Spinal Column Disorders





The spinal column comprises the longitudinal axis of the body. It plays crucial roles in bearing weight and withstanding external forces, protecting the spinal cord, maintaining upright posture, and facilitating movement. Physical therapist assistants play crucial roles in managing spinal column disorders. Such orders may result in acute and chronic pain, decreased neurological function, decreased muscle strength, alteration of sensation, and postural changes.







The Spinal Curves





Maintained by ligaments, muscles, and bony architecture the spinal curves are responsible for the maintenance of normal posture, pelvic stability/mobility, spinal cord/nerve root protection, etc. The cervical, thoracic, and lumbar curves may be altered by several anomalies leading to stereotypical primary and compensatory signs and symptoms.



Excessive Kyphosis



Potential Causes


Poor posture

Structural abnormalities of the bones

( e.g. Scheuermann’s kyphosis)

Degenerative conditions
Spinal injury

Age


Common Clinical Manifestations

Rounded shoulders

Dowager’s Hump

Tight hamstring(secondary)

Pain or stiffness

Paresthesia

Fatigue
Balance impairment

Shortness of breath or difficulty breathing.

Compensatory hyper cervical and lumbar lordosis


Physical Therapy Intervention


Postural exercises/activities

Strengthening exercises

Stretching exercises

Mobility exercises

Proprioceptive training

Orthotic use






Excessive Lordosis



Potential Causes


Congenital: developmental abnormalities

Postural

Muscle imbalances: Weak abdominal muscles and tight hip flexors can contribute to lordosis.

Scoliosis (secondary)

Osteoporosis secondary)

Spinal stenosis (secondary)


Common Clinical Manifestations


Swayback appearance

Back pain

Maladaptive muscle

Paresthesias


Physical Therapy Intervention


Postural exercises/activities

Muscle strengthening

Passive stretching

Pain management





Scoliosis







Potential Causes


80% of scoliosis is idiopathic

Muscle Imbalances (weakness, hyper(o) tonicity

Bony anomaly



Common Clinical Manifestations


Hip and shoulder assymetry

Single C curve

Structural S curve

Primary curve with functional compensatory curve
Rib cage rotation

Razor back deformity

Back Pain

Difficulty sitting

Difficulty breathing


Physical Therapy Intervention


Postural exercises

Strengthening exercises

Stretching exercises

Breathing exercises

Proprioceptive exercises











Herniated Nucleus Pulposis





A bulging or protruding disc is when the nucleus presses against the outer ring, the spinal disc begins to bulge and potentially compressed or irritates the spinal nerve root.

Excrusion occurs when there is a break in all the annular rings leading to a portion of the pulposis compressing the nerve root


In sequestration, a portion of the pulposis pinches off and irritates sensitive structures.


NOTE: As all cartilage, the intervertebral disc is avascular and aneural and therefore does not heal well and is not a direct source of pain when damaged.

The vertebral endplate is a thin, porous layer of cartilage and bone that separates the intervertebral discs from the vertebral bodies, acting as a crucial interface for nutrient transport, load transfer, and maintaining disc structure and function.


The end plates are the primary pathways for nutrients to reach the avascular disc) from the blood supply of the vertebral body. The endplate is innervated and is a source of back pain when damaged.

Potential Causes


Trauma

Repetitive Motions

Poor Posture

Sedentary Lifestyle

Heavy Lifting

Obesity

Smoking

Genetics

Osteoarthritis

Spinal stenosis


Common Clinical Manifestations


Local/radicular pain

Paresthesia/numbness

Muscle weakness


Physical Therapy Intervention


Stretching

Trunk strengthening

. Posture exercises

Special exercise to reposition pulposis

Pain management


Surgical Management


Microdiscectomy: Removal of the herniated disc material.

Laminectomy: Removal of part of the bone covering the spinal cord to create more space for the nerves.


Fusion surgery: Joining two or more vertebrae together to stabilize the spine.






The intervertebral disc is important in the normal functioning of the spine. It is a cushion of fibrocartilage and the principal joint between two vertebrae in the spinal column.


The nucleus pulposis is gel-like structure that sits at the center of the intervertebral disc and accounts for much of the strength and flexibility of the spine. It is made of 66% to 86% water with the remainder consisting of primarily type II collagen (it may also contain type VI, IX, and XI) and proteoglycans.


The annulus fibrosis consists of “lamellae” or concentric layers of collagen fibers. The fiber orientation of each layer of lamellae alternate and therefore allow effective resistance of multidirectional movements.

The annulus fibrosis encircles and contains the nucleus pulposis. A “herniated disc”, “slipped disc”, “bulging disc”, etc is related to damage to the annulus resulting in nucleus pulposis displacement with resultant pressure on sensitive structures.











Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine. It causes inflammation of the joints between the vertebrae, leading to stiffness, pain, and eventually fusion of the spine.
​

The exact cause of AS is unknown, but it is believed to be an autoimmune condition, where the body's immune system mistakenly attacks its own healthy tissues. Genetic factors, such as the HLA-B27 gene, may play a role.


Spondylosis often referred to as spinal osteoarthritis, is a condition characterized by the degeneration of the spine and its related structures, primarily due to age-related wear and tear, leading to pain, stiffness, and potentially nerve compression.

Spondylolisthesis a condition where one vertebra slips forward over the vertebra below it. This displacement can occur in any direction, but is most commonly anterior. Degenerative Spondylolisthesis most commonly occurs at L4/L5.


Lytic spondylolisthesis is typically caused by a stress fracture or defect in the pars interarticularis, a small bony bridge in the spine located between the superior and inferior articular processed