Spine & spinal cord

The discs between the bones of the spine act as cushions. When part of a disc bulges or breaks through its outer layer (a slipped or prolapsed disc), it can press on a nearby nerve root. In the lower back this often causes sciatica: pain that spreads from the buttock down the leg, sometimes with numbness, tingling or weakness.

Assessment starts with your symptoms and a neurological examination of strength, sensation and reflexes. An MRI scan of the spine shows the discs and nerves, and is arranged when the findings suggest nerve compression or when symptoms are not settling.

Many people improve without surgery, with time, pain relief, physiotherapy and staying active. Depending on the condition, surgery such as a discectomy may be considered where there is significant nerve compression, weakness that is getting worse, or pain that continues despite appropriate non-surgical treatment.

The cervical spine is the part of the spine in the neck. With age, the discs and joints can wear (cervical spondylosis), and a disc can bulge or slip. This may cause neck pain, or pain, numbness, tingling or weakness spreading into the shoulder, arm or hand when a nerve root is pressed on (cervical radiculopathy).

The doctor examines your neck, arm strength, sensation and reflexes, and checks for signs that the spinal cord itself is affected. An MRI scan of the neck is arranged where needed, and X-rays or CT may be used to look at the bones and alignment.

Depending on the condition, treatment may include observation, medicines and physiotherapy. Surgery to relieve pressure on the nerve or spinal cord, such as a cervical discectomy, foraminotomy or decompression, may be considered where symptoms are severe, persistent or getting worse.

Spinal stenosis is narrowing of the spinal canal or of the openings where the nerves leave the spine, usually caused by wear of the discs and joints and thickening of the ligaments. In the lower back it can cause pain, heaviness or numbness in the legs on walking or standing that eases when you sit or bend forward (neurogenic claudication).

In the neck, narrowing can press on the spinal cord itself (cervical myelopathy). Signs include clumsy hands, difficulty with buttons or writing, numbness, and unsteady walking. These changes may come on gradually and are easy to put down to age, so they are worth having checked.

Assessment includes a neurological examination and an MRI scan. Depending on the condition, treatment may include observation with regular review, medicines and physiotherapy, or decompression surgery to relieve pressure on the spinal cord or nerves.

Tumours can grow in the bones of the spine (vertebrae), within the spinal canal around the spinal cord, inside the spinal cord itself, or along the nerve roots. Some start in the spine; others have spread from cancer elsewhere in the body (spinal metastases). Many spinal tumours are not cancerous, but they can still press on the spinal cord or nerves.

Symptoms may include back or neck pain that is persistent or worse at night, pain spreading into the arms or legs, numbness, weakness, or changes in bladder or bowel control. An MRI scan with contrast is the main test, and CT, a biopsy or other tests may be needed to confirm the type of tumour.

Depending on the tumour, management may include imaging surveillance, biopsy, surgical decompression, removal of the tumour, and stabilisation of the spine. Radiotherapy, chemotherapy and other oncology treatment are arranged with partner specialists as part of a multidisciplinary plan.

A vertebra can break after a fall, accident or sports injury. In people with osteoporosis (thinning of the bones), a vertebra can collapse after a minor fall, lifting, or sometimes with no clear injury. This is called a vertebral compression fracture, and it often causes sudden back pain that is worse on standing or moving.

Assessment includes an examination and imaging: X-rays, CT to show the bone, and MRI to show whether the fracture is recent and whether the spinal cord or nerves are affected. Bone health is also considered, as treating osteoporosis helps lower the risk of further fractures.

Many fractures heal with pain relief, a period of rest and support, and a brace where suitable. Depending on the fracture, vertebral augmentation (vertebroplasty or kyphoplasty) may be considered for selected painful compression fractures, and surgery to decompress or stabilise the spine where a fracture is unstable or is pressing on the spinal cord or nerves.

Spinal instability means the vertebrae move more than they should. One example is spondylolisthesis, where one vertebra slips forward over the one below, which can narrow the spinal canal and press on the nerves. Instability can also follow wear and tear, injury, tumours or previous surgery.

Spinal deformity includes scoliosis (a sideways curve of the spine) and kyphosis (a forward rounding). Assessment looks at your symptoms, your posture and nerve function, and imaging such as standing X-rays, CT and MRI.

Some people continue to have pain or nerve symptoms after spine surgery, or develop new problems at nearby levels. A revision assessment reviews your history, previous operations and new imaging to understand the cause and discuss whether further treatment, surgical or non-surgical, may help.