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Spine
The spinal column is made up of vertebrae that stack up on each other. Between each vertebra is a cartilage pad called the intervertebral disc. Discs are cartilage, not bone. They have a soft center like crabmeat and a tough capsule around the edges like heel cord tendon to bind the vertebrae together. From the skull down are seven cervical (neck) vertebrae, 12 thoracic (chest area) vertebrae and 5 lumbars between the last rib and the sacrum, the back part of the pelvis. Four to six tiny coccyx vertebrae are at the top of the sacrum. The back part of each vertebra forms a protective covering for the spinal cord and spinal nerves, the spinal cord ending at the last rib. In the lumbar area there are only spinal nerves. Back pain is one of the top ten reasons for consulting a doctor. Nearly everyone has had it at some time or the other. Most of the time it is self-limited. Unless a bone is fractured or has tumor or infection in it, bones of the spine rarely cause pain. Pain is usually from the discs trying to pull away from the bone. If a disc protrudes out far enough, it can compress a spinal nerve and cause leg or arm pain. In the neck, it may also compress the spinal cord. MRI scans on people without back pain have shown a fairly large number of them to have degenerated discs, bulging discs, and even herniated discs, so changes in the discs don’t always cause pain. If and when a disc protrudes (we also say herniates or ruptures) enough to hit a nerve, the pain goes down the arm or leg. Lumbar disc problems are 10 times more common than cervical disc symptoms. Pain may also be followed by numbness, weakness and loss of reflexes. Each spinal nerve goes to particular muscles and supplies sensation for a particular finger or toe, so a neurological exam may reveal the location of a disc problem. Common spine problems are: herniated discs, spinal stenosis, cervical myelopathy and spondylolisthesis. For more details on these conditions, click on those subjects on the home page. For more
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