Search this site
website search icon link
Article Listings
Expand All | Collapse All
Active Living
Full Listing with story descriptions
A Healthy Balance
Ankle Sprains
Active Kids, Healthy Kids
Active Kids in Winter
Athletic Skin Infections
Children, Nutrition & Exercise
Beat the Heat!
Cold Weather Workouts
Concussions
Core Stability
Cross Country Skiing
Exercise and Disabilities
Exercise and Menstrual Irregularities
Exercise in the Cold
Exercise in the Heat
Exercise is Medicine
Exercise Options
Exercising in Pregnancy
Female Athletes
FITT Prescription
Footwear for Running
From Surviving to Thriving
Flexibility
Gadgets & Gizmos
Get Moving!
Get Motivated
Golf Exercises
Golf Injury Prevention
Head Injuries
Hockey Injuries
Home Gyms
Immunization
Jump Start Weight Loss
Knee Cap Pain
Knee Ligament Injuries
Live Actively
Low Back Pain
Osteoporosis & Exercise
Osteoarthritis
Osteoarthritis of the Knee
Plantar Fasciitis
Prehistoric Workout
Prevention of Sports Injury
Proprioception
Recreational Safety Equipment
Running
Safe Snow Shovelling
Shin Splints
Ski Conditioning
Shoes & Fit
Sore Elbow
Sore Shoulder
Spinal Cord Injuries
Staying Active
Staying Fit in the Cold
Sports Nutrition & Supplements
Strength Training
Swimming Injuries
Teen Sports Injuries
Walking
Water and Exercise
Weight Training
7 Wonders of Walking
Adolescent Health
Full Listing with story descriptions
Acne
Adolescent Behaviour Problems
Adolescent Growth & Development
Body Image
Body Piercing
Bullying
Chronic Diseases in Teens
Communications Skills
Concussion in Sport
Cosmetics & Skincare
Dangers of Artificial Tanning
Depression
Depression - Causes
Drug Use
Female Physical Exam
First Period
Internet Safety
Junior High
Mentoring to Quit Smoking
Mononucleosis
Parent-Teen Communication
Parent -Teen Interaction Patterns
Personal Care
Psychological Assessment
School Problems
Self Esteem
Self Esteem & Body Image
Sexually Transmitted Diseases
Talking About Sex
Taking Chances
Tattoos
Teaching Respect
Teens & Smoking
Teenage Blues
Teen Bedwetting
Teen Drivers
Teen Girls
Teen Health
Teen Immunization
Teen Independence
Teen Rebellion
Teens & Divorce
Teenagers and Sexual Issues
Teens & Exercise
Water and Exercise
A Woman's Physical
Your First Job
Youth Violence
Ask the Doctor
Bone Density Testing
My Doctor Says I Need a Test
Childbirth
Full Listing with story descriptions
Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
Alcohol in Pregnancy
Building a Better Baby
Birthing Etiquette
Birth Plans
Birthing Procedure Trends
Bleeding in Pregnancy
Breastfeeding Benefits
Caesarean Section by Request
Care for the New Mother
Cord Blood Banking
Delaying Motherhood
Blue after Baby or Postpartum Depression
Diabetes in Pregnancy
Eating Well for Pregnancy
Evolving Ideas about Pregnancy and Birth
Exercise in Pregnancy
Flying During Pregnancy
Folic Acid in Pregnancy
High Blood Pressure in Pregnancy
Getting a latch on breastfeeding
Group B Streptococcus
Induction of Labour
Infections During Pregnancy
Intrauterine Growth Restriction (IUGR)
In-Vitro Fertilization
Low Birth Weight Babies
Medication & Pregnancy
Miscarriage
Managing Your Own Labour
Monitoring Your Labour
Nausea & Vomiting in Pregnancy
Pain Relief in Labour
Prenatal Classes
Preterm Labour
Planning a Pregnancy
Pregnancy Weight
Prenatal Care Providers
Postpartum Repetitive Strain Injuries
RH Disease
Rupture of Membranes Before Labour
Sex During Pregnancy
Skin Changes in Pregnancy
Smoking and Pregnancy
Support During Labour
Travelling While Pregnant
Ultrasound for Fun & Photos
Natural Remedies in Pregnancy
Pregnancy Weight Gain
Vaccinations During Pregnancy
Vacuum & Forceps for Delivery
Vaginal Birth After Caesarean
When Baby Comes Home
Childhood
Full Listing with story descriptions
Asthma in Children
Attention Deficit Disorder
Babysitter
Bed Wetting
Chickenpox
Childcare Options
Children's Headaches
Childhood Obesity
Choosing A Babysitter
Circumcision
Colds & Flu
Common Childhood Skin Infections
Croup
Developmental Milestones
Diaper Rash
Daytime Wetting
Introducing Solid Foods
Developmental Co-ordination Disorder
Diarrhea
Discipline
Earache
Eczema
Feeding Your Baby
Feeding Your Toddler
Fever
Head Lice
Hearing
How Children Grow
Hearing Loss
Hearing Issues in Newborns
Heart Murmers
Hip Clicks
Influenza
Iron
Is it an Emergency?
Children and Sports Injuries
Lazy Eye (Amblyopia)
Learning Disabilities
Leg Problems
Not Just Baby Fat
Orthodontics
Preparing for Lab Tests
Recognizing Learning Disabilities
Red Rashes
RSV-Childhood Respiratory Virus
Safe Summer Fun
School
Scoliosis
Sick Toddler
Sleep Struggles
Sniffles, Fevers, Rashes & Coughs
Sore Throats
Speech Problems
Strep Throat
Toddler Safety
Thumbsucking
Tooth Injuries
Travelling with Children
Tummyache
Urinary Tract Infections
Vaccinations
Vaccination and Autism
When to go to the Doctor
Whooping Cough
Worried Sick
Yeast Infections in Children
Chronic Pain
Full Listing with story descriptions
Introduction
Managing Your Pain
Movement Matters
Moving Forward
Nutrition
Opioids
Pacing
Pain Medications
Prevention
Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
Full Listing with story descriptions
Antibiotics and Dental Surgery
Baby Bottle Tooth Decay
Baby Teeth
Bad Breath (Halitosis)
Children's Dental Injuries
Choosing a Dentist
Cosmetic Dentistry
Mouth Guards
Dental Exam
Dental Care Devices
Dental Caries
Dental Care Offshore
Dental Implants
Dental X-Rays
Dentures and Healthy Jaw
Esthetic Dentistry
Fluoride
Fluoride Findings
First Dental Visit
Headaches
A Healthy Mouth
Healthy Mouth, Healthy Body
Jaw Joint and Muscle Problems
Keeping it Clean
Laser Use in Dentistry
Mouth Protection Equipment
Oral Cancer Screening
Oral Healthcare
Oral health and long term care
Oral Health Care Products
Orthodontics
Orthodontist First Visit
Painless Dentistry
Periodontal Disease
Removable Dentures
Root Canal
Seniors Oral Care
Sensitive Teeth
The Smile You Want
Sore Mouth, Aching Jaw
Snoring and Sleep Apnea
Smiling through the Senior Years
Teeth for Life
Temporomandibular Disorders (TMD)
Tobacco Risks to Oral Health
Tongue Piercing
Tooth Whitening
Travel Dentistry
Water Fluoridation
Wisdom Teeth
Your Healthy Smile
DIABETES
Full Listing with story descriptions
10,000 Steps
A1C Test
Accurate Blood Glucose Testing
Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
Alternate Site Testing
Artery Health
ASA Therapy
Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
Blood Glucose Myths
Blood Glucose Testing
Blood Glucose Testing Tips
Blood Sugar Lows
Blood Glucose Monitors
C-Peptide Testing
Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Celebrating Health
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Dangers of Uncontrolled High Blood Pressure
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
Diabetes Diet
Diabetes Distress
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
Diabetes and Oral Health
Diabetes and Thyroid Disease
Diabetes and Your Mouth
Diabetes and Your Eyes
Diabetes in Cats
Diabetes in Dogs
Diabetes Management ABCs
Diabetes Meter Technicians
Diabetes Myths
Diabetic Ketoacidosis
Diabetic Retinopathy
Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eating Well During Shift Work
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
Footwear and Foot Health
Fruits and Veggies
Gastroparesis
Gestational Diabetes
Get Active
Get Physical
Gift Ideas
Glucose Meters
Glycemic Index and Glycemic Loads
The Glycemic Index
Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
Hypoglycemic Unawareness
Impaired Glucose Tolerance
Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
Insulin Handling
Insulin - the Key to Energy Management
Insulin Pumps
Insulin Pen Needles
Insulin Pump Infusion Sets
Insulin Pump Therapy
Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
Insurance
Ketones
Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
Managing Blood Glucose
Metformin
Nutrition Food Labels
Meal Planning
Your Medication Expert
Medication Research Studies
Metabolic Syndrome
Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
Oral Health and Diabetes
Osteoporosis and Diabetes
Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
Preparing for Activity
Putting off Insulin
Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
Setting Goals for Physical Activity
Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
Social Media & Diabetes
Solving the Insurance Puzzle
Stress and Diabetes
Success in School
Supplements
Supporting Spouse with Diabetes
Sweeteners
Sugar, Carbs and Blood Glucose Control
Think Positive with Diabetes
Tiny Bites Equal Big Calories
Travelling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
Full Listing with story descriptions
ADHD in Children
Allergic Rhinitis
Allergies
Antibiotic Use
Arthritis
Aspirin Every Day?
Asthma
Back Pain
Back Pain Myths
Back Pain - Lower
Birth Control
Bladder Problems
Blood Transfusions
Breaast and Prostate Cancer Screening
Carpal Tunnel Syndrome
Check-Up
Colon Cancer Screening
Contact Lenses
Contraception
COPD
Cost of Doctor's Visit
Diabetes Management
Diarrhea
Diagnostic Tests
Do I Need a Bone Density Test?
Doctor Visit
Driving Vision
Dizziness
Dealing with Dry Eyes
Does My Sore Knee Require an MRI?
Do I Need an Annual Physical?
Eczema
Electronic Medical Records
Epilepsy
Eye Exam
Family Doctor
Fibromyalgia
Floaters and Flashes
Food Poisoning
5 Ways to Stay Healthy
Gallbladder
Get Active!
Glare
Headaches
Healthcare Teams
Heart Health
Hemorrhoids
Hepatitis C
Human Papilloma Virus
High Blood Pressure
High Blood Pressure Risks
How to Talk to Your Doctor
Hypothyroidism
Insomnia
Irritable Bowel Syndrome
Joint Replacement Surgery
Kidney Disease
Lazy Eye Blindness (Amblyopia)
Medical Digital Technology
Migraine
Meningitis
Multiple Sclerosis
Multiple Myeloma
Obesity
Opioid Myths
Primary Healthcare Reform
Prostate Problems
Quitting Smoking
Red Eyes
Respiratory Tract Infections
Restore Your Core
Rosacea
Screening Tests
Shingles
Sinusitis
Special Diagnostic Tests
Stopping Stroke
Stroke
Superbugs
Thyroid
Ulcers
Urine Tests
Vaccination Controversies (ask the doctor)
Win by Losing
Urinary Tract Infections
Vision Flickers
First Aid
Full Listing with story descriptions
Bites and Stings
Burns
Choking
Cuts and Scrapes
Emergency Care Guidelines
Eye Injuries
Fainting and Convulsions
First Aid Travel Kit
Hypothermia and Frostbite
Nosebleeds
Poisoning - Household
Sunburn
Growing Older
Full Listing with story descriptions
Advance Care Plans
Age-Related Macular Degeneration
Alzheimer Disease
Avoiding Memory Loss
Building Strength
Caring for the Caregiver
Cataracts
Can I see Well Enough to Drive?
Cholesterol
Congestive Heart Failure
Coping with Dementia
Constipation
Controlling Medications
C.O.P.D.
Delirium
Dementia and Agitation
Dizziness (Vertigo)
Eating Well
Elder Abuse
Exercise Benefits
Erectile Dysfunction
Eye Care
Eyesight and Driving
Feet
Frailty
Fungal Nail Infections
Get Active!
Glaucoma
Grief
Have Health, Will Travel
Health Tips for Seniors
Hearing
Incontinence
Joint Replacement
Lab Tests
Living Longer With Diabetes
Macular Degeneration
Male Menopause (Andropause)
Maintaining Quality of Life as You Age
Memory Loss
New Corneal Treatments
Nutrition for Seniors
Osteoarthritis
Osteoporosis
Parkinson Disease
Problem Gambling
Prostate Health
Retirement
Seniors and Medications
Senior Sexuality
Sexually Transmitted Infections
Screening Tests
Seniors and Driving
Sleeplessness
Skin Structure
Skin Protection
Skin Over 50
Solving Sleep Issues
Staying Healthy
Stroke Prevention
Travel Tips for Snowbirds
Wills and Personal Directives
Modern Living
Full Listing with story descriptions
Abuse
Acupuncture
Adult ADHD
Aging and Memory
Alcohol and Your Health
Anger Management
Antidepressants
Barbecue Basics
Bathtub Safety
Binge Drinking
Bisphenol A
Canada's New Blood System
Caring for a Loved One Dying at Home
Carpal Tunnel Syndrome
Computer Stress
Coping With Change
Cosmetic Surgery
Cosmetic Pesticides
Depression
Diabetes Epidemic
Discipline
Diseases from Pets
Downsizing
Dying at Home
Erectile Dysfunction New Treatments
Exotic Travel
Fertility Issues
Fetal Alcohol Spectrum Disorder
Foodborne Illness
Flu Pandemic
Grief
Harassment
Healing Through Music
Healthy Computing
Humidex
Hypnotherapy
Ice Safety
Indoor Air Quality
Lymphedema
Mature Student
Melamine in Food
Middle Age Health
Mind-Body Connection
Mom Time
Money Matters
Outdoor Workers and Sun Safety
Patient Safety in the Hospital
Pets and Health Benefits
Pet Therapy
Physiotherapy Visit
Planning for End of LIfe
Reproductive Freedom
Safe Drinking Water
Schizophrenia
Smokeless Tobacco
Sexually Transmitted Diseases
Soy
Stigma of Mental Illness
Street Drugs
Stressed or Depressed?
Stress in the Workplace
Stress Leave
Swim to Survive
Sunburn
Sunglasses
Time Management
Travel Health Protection
Travel Comfort Tips
Travel Immunization
Understanding Change
Unplugging
Whiplash
Wind Chill Index
Workplace Drug Testing
Workplace Health
Nutrition
Full Listing with story descriptions
5 Tips to Manage Weight
10 Ways to Cut Down on Fat
Battle the Bulge
Boost Your Bone Strength
Body Image
Breakfast is Important
Bowel Health
Building Your Bones
Celiac Disease
Challenging the Milk Myth
Diet Reality Check
Drink Up!
Eating Smarter & Cheaper
Energy Drinks
Food Allergies
Food for Active Kids
Fast Food
Food Labels
Giving Up Gluten
Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
Healthy Eating for Seniors
Healthy Eating on Business Travel
Healthy Ethnic Meals
Fad Diets
Fruits & Veggies - 5-10 a Day
Fats
Fat Phobias
Fats & Cholesterol
Feeding Your Kids
Fibre
Food Chemistry 101
Food and Mood
Getting Kids to MOVE
Healthy Eating for Teens
Healthy Habits
Herbal Medicine and Nutrition
New Ingredients for Your Shopping Cart
Iron
Kid's Food
Liquid Candy
Meal Planning with Planned Overs
Mercury Levels in Fish
Night Snacking
Night Shift Eating
Nutrition on the Net
Nutrition Myths Busted
Nutrition Questions Top 5
Nutrition for Menopause
Essential Omega-3
Preventing Cancer Through Nutrition
Picky Eaters
Power of Fruits & Veggies
Portion Control
Power Lunch
PMS and Nutrition
Preparing for Surgery
Probiotics
Reducing High Blood Pressure
Replacement Meals
Sensible Snacking
Sodium
Sodium and Blood Pressure
Sports-Minded Nutrition
Sugar Substitutes
Survive and Thrive
Teen Nutrition
Tips for a SuperDiet
Understanding Food Biotechnology
Vacation Eating
Vitamins D
Vitamins and Minerals
Vegetarian Diet
Weight Loss
Weight Wise Tips
Pharmacy Care
Full Listing with story descriptions
After a Heart Attack
Adverse Drug Reactions
Adult Vaccinations
Allergy Attack
Antibiotic Overuse
New Anticoagulant Medications
Inhaled Asthma medications
Arthritis Medications
Biologics
Biological Response Modifiers
Blood Pressure Monitoring
Blood Thinners
Calcium and Iron Supplements
Changing Role of the Pharmacist
Children's Cold Remedies
Child's Fever
Choosing Sunscreens
Cold Relief
Cold Sores
Constipation and Haemorrhoids
Diuretics and Potassium Supplements
Drug Recalls and Withdrawals
Drug Interactions
Emergency Contraception
Erectile Dysfunction
Expanding Role of Pharmacies
Eye Protection - Sunglasses
Feminine Hygiene
Generic or Name Brand?
Heartburn
Heart Health
Insomnia
Kids and Cold Medications
Medication Questions?
Metabolic Syndrome
Natural Medicines
New Blood Thinners
Non-Steroidal Anti-Inflammatory Drugs
Obesity Medication
Over-the-Counter Drugs
Over-the-Counter Pain Relievers
Over-the-Counter Drugs and Pregnancy
OTC Pain Relief
Packing Medications for Travel
Pharmaceutical Studies
Preventing Summer Hazards
Research Studies
Quit Smoking
Skin and Cosmeceuticals
Sports & Nutrition Supplements
Sunscreen
Taking Medication
Take as Directed
Using Antibiotics Wisely
Viagra
Vitamin D
Yeast Infections
Your Best Shot
Your Medicine Cupboard
Prevention
Full Listing with story descriptions
Accident Prevention
Alcohol
Antibiotic Resistance
Backpack Pain
Bacteria Fight Back
Bedbugs
Disaster Planning
Diseases from Pets
Caffeine
Cell Phones and Driving
Childhood Obesity
Cancer Prevention Tips
Chronic Disease Prevention
Cold and Flu Season
Disaster Planning
Diseases from Pets
Distracted Driving
E-cigarettes
Farm Safety for City Kids
Foodborne Illness
Flu Pandemic
The Flu and You
Heading Home for a Visit
Health Tips for Snowbirds
Hearing Loss and Music Players
H1N1 Virus - Plan Ahead
Household Mould
Infection Control
Injury Prevention
Live Actively!
Insect Repellant
Keys to Preventing Cancer
Kids' Mental Health
Live Actively!
Low Birth Weight
Meningitis
Norovirus
Are Pesticides Safe?
Preventing Burns and Scalds
Preventing Cancer through Nutrition
Quit Smoking 101
Respiratory Infections
Seniors and STIs
Should You Immunize?
Sun Safety
Surviving Disaster
Sushi Preparation
Teens, Drugs and Driving
Travel Health Considerations
Travel Medicine 101
Travel Tips
Type 2 Diabetes Prevention
Water Smarts
Vision Damage
Water Wisdom
West Nile Disease
Whooping Cough
Workplace Alcohol Abuse
Women's Health
Full Listing with story descriptions
15 Great Reasons to Breastfeed
Anemia
Approaching Menopause
Birth Control
Breast Cancer Screening
Breast Cancer - Genetic Risks
Breast Cancer Self-Exam
Breast Cancer Screening Guidelines Changes
Breast Health
Breastfeeding Myths
Cervical Cancer Screening
Contraception
Contraception for Mature Women
Cosmetic Procedures
Cystitis
Endometriosis
Estrogen's Effect on the Brain
Fear of Fracture
Fibroids
Heart Attack
Hirsutism - Unwanted Hair
Hormone Replacement Therapy
The IUD
Menopause - What Men Should Know
Menstrual Bleeding - Abnormal
Menstrual Bleeding - Heavy
Menopause
Menstruation Myths
Menstrual Pain
Third Generation Birth Control Pills
Osteoporosis
Ovarian Cancer
Ovarian Cysts
Oral Contraction (The Pill)
Pap Test
Premenstrual Syndrome
Sexually Transmitted Infections
Urinary Incontinence
Vaginitis
Varicose Veins
Viagra for Women
Yeast Infections
Your Pelvic Floor
Family Health Online / Pharmacy at Safeway
spacer   spacer pharmacy image pharmacy
Family Health Magazine - FAMILY MEDICINE

Explaining Spine Surgery
Surgery for sciatica takes the pressure off

The combination of two irresistible forces — time and gravity — creates the need for spinal surgery. Even though teens undergo it, most people are in their fifties, sixties and seventies. Many suffer from chronic back pain after years of wear and tear on their spines. Various factors cause advanced degenerative disc disease (DDD). We don’t know why some people have more symptoms than others. Genetics appears to influence the effects of aging and mechanical loading of the spine.

Normal spine
Spine with stenosis

An aging back

As we get older, the spongy discs between the vertebrae in our spines (see spine anatomy sidebar below) slowly dehydrate. They become less able to cushion against the shocks of daily living. This happens often, and without symptoms. Surprisingly, studies using magnetic resonance imaging (MRI) reveal that about a third of people in their thirties show signs of disc degeneration.

By the time we reach our seventies, degenerated discs are common. About 70 per cent of people in that age group are affected. As gravity makes vertebrae press down on the discs, we literally feel the weight of years in our spines. Indeed, up to several centimetres in height may be lost as the discs and spine settle with normal aging.

Disc thickness is not the only change to affect the spine with age. Sometimes, the tough outer lining (annulus fibrosus) that encircles the disc’s spongy centre weakens and tears.

The smooth gliding surfaces of the facet joints may also roughen and undergo bony remodelling, much as osteoarthritis thickens the knuckles. After years of tiny movements, even the dense bone of the vertebrae can wear at the edges. Bony spurs may also develop, irritating surrounding soft tissues.

Such structural changes can lead to spinal stenosis, a narrowing of the spinal canal’s interior. Like degenerating discs, spinal stenosis becomes common as we age. Many people have few symptoms.

Over time we all experience changes in the structure of our spines. As the spine ages, a disc bulge is likelier to become a more serious herniated disc. (This is also referred to as a ruptured, extruded, sequestrated or slipped disc.) Still, a disc bulge or even herniation is common, and often does not lead to significant clinical symptoms.

Disc herniation occurs when a weakness in the structure of the annulus fibrosus gives way. A small portion of the inner disc’s more gelatinous spongy centre is pushed out (extruded). It is a bit like squeezing toothpaste out of a tube once you have broken the aluminum seal. Many people with this problem do not remember a specific event - pain just appears one day. Disc tissue is most often forced out between the L4 and L5, or L5 and S1 vertebrae. If disc tissue pushes into the spinal canal and presses on nerve tissue, severe sciatica may result.

Following the nerve pathway to identify pain

The sciatic nerve system branches out from the low back between the L4, L5 and sacral (S) vertebrae, and runs down through the buttocks and legs into the feet. Depending on which area of the sciatic nerve system the bulging disc is pressing against, the pain will follow a distinct pathway down the leg towards the foot. These pain patterns help diagnose where the problem disc is located.

Sciatica can vary from mild tingling to completely disabling pain. Sneezing, coughing or laughing can cause a stab of pain. Standing or sitting for long periods make pain worse. Nerve pathways that control the bladder and bowel can also be affected, as they branch off in the lower back and sacrum.

Conservative Non-surgical treatment of sciatica

Before considering spine surgery to relieve sciatica symptoms, most doctors will prescribe treatment that might include:

  • medication for inflammation, like ibuprofen.
  • medication such as acetaminophen combined with codeine, which reduces sciatic pain.
  • other medications that ease nerve-related pain.
  • active therapies including physiotherapy to stretch and exercise muscles, relieving spasms. This would gradually progress to exercises that rebuild core torso muscles supporting the back.
  • passive therapies including applying heat or cold, ultrasound, massage, and acupuncture.

If symptoms do not significantly improve after trying conservative treatment (see sidebar), surgery may be needed. Discs have a very limited capacity for self-repair and do not regenerate. Once the disc is squeezed out, it cannot be pushed back in — although the body often absorbs a portion that has extruded. With a herniated disc, the extended portion of the disc that is pressing on a nerve root may require removal. The bulk of the remaining disc is left intact to act as a shock absorber. Occasionally, sciatica eases even though the herniated part of the disc does not shrink. In such cases, the nerve has adjusted to its new environment.

Microdiscectomy

The most common operation that spine surgeons perform is called a microdiscectomy. Done for severe disc herniation, this relieves pressure on the affected nerve root.

First, the ruptured disc is located using CT (also known as CAT) scans or MRIs. Nerve PathwaysThis helps to plan for surgery. During surgery, the space between the affected vertebrae is entered through the back of the spine. To get there, a bit of bone from the bottom and top of the adjacent lamina often must be cut away. The lamina forms the arching walls that make up the back of the spinal canal. Using this widened entry, the surgeon searches for the nerve root that is under pressure. Once it is found, the nerve fibre is protected and gently teased to one side to allow access to the ruptured portion of the disc. Finally, the extended portion of disc tissue is removed, leaving the remaining disc largely intact. Taking pressure off the nerve root helps stop the irritation and creates more room for the nerve.

Rates of recovery from surgery vary. Patients having routine disc surgery often go home the same day. Depending on age, general health and motivation, some return to their daily routines in a few weeks. Others can take three to six months to recover.

Partial removal of the disc can affect the spine’s ability to carry heavy loads. The remainder of the disc must adapt to make up for the missing part. The risk of another portion of the disc herniating is approximately 15 to 20 per cent. Patients can expect significant improvement following surgery, but they may not have a 100 per cent recovery.

Spinal fusion

Disc herniation and sciaticaAfter decades of wear and tear, the spine’s vertebrae may no longer align properly. They are like a wobbly column of building blocks. One vertebra may slip forward on top of another, grinding back and forth, often putting pressure on nerve roots. Thanks to this, spinal fusion is the second most common procedure that spine surgeons perform. In this surgery, a section of the spine is immobilized to provide stability and pain relief. Usually, it is needed in the lower back.

The surgeon places a bone graft along the spine segment to be fused. The graft may come from the patient, an organ donor, or be made of a synthetic material. As it can take a year or two for the graft to fully integrate into nearby bone, metal alloy (often titanium) rods and screws form an internal splint to keep the vertebrae in place. Corrective wedges made of metal alloy or synthetic materials may be placed between two vertebrae to restore balance and supply more area for additional bone graft. Once the spine has fused, the rods and screws stay in place unless they cause irritation.

Most people are comfortable after a month or two. However, it often takes six months to a year to really get back to normal.

Repairing stenosis

For stenosis, the goal is to enlarge the spinal canal to provide more room for the spinal nerve elements. As with disc herniations, stenosis can cause severe nerve pain that radiates into the legs. Pain is often made worse by walking and relieved by rest. In people for whom conventional non-surgical therapies do not work, pain due to a compressed nerve can be improved with surgery. However, back pain from the wear-and-tear process that caused the stenosis will remain.

During surgery, ‘surgical decompression’ widens the canal where it has narrowed by removing part of the lamina. If necessary, some disc material and bony spurs will be removed too. This takes pressure off the nerve. If the spine is also unstable, spinal fusion (see above) may be done along with surgical decompression surgery. Recovery can take three to six months.

Success rates

Patients often ask spine surgeons about success rates. This question must be answered carefully since it is vital to have realistic expectations.

Spine surgery can be very successful. It usually helps pain from nerve compression (the radiating nerve symptoms in the legs). Surgery also relieves painful nerve pressure and stabilizes the spine. However, it is hard to relieve the low back pain that comes from mechanical degeneration. Nor can surgery reverse or cure arthritis – one reason why about one in four people may need a number of spinal procedures throughout life.

The future of spine surgery

You may wonder why we can replace hips and knees but not discs. Artificial discs have been around for some 30 years now. The first ones did not work well at all. Today’s discs are better. However, while early results are encouraging, mid- to long-term results are less so. Much controversy still exists about artificial discs. Part of the difficulty is that often people have more than one problem with their spines.

At present, we do not have a good way to replace discs and joints over multiple levels or do a comprehensive ‘total back replacement.’ Still, with better understanding of hip and knee replacements, we may yet translate that knowledge to successfully treat arthritic backs. Emerging research into biologic strategies holds tremendous promise. For instance, tissue engineering and regenerative medicine may one day slow or ward off degenerative disc disease.

Spine Anatomy

The spine serves as a mechanical connection between the arms and legs. It is also the central pathway for the spinal cord and the nervous system. At each level of the spine, individual nerves branch off from the spinal cord and spread through the body. They allow the brain to control body movement and function.

Four sections of the spineThe spine is a column of 24 bones, which doctors think of in four sections.

  • The neck (or cervical spine) consists of seven vertebrae. Nerves in this section generally control the arms and hands.
  • The middle back (thoracic spine) is made up of twelve vertebrae. Nerves here control the chest and abdomen.
  • The low back (lumbar spine) has five vertebrae. The nerves control the legs and feet.
  • The sacrum is a bony structure that connects the spine with the pelvis. Nerves in this region control the bowel and bladder.
  • At the end of the sacrum are two to three partly fused bones that make up the tailbone (coccyx).

Shock-absorbing discsBetween each vertebra are shock-absorbing discs. They have a gel-like core surrounded by a tough fibrous ring called the annulus fibrosus. This makes the discs both elastic and durable. The lumbar spine and pelvis support much of the body’s weight. This pressure is why most bulging or ruptured discs happen between the fourth and fifth lumbar vertebrae and the sacrum (labelled as L4, L5, and S1).

 

The top view of a vertebraSeen from above, a single vertebra looks a bit like a bird’s foot. The spinous process, flanked on each side by the transverse processes, could be the toes, while the curved body of the vertebra could be the heel. The lamina is the smooth back covering of the spine between the transverse and spinous processes. Just above the lamina, and level with the top of the body of the vertebra, are two structures like pedestals, called the facet joints. Together, these various parts form an arched central canal through which the spinal cord passes. When the spinal cord reaches the lumbar region, it splits into bundled strands of nerve root.

More articles from this section
Article Listing
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [FM_FHb10]
Articles in the Family Medicine section of Family Health OnLine are sponsored by: Safeway ad
Articles in this section of
Family Health OnLine are sponsored by:
Safeway Ad