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Spine

Your spine plays an integral role in your health and quality of life. When your spine is compromised, whether by deformity, degeneration or a spinal tumor, the pain and disfigurement can be devastating. The spine is the structure that encloses and protects the spinal cord, which is the bundle of nerves that transmits signals from the brain to the rest of the body. It consists of a stack of bones (vertebrae, the sacrum and the coccyx) and the discs separating the bones.

Common diagnoses for spine problems include spinal tumor, scoliosis or other deformity.

Texas Health Resources has a multidisciplinary team of experts who can quickly and effectively diagnose the source of spine problems and provide you with a range of treatment options. Texas Health has spine specialists on the medical staff who can perform advanced surgeries, as well as make recommendations about other treatments. Many Texas Health hospitals offer rehabilitation services with advanced equipment and experienced therapists.

Keep your spine healthy and pain free

Keeping your spine healthy is one of the best things you can do for your back and for your overall health. Try these tips to align your spine:

    Standing
  • When standing, keep your knees slightly bent and place one foot slightly in front of the other.
  • Do no stand bent forward at the waist for long periods of time.
    Lifting
  • If an object is too heavy or awkward, get help.
  • Spread your feet apart to give you a wide base of support.
  • Stand as close to the object you are lifting as possible.
  • Bend at your knees, not at your waist.
  • Tighten your stomach muscles as you lift the object or lower it down.
  • Hold the object as close to your body as you can.
  • Lift using your leg muscles.
  • As you stand up with the object, DO NOT bend forward.
  • DO NOT twist while you are bending for the object, lifting it up or carrying it.
    Sitting
  • Keep your knees slightly higher than your hips – use good posture with your back straight.
  • Avoid slouching your shoulders forward.
    Sleeping
  • Sleeping on your back puts approximately 50 pounds of pressure on your spine; placing a pillow under your knees cuts the pressure approximately in half.
  • Lying on your side with a pillow between your knees may reduce pressure on your back.
  • Do not sleep in a position that causes your spine to hurt.
  • Your body will usually tell you what position works best for you and your spine.
    Other measures to keep your spine healthy
  • DO NOT wear high heels. Use cushioned soles when walking.
  • Use a stool under your feet while sitting so that your knees are higher than your hips.
  • If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don't lift heavy objects just after a ride.
  • Quit smoking.
  • Lose weight.
  • Do exercises to strengthen your abdominal muscles on a regular basis. This will strengthen your core to decrease the risk of further injuries.

Diagnosing spine problems

Your physician will diagnose your spine problems based on the findings of a medical history, physical exam and diagnostic tests.

    For your medical history, the physician may ask questions such as:
  • Have you had an injury?
  • Where are you feeling pain and how intense is it?
  • Does the pain radiate to other parts of your body?
  • Are you feeling numbness or weakness?
  • What factors make the pain feel better or worse?
  • Have you had any recent weight loss, fever or illness?
  • Have you had any problems with your bladder or bowels?

During the physical exam the physician will examine your range of motion and nerve function and touch your body to locate the area of discomfort. If the physician is concerned about a possible spine tumor or scoliosis, they will conduct a neurological exam to look for any changes in strength, sensation or reflexes. If scoliosis is suspected, the physician will conduct a forward bending test that will help the doctor define the curve.

    Depending on the findings of the medical history and physical exam, your physician may use one or more of the following tests to determine the source of your spine problem:
  • Cerebrospinal fluid (CSF) examination
  • Cytology (cell studies) of CSF
  • Myelogram
  • Spinal computed tomography (CT)
  • Spine magnetic resonance imaging (MRI) or lumbosacral spine MRI
  • Spine X-ray
  • Scoliometer screening (a device measures the curvature of the spine)

Texas Health hospitals have advanced equipment available, such as 64-slice CT scanners, for diagnosing spine problems.

Treatment options - spinal tumor

A spine tumor is a growth of cells (a mass) within the bones of the spine (vertebrae) or around the spinal cord (the column of nerves that control the limbs). Tumors are either benign or malignant. Benign tumors do not spread from their original location but may be "locally aggressive." Malignant tumors are cancers that can spread their cancer cells to other parts of the body. Whether the tumor spreads or not, a spine tumor can threaten life and cause permanent disability.

The goal in treating a spine tumor is complete removal of the tumor when possible, or local control and spine stability when complete removal is not appropriate. Many other factors are always considered in order to prevent permanent damage to the collateral tissue including the muscles ligaments and nerves. Radiation and chemotherapy may be prescribed, as well as surgery. New techniques and instruments allow surgeons on the medical staff of Texas Health hospitals to reach tumors that were once inaccessible.

After spinal tumor surgery treatment

Treatment following surgery may include radiation and/or chemotherapy. The side effects from radiation can be severe including reddened or painful skin at the treatment site, nausea, vomiting, loss of appetite and fatigue. Chemotherapy can cause similar side effects. However, many of these side effects can be treated with drugs.

Depending on the extent of the surgery and the patient's medical status, physical therapy may be prescribed. Many Texas Health hospitals offer rehabilitation services with advanced equipment and experienced therapists. Rehabilitation usually includes training and exercise with a physical therapist.

Spine tumor patients are carefully monitored by their physician to watch for the reoccurrence of tumors.

Treatment options - scoliosis

Scoliosis is the presence of abnormal sideways (lateral) curves and longitudinal rotations of the spine. The condition — not a disease — can be accompanied by back pain, muscle tightness and fatigue, along with restricted lung capacity and possible neurological symptoms such as nerve pain, weakness, numbness and tingling.

    The available options for treating and coping successfully with scoliosis have never been greater. The goal is to provide the most appropriate and least invasive care. Appropriate treatment depends on a number of factors:
  • Severity and rigidity of the curve
  • Cause of the scoliosis
  • The expected course of the condition, and the patient's
    • Age
    • Overall health
    • Medical history
    • Tolerance for specific medications, procedures and therapies
    Treatment options include:
  • Watchful waiting
  • Exercise and physical therapy
  • Bracing
  • Anti-inflammatory medications
  • Surgery

Regular exercise, weight management and smoking cessation are almost always recommended.

Surgical intervention

In cases where the curvature is severe or does not respond to bracing, surgery may be recommended. Experienced surgeons on the medical staff perform surgery using the most appropriate innovative and least invasive spine surgery techniques. Less invasive surgery offers more cosmetically acceptable scars, a shorter hospital stay and a quicker recovery.

Surgery for scoliosis involves correcting and balancing the curve and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bones knit themselves solid.

After scoliosis surgery treatment

Rehabilitation for spine surgery patients is designed to help them get back to their lives as quickly as possible. Patients will receive written instructions concerning rehabilitation when they leave the hospital, and their physician may prescribe specific rehabilitation services.

Rehabilitation usually includes training and exercise with a physical therapist.

Treatment options – other spinal deformities Physicians on the medical staff at Texas Health Resources' hospitals also treat non-scoliosis spinal deformities. These conditions include kyphosis, spondylolisthesis and post-traumatic conditions.

Kyphosis

Kyphosis is a curving of the spine that causes a bowing of the back. The condition is classified as either postural or structural. Postural means the kyphosis is attributed to poor posture, usually presenting a smooth curve, which can be corrected by the patient. Structural kyphosis is caused by an abnormality affecting the bones, intervertebral discs, nerves, ligaments or muscles. Kyphosis due to a structural cause may require medical intervention because the patient alone cannot control curve progression.

    Causes of kyphosis include:
  • Degenerative disease (such as arthritis)
  • The wedging together of several bones of the spine (vertebrae) in a row (in adolescents)
  • Fractures caused by osteoporosis
  • Diseases such as muscular dystrophy, polio and spina bifida
  • Congenital defect

The goal for treating kyphosis is to provide the most appropriate and least invasive treatment to improve the patient's condition and quality of life. Surgery for abnormal kyphosis is usually the last treatment option tried; non-surgical treatments, such as physical therapy, are usually first recommended. If the pain and other symptoms do not lessen after several months of non-surgical treatments, the doctor may suggest surgery.

Spondylolisthesis

Spondylolisthesis is a condition in which a bone (vertebra) in the lower part of the spine slips forward in front of the bone below it. In children, spondylolisthesis is often due to a birth defect in the lower part of the back; in adults, the most common cause of the condition is an age related degenerative process, such as arthritis. Other causes include stress fractures and traumatic fractures, often as the result of very physical sports, such as football, gymnastics or weightlifting.

The goal for treating spondylolisthesis is to provide the most appropriate and least invasive treatment to improve the patient's condition and quality of life. Surgery for abnormal spondylolisthesis is usually the last treatment option tried; non-surgical treatments, such as physical therapy, are usually first recommended. If the pain and other symptoms do not lessen after several months of non-surgical treatments, the doctor may suggest surgery.

Post-traumatic conditions

Trauma to the spinal cord and column can be a devastating injury with multiple complications including post-traumatic deformity. Appropriate imaging is used to diagnose a post-traumatic deformity.The goal for treatment is to provide the most appropriate and least invasive treatment to improve the patient's condition and quality of life. Surgical intervention may be required if the deformity is progressive or if there is a new onset or progression of a neurologic deficit. Less invasive surgery, which offers more cosmetically acceptable scars, a shorter hospital stay and a quicker recovery, may be appropriate for some patients with post-traumatic deformities.

Frequently asked questions

Q: If I am experiencing back pain, what are some signs that would indicate that I should see a physician?

A: Call your health care provider if you have persistent, severe back pain, especially if you have also have numbness, loss of movement, weakness, or bowel or bladder changes.

Q: What are spine tumors?

A: Spine tumors are abnormal growths of tissue found in and around the spine. Tumors in the spine may be primary (begin in the spine) or secondary (metastatic – move to the spine from other locations). The most common cancers that move to the spine are breast, lung, renal and prostate.

Q: What causes scoliosis?

    A: Scoliosis has three general causes:
  • Congenital (present at birth) scoliosis is due to a problem with the formation of the spine bones (vertebrae) or fused ribs during development in the womb.
  • Neuromuscular scoliosis is caused by problems such as poor muscle control or muscle weakness, or paralysis due to diseases such as cerebral palsy, muscular dystrophy, spina bifida and polio.
  • Idiopathic scoliosis is scoliosis of unknown cause. It appears in a previously straight spine.

Idiopathic scoliosis in adolescents is the most common type of scoliosis. Some people may be prone to a curving of the spine, and most cases occur in girls.

Q: What does a back brace do for scoliosis patients?

A: A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis.

Q: If I have scoliosis, will I have to have surgery?

A: In cases where the curvature is severe or does not respond to bracing, surgery may be recommended. In determining whether to recommend surgery, the physician will consider the severity and rigidity of the curve; the patient's age, overall health and medical history; and cause of scoliosis.