Locate your area of pain Neck pain Back pain Low back pain Scoliosis Osteoporosis Sciatica Locate your area of pain Neck pain Back pain Low back pain Scoliosis Osteoporosis Sciatica

Possible causes of neck pain

Cervical stenosis

In the neck there are 7 bones, known as cervical vertebrae, with cushions (called intervertebral discs) between each vertebra. One of the problems that can occur in the cervical spine is called degenerative cervical myelopathy (DCM). Myelopathy indicates that the spinal cord is compressed. This can occur when the spinal canal is restricted due to degeneration of the intervertebral discs and bones (stenosis), causing the spinal cord to narrow.

Herniated disc

The spine is composed of bones (vertebrae), each separated by a sturdy shock-absorbing cushion called the intervertebral disc. The vertebrae are divided into 7 cervical vertebrae (neck), 12 thoracic vertebrae (chest), 5 lumbar vertebrae (lower back), 5 sacral vertebrae and the coccyx. Herniated discs can occur at the cervical, thoracic or lumbar level; the lumbar and cervical areas are the most often affected.

Source: EUROSPINE Patient Line

Possible causes of back pain

Spinal stenosis

Spinal stenosis is a narrowing of the canal in which the spinal cord or nerves run from the head to the lower back. This narrowing causes pressure on the contents of the spinal canal. Lumbar stenosis can occur in the last 5 bones of the lumbar area.

Source: EUROSPINE Patient Line

Possible causes of low back pain

Lumbago

The lower part of the spine, at the back between the ribs and hips, is called the lumbar spine. It is composed of 5 bones called vertebrae separated by a cushion between each of them. These cushions, called intervertebral discs, absorb the impacts that occur when walking or running so that the bones do not strike each other.

Spinal stenosis

Spinal stenosis is a narrowing of the canal in which the spinal cord or nerves run from the head to the lower back. This narrowing causes pressure on the contents of the spinal canal. Lumbar stenosis can occur in the last 5 bones of the lumbar area.

Herniated disc

The spine is composed of bones (vertebrae), each separated by a sturdy shock-absorbing cushion called the intervertebral disc. The vertebrae are divided into 7 cervical vertebrae (neck), 12 thoracic vertebrae (chest), 5 lumbar vertebrae (lower back), 5 sacral vertebrae and the coccyx. Herniated discs can occur at the cervical, thoracic or lumbar level; the lumbar and cervical areas are the most often affected.

Source: EUROSPINE Patient Line

Scoliosis

Introduction

There are different types and causes of scoliosis: congenital, associated with other syndromes, neuromuscular, degenerative and idiopathic. Idiopathic scoliosis can appear at an early age, at age six or earlier, or have a later onset after age six.

Adolescent idiopathic scoliosis

The spine has a three-dimensional shape. From the front it looks straight, from the side you can see the normal curves.

Scoliosis is an abnormal curvature and twisting of the spine.

Who can suffer from it and when? What are its causes?

Adolescent idiopathic scoliosis can occur in young people. It is more common in women than in men. It is usually perceived during the rapid growth that occurs during puberty. If the origin of scoliosis is unknown, it is called "idiopathic scoliosis". Currently some evidence indicates that there is a genetic component and that in some cases there is a family history. Monozygotic twins usually have the same curvature.

Diagnosis

Symptoms/signs

Scoliosis is often visible through a change in the appearance of the back. The curve of the spine may be visible. The ribs may protrude slightly, on one side, causing a bulging of the ribs. It is also possible that one shoulder is higher than the other or that the shoulder blade is more prominent. Sometimes a part of the hip may be more prominent.

Back pain is not usually one of the main symptoms of scoliosis in children.

Tests usually include the Adams test (or "forward trunk flexion" test) which helps the doctor determine the extent of the scoliosis. A detailed analysis of the nerves, muscles and skin will make it possible to exclude other causes of scoliosis.

You will usually be recommended to see a specialist to have some x-rays taken, to make sure the X-rays are correct and that exposure to radiation is reduced. It is not always necessary to perform an MRI. It is recommended the opinion of a specialist in the treatment of scoliosis is sought and, in general, the patient will be assessed and monitored until growth is complete.

Growth is usually completed two years after puberty.

Treatment

Treatment, prognosis and tests. The road to recovery

Evaluate, review and confirm. A curvature of the spine after the age of 8 does not affect the internal organs or heart or lung function. Participation in physical and sporting activities should not be restricted at all. A curvature in the spine is not a "weakness" and should not be considered disabling.

In young people who are still growing, wearing a spinal brace may reduce the chance of the curvature worsening. Once the full growth of the spine is complete, the clinical efficacy of a brace is low.

Spinal surgery is an effective treatment for larger curvatures. The main advantage is the improvement in the shape of the body and the certainty that the curvature will remain stable after the intervention. The intervention for scoliosis correction may vary depending on the extent of the curvature and other surgical specificities of the spinal curvature. The risks of the intervention must be explained in detail and assessed against the potential advantages of this operation. This consent process should be part of a shared decision between the doctor, the patient, and their family.

Source: EUROSPINE Patient Line

Osteoporosis

Introduction

Osteoporosis is a condition that reduces bone density and quality. Density refers to bone mass (bone mineral density) and quality to bone fibres. Osteoporosis causes bones to lose strength and become more fragile and porous, which increases the risk of fracture. Osteoporosis usually progresses asymptomatically and gradually, with no pain or symptoms until the first fracture occurs.

It is a general disease, so it can affect all the bones of the body. However, some bones, such as those in the wrists, femur, or bones in the spinal column are more likely to develop symptoms or fractures due to their anatomical structure and mechanical exposure to heavier loads.

Loss of mechanical strength can lead to fractures in the spine without any prior injury. It is estimated that up to half of women and a third of men suffer at least one osteoporotic fracture of a bone in the spine during their lives.

Vertebral fractures due to osteoporosis can lead to the sudden onset of pain. The patient feels sudden severe pain (usually associated with a "cracking" in the back). It usually worsens with activity and decreases at rest. An X-ray or magnetic resonance imaging (MRI) scan can confirm that there is a fracture in a vertebra. Vertebral fractures can have serious consequences, such as loss of height, severe back pain, and deformity (sometimes known as hyperkyphosis). It usually improves in about 3 to 12 weeks, as the fracture recovers and has no side effects. Sometimes the fracture takes time to heal and persistent pain occurs that causes a reduction in physical activity with side effects such as low self-esteem.

Sometimes, especially when there are several fractures, this can lead to deformities and loss of balance in the spine.

Due to the ability of the spine to self-regenerate, asymptomatic fractures are common: after a period of back pain, the patient improves and forgets about the event. If an X-ray is later performed for another reason, a fracture may be observed, now without symptoms.

Diagnosis

Not all vertebral fractures that occur in elderly people are due to osteoporosis. Osteoporosis should be checked for before starting treatment.

A history of vertebral, wrist, or hip fractures may indicate osteoporosis. The most reliable test for diagnosing osteoporosis is dual-energy X-ray absorptiometry (Dual-Energy X-ray Absorptiometry, DEXA). This test can confirm the presence of osteoporosis and also determine the degree of the disease.

Treatment

Non-surgical treatment

The goal of non-surgical treatment is to delay and prevent the progression of osteoporosis by causing a change in bone metabolism. Having a healthy diet and lifestyle and doing physical exercise is important for treatment. Preventing falls using "protective" devices such as canes or crutches can be helpful for elderly people.

There are medications that inhibit or delay the loss of bone mass (bisphosphonates and hormones, among others) and stimulate bone formation. In general, calcium intake to improve bone quality can take months or even years. Therefore, this treatment must be maintained for a long period and patients must be monitored periodically. Calcium and vitamin D are important in the medical treatment of osteoporosis.

Surgical treatment

It is estimated that only 10% of osteoporotic vertebral fractures require surgical intervention. The main objectives of surgical treatment can be summarised in the following points:

  1. Pain relief
  2. Stabilisation of the fractured vertebra
  3. Reduction of the deformity
  4. Elimination of pressure on the spinal cord
  5. Straightening of the spine

Stabilisation and pain relief can be treated by kyphoplasty or vertebroplasty, which involve the introduction of a type of bone "cement" into the bone. If there is a deformity of the spine, it can sometimes be solved by a significant surgical intervention with vertebral instruments.

Source: EUROSPINE Patient Line

Possible causes of sciatica

Sciatica

The sciatic nerve is the largest nerve in the body and runs from the lumbar region of the back, under the buttocks and down the hips to each leg. "Sciatica" means that the sciatic nerve is compressed or irritated and causes pain that can range from mild to severe, and tingling in the legs. The pain may be made worse by sneezing, coughing, or sitting for long periods of time. Sciatica is a symptom of a spinal disorder and not a spinal disorder itself.

Source: EUROSPINE Patient Line

Surgery

Spine Surgery

Spine surgery is one of several specialties that have undergone revolutionary changes in recent years.

The goal is to correct the structural abnormalities of the spine that cause back pain, when that is the cause. For example, when a herniated disc compresses a nerve root, and all non-surgical treatments have failed, removing the herniated disc material allows the compression to be removed.

In the IAC the recommendation for surgical treatment is made based on the proven scientific evidence and the different Clinical Practice Guidelines, in which the members of this Institute have had the opportunity to participate.

Surgery is recommended, in addition to obvious cases such as fractures, tumours or some scoliosis, in those cases in which it is demonstrated that:

There is a compression of the nerve roots or spinal cord, significant enough to leave sequelae if not resolved quickly, which is the case in the intervention for “cauda equina syndrome due to herniated disc”.
There is a compression of the nerve roots which, although it will not necessarily leave sequelae, causes symptoms and lasts more than 6 weeks without improving despite non-surgical treatments.
Disabling low back pain resulting from vertebral instability that does not respond to conservative non-surgical treatment.
Spinal deformity problems such as adolescent scoliosis, congenital scoliosis or adult scoliosis.
Tumours or infectious lesions.

Both the risk and the type of tests that need to be applied are decided in conjunction with the rest of the surgical team and always determined individually for each patient.

Thus, it is possible to optimise the surgical strategy while providing greater safety since the possibility of nerve injury is minimised.

The IAC has one of the most technologically advanced hybrid operating theatres in Europe with a navigation system with intraoperative control of the implanted instruments and a scanner that provides a large real-time field of vision of the patient during surgery. With these images and thanks to the neuro-navigator, the intervention process can be planned, reviewed, documented and even broadcast live, offering much more accurate, safer spine surgery for our patients.

At the Advanced Spine Institute, our priority is to involve the patient in the entire process. We are therefore pioneers in the application of a series of perioperative measures in order to reduce the stress associated with a surgical intervention. It is known as the ERAS project.

All this is possible thanks to our location in the Jiménez Díaz Foundation, a highly sophisticated hospital with 24-hour attention from all specialists in the event of complications and with the availability of a top-level ICU.

Cirugía

Pain management

Objective: reduce pain to improve the patient's quality of life.

Between 70 and 85% of the adult population suffers from back pain at some point in their life. According to the 2019 Spanish National Health System report, low back pain in the Spanish population is the second most common chronic health problem, with 18.5% of the population affected, behind arterial hypertension, which affects 19.8%. However, in up to 80% of cases, this pain does not correspond to a single structural problem.

Multidisciplinary management of these problems, including functional rehabilitation and pain management, is therefore important.

The use of local treatments, aimed at managing the different sources of pain, produces a significant improvement in symptoms, allowing the patient to return to normal activities. These treatments can last from weeks to years.

Each patient requires individualised management, depending on their symptoms and the different imaging tests. These tests include epidural infiltration, facet blocks, intradiscal treatment or myofascial treatments.

At the IAC we have many years of experience in treatment with targeted techniques for pain management, and the analysis of their results has led us to the optimise use, to abandon some techniques that did not demonstrate the desired efficacy, and to be pioneers in the incorporation of new techniques, such as intradiscal treatment with Discogel®

Pain treatment

Regenerative treatment

PRP Therapy

Currently, regenerative medicine is a non-surgical treatment solution that uses the body’s natural healing process to rebuild damaged tissue, heal injuries more effectively, and eliminate pain. Regenerative medicine targets the underlying source of pain without relying on medication or surgery.

The IAC has been a pioneer in the investigation of these procedures for the treatment of spinal disorders.

Analysis of the results of the management of these procedures has led us to restrict the use of some procedures and develop new ones, such as the use of PRPs in certain intradiscal lesions.

Platelet Rich Plasma (PRP) has proven to be a regenerator of chondral tissue in general, and its results have shown great utility in the management of tendon, subcutaneous tissue and chondral lesions. In the spine, it has shown great anti-inflammatory potential in intervertebral discs and has become a very promising alternative (biological) treatment for disc disease.

PRP Therapy

Intraoperative neuromonitoring

Intraoperative Neurophysiological Monitoring

As with any surgery, spine surgery carries the risk of complications. Although rare, neurological injury has the potential to produce severe sensory and motor damage. Due to the nature of the complications that can occur with spine surgery, intraoperative neurophysiological monitoring (IONM), or neuromonitoring, is a procedure increasingly used in certain procedures.

The IAC was one of the first Spine Units to incorporate a team of Neurophysiologists into the multidisciplinary team, specialists in intraoperative monitoring. We currently follow the recommendations of the Spanish Spine Society (Sociedad Española de Columna).

Innovación

Osteoporosis

METABOLIC BONE DISEASE UNIT

Osteoporosis is a silent disease that gives no warning signs until a fracture occurs. A study determined in 2010 that 2.4 million Spaniards over the age of 50 suffered from osteoporosis and as a result there were 204,000 new fractures, with vertebral fractures being the most frequent. By the year 2025, it is estimated that the incidence of this type of fracture will increase by 40%. The incidence of these fractures is increasing mainly due to a longer life expectancy.

The Metabolic Bone Disease Unit of the Fundación Jiménez Díaz is a pioneer in Spain in treating these diseases and in introducing various densitometric techniques to measure bone mass.

It is a national and international reference in the field of education, research and epidemiological studies based on clinical and bone densitometry data.

The unit is currently recognised as a reference centre by International Osteoporosis Foundation, as a specialised centre by ORPHANET-SPAIN and belongs to the Network for collaborative research in ageing and fragility (Red Temática de Investigacion Cooperativa en Envejecimiento y Fragilidad – RETICEF) and to the Biomedical Research Centre for Rare Diseases with Bone Affecting Network (Centro de Investigacion biomédica en red de enfermedades raras con afectación ósea -CIBERER).

Techniques and studies offered by the unit:

  • Study and rapid treatment of patients with fragility fractures, osteoporosis, calcium metabolism disorders and other bone diseases.
  • Performance of densitometry (DXA) in a very short time.
  • Participation in clinical trials of drugs for osteoporosis or other bone diseases (hyper- and hypoparathyroidism, Paget’s disease, etc.).
  • Counselling and advice in metabolic bone diseases with genetic and family related components.
Osteoporosis and metabolic bone disease unit

Yoga

Proven Benefits of Yoga

Back pain is sometimes associated with a disease or condition, although the vast majority of cases of low back pain have an unknown cause and are therefore described as non-specific. Current clinical practice guidelines maintain that physical exercise can be beneficial; in particular, yoga is sometimes used as a treatment for low back pain.

Yoga is enjoying increasing popularity globally as a form of mind-body exercise with overall lifestyle benefits. Recent studies have investigated the potential of this discipline to relieve the symptoms of lumbar disorders.

A new Cochrane review summarises the results of 12 clinical trials involving 1080 men and women with an average age of between 34 and 48. The trials were conducted in India, the United Kingdom and the United States. All participants suffered from chronic non-specific low back pain.

The review found that practicing yoga could improve back function and may slightly reduce symptoms of low back pain in the first 6 to 12 months, although the effect was better than other treatments.

On the other hand, yoga can cause an increase in back pain in some people. About 5% of participants in the yoga group experienced increased pain, although it could be similar to the risk of side effects from any other back exercise. That is why the IAC collaborates with one of the most professional specialist yoga centres in Madrid, El Gong, where different types of yoga are taught by instructors with extensive experience and practices are optimised for each individual (www.elgong.es)

(Reference: Wieland LS, Skoetz N, Pilkington K, Vempati R, D’Adamo CR, Berman BM. Yoga treatment for chronic non-specific low-back pain. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD010671. DOI: 10.1002/14651858. CD0106

Chiropractic

Improving the movement of the spine and the physical function of the body

Chiropractic correction is a procedure in which trained specialists (chiropractors) use their hands or a small instrument to apply rapid, controlled force to a joint in the spine. The goal of this procedure, also known as spinal manipulation, is to improve the movement of the spine and improve the physical function of the body.

Chiropractic adjustment can be effective in treating pain in the low back and cervical region resulting from major joint problems. Some studies suggest that spinal manipulation may also be effective for headaches.

Not all people respond to chiropractic adjustments, it depends on the particular situation of each patient and the specialist providing treatment. Dr Alvarez Galovich is a collaborating professor at the Real Centro Universitario María Cristina where he teaches students studying for the Higher Degree in Chiropractic. This is the only specialised training centre in Spain, with a course lasting 5 years. He also participates in different studies in collaboration with the Chiropractic Research Network, which allows this practice to be adapted and individualised for each patient.

Quiropráctica
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