Degenerative and Rheumatologic Spinal Disorders
Most Americans will experience back pain at some point in their lives. While this type of pain can sometimes be temporary, it can also be caused by chronic spinal problems that can lead to disability and reduced quality of life.
These problems can be caused by wear and tear on the joints (degenerative disorders) or inflammation from an autoimmune response in the body (rheumatologic disorders).
At Yale Medicine, experts from the fields of neurosurgery, neurology, orthopaedics, physical medicine and rehabilitation (also called physiatry), and physical therapy work together to diagnose these conditions and identify the most effective—and least invasive—treatment options for every patient.
What are the types of spinal disorders?
There are two major types of spinal disorders: degenerative and rheumatologic.
Degenerative disorders result in loss of bone or soft tissues, usually because of age-related wear and tear. The spine is made up of joints that allow movement and disks that provide cushioning.
”The disks of the spine are like shock absorbers in a car," says Patrick Tomak, MD. "When the shocks go, the springs bear the load, and the frame sees excessive wear and tear."
Less often, these disorders are caused by injury, infection or a tumor growing on or around the spine. Some common degenerative spinal disorders include:
- Herniated disk. Also called a slipped or ruptured disk, this condition occurs when the soft interior of a spinal disk pushes out through its hard exterior. The injury can be caused by a sudden movement or excessive strain, but usually happens over time. The protruding disk can irritate nearby nerves and cause pain or numbness in the back or down the arms, or legs.
- Osteoarthritis. An estimated 27 million Americans have this most common type of arthritis. When the protective cartilage surrounding bones wears down over time, it causes pain, stiffness and tenderness in surrounding joints. Osteoarthritis often affects the spine and tends to get worse over time.
- Rheumatologic disorders. These occur when the body's immune system attacks its own joints, triggering painful and damaging inflammation, which can lead to the breakdown of bones and soft tissue. These types of spinal disorders are much less common. Rheumatoid arthritis, for example, only affects about 1.5 million adults.
- Spinal stenosis. This occurs when overgrown tissue or bone spurs build up around the spinal nerves and narrows the space around them. In severe cases, this can compress nerves and cause back pain and difficulty walking.
What are the symptoms of spinal disorders?
For both degenerative and rheumatologic spinal disorders, pain or discomfort are usually the worst symptoms. This can include back or neck pain, as well as cramping, numbness or tingling in the arms and legs. Sometimes, a pinched or compressed nerve can affect mobility or sexual functioning, as well.
In severe cases, the pain can feel as bad as a broken bone. "[Patients will say] I feel like my head is falling off and I can't feel my hands," says Dr. Tomak. "The neck becomes so unstable that it hurts all the time."
With compression of the spinal cord in the neck, patients can also have trouble using their hands to fasten buttons and jewelry clasps. Some have difficulty walking and/or begin to struggle with balance issues.
How are spinal disorders diagnosed?
Doctors begin by looking at a patient's symptoms and taking a medical history. Next they will perform a computerized tomography (CT) or magnetic resonance imaging (MRI) scan to check for damage to the spinal cord, nerve roots and joints.
For rheumatologic disorders, blood tests can reveal that a patient has elevated levels of certain antibodies, which indicate inflammation in the body.
X-rays can also show how much damage has been done from rheumatoid arthritis: "The spine is a series of blocks," explains Dr. Tomak. "In this case, the blocks shift. What should look like a straight pillar looks like a staircase. This shifting causes instability, pain and compression of the nerves and spinal cord."
What are the risks for spinal disorders?
Age. Age is the number one risk factor for degenerative spinal disorders.
Genetics. Family history can also play a role in how quickly your joints wear down.
Lifestyle. Lifestyle factors, including obesity (which puts extra stress on the joints) and smoking (which damages cartilage) can raise risk for degenerative spine disorders.
Physical stress. People who have put a lot of stress or strain on their back or neck—by playing sports, doing manual labor, or frequently carrying heavy things, for example—are at higher risk.
The risk factors for rheumatologic disorders are less clear. Certain genes may increase susceptibility to viruses or bacteria that can trigger the disease, and family history appears to play a role. More women develop rheumatologic disorders than men, and symptoms tend to start between age 40 and 60.
How are spinal disorders treated?
Pain related to degenerative spinal conditions can be treated with medications, such as nonsteroidal anti-inflammatories (NSAIDS)—either over-the-counter versions, like aspirin or acetaminophen, or prescription-strength drugs. Steroid injections may also be given to reduce inflammation and relieve pain.
Sometimes, physical therapy is prescribed to help patients exercise safely and stay flexible and mobile.
For some disorders, surgery may be required. Yale Medicine specializes in both minimally invasive procedures and complex reconstructions. These may include:
- Extensive reconstructions. Spines that are severely deteriorated or that have been damaged by an accident or prior surgeries may require complex repairs. The spine may be stabilized with rods and screws, or vertebrae may be replaced by artificial materials.
- Laminectomy. Also known as decompression surgery, this procedure relieves pressure on the spinal cord and nerves by removing the lamina—the "roof" of the spinal canal.
- Minimally invasive disk surgery. Herniated disks can be repaired or removed with a tiny incision and through a small tube inserted into the back. Disks can also be shrunk using a needle, through a process called electrocauterization.
- Spinal fusion. Some conditions that involve tumors, slippages, or curvatures of the spine may require fusion—a “welding” together of several vertebrae so they heal together as a single bone. This is typically an invasive operation, done through an incision in the back, the side or the lower abdomen.
- Vertebroplasty. This minimally invasive procedure can relieve pain and improve support for people with broken or cracked vertebrae. Surgical cement is injected into the affected bones, bolstering growth and stabilizing weak areas.
Treatment for rheumatology disorders can involve physical therapy or surgery to repair damaged joints; also helpful may be medications to reduce inflammation (like NSAIDS or steroids) or to suppress the immune system (like biologics).
What is recovery from spinal surgery like?
Recovery from spinal surgery can take anywhere from hours to months. For some minimally invasive procedures, patients can leave the hospital the same day and return to work the same week. Other operations require more recovery.
For procedures like spinal fusion, patients may never regain full range of motion. Physical therapy is common after spinal surgery and can help patients build back the strength and flexibility they've lost.
There is no cure for some spinal disorders, like rheumatoid and osteoarthritis. But many patients can learn to manage their symptoms and live normally in spite of their disease.
What makes Yale Medicine's approach to treating spinal disorders unique?
Yale Medicine is home to the most cutting-edge diagnostic and surgical technology, including intra-operative MRI and angiogram capabilities. Patients are often referred to us when their spinal problems are unusually complicated.
We take a multidisciplinary approach to spinal disorders. Patients are diagnosed and treated by a team of neurologists, orthopedists, physical therapists and pain management specialists.
Our specialists have the ability to do more minimally invasive procedures than other area hospitals. We also specialize in complex surgeries. Spinal surgeons consult regularly with other specialists; oncologists are involved in treating spinal tumors, for example, and vascular surgeons are often present to minimize bleeding.