Answers written by: Dr. Matthew Cunningham, Spine Surgeon
Q1. I’ve had RA since I was 17 – now told it’s actually lupus. It’s now getting to the point where I have an awful lot of joint damage. I also have osteoarthritis and osteoporosis. After MRI’s of the cervical and lumbar spine, I was told I had some ‘leakage’ in some of the cervical disks, nerve impingement and degenerative arthritis throughout. After bone scans, I’ve been told that I had a healed fracture and that it looked like I had been in a bad accident. My neck and lower back will hurt more often, but it usually eventually resolves itself. Despite my bone issues, I seem to have incredibly strong and healthy muscles. Is there anything I should be doing now to maintain that?
Despite the diagnosis of RA, most initial presentations for back pain are for muscular symptoms. Although it is a good idea to get it checked out, the initial management should be directed at the muscles as a pain generator, and include: relative rest, moist heat, massage to the area, and anti-inflammatories (if you can tolerate them) to relieve the spasm/inflammation flare symptoms. Physical therapy and “core” strengthening should follow.
Q2.After moving my apartment a few weeks ago, I’m having tingling and dull pain in my right upper back. It’s enough pain to cause me to lie down after being on my feet for a while – it’s the only position that relieves the pain. The pain started about a month before that, when I was on my feet for a long train commute and walking around everyday for a new job I recently started. Is this permanent? What should I do? I’m only 29 and have never had back problems.
The tingling that you feel in the upper back may be from a degenerating disk or a “slipped disk” in the Cervical spine, and should be checked out. Disks are made of 2 tissues: an inner nucleus pulposus and an outer annulus fibrosus. As disks degenerate they lose height and start to “sag” radically outward, which we would describe on an MRI or CT as a “bulging disk”. If the outer part of the disk should form a rip, and the inner part should “squirt out” then this is a “slipped disk” (or more technically a herniated nucleus pulopsus).
Q3. My daughter came home with a note from the school nurse saying that she may have scoliosis? What does this mean and what are my next steps? Are there warning signs I may have missed?
Scoliosis is a curvature of the spine, most easily seen as asymmetry of the back when you look directly from the back and compare Right to Left. We follow the spinal curvature both clinically with physical exam, and with x-rays, but the x-rays are the real definition. Measurements of the curvature are made by drawing lines from the vertebral endplates (called the Cobb Method), and angles that are 10 degrees and higher give the patient the diagnosis of scoliosis. She should be checked out by a spine specialist, and may need an x-ray to confirm the diagnosis. For minor curves serial exams are indicated, for bigger curves patients may need to wear a brace, and for very severe curves surgery may be required.
Matthew E Cunningham MD PhD is an orthopedic surgeon at HSS, specializing in Pediatric and Adult, Spine and Scoliosis surgery. Dr. Cunningham’s interests include minimally invasive and open surgery for spine deformity and degenerative conditions. He currently is the Interim Chief of the Scoliosis Service, Director of the John Cobb Scoliosis Fellowship, Principal Investigator of the Molecular and Cellular Spine Research Laboratory at HSS, and acts as a reviewer for Clinical Orthopedics & Related Research, Hospital for Special Surgery Journal, Journal of Orthopedic Research, Arthritis Research & Therapy Journal, Scoliosis Journal, Biochemistry Journal, American Academy for Laboratory Animal Science Journal, and Journal of Biomechanics.