open

The ageing spine

As we get older, the intervertebral discs between the vertebrae start to undergo a process of degeneration, first becoming dehydrated and then gradually losing height, like a waterbed with a leak. The vertebrae also start to change shape and small spikes of bone, called “osteophytes”, start to grow from their edges.  The combination of the loss of intervertebral disc height and osteophyte formation can cause narrowing of the neural foramina, so the nerves leaving the spinal column can become pinched causing pain. If this happens in the arm it is called “brachalgia” and when it happens in the leg it is called “sciatica.

Neuralgic pain from a trapped and swollen nerve root is extremely painful. Conventional painkillers rarely help, even in very large quantities, and even special nerve pain medications, such as Gabapentin and Pregabalin, often don’t help much either. Many people say it’s the worst pain they have ever experienced. 

Only two treatments generally help with neuralgic spinal pain. These are injections of steroids right onto the affected nerve root, or surgery either to drill some bone away from around the neural foramen in an operation called a “foraminotomy”, or other operations to decompress the nerves and make more space for them. These operations include spinal decompression and various forms of spinal fusion operations. 

Between each pair of vertebrae is also a pair of facet joints, without which we would not be able to bend forwards or backwards, bend from side to side or even turn around. These small joints are crucial to all our spinal movements and just like any other joints they tend to wear out. 

They tend to wear out the most in two areas of the spine. Firstly, the facet joints in the neck start to show signs of wear and tear from middle age onwards and the joints and the lowest part of the spine, between the lower part of the lumbar spine and the sacrum particularly, show signs of wear and can cause pain from fairly early middle age onwards. The most commonly affected level is L5/S1 with the level above it, L4/5, being the second most commonly affected. 

As we get older the spine becomes a little stiffer as the intervertebral discs and facet joints start to show signs of wear and the range of movement between them starts to reduce. Along with this reduction in range of movement some people get pain, and age-related problems in the neck are frequently felt not only in the neck but also into the back and side of the head and also down into the shoulders and even as far down as the shoulder blades. Where problems occur in the lumbar spine the pain is normally felt in the back, buttocks or thighs. People with age-related problems in the spine can also have trapped nerves, ruptured discs, sciatica, vertebral body fractures and the risk of cancer increases with age and, although small, the risk of spinal metastases must always be considered as a possibility in people with spinal pain as they get older. 

We specialise in age related spinal problems, and they are usually treated with a combination of exercises, drugs, image guided injections, RFA procedures, and occasionally surgery when all else fails.