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october 2012

Know It When Your Back Creaks With Age

Dr Tejas Thakker
Curves are a normal part of the spine’s structure. A side view of the spine resembles a soft ‘S’ shape. The normal curves are termed lordosis and kyphosis. However, the natural curves should not be mistaken for spinal disorders also called Lordosis and Kyphosis.

Good posture is about all parts of the spine being in correct alignment so that the body weight is evenly distributed. This means that if someone is not in correct posture it can put strain on certain parts of the spine (usually the lumbar or lower back).

The spine is not straight and it was never meant to be straight. Each part of the spine has a soft curve to it. The curve directions alternate down the spine. These form a kind of spring that enables shock absorption by the spine. It would actually be very bad if the spine were to be straight!

During our lifetime, our spines are required to withstand considerable physical weight bearing stresses resulting from activities of daily living. As a result of these stresses, ‘wear and tear’ or degeneration occurs in all parts of the vertebral column. Degeneration which occurs in the spine as a consequence of daily living is considered part of the normal ageing process.

Signs Of An Ageing Spine
Most people are concerned with changes in their body shape as they age. Although some changes inevitably occur with ageing, your lifestyle choices can slow down or speed up these changes. With age a person may become shorter. After the age of 40, people typically lose 1cm every 10 years and the height loss increases after the age of 70.

Some people live to old age without experiencing any of the symptoms typically associated with an ageing spine. Others may experience the following:
  • Loss of bone density
  • Spinal fracture, even from minor trauma
  • Stiffness
  • Decreased range of motion in the joints: difficulty in bending, twisting, or walking
  • Discomfort or pain after long periods of sitting or standing
  • Difficulty in getting up from a sitting position
  • Difficulty in lifting heavy objects
  • Loss of flexibility
  • Increased susceptibility to back problems in colder weather
Conditions Associated With An Ageing Spine

Osteoporosis: It is a common bone condition characterised by decreased bone mass and the deterioration of bone tissue. Often called “the silent thief”, it progresses without symptoms until a fracture occurs. The weightbearing bones such as the hip and spine are the most susceptible. The spine is particularly vulnerable—in fact, vertebral compression fractures (also referred to as spinal fractures) are common in patients with severe osteoporosis. A humped back—or Dowager’s hump—is an obvious sign of severe osteoporosis.

Disc degeneration: The spine consists of bones (vertebrae) and discs (spongy, cartilaginous pads located between each vertebra) that serve as cushions for the vertebrae. At birth, the discs are comprised primarily of water. Throughout youth and early to midadulthood, flexion of the torso and spine keeps water moving through the discs, drawing nutrients in and flushing waste products out. This keeps the discs strong, flexible and healthy. As the spine ages, the intervertebral discs gradually become more fibrous and inflexible. This fibrosis and stiffening affect the discs’ ability to process water. They become progressively more dry and brittle, due to dehydration, and lose their shock absorbing qualities. Some degree of disc degeneration is normal; however, problems can occur when discs pinch or place pressure on adjacent nerve roots and/or the spinal cord. The most common early symptom of a problem related to disc degeneration is usually pain in the back that radiates to the buttocks and upper thighs.

Spinal osteoarthritis: Osteoarthritis is the most common form of arthritis, and most frequently occurs in weight bearing joints. Spinal osteoarthritis affects the vertebral facet joints that enable the spine to bend and twist. As the facet joints deteriorate, cartilage may become inflamed and eventually start to break away from the joint surfaces. Vertebrae begin to rub together, and the surrounding nerves and tissues can become inflamed, making movement painful. Osteoarthritis also may trigger the formation of osteophytes (bony spurs), which can cause the spinal disc space to narrow, and the affected disc to collapse.

Spinal stenosis: Spinal stenosis is a narrowing of one or more areas in the spine—most often the lower back. This narrowing can put pressure on the spinal cord or on the nerves that branch out from the compressed areas. This can lead to a number of problems, depending on which nerves are affected. In general, spinal stenosis causes cramping, pain or numbness in the legs, back, neck, shoulders or arms; loss of sensation in the extremities; and sometimes problems with bladder or bowel function.

Your spine is not straight and it was never meant to be straight. Each part of the spine has a soft curve to it. It would actually be very bad for you if the spine were to be straight! With that knowledge in hand, keep your back strong enough to weather age.
Treating The Ageing Spine

A variety of treatments are available for the clinical syndromes related to spinal degeneration. Medical treatment must be customised for each patient and focused on the predominant degenerative problem causing symptoms in that individual.

Treatments range from pain medications to manipulations, injection therapies, physical therapy and finally surgery. The effectiveness of nonoperative treatments has come under question in several studies.

  • Benefits have been noted with “physical therapy” in many degenerative syndromes although standardisation of treatment and high quality investigation into optimal effectiveness of exercise, and strengthening programs has been limited.
  • The effectiveness of manipulation has only been clearly demonstrated in low back pain of short duration but not in chronic low back pain.
  • Injection therapies appear to offer no therapeutic benefit with trigger point injections yet have been shown to give some temporary relief with epidural steroid injections. Again the effectiveness of the therapy appears to be very dependent upon the technique employed and the primary degenerative problem in the patient.
  • Surgery in those patients with severe symptoms and a clear focal problem can be very effective in the setting of degenerative problems. When nonoperative treatment fails, even in the elderly, safe operative intervention is possible.
Dr Tejas Thakker is Consultant Orthopaedic Surgeon, Apollo Hospitals International Ltd, Ahmedabad.