mainly to the cheeks, nostrils and upper lips. The third branch is the mandibular branch, which controls the lower jaw and lip. Because the facial nerve splits in half to go to each side of the face, most of the painful symptoms are one-sided.

Symptoms of Neuralgia

Early symptoms of trigeminal neuralgia are usually mild and short in duration, but as the attacks progress, they usually become more painful and last far longer than they once did. Usually, pain and other symptoms affect only one side of the face. Depending on the branch of the nerve affected, the individual may struggle to blink, smile, chew or make other facial expressions. The pain may feel like an electric shock or like a muscle spasm. Each attack can last up to several minutes and may be a part of a larger grouping known as an episode, which could last for several weeks.

Causes

Trigeminal neuralgia is most often related to a large blood vessel that is too close to the trigeminal nerve in the face. As blood pushes through the vessel, it can rub the wrong way on the nerve, causing it to become irritated and misfire. This problem may occur as one ages or may be part of a different condition, such as multiple sclerosis.

Once diagnosed, trigeminal neuralgia pain can be set off by multiple triggers. Most triggers involve a sensation on the face. For example, shaving, chewing, putting on makeup or standing in the wind can all become triggers.

Diagnosis

The main way that a doctor will diagnose this condition is through a complete review of the symptoms. The doctor will inquire about the type and location of the pain as well as the triggers that start the pain. He will also do a complete neurological evaluation to gain more understanding and to rule out other conditions. An MRI may give more information about the cause of the pain.

Treatments

Treatment nearly always begins with medications to control the symptoms. Anticonvulsants and muscle relaxers are the most popular choices, and even Botox may be used as a minimally invasive treatment. If medications alone do not control pain, trigeminal neuralgia surgery may be necessary to reduce compression of the affected nerve. Gamma knife surgery or radiofrequency thermal lesioning may be used instead.

Although trigeminal neuralgia is a chronic condition, it does not have to rule one’s life completely. By working with a health care professional, individuals can learn to manage their symptoms, decrease the pain using a combination of medications, lifestyle changes and occasionally surgery and find great quality of life despite the diagnosis. Patients are encouraged to become full participants in their health care to get the best possible relief with targeted treatments.

Hip Joint Arthritis

Hip Joint Arthritis

Arthritis can occur and cause inflammation in the joints of the body. Movement can become painful, and swelling can also occur. Cartilage or the “shock absorber” of the joint can break down causing motion in that joint to become painful. When the hip joint is affected, pain when walking is a noted symptom.

What is Hip Joint Arthritis?

Cartilage tissue in a joint can break down over time. The large joint in the hip supports body weight and assists in motion when walking or running. When the cartilage tissue begins to deteriorate there is a noticeable pain when walking or bearing body weight.

What Causes Hip Joint Arthritis?

There is no specific cause of hip joint arthritis, but there are several factors that may be noted in patients that experience this type of arthritis. Some of the reasons for hip joint arthritis are:

  • Injury to the hip joint.
  • Carrying excessive body weight.
  • Increasing age of a patient.
  • Activities that cause increased weight or movement on the hip joint.

What are the Symptoms of Hip Joint Arthritis?

A discussion with your physician is needed if you have any of the following symptoms:

  • Joint pain or stiffness after sitting for long periods of time.
  • Crunching or grinding feeling or sound in the hip joint.
  • Inability to walk without pain.
  • Activities such as putting on shoes and socks are difficult.

How is Hip Joint Arthritis Treated?

Improving mobility is the primary treatment goal for treating arthritis of the hip joint. The following are used to treat arthritis of the hip joint:

  • Losing weight to take pressure off of the hip joint.
  • Medications for decreasing inflammation and reducing pain.
  • Using a cane as a mobility device to assist with walking and standing.
  • Surgery
  • Cortisone injection hip joint arthritis.

Another cause of hip joint arthritis that may occur is septic arthritis hip joint. Septic arthritis is inflammation of a large joint, such as the hip, caused by bacteria, virus or fungus. Elderly adults and young children are vulnerable to acquiring septic arthritis hip joint. Individuals with preexisting conditions that lower the immune system and those with open wounds are also at higher risk for septic arthritis.

Discussing hip inflammation and joint pain with your physician is very important. Early diagnosis and treatment will always help avoid further complications and severe injury.

Learn more about modern treatments in SPNA Clinic.

Metabolic Bone Conditions (MBD)

Metabolic Bone Conditions

Metabolic Bone Conditions (MBD) is a general term that includes a host of diseases and clinically related disorders in which there is an abnormal bone remodeling process occurring. Bone strength and structures are impacted by abnormalities of mineralization, vitamin D deficiencies, certain drugs like steroids and a variety of diseases like Paget’s disease.

Skeleton bones are constantly breaking down and rebuilding. The two main components of the bone building process are osteoid (collagen) and the mineral complexes calcium and phosphate that are contained in the collagen. When the rebuilding process is abnormal, bone density is reduced. As a result, the bones become brittle or weak, causing a host of physical problems.

What are the Types of Metabolic Bone Diseases?

Metabolic Bone Disorders are referred to as Metabolic Bone Disorders (MBD) and Metabolic Bone Disease (MBD). The terms are often used interchangeability, but they all refer to a spectrum of diseases and disorders involving skeletal bone degeneration. The most common type of MDB is osteoporosis. Approximately 57 million people have osteoporosis or low bone mass. Women over the age of 50 are particularly vulnerable to developing bone diseases like osteoporosis.

MBD can impact the general skeleton or a specific bone or set of bones. Some of the most common types of Metabolic Bone Diseases or disorders are the following:

  • Osteoporosis
  • Osteomalacia (adults)
  • Rickets (children)
  • Paget’s disease
  • Osteogenesis
  • Osteopetrosis
  • Fibrous dysplasia
  • Renal Osteodystrophy

This is certainly not a complete list, but it does give an idea of the wide variety of diseases and disorders that fall under the umbrella term MBD.

What are the Common Metabolic Bone Symptoms?

Bone disorders are often left untreated because the symptoms remain hidden until something serious happens. In fact, osteoporosis is sometimes called the “silent disease.” Technically, the first symptom is an abnormal bone rebuilding process, but it is the external symptoms that often drive people to seek medical attention. For example, someone with osteoporosis experiences a bone fracture due to bone fragility. Sometimes people discover they have MBD after getting x-rays or blood tests for a different medical problem.

Typical metabolic bone symptoms include:

  • Fragility or spontaneous fractures
  • Visible bone deformities
  • Back pain
  • Compression of the spine leading to height loss
  • Kyphosis (curvature of the spine)
  • Bone or joint pain

The most common fragility fractures include the hip, wrist and vertebrae. However, any bone is subject to MBD. Detecting the specific type of MBD typically includes lab investigations, x-rays and bone scans.

What Does the Metabolic Bone Treatment Involve?

There are many ways to manage a Metabolic Bone Disorder. Treatment is a joint effort of the patient and the physician, and the specific type of metabolic bone treatment depends on the bone disorder. For example, osteoporosis is managed with exercise, increasing the Vitamin D and calcium intake, estrogen replacement, taking bisphosphonates and other elements critical to bone building.

When a bone is severely deformed, it may be necessary to undergo an invasive diagnostic test like discography or surgery. The Spine & Pain Clinics of North America (SAPNA) can diagnose and treat Metabolic Bone Conditions to relieve pain and slow the progression of bone weakness and bone deformation.

Learn more about modern treatments in SAPNA Clinic.