Watch your back

The word "degenerative" suggests ageing. Especially when we say "degenerative spine". But the wear and tear of the spine is not just about growing old. The deterioration, which is painful and produces a numbness that immobilises movement, can kick in when we are in our 20s.

With the current lifestyle of long hours at the desk, frozen in front of a computer screen and a lack of active movement or exercise can cause wear and tear of the spine to occur sooner than later, according to orthopaedics.

"Degenerative spinal conditions are the result of wear and tear that the spine endures over the years," explains Dr Tan Chong Tien, a specialist surgeon at Orthopaedics International. "Even in the ordinary activities of daily life, the spine has to withstand the load and absorb the stresses that come with these various daily activities."

Sometimes strenuous activities or injuries can compound the degenerative processes. The cumulative effects result in the degenerative process of the spine.

Degenerative spine conditions may come in three stages. The first affects mainly those in the 20 to 40 age group. In this early stage of degeneration, only the intervertebral disc – the structure between the two adjacent vertebral bodies – is affected.

The strong interlacing fibrous structure (annulus) that joins the two adjacent vertebrae together could develop cracks, and an inner core of gelatinous structure (nucleus) could harden. This is called Degenerative Disc Disease – and it is responsible for the common back pain that many of us have complained about.

Another condition in this early stage of degeneration is Slipped Disc. This happens when degenerated fragments of the nucleus impinge on the nerve roots within the spinal canal to cause the nerve root pain (sciatica), which radiates down the thigh and leg.

The second stage of degeneration affects those aged 40 and above. Together with the disc degeneration, the facet joints also become degenerated and enlarged. This results in the spinal canal becoming very narrow, and causing Spinal Canal Stenosis.

The other conditon is Degenerative Spondylolisthesis. This occurs when the facet joints become very worn out and can no longer provide the stability that holds the segments together.

"The third stage of degeneration affect those aged 60 years and above," Dr Tan says. "This is when there is loss of bone substance, affecting mainly post-menopausal women, resulting in the bone becoming very fragile. This condition is called Osteoporosis."

Dr James Tan Siah Heng of Neurosurgery International points out that the commonest presentation of degeneration is pain and stiffness.

"Most of the time, the pain is self limiting – meaning that it will reduce over time with simple medications like paracetamol or painkillers and with simple stretching exercises," he says.

The pain is usually the worst at the end of the day, after a long day of work. Increased load due to excessive weight and a sedentary lifestyle will heighten the risks of more pain.

"As we grow older, the muscle mass actually decreases if we don't use it regularly," Dr Tan says. When the degeneration occurs, it is not reversible. The worn out disc and bone spurs will continue to deteriorate.

With the proper exercise and treatment, this degeneration will slow down but the spine will not revert to its original condition.

When the nerves or spinal cord get squeezed, symptoms of tingling and numbness appear. With continued pressure on the nerves, weakness will be detected.



Walking, cycling and swimming are good exercises for the spine, and help with back pain prevention when there's better flexibility and core muscle strength, when there's weight loss and increased endurance.

Low impact exercises, including aerobics and pilates, can increase flexibility, strength and endurance in your back and allow muscles to work better, says Dr Ngian Kite Seng, specialist orthopaedic surgeon with Orthopaedics International.

"Bending and stretching exercises improve flexibility," he says. "Flexibility in the hips and legs also help in reducing strain on the back. Abdominal and back muscle exercises help condition core muscles to work like a natural corset to protect your back."

If the pain is more severe or persistent, further treatment often includes physical therapy. In patients with significant disc and facet joint inflammation, steroid injections may be used to help in recovery. For those with pain that is disabling or with significant nerve compression, further intervention may be needed.

Dr Ngian notes that intervention may be minimally invasive in less severe cases, such as mild disc protrusion and facet joint syndrome. Common procedures include nucleoplasty and radio-frequency ablation of facet joint nerves – techniques to reduce disc pressure and to block nerves causing pain and may give relief.

"However, surgery is necessary where there is significant nerve compression or structural problems. This may involve decompression of nerves, fusion and artificial disc replacement," he says. Today, there are ways to do such surgery using minimal access techniques and better implants to allow a shorter recovery time and improved results.

Warning signs

Warning signs

At what point should one take back pain seriously and get a check-up?

Dr James Tan Siah Heng of Neurosurgery International says it becomes serious when you have one or more of these symptoms:

Weakness: When there is actual nerve compression with damage to the nerve fibres. If left untreated, paralysis may occur and be permanent;

Numbness or tingling: Occasional numbness that lasts for a short period may be a sign of early nerve compression. If it is persistent, it means nerve damage has taken place and muscle weakness will soon follow;

Loss of bladder and bowel control: This is a very serious situation that warrants immediate admission to hospital and surgery. Sudden incontinence means severe spinal cord or roots compression that, if left untreated, will result in permanent disability;

Persistent pain on neck movement: The pain from neck sprains usually lasts from several days to one to two weeks. If the pain persists in severity and worsens over time, especially if it is associated with a fall or accident, there may be an undiagnosed neck fracture with instability.

Pain that radiates down the arms: This radicular pain is caused by the nerve root being squashed (usually due to a herniated disc). Initially, it may just be pain but with time, tingling and weakness will develop.

This article was first published in The Business Times.