PATIENT RESOURCES
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Lumbar Spine Anatomy
The lumbar spine or low back is made up of five vertebral bones including a sixth called the sacrum. The sacrum is the large triangle bone that connects your hips to the spine. The coccyx or tailbone is the most bottom part of the sacrum. The lumbar bones are labeled L to indicate the lumbar spine. The sacrum is labeled S1. It is not uncommon to have six vertebral bones.
When two numbers are written together, i.e. L4-5, this is indicating the disk and nerves that exit between these two bones. This is considered one level. Between the vertebral bones, there are disks to cushion the spine. They are similar to the meniscus in the knees. There are two nerves that can be effected at each level: the exiting and traversing nerve root. The joints that connect each vertebral body to the one above and below are called the facet joints. There are two at each level and help with the mobility of the spine. The central canal refers to the area where the nerve run up and down the spine. The spinal cord ends near L1 and turns into the cauda equina. This is a free floating bundle of nerves in the dural sac. The exiting nerve roots depart the central canal through the foramen.
Sciatica/Radiculopathy
Sciatica is the layman's term for radiculopathy. Sciatica refers to the bundle of nerves that travels from the lumbar spine down into the leg. A patient can experience sciatica from a pinching of nerves in the lumbar spine or less commonly in the buttocks region. Radiculopathy is the compression of nerves in the lumbar spine which can range from numbness, tingling, burning, dull, or sharp pain. There are many reasons why a patient may have radiculopathy.
Spondylolisthesis
Spondylolisthesis is also referred to as a slipped vertebral body. When the spine is bent forward or backward, the vertebral bodies should stay in alignment with each other. A spondylolisthesis may be a degenerative process or something that has occurred during puberty. A degenerative spondylolisthesis is due to the facet joint becoming incompetent due to arthritic changes. An isthmic spondylolisthesis happens when the spine is maturing. A connecting piece of bone does not fully form resulting in a pars defect. Two vertebral bodies have to match up to form the foramen where the nerve exits. If one vertebral body is slid forward or is mobile, this can compress the nerve root.
Herniated Lumbar Disk
The lumbar disc is the cushion between two vertebral bones. It is made of cartilage material similar to the meniscus in the knee. The center of the disc has a jelly like substance called the nucleus pulposus. The outside ring of cartilage material that encircles the nucleus pulposus is called the annulus. A herniated disc can happen for a multitude of reasons; a car accident, work injury, lifting a heavy object, or something as simple as picking up a sock off the floor. The nucleus pulposus extrudes from inside the disk into the central canal or foramen where the nerves are to innervate your legs. This can cause back pain along with a plethora of symptoms into the legs. The symptoms into the legs is called radiculopathy, or sciatica. These symptoms can range from numbness, tingling, burning, dull or sharp pain.
Lumbar Stenosis
This diagnosis refers to the compression of the central canal for a variety of reasons but more often due to age related changes. A patient can experience heaviness or weakness in their legs when walking for any distance. These sensations are relieved with rest. This heaviness or weakness is called neurogenic claudication.
Anatomy of Cervical Spine
The cervical spine or neck is made up of seven vertebral bones. The cervical vertebral bodies are labeled C to indicate the cervical spine. When two numbers are written together, ie: C4-5, this is indicating the disk and nerves that exit between these two bones. This is considered one level. Between the vertebral bones, there are disks to cushion the spine. They are similar to the meniscus in the knees. There is an exiting nerve root that departs from the spinal cord at each level. The joints that connect each vertebral body to the one above and below are called the facet joints. There are two at each level and help with mobility of the spine. The central canal refers to the area where the nerve run up and down the spine. At the cervical level, the spinal cord is solid and occupies the majority of the central canal. The exiting nerve roots depart the spinal cord through the foramen.
Cervical Radiculopathy
A patient can experience radiculopathy from a pinched nerve in the cervical spine. These symptoms can range from numbness, tingling, burning, dull, or sharp pain. A common referral point is the shoulder blade region. There are many reasons why a patient may have radiculopathy.
Herniated Cervical Disk
The cervical disc is the cushion between two vertebral bones. It is made of cartilage material similar to the meniscus in the knee. The center of the disc has a jelly like substance called the nucleus pulposus. The outside ring of cartilage material that encircles the nucleus pulposus is called the annulus. A herniated disc can happen for a multitude of reasons; a car accident, work injury, lifting a heavy object, or something as simple as picking up a sock off the floor. The nucleus pulposus extrudes from inside the disk into the central canal or foramen where the nerves are to innervate your arms. This can cause neck pain along with a plethora of symptoms into the arms and shoulder blade region. The symptoms into the arms is called radiculopathy. These symptoms can range from numbness, tingling, burning, dull or sharp pain.
Cervical Stenosis
When a disk or bone spurs cause compression of the central canal in the cervical spine, this is called cervical stenosis. Cervical stenosis differs from lumbar stenosis due to the spinal cord that fills the majority of the central canal. If the spinal cord is compressed enough, a patient may experience symptoms of myelopathy. A good history and physical exam can determine if a patient is myelopathic. This may include a history of balance issues, falls, changes in handwriting, or decrease ability to perform fine motor tasks like buttoning a shirt.
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