Degenerative Spinal Conditions

This refers to the majority of conditions that patients may see a Neurosurgeon for and generally refer to things that occur as a result of ageing and/or mechanical stress.

Disc Protrusion

May also be referred to as ruptured, bulging, and herniated discs. 

• Cervical- Can cause nerve or spinal cord pinching.  Nerve pinching may cause arm and shoulder pain, numbness and weakness, while spinal cord pinching may cause difficulty walking and clumsy,numb hands.
• Lumbar- Can cause nerve pinching (spinal cord ends at the upper end).  This can result in pain, numbness, and weakness.  If severe can cause bladder and bowel problems.
• Thoracic- Very uncommon to cause problems- if so, will affect spinal cord and therefore difficulty walking.

Instability is uncommon but not rare in relation to degenerative spine problems.  Controversial definitions among doctors:

Lumbar

• Isthmic Spondylolisthesis is the most common stability issue for young adults.  It involves cracks through part of the lowest lumbar vertebrae allowing slipping forward of that vertebra on the sacrum.  Present in about 7% of the population.

• Degenerative spondylolisthesis is where there is development of weakness in the joints at the back of the spine allowing slipping forward of the vertebra

Cervical
The most common cause of instability is degenerative spondylolisthesis, however may also result from old/unrecognised trauma.

Trauma

Fractures may occur at any level of the spine related to injury.  These most commonly present to hospital at the time of injury.  Neck injuries may produce quadriplegia while injuries of the thoracic and low back may cause paraplegia.

• Whiplash
  This is a common condition which generally does not require surgery and is self-limiting.  It can be disabling for a long time and usually scans can’t predict the severity or duration of the pain.  Usually a result of a motor vehicle accident(typically rear end collision to stationary car.

Arthroplasty (artificial Disc)

Emerging technology, where patients who may previously have had spinal fusions, instead, have implants which maintain mobility of the spine to try to prevent long term stress related to fusion.  Is currently available for the lumbar and cervical spine.

Tumour

• Vertebral tumours
  These tumours involve the vertebra itself.  Most commonly these are tumours that have spread from somewhere else (metastasised).  Uncommon primary tumours such as osteoblastomas, sarcomas, chondrosarcomas, and chordomas.
• Intradural Spinal Tumours
  This refers to all tumours occurring within the linig of the spinal cord.  It may include tumours within the substance of the cord itself (intrinsic)or outside pushing on it (extrinsic)
• Intrinsic-
  Astrocytoma, Ependymoma, Cavernous Haemangioma.
• Extrinsic-
  Meningioma, Neurofibroma, Nerve sheath tumour, Neurilemmoma, Paraganglioma

Syringomyelia

Refers to fluid within the spinal cord. May also be called Hydromyelia.  Due to a number of things, including problems at the junction or the head and neck (Arnold-chiari malformation), tumours, and trauma.  Often small syrinxes seen on scans which have no known cause or consequence.