The spinal column is responsible for transmission of body weight from the head to the pelvis and protection of the spinal cord. The spinal column consists of bony vertebral bodies connected together by cartilage-like structures (discs) and ligaments (Figure 1).
The spine is a mobile structure and its mobility depends on integrity of these structures. Variety of diseases can affect the spine and results in functional failure producing variety of symptoms and signs.
Degenerative disease of the spine (spondylosis)
The spine is subjected to wear and tear like all joints in the body, with resultant changes in the structure. Degeneration of the disc may cause it to bulge and compress spinal cord or nerves. This will produce pain in the neck, back, arm or leg, even numbness or weakness. See Figures 2 and 3. These degenerative disorders are diagnosed through physical examination and confirmed by imaging studies. See Figure 4 (MRI).
Tumours of the spine
This may include tumours of the spinal column or the spinal cord. Tumours may be primary (originating from the spine) or more commonly spread from other sites (such as prostate, lung and breast). They produce a variety of symptoms, like back/leg pain, neurological symptoms (weakness, numbness, unsteady gait). Treatment is dependent on the patient’s condition, extent of tumour and severity of symptoms.
Surgical decompression to relieve spinal cord or nerve pressure may be needed to obtain relief from symptoms. Additional procedure may be needed to stabilize the spine. Further treatment with radiotherapy and chemotherapy may be necessary.
Injuries to the spine are common in road traffic accidents, falls from height and diving injuries. Spine fractures (Figure 7) can cause pain or neurological deficits. Surgery is needed in cases where the spine is rendered unstable or when there is a blood clot or prolapsed disc causing acute cord compression. Minimally invasive procedures (vertebroplasty or kyphoplasty) can be performed for pain relief in some fractures of the spine.