Spine

If you look at the spine from the side, it has two S-shaped curves. These natural curves are designed to absorb and distribute shocks. The spine gives the body its upright posture. It consists of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, the sacrum and the coccyx (tailbone). The last two elements develop as several vertebrae fuse together during the period of growth between the ages of 18 and 30. There are 23 spinal discs between the vertebrae. They are composed of a ring of connective tissue and a soft, gel-like core that has a cushioning effect. Only the first and second cervical vertebrae in the neck do not have this kind of cushioning – they form a special kind of joint. There are no spinal discs in the fused sacrum and coccyx either.

An extensive network of strong ligaments between the individual vertebrae ensure the stability of the spine. However, the ligaments and muscles also provide maximum flexibility.

Here are some of the common problems and diseases that can affect the spine.

This is not a comprehensive list.

• Slipped disc (herniated disc)
• Curvature of the spine

Slipped disc (herniated disc)

Strain, deterioration or an accident can cause the ring of connective tissue in a spinal disc to tear. If the ring does not tear completely, but is weakened, pressure from the gel-like core can cause the spinal disc to bulge. If the ring of connective tissue is entirely torn, the gel-like core flows into the spinal canal and presses against the spinal cord or the nerve root. This also leads to acute inflammation around the affected nerve, because of the chemical breakdown of the leaked tissue. Typically this causes severe pain in the arms or legs. Sensory disorders such as a tingling sensation, or the weakening or paralysis of individual muscles can also occur – large slipped discs in the lumbar part of the spine can even cause problems with urination and bowel movements.

In most cases, surgery is required if the herniated disc is causing signs of paralysis or problems with excretion/urination. Otherwise slipped discs are usually first treated using pain killers and muscle relaxation, followed by physiotherapy to strengthen the back and stomach muscles.

You can find more information in the clinical picture of herniated disc, disc hernia, discus prolapse.

Curvature of the spine

Curvature of the spine beyond the normal two S-shaped bends leads to incorrect posture. An inward curvature of the spine is called lordosis, while an outward curvature is known as kyphosis. A sideways curvature and twisting along the vertical axis is called scoliosis.

Even though a sideways curvature of the spine is not part of the spine’s natural shape, it does not always require treatment. This condition most commonly affects the thoracic vertebrae. It can be caused by a lopsided posture, legs of different lengths, parts of the spine with either limited movement or hypermobility, the musculature of the back or certain inherited genetic factors. Scoliosis must be treated if it is having a sustained impact on the natural balance of the spine, because that can lead to excessive strain and premature wear and tear. In extreme cases scoliosis can push the spine sideways and cause significant instability. The person may also suffer from recurring instances of blocked vertebrate, persistent muscle tension and nerve irritations.

It is important to retain the elasticity of the spine and strengthen the stabilising muscles in the torso. Braces and operations are only used in severe cases of scoliosis and require an extensive diagnosis and, in the case of surgery, the benefits and risks must be carefully weighed up. 

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Our medical specialists regularly answer readers’ questions in newspapers, magazines and online. We have put together a few of these questions and answers for you here. Please note that the Q&A is purely informative. The advice provided is not comprehensive and does not substitute a consultation with a medical professional.

Feeling of instability in the spine

«For a long while now, I (70, male) have noticed that my back is becoming increasing unstable. It’s worst when I’m standing. I can’t stand for more than five minutes. Or after walking for around 15 minutes I have to sit down or stand still for a moment until the pain goes away. I do physiotherapy exercises every day, but I haven’t noticed any improvement. I’ve also had several epidural infiltrations that didn’t help. What else could I try?»

Based on your brief description, your pain appears to be caused by a major mechanical problem. It’s most likely a worn out spinal disc, a constriction of the spinal canal and possibly also osteoarthritis of the intervertebral joints. Spinal discs and intervertebral joints that have degenerated, i.e. become old/worn out with possible microtrauma (small injuries), can be incredibly painful. A feeling of instability is often caused by worn out spinal discs, firstly through a restriction of the back muscles due to pain, which then no longer work together properly, and secondly through an effective instability (spondylolisthesis) in that part of the spine, if the spinal disc is no longer separating the vertebrae properly and acting as a cushion.

Pain relief should be the first priority before doing any active physiotherapy or exercises at home. Given that you have been suffering from this condition for the last four years, I would recommend getting checked out by a medical specialist, including x-ray and MRI examinations (cross-sectional imaging) of the lumbar vertebrae.
Dr. med. Antoine Dinichert, Back and Neurosurgery Centre, Clinique La Colline