Spine

The spine is literally the backbone of the body, starting at the neck and ending at the tailbone. Every day our spines withstand a lot of stress, making it a common site of overuse pain and injury. The spine is composed of 33 vertebrae that are grouped into regions defined by their location and function.

Spine anatomy

The spine is composed of the following vertebrae, from top to bottom:

  • 7 cervical vertebrae (C1-C7)
  • 12 thoracic vertebrae
  • 5 lumbar vertebrae (L1-L5)
  • 5 fused sacral vertebrae (S1-S5)
  • 4 fused coccyx (tailbone) vertebrae

The cervical vertebrae in the neck are responsible for neck flexion/extension, rotation and bending. The thoracic spine is connected to the rib cage and primarily functions to give the body support with very little motion. The lumbar spine (the lower back) allows the spine to flex (bend forward) and extend (bend backwards). The sacrum and coccyx are fused and function to connect the spine to the pelvis.

The spinal cord runs from the brainstem down to the lumbar spine in a canal and is surrounded and protected by vertebrae bones. Nerves that control muscle function begin in the brain, travel to the brainstem, move the spinal cord and exit the spinal cord toward to the muscle they control. Similarly, sensory nerves originate in the skin or muscle of the body, and then travel to the spinal cord up to the brainstem and end in the brain for processing.

Muscles and very strong ligaments support the spine and maintain stability, while also allowing movement (flexion/extension, rotation and bending). The intervertebral discs sit between each of the stacked vertebrae in the spine and cushion the vertebrae during movement.

Acute Spine Injuries

Acute spine injuries happen suddenly. This can be cause from things such as a car accident or a fall. 

 

Burst fractures

These thoracic or lumbar spine fractures generally result from a high-energy impact, such as a car crash, fall from a height, or contact sports that forcefully smashes the spine. The energy of the injury causes the vertebrae to fracture or burst, into multiple pieces and the injured vertebrae lose height, which can lead to instability and a deformity and/or injury to the spinal cord.

X-rays of the spine, including upright or standing, are necessary to determine if the spine is stable. A CT or CAT scan and/or an MRI may be required for a better view of the injury.

Generally, stable burst fractures are treated with braces and pain medication. However, unstable fractures require surgical stabilization to protect the spinal cord from injury and the spine from future deformity. Any fracture associated spinal cord compression will need surgery to decompress the cord.

Compression fractures

Similar to burst fractures, these vertebrae fractures usually result from a compressive force or because of low bone density conditions (i.e. osteogenesis imperfecta). The compressive force from the injury causes the front part of the vertebrae to partially collapse, resulting in a wedge-shaped vertebra. These injuries are always stable and are treated with a brace for pain control. Once the initial pain is better, children often benefit from a course of physical therapy to improve core strength.

Flexion/distraction chance fractures

These fractures result from a high-energy bending of the body, such as the harsh jerk your body experiences during a front end collision when you wear only the lap belt (and not the shoulder portion) of a seatbelt. When the vertebrae are forcibly flexed forward, the front section of the vertebrae may compress (wedge) and the vertebrae’s back section or supporting ligaments can pull apart.

Treatment will depend on whether the back of the spine has an injury to the bony vertebrae or the supporting ligaments. Bony injuries typically heal well with a brace or cast and don’t require surgery. However, ligament injuries heal poorly and usually require surgery to stabilize the spine with screws and rods.

Fracture dislocation

These devastating injuries are the result of very high-energy impacts involving one or more vertebrae fractures as well as supporting ligaments that are injured from a rotation (twisting) force. The combination of these injuries makes the spine unstable and vertebrae can dislocate, or come out of the normal position. A dislocation causes an injury to the spinal cord, which can result in sensory and muscle function shortfalls, or permanent paraplegia. These injuries often require immediate surgical treatment to decompress the spinal cord and stabilize the spine.

Chronic Spine Injuries

Chronic spine injuries are ongoing. This can be caused by muscle strains and overuse, but constant pain could be a sign of something more serious. 

Back pain

Up to 50 percent of teens will experience back pain before the age of 20. Most back pain will resolve without treatment.  In children age 10 and under, back pain is extremely uncommon unless there is a specific injury. In fact, the most common cause is constipation. If your child or teen has ongoing pain, consider setting up an appointment to be seen by a doctor.

Common sources of back pain in children and adolescents include:

  • Overuse/muscle strains
  • Stress fractures (spondylolysis)
  • Scheuermann's kyphosis
  • Herniated disc
  • Backpacks

Childhood back pain can be caused by a variety of issues ranging from normal growing pains to activity-related injuries requiring urgent treatment. Your child needs immediate medical attention if he has any of these symptoms:

  • Constant back pain
  • Pain that's only in one specific area
  • Pain that requires pain medication
  • Pain that limits activities
  • Pain associated with fevers, chills and weight loss

In the adolescent age group, back pain is very common and is usually concentrated across the middle of the lower back—and may be noticed especially when sitting or standing for long time periods. You may also notice that your child slouches more often and insists it hurts to sit up straight.

It’s normal for a teen to experience aches right after a growth spurt – muscles typically grow strong before they grow long—but these aches rarely require pain medication or limit activity.

In order to stop the backache, your child may need to build up back and core strength and a short course of physical therapy may be helpful.

Back pain is an extremely broad topic and may or may not be due to the back itself. Your child’s doctor will complete a physical examination and ask several questions to determine the cause and location of the pain. If necessary, X-rays will be ordered during the initial visit and then imaging tests and blood work may be recommended at subsequent visits if the cause is still not clear.

Spondylolysis and spondylolisthesis

Spondylolysis is a defect in the vertebrae of the spine in a location of the bone known as the pars interarticularis. This pars region represents the connection between the front part of the back bone (vertebral body) which houses the spinal cord and nerves, to the back part of the back bone (posterior elements).

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