Tag Archives: bone spurs

Spine-Related Musculoskeletal Conditions – Part 7 – Myelopathy

In this series, we have been reviewing spine-related musculoskeletal conditions that are frequently seen in dentists and surgeons.  In this post, we will be looking at myelopathy.

Myelopathy

Definition: Myelopathy is damage to the spinal cord caused either by a traumatic injury or a chronic musculoskeletal condition. The term myelopathy generally refers to damage to the spinal cord, but may be used in reference to a handful of specific conditions, including:

  • Cervical Spondylotic Myelopathy: This is by far the most common form of myelopathy and involves the compression of the spinal cord in the cervical spine (neck). We will discuss cervical spondylotic myelopathy further below.
  • Thoracic Myelopathy: This occurs in the middle region of the spine. Typically, the spine gets compressed due to bulging or herniated discs, bone spurs, or spinal trauma.
  • Lumbar Myelopathy: This is a rare condition because the spinal cord typically ends in the upper section of the lumbar spine; however, the if the spinal cord is low-lying or tethered, it can be affected by this condition.

Cervical Spondylotic Myelopathy

Overview:  Cervical spondylotic myelopathy is damage to the spinal cord due to spinal degeneration, most commonly in the form of spinal osteoarthritis. As the spinal cord is compressed (spinal stenosis) due to inflammation and osteophytes, it can cause damage to the spinal cord and lead to an array of neurological symptoms.

Causes:  As discussed above, the inflammation and bone spurs (osteophytes) common to spinal osteoarthritis can exert pressure on the spinal cord and cause damage.  Bulging and herniated discs and thickened ligaments can also contribute to myelopathy.  In rarer cases an acute, traumatic injury to the neck can result in myelopathy.

Symptoms:  Numbness, weakness, and/or tingling in the hands or arms, loss of balance, stiffness in the legs, and urinary urgency.

Diagnosis: A CT scan with a Myelogram is used to reveal indentations in the spinal fluid sac.  In this procedure an opaque dye is injected into the spinal canal prior to the CT scan to create contrast and provide images of the spinal canal.  This is done in conjunction with an MRI, which provides imaging of the spinal cord and nerve roots, as well as the intervertebral discs and spinal ligaments.

Treatment: Surgery to decompress the spinal cord and prevent further damage is the most common treatment for cervical spondylotic myelopathy.  The precise nature of the surgery varies and depends on the severity of the condition and its location.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

1. Spine-health, https://www.spine-health.com/.
2. Mayo Clinic, http://www.mayoclinic.org/.
3. The Neurological Institute of New York,
http://columbianeurology.org/about-us/neurological-institute-new-york.
4. John Hopkins Medicine, http://www.hopkinsmedicine.org/.
5. WebMD, http://www.webmd.com/.

Spine-Related Musculoskeletal Conditions – Part 2 – Spinal Osteoarthritis

In the first part of this series, we discussed the fact that dentists and surgeons often suffer from musculoskeletal conditions.  In the remaining posts in this series, we will be looking at particular musculoskeletal conditions, starting with spinal osteoarthritis.

Spinal Osteoarthritis

Definition: Spinal osteoarthritis is also known as degenerative joint disease. It is a breakdown of the cartilage in the facet joints, which link together the spine’s vertebrae.

Overview: At the top and bottom of each vertebra is a small pair of joints called facets. Facets connect the vertebrae in order to restrict movement in certain directions and to allow the spine to move as one fluid unit.  The surfaces of the facets, like any other joint in the human body, are covered by a lubricating cartilage which allows them to operate smoothly and with little friction.

When the cartilage protecting the facets degrades or wears down, the bony surfaces of the facets rub against each other.  This can cause inflammation, severe pain, and the formation of osteophytes (bone spurs) on or around the joint surfaces.  It may also cause numbness and/or weakness in the legs and arms as a result of contact between the vertebrae and the nerves leaving the spinal cord.

Symptoms: Neck pain and stiffness. Severe pain may radiate down into shoulders and up the neck.  Weakness, numbness, or tingling in the fingers, hands, and/or arms are also often present.  Usually back discomfort is relieved when a person is lying down.  Studies have also linked anxiety and depression to osteoarthritis.[1]

Causes: Spinal osteoarthritis frequently occurs in conjunction with degenerative disc disease.  As the discs between the vertebrae in the spinal column degrade and decrease in volume, the increased pressure and contact between the facet joints can cause an accelerated degradation of the joint cartilage.

Repetitive strain or stress on the spine, often due to poor posture, to is a common cause of spinal osteoarthritis.  People with jobs requiring repetitive movements and strained positions are considered to be at greater risk for conditions like spinal osteoarthritis; however, injury or trauma to a joint or a genetic defect involving cartilage are also causes.  Dentists are at a higher risk than many other professions to develop this condition due to the awkward, static postures they must maintain.

Diagnosis: X-rays may be used to identify loss of cartilage, bone spurs, and bone damage. Magnetic resonance imaging (MRI) may be used to analyze the intervertebral discs and the nerves exiting the spinal column.

Treatment: Conservative, non-invasive treatment plans may include some combination of heat/cold therapy, medication, physical therapy, strength training, and stretching. In more severe cases, a surgical treatment such as spinal fusion is utilized.

Our next post in this series will examine spinal stenosis, another common cause of neck and back pain.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

[1] Sharma, A., et. al, Anxiety and depression in patients with osteoarthritis: impact and management challenges, Open Access Rheumatology: Research and Reviews 2016:8 (2016).

References:

1. Spine-health, https://www.spine-health.com/.
2. Mayo Clinic, http://www.mayoclinic.org/.
3. The Neurological Institute of New York,
http://columbianeurology.org/about-us/neurological-institute-new-york.
4. John Hopkins Medicine, http://www.hopkinsmedicine.org/.
5. WebMD, http://www.webmd.com/.