Spine

The spine is the axial column consisting of 33-34 vertebrae (7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae, and 4-5 coccygeal vertebrae). The largest vertebrae are the lumbar vertebrae. The sacral and coccygeal vertebrae are fused together, forming the sacrum and coccyx bones respectively. The vertebrae differ in their structure, which is related to the functions they perform. For example, the first cervical vertebra, also known as the atlas, has a completely different structure than the second cervical vertebra, known as the axis, which enables rotational movements in the cervical spine.

Fot.1 Kręgosłup Autor Nieznany licencja CC BY-SA-NC

Between the vertebral bodies, there are intervertebral discs that serve as shock absorbers and enable movement between the vertebrae. The intervertebral disc is composed of a nucleus pulposus and an annulus fibrosus. Additionally, the spine is reinforced by ligaments that run both along the entire spine and between the vertebrae.
Unfortunately, in modern times, we spend too much time in a seated position and neglect ergonomics and work hygiene, which can cause pain and discomfort in the spine and surrounding tissues. At MIRAI, we effectively treat:

Discopathy

Discopathy is a degenerative disease of the intervertebral discs. There are three degrees of disc damage that can be distinguished:

• Protrusion: protrusion of the intervertebral disc towards the spinal canal
• Extrusion: rupture of the annulus fibrosus of the disc
• Sequestration: detachment of a part of the nucleus pulposus and displacement of that part beyond the boundary of the disc

Epidemiology: Discopathy most commonly occurs in the lumbar region. The frequency of discopathy increases with age, although it is increasingly affecting young individuals as well. This is mainly due to a sedentary lifestyle and lack of physical activity. Other risk factors for discopathy include heavy physical work, spinal overload, obesity, smoking, and genetic factors.

Symptoms of discopathy: include pain in the spinal region, which may radiate down the leg. Numbness, tingling, and increased muscle tension in the para-spinal muscles are often observed. The symptoms depend on the extent of intervertebral disc damage.

Diagnostic: In order to diagnose the disease, in addition to a detailed medical history and clinical examination including a neurological examination, the doctor may recommend that the patient undergo a magnetic resonance imaging (MRI) scan, which visualizes structural changes in the intervertebral discs and other components of the spine. Additionally, at MIRAI in Warsaw, Wola, we perform a detailed functional analysis of the spine in motion. Combining the patient’s symptoms, the structure of their spine, and their functional abilities allows us to outline an effective treatment path.

Treatment of discopathy: Treatment usually begins with conservative management, in which physiotherapy plays a crucial role. It is important to select appropriate exercises for the patient, apply manual therapy, and supplement the process with physiotherapy treatments. An essential component of treatment is patient education on how to cope with pain on a daily basis and how to reduce the risk of its recurrence. When conservative treatment does not achieve the desired results or when there are concerning neurological deficits, surgical intervention may be necessary, although this is a very rare occurrence.

Degenerative spine disease (spondylosis, spondyloarthritis)

Degenerative spine disease is a chronic, progressive, and non-inflammatory condition. Changes occur on the edges of the vertebral bodies, intervertebral joints, and intervertebral discs. These changes lead to a gradual narrowing of the spinal canal. It is worth noting that untreated degenerative changes can lead to very serious conditions, including myelopathy, which is compression of the spinal cord.

Epidemiology: The frequency of degenerative spine disease increases with age. It can also occur in younger individuals who may have predisposing factors such as previous spinal injuries, spinal overload (e.g. in professional sports or physical work), obesity, and genetic predisposition.

Symptoms of degenerative spine disease: pain, limited range of motion in the spinal joints. Muscle atrophy around the spine, tenderness on palpation, and structural changes (osteophytes – bony outgrowths located on the anterior and posterior edges of the vertebral bodies) are often observed. In cases of significant degenerative changes compressing neural structures, neurological symptoms may occur (sensory disturbances, muscle weakness, gait disturbances, bowel dysfunction, or bladder/rectal sphincter dysfunction).

Diagnosis: An essential part of the examination is the patient’s medical history and a clinical examination, including a neurological examination. In addition, X-rays are needed to diagnose degenerative changes. Sometimes, the doctor may order an MRI to exclude other conditions or to more accurately assess the structures of the spine.

Treatment of degenerative spine disease: In conservative treatment, physiotherapy plays a key role. Exercises should be tailored individually to the patient, depending on their condition. Manual therapy and physical therapy treatments are also used. In some cases of significant degenerative changes, surgical intervention may be necessary.

Radiculopathy

Radiculopathy is a condition that involves irritation of the spinal nerves, the roots of those nerves, or both. It most commonly occurs as a result of spondylosis or disc pathology.

Epidemiology: The frequency of radiculopathy increases with age, slightly more commonly in men than in women. Cervical radiculopathy is less common than lumbar radiculopathy.

Symptoms: Acute, radiating pain along the course of the nerve to the shoulder, arm, or hand in the case of cervical radiculopathy (brachialgia) or to the buttock, thigh, calf, or foot in the case of lumbar radiculopathy (sciatica), sensory disturbances, and muscle weakness.

Diagnosis: Diagnostic imaging such as MRI or CT scan is used, along with a detailed patient history. A thorough physical examination is also necessary, assessing muscle strength, superficial sensation, and neurological reflexes.

Treatment: The treatment of radiculopathy aims to initially “calm down” the irritated nerve. This can be achieved through properly tailored exercises, manual therapy (mobilizations, tractions, neurodynamics, soft tissue work), physical therapy (electrotherapy, ultrasound, laser therapy), kinesiotaping, and patient education. In the acute phase, the patient is often supported with analgesic and anti-inflammatory medications. Surgical treatment is considered when conservative treatment has been used for a longer period without desired effects or when extremely large impairments occur.

Scheuermann’s Disease (Juvenile Kyphosis)

In Scheuermann’s disease, the vertebrae undergo deformation, taking on a wedge shape. This results in changes in the curvature of the spine. There is an increased kyphosis of the thoracic spine and stiffness in the thoracic region.

Epidemiology: It most commonly affects adolescent boys, but can also occur in young girls aged 11-18 years. The first symptoms can be observed during puberty, although cases have been reported as early as 9 years of age. The literature suggests that this condition affects 0.5-8% of the population. The exact causes are not fully understood, but genetic factors are believed to have the greatest influence.

Symptoms of Scheuermann’s Disease: Back pain, a “slouched” posture with rounded back, forward head and shoulders, tilted shoulder blades, compensatory hyperlordosis in the lumbar and cervical regions, protruding abdomen, anterior pelvic tilt, barrel-shaped/pectus excavatum chest, lateral spinal curvature, stiffness of the spine (especially in the thoracic region), circulatory and respiratory disturbances, and neurological symptoms (weakness in the lower extremities, radicular pain).

Diagnosis: The diagnosis of Scheuermann’s disease involves taking a patient history, conducting a physical examination, and using X-rays to assess the spinal structures in detail. Additionally, the Risser test (which evaluates skeletal maturity), clinical tests, goniometric measurements, and spirometry may be used. Diagnosis can also be complemented with MRI and bone scintigraphy.

Treatment of Scheuermann’s Disease: n the early stages of the disease, conservative treatment is typically employed whenever possible. This includes corrective exercises, bracing (for more severe cases), physiotherapy, and patient education. Surgical treatment is rarely employed and is reserved for cases with significant deformity that causes debilitating and restrictive symptoms.

Untreated or late-diagnosed Scheuermann’s disease can lead to the development of early degenerative changes in the spine and chest.

Stress Fracture of the Vertebra

Unlike normal fractures that occur as a result of trauma, stress fractures occur due to the accumulation of micro-damage in the bone. In such fractures, the bone is subjected to high loads over a long period of time, and the tissue fails to keep up with the rebuilding process.

Epidemiology: Stress fractures most commonly occur in professional athletes and military personnel. Additional risk factors include alignment disorders, metabolic disorders, osteoporosis, osteopenia, poor diet, impaired blood flow, and being female. In terms of sports, athletes in disciplines such as gymnastics, ballet, volleyball, diving, soccer, and cricket are most at risk.

Symptoms of a stress fracture of the vertebra: Pain not caused by any trauma, tenderness, mild warmth, and swelling at the fracture site. The pain often occurs at the end of a training session or after its completion. Because the discomfort is not severe, patients often seek medical attention after several weeks. Over time, the pain gradually increases.

Diagnosis: MRI is the most accurate diagnostic tool for evaluating stress fractures. Changes may not be visible on X-rays for 2-8 weeks after the onset of symptoms. Initially, an ultrasound scan can be performed as it is a cheaper imaging study that can also detect signs of overload in the affected area. Besides imaging studies, an orthopedic specialist conducts a thorough patient history and clinical examination. It is often observed that the patient started more intense training a few weeks prior.
Note: The provided translation is for informational purposes only and should not be relied upon as a substitute for professional medical advice.

Treatment of stress fracture of the vertebra: Patients are typically advised to take a break from physical activity for about 8 weeks, although low-impact exercise that does not overly stress the affected area is allowed. Physical therapy interventions such as magnetic field therapy and cold packs may be recommended. Surgical treatment is performed when there is no bone union or delayed bone union, or when a complete fracture occurs.

You’re welcome!