Spinal column wear

Spinal column wear develops over an extended period of time. Often the wear process begins in the area of the intervertebral disc. Extreme strain and advanced age are the main causes of wear on the vertebral segments.


Indication

One speaks of a degenerative spine in case of significant wear and the degradation of the vertebral segment structures as well as their function.

Causes

The causes mainly depend on age and other external factors. For example, years of heavy physical labour can lead to spinal column changes similar to wear. People's individual predisposition, sports and their intensity as well as smoking and excess weight influence wear as well. Complaints can develop gradually over the course of years.

The 24 vertebrae that make up the human spine and the intervertebral discs between them are divided into 3 sections: The cervical spine (7 vertebral bodies), the thoracic spine (12 vertebral bodies) and the lumbar spine (5 vertebral bodies). The vertebral segment forms the smallest functional unit of the spinal column. It consists of the intervertebral discs and the adjacent vertebral bodies, the respective vertebral joints and the corresponding ligament structures. The fourth section, the sacrum, consists of segments that have already turned to bone.

Usually the first signs of wear occur in the area of the intervertebral disc. Since the intervertebral disc is not supplied directly by vessels but indirectly by diffusion, its maintenance depends on genetic and other factors. The ongoing supply of nutrients to the intervertebral disc may not be maintained due to increased strain on the spinal column, for example due to increased physical labour, sitting activities with nothing to balance them, incorrect weight bearing or congenital malpositions. This reduces the ability of the intervertebral disc to retain water. The intervertebral disc becomes flatter.

As the thickness of the intervertebral disc decreases, spinal column instability gradually develops and the function of the nerves may be restricted as well. First the body helps itself by attempting to stabilise the spinal column through the formation of more bone mass in the vertebral bodies. This fails in many cases, resulting in wear of the small vertebral joints. These degenerative changes, individually or in combination, lead to pain and/or the loss of functionality in the affected areas supplied by the segments.

Diagnosis

Degeneration of the spinal column is diagnosed by a doctor following a detailed medical history and examination, often with the help of imaging methods.

Symptoms

The symptoms of a degenerative spinal column often develop over a longer period of time, and result in spreading or acutely occurring pain. Back mobility is restricted and an inflammatory reaction often develops in the vertebral joints. Sensitivity and/or motor function can be disturbed as well, occasionally leading to paraesthesia and signs of paralysis because the outgoing nerve cords are crowded. Limitations of different severity range from the minor impairment of fine motor functions to the complete flaccid paralysis of certain muscle groups. Urinary bladder and rectum control are reduced in rare cases.

With increasing age, the vertebral canal can be constricted due to years of wear and thickening of the joints. What are known as osteophytes and ossifications can develop in the area of the spinal column as a result. This can lead to stiffening of the vertebral joints as bone mass forms on the joint because of wear.

Therapy

Depending on the degree of severity, therapy is initially conservative with physiotherapy and orthoses. Medications are frequently used.

An operation is considered in case of motor and/or sensory failures.

Back orthoses are used both in conservative therapy to provide relief for the affected areas of the back and for postoperative follow-up.


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