Diagnosis Of Bone-Related Problems

Hi,

I am Dr. Sidharth Verma and today I will tell you about spine so many times we see patients who are confused about their diagnosis so we tell them that you have L4-5 or L2-3 or L1-2 problems or you have facet joint issues so they sound and look very confused because they don't know the terminology, so I thought I will explain to you what are these difficult terms so that you can understand what is happening to your body and then you can get treated properly.

So our human spine that is the back it consists of lots of small bones and these bones are known as vertebra so if you see it can be divided into various portions, one in the neck is known as the cervical spine, one from the area of the neck to the lower back is known as thoracic spine and one in the lower back is known as the lumbar spine and below that is the sacral spine. There is also another type of bones which are there that is coccygeal spine which have become fused now so you should understand that there are a lot of bones and the spine is made up of small bones.

Now these bones they are small and they are joined together by various joints, every two bones are joined by three joints, one is the joint wherein there is an intervertebral disk and there are two more joints which are known as the facet joints so if you see why these joints are required is because the spine is a mobile organ means it has a lot of mobility and it provides a range of motion to us so that we can bend, turn, twist and do a lot of other activities and why bone is required is because the spine essentially not only stabilizes the skeleton but also provides support and protection to the spinal cord which is a big nerve or collection of the nerves which passes from the brain to the periphery, that is this is the structure through which the brain controls all the other muscles and the organs of the body.

So you see this is a model of the human spine and if you see it shows a lot of different bones so these are the lumbar vertebrae and they are numbered in five and they are labelled as per their name so it is like L1, L2, L3, L4 and L5, so if you see between the L1 and L2 there is a disc which is known as the intervertebral disc that is the L1-L2 disc, this is the L2-L3 disc, this is the L3-L4 disc, this is the L4-L5 disc and this is the L5 and first sacral vertebra that is S1 so that is L5-S1 disk, so I hope now you are clear when your MRI reads L1, L2, L3, L4, L5 and it will not confuse you.

Now, what are these structures coming out? these are the nerves which are coming out from this hole. This hole is known as the foramen and since it is between the two bones that are vertebra it is known as the intervertebral foramen. These nerves leave the spinal cord and come out and then they go to the various organs. Now let us turn this model and see what is behind, behind each of these bones they are united at two joints, this is one joint and this is 2nd, so this is the upper bone and this is the lower bone and these two are the joints where they are uniting these are known as the facet joints, so this is the right facet joint, this is the left facet joint of the L1 and L2 vertebra similarly this one is another facet joint right one, left one of the L2 and L3 vertebra, so why this is important to know this is because these facet joints can become arthritic or with age this discs can reduce in height and puts more load on these joints and they can become damaged and then result in pain and such patients will also have back pain, so by knowing this, that they can cause pain, your pain physician can actually treat you and what they will do is they will numb the nerve which supplies this joint and then you will not have pain.

Now there are other structures also which can be resulting in the pain and these structures are not seen in this model but I will show you how they are attached so these structures are your muscles, so the muscles attachments if you see an average 80 kg adult will have a spine which will be only this much thick and as a result the remaining portion is occupied by the muscles, so muscles are huge like one of the muscles which starts from here and also from here so this big thickness is for a single muscle, so if you see they form a complete column and which supports the spinal cord and vertebra. So spinal cord is this one which is enclosed in this vertebra and the spine is enclosing this spinal cord and in turn, the muscles are around this vertebra or the spine and they provide support to the spine as well as they ensure there are movement and motion, so I hope you understand this common terminology.

Now your pain physician may also tell you that you are having a facet joint hypertrophy or facet joint arthropathy what does that mean? now with increasing age the height of this disc it reduces which puts more and more load on these joints also these joints become osteoarthritic means their age-related changes occur and they may become inflamed or even painful, if this happens then it is very difficult for the patient to extend or to cause any movement which results in motion at these joints, so in those cases we say that the patient has developed a facet joint arthropathy and the pain physician will tell you that you which level is involved and then he will do a procedure to relieve you from this kind of pain, now these bones are covered on all sides by big muscle, thick muscles so if I take an average adult who is 80 kg, the size of the bones will be similar to this only so although the person may be very thick but the his bones will be this much only so you can very well imagine that how thick the muscles will be, so for example in this particular model one of the muscle will start from here and here and it will go like this so you can understand that the muscle thickness is too much and they form a column so that is why your doctor will often tell you that you need to exercise so that you can develop your muscles properly.

Another thing which commonly people ask is listhesis. Listhesis is that the bones which are normally aligned one over the other, now the alignment is changed so this terminology is known as listhesis that means that in addition to other things this is one more component which can give rise to the pain in the particular patient. Now some patients will also have what is known as scoliosis. Scoliosis means there is a bending of the spine so what happens is because of various reasons the spine may not be straight but it may be bent like this so these patients will have more loading of the facet joints on one side, on the side which it is bent and this will lead to pain here and it can also lead to damage in the opposite joint and subsequently pain there also. So I hope these common terms have been explained to you and if you have any further doubts or any queries I will be very happy to answer, you can connect with me on my lybrate website and I would be very happy to answer your queries.

This is doctor Sidharth Verma and I am a pain physician and if you have any kind of queries please feel free to contact me.

Thank you