Sciatica - The sciatic nerve exits the spinal column between the lowest lumbar vertebral body (L5) and first level of the sacrum (S1). It supplies sensation to the posterior thigh and buttock, knee flexors, and foot muscles. When this nerve is compressed, inflamed, or irritated anywhere along its length, pain may result. The term sciatica refers to pain radiating down the sciatic nerve into the posterior thigh, leg, and little toe, mostly due to nerve root irritation in the spinal column.

Low back pain - Low back pain can come in a variety of forms. Pain in the lumbar (waist) area of the back can be described as sharp, sudden, dull, or constant. The spine is made up of vertebrae (bones), cartilaginous cushions known as discs, and nerve roots; any of these components can be the source of pain. The pain can result from a sudden injury or from gradual wear with age and repetitive strain.

Osteoporosis - Osteoporosis is defined and diagnosed by a decrease in bone mineral density. Osteoporosis results in decreased mechanical strength and increased likelihood of structural failure. Osteoporosis is the most common skeletal disease associated with aging.

Disc Herniation - Disc herniation is a common cause of leg and back pain. A disc is composed of two parts: an outer rim of fibrous (tough) tissue surrounding an inner loose material. When there is a break in the outer rim, the inner material can leak out of the disc space and enter the spinal canal where the disc material can compress nerve roots or the spinal cord.

Compression on the nerves can cause sciatica or shooting pain down one or both legs. Back pain can accompany the leg symptoms as well. Furthermore, neurological symptoms such as weakness or numbness in the involved legs may occur.

The pain associated with disc herniation usually improves with lying down and worsens with prolonged sitting/standing or walking. Rarely, bowel or bladder problems and progressive neurological deficits (such as weakness) may develop; this type of situation requires urgent surgical decompression of the nerves under pressure.

Degenerative Disc Disease - The vertebrae (bones) of the spinal column are separated from each other by cartilaginous cushions known as intervertebral discs. The discs provide structural support to the spine and act as shock absorbers, taking in the stress created by movement. The discs are mostly water, allowing them to be very elastic and absorb stress. However, age, repetitive strain, and (possibly) genetics cause disc wear and tear. Because there is little blood supply to the disc, it cannot repair itself if injured.

DDD can produce pain as a worn disc becomes thin, narrowing the space between the vertebrae. With less space available, nerves may become compressed, causing them to swell and signal pain. Pieces of the damaged disc may also break off and cause irritation of the nerves. As the disc loses its ability to absorb stress and provide support, other parts of the spine become overloaded, thus leading to irritation, inflammation, fatigue, muscle spasms, and back pain.

The amount of pain from degenerative disc disease can vary from naggingly irritating to severely debilitating. Most patients have some underlying chronic low back pain with intermittent episodes of severe pain. Usually, sitting worsens the pain more than standing. Bending, twisting, and lifting generally worsen the pain and lying down reduces it by relieving the strain on the disc space. In addition to back pain, there may also be pain, numbness, and tingling in the legs if the disc degeneration is located in the lower spine. Pain in the neck, shoulder blades, arms, and hands as well as numbness and tingling in the shoulder and arms may be present for disc degeneration in the upper spine.

Spondylolisthesis - Spondylolisthesis is a condition in which a vertebra is displaced forward of the one below it in the spine. This problem can cause both back pain and leg symptoms.

There are different causes of spondylolisthesis. The congenital form (being born with abnormalities which contribute to the displacement) is a rare cause. Other causes include trauma (sudden falls, accidents, etc.), degenerative changes in the spine (like arthritis), or destruction by tumors.

Spondylolisthesis is characterized by the percentage of displacement of one vertebra over another. Displacement of over 50% is considered high grade.

The treatment of spondylolisthesis is usually non-surgical. Physical therapy to strengthen the back and abdominal muscles is the primary mode of treatment. Medication such as NSAIDS (aspirin, Aleve, etc.), steroids or narcotics can help with the pain and inflammation. Epidural injections can also be effective, especially with leg symptoms. Surgical treatment becomes necessary when conservative management fails. Surgery is especially effective for patients with leg symptoms.

Myelopathy – Cervical spondylotic myelopathy (CSM) is caused by compression of the spinal cord in the upper spine, or cervical stenosis. Bony spurs formed by long-standing arthritis grow into the canal and compress or place pressure on the cord.

Symptoms of myelopathy include neck pain, problems with balance, numbness in the hands and fingertips, and difficulty with fine movements like buttoning a shirt. Patients can also display exaggerated reflexes.

Conditions which can result in myelopathy are multiple sclerosis, amyotrophic lateral sclerosis, and spinal cord disorder. However, cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in the elderly.

Spinal Curvature - Curvature of the spine takes two forms. Scoliosis is a lateral (toward the sides) curvature in the normally straight vertical line of the spine; it may occur in the thoracic or lumbar segment of the spine, and it may or may not include rotation or deformity of the vertebrae. Kyphosis is a curving of the spine that causes a bowing of the back - usually the upper back.

The treatment of scoliosis is determined by the extent of the deformity and the stage of bone growth (how near the growth centers are to closure). Many scoliotic curves require no treatment (less than 30 degrees) but should be followed in 6-month intervals. More serious cases may require observation, exercise, a back brace, or surgery. The treatment is most successful when it is started early.

The treatment of kyphosis depends on the cause of the disorder. For kyphosis caused by poor posture, treatment may consist of exercises, a firm mattress for sleeping, and a back brace to straighten the curve until growth is complete. Bedrest is recommended for severe pain. Gradual weaning from the brace begins after maximum correction of the curve by the back brace has occurred. Surgery may be indicated if neurological symptoms occur. Traction may be used for pain relief.

Spinal stenosis - Spinal stenosis refers to narrowing of the spinal canal which causes pressure on the spinal nerves or cord. This condition is mostly seen in patients over the age of 50. Although the cause of spinal stenosis is not clear, two types have been described.

The congenital form of spinal stenosis is seen in individuals who are born with a narrow spinal canal. In these individuals, minimal changes in the structure of the spine can cause severe spinal stenosis.

The more common acquired form of stenosis is caused by progressive changes in different spinal elements (such as the discs, joints, ligaments, etc.) As people age, all these different elements sag or bulge and form arthritis that narrows the spinal canal.

Patients with spinal stenosis complain mainly of leg pain which worsens with walking. Back pain is also commonly seen with this problem. The leg pain is often improved with sitting or bending over. Rarely, bowel or bladder symptoms or progressive weakness can occur; these symptoms are very severe and necessitate immediate surgery.

Radiculopathy - Radiculopathy refers to any disease of the nerve root. Radiculitis indicates actual inflammation around the nerve root; the associated pain is sometimes called radicular pain. Thus radicular pain may radiate directly from mechanical abnormalities or indirectly from herniated discs, fractures, or tumors.