Spine Pain: 3 Rare but Severe Conditions that Might Affect You
By Christine Rhodes, MS | Reviewed By Forest Tennant, MD, DrPH | Article Featured on Practical Pain Management
Injuries, abnormalities, and gradual wear and tear can lead to the development of severe spine pain. With straining, twisting, and spraining, soft tissues around the spine can become inflamed, causing pain and muscle spasms over time. This pain can be very debilitating and cause a patient to significantly reduce their day-to-day activities.
The severe pain that accompanies the following rare spine conditions detailed below can affect you or a loved one. Being knowledgeable about these conditions can help you to speak to your doctor if you feel you may have similar symptoms.
Arachnoiditis
Inflammation is the body’s protective response to infection or injury, but when there are no foreign invaders to fight off, the immune system can damage its own tissues. Arachnoiditis means inflammation of the arachnoid, which is the middle layer of the spinal canal covering. This covering is like a pipe that encompasses the spinal cord, nerve roots (known as the cauda equina), and protective fluid that flows inside the canal. The prevalence of arachnoiditis is not officially known, but approximately 11,000 new cases occur each year.
The clinical term most often used for arachnoiditis today is adhesive arachnoiditis (AA), which means that the spinal canal covering has attached itself to nerve roots by adhesion. Factors such as aging, other chronic spinal conditions, obesity, lack of exercise, and genetics can lead AA to become more prominent. Historically, arachnoiditis has been caused by tuberculosis or syphilis infections, a puncture or injury to the spinal canal covering (including through obstetric epidurals, spinal injections, or spinal taps), surgery, trauma, viral infections. exposure to the toxic dyes used in myelograms, and preservatives used in epidural anesthesia or injections. The most common causes of AA are slipped or protruding discs, spinal canal stenosis (narrowing), osteoporosis, kyphoscoliosis (abnormal curvature of the vertebrae), and arthritis.
Medical interventions to treat a chronic spine disorder can inadvertently accelerate the inflammatory and adhesion process, according to Forest Tennant, MD, DrPH, intractable pain specialist and Editor Emeritus of PPM. Unfortunately, AA may cause severe neurologic damage and pain as it progresses and becomes a neuroinflammatory disease, entrapping nerve roots and destroying nerve cells. Fortunately, new magnetic resonance imaging (MRI) done with contrast dye now permits physicians to look for and diagnose AA in its early stage.
Common symptoms of adhesive arachnoiditis can include leg weakness, bizarre sensations (eg, bugs crawling) on legs and feet, and bladder and bowel dysfunction. Pain associated with the condition can be accelerated or relieved by changing positions; patients often cannot sit for very long and may find relief by lying on the floor, for example.
“In the past, adhesive arachnoiditis was considered a hopeless, progressive, and debilitating disease that could only be treated by symptomatic pain relief,” said Dr. Tennant. “Today, however, new therapeutic drugs, such as ketamine and low-dose naltrexone, and measures to help pull apart the scarred areas of the spinal cord such as stretching and massage therapy are bringing relief and recovery to these patients.”
Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a type of inflammatory arthritis that affects the spine, causing fusions of the bones and joints. The disease leads to stiffness, immobility and, in severe cases, changes in posture (such as kyphosis, which is the abnormal positioning of the upper spine into a “hunched back”). According to the John Hopkins Arthritis Center, recent population estimates indicate that the prevalence of AS in the United States is approximately 0.2% to 0.5%, and occurs more frequently in men than women (2:1). Age of disease onset usually peaks in the second and third decades of life. In addition, approximately 80% of patients with AS experience symptoms at around 30 years of age, while only 5% will present with symptoms around 45 years of age.
For most patients, an acute painful episode is followed by temporary remission when symptoms subside. However, patients may have severe pain and stiffness for long periods and others may develop AS-related symptoms in other parts of the body, such as anterior uveitis (inflammation) in the eyes. Most AS sufferers produce a genetic marker protein called the human leukocyte antigen B27 (HLA-B27), but many individuals with this marker never get AS while others can develop the condition without having the protein. According to the John Hopkins Arthritis Center, the prevalence of AS increases to approximately 5% among patients who are HLA-B27 positive.
Treatments for AS include pharmacologic agents that help to reduce inflammation as well as physical therapy and exercise to stay flexible and mobile. First-line medications to treat pain often include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Another class of drugs indicated for AS includes the disease-modifying antirheumatic drugs (DMARDs). These medications, which include methotrexate and sulfasalazine, work slowly to help reduce inflammation and slow the progression of the disease. Newer, promising agents include tumor necrosis factor (TNF) blockers, which suppress the body’s response to TNF, a chemical that causes inflammation, and may help slow the progression of AS. Available TNF blockers include infliximab, etanercept, adalimumab, certolizumab, and golimumab.
Transverse Myelitis
Transverse myelitis refers to inflammation that spans across the same section of the spinal cord, which may occur as a side effect of an infection such as Lyme disease or measles, or an autoimmune disease such as lupus or multiple sclerosis (MS). The annual incidence of transverse myelitis ranges from 1.34 to 4.6 cases per million and it occurs more often in females than males, with the highest cases being those between ages 10 and 19, and 30 and 39. Approximately 1,400 new cases of transverse myelitis are diagnosed each year, with 33,000 Americans having some type of disability resulting from the condition.
The inflammation causes damage to the area around the nerves, potentially resulting in scarring that blocks nerve impulses and leads to physical problems. Symptoms of transverse myelitis include back or neck pain, weakness or abnormal sensations in the arms or legs, or a loss of bladder or bowel control.
Treatment with corticosteroids, plasma exchange therapy (also known as plasmapheresis, often described as “blood cleansing” via transfusion), antiviral medication, pain medication, or immunosuppressants may relieve symptoms. Physical and occupational therapists are also provided to help patients relearn how to perform day-to-day activities. Most recovery occurs within three months, but recovery may take a year or more. About one-third of patients will recover completely after an episode of transverse myelitis. Another third may have lingering difficulties in walking, numbness or tingling, and bladder and bowel problems. Yet another third may need a wheelchair and ongoing assistance with activities.
Get the Help You Need
Although these conditions are relatively rare, anyone who experiences pain, weakness, or abnormal sensations in the back or neck, or even in their arms or legs, should talk to their doctor to get a proper diagnosis and seek out the necessary treatment provided above.
Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
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