The spinal column consists of four regions: the cervical (neck); thoracic (mid back); lumbar (low back); sacrum/coccyx (tail bone). Different categories of disease can affect these regions, ranging from arthritis to cancer, infection and even metabolic. Age, gender, lifestyle, trauma, nutrition and genetics are variables for each disease. Some are progressive and life threatening, while others are degenerative and disabling only after long periods of time.
Osteoarthritis
Osteoarthritis of the spine (the "wear and tear" type) is the most common disease of the entire spinal column. It frequently occurs in the lower cervical and lumbar regions and includes wearing down of the discs and formation of bone spurs. Trauma and poor posture are the most common causes. Stiffness is common initially, but as it progresses over many years, lateral stenosis (compression of nerve roots) or central stenosis (compression of the spinal cord) may result.
Inflammatory Diseases
Rheumatoid arthritis is a painful and inflammatory condition of unknown cause that often begins in the hands, but will eventually affect the lower cervical spine in 80 percent of patients. Predominantly afflicting older females, severe stiffness and reduced range of motion are its hallmarks. Ankylosing spondylitis is another chronic inflammatory disorder of the spine and axial skeleton, but it mainly affects younger adult males. As it progresses, spinal fusion can occur, which is called "bamboo spine."
Cancer
Cancer is the most life-threatening disease of the spine. Primary tumors of the spine from most common to least include: multiple myeloma, chordoma, giant cell tumor and hemangiomas. Advanced cancer can spread to the spine from other sites such as the breast, lung or prostate, which is a process termed "metastasis." Spinal cancer can be lytic (bone eating) or blastic (bone enlarging).
Infection
Infection of the spine (termed "osteomyelitis") is another serious disease that can become life threatening without antibiotics. Staphylococcus is the most common bacteria. Drug addicts and the immuno-suppressed are the most predisposed, although diseases such as tuberculosis, AIDS and syphilis can spread to the spine also.
Osteoporosis, Osteomalacia and Paget's
Osteoporosis is another common spinal disease characterized by decreased bone mass and density, especially in the lumbar and upper thoracic spine of women. General aging, lack of exercise and nutritional deficiencies are the most common causes. With progression, thoracic compression fractures can result in an extreme "dowager's hump." Osteomalacia is a similar disease, but here the quality of bone is affected, not the quantity, which is why it creates "soft bones." Vitamin D deficiency is the most common cause, thus it is often called adult rickets. Paget's disease also results in fragile bones in the elderly and can affect the spine, but its cause is distorted osteoclast (recycling) activity.
Scoliosis
Scoliosis is relatively common, especially among girls aged 10 to 16 years, and infers a lateral curvature of the spine, usually in the thoracic region between the shoulder blades. Scoliosis most commonly appears in adolescence (idiopathic) and can become progressive in 60 percent to 80 percent of cases. Scoliosis can also be congenital, caused by a trauma or infection of the spine, develop from neuromuscular conditions such as cerebral palsy and muscular dystrophy, or occur as a result of poor nutrition and even bad posture. Disfiguration and back pain are the most common concerns.
References
- "Essentials of Skeletal Radiology"; Terry R. Yochum, D.C.; 2004
- The Mayo Clinic: Paget's Disease
- The Merck Manual: Scoliosis
