The Spine

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry


The vertebral column consists of 7 cervical vertebrae, 12 thoracic, 5 lumbar and 5 sacral vertebrae (fused to form the sacrum) and 5 small vertebrae fused to form the coccyx. It radiates pain arising from the neck and low back and the spine. Common clinical syndromes associated with cervical spondylosis are myelopathy and radiculopathy and both syndromes are distinct. The prevalence of low back pain in the elderly is reported to range between 13 and 49%. The aetiology of back pain may be different in older people. As the patients get older, the diagnostic probabilities as to their prevalence change, such as malignancy/neoplasia, compression fractures, spinal stenosis and aortic aneurysms. Spinal stenosis due to hypertrophic degenerative processes and degenerative spondylolisthesis is more common in older people.


Neck pain Low back pain Cervical spondylosis Myelopathy Radiculopathy Spinal stenosis 


  1. 1.
    AANS. Anatomy of the spine and peripheral nervous system.…retrieved 4 March 2015.
  2. 2.
    Moulton A. Understanding Spinal Anatomy-Overview of the spine. retrieved 4 March 2015.
  3. 3.
    Merck Manual. Overview of spinal cord disorders. Retrieved 4 March 2015.
  4. 4.
    Nogradi A, Vrbova G. Anatomy and physiology of the spinal cord. Madame Curie Bioscience Database (Internet). Austin (TX): Landes Bioscience; 2000. Retrieved 4 March 2015).Google Scholar
  5. 5.
    Shedid D, Benzel EC. Cervical spondylosis anatomy: pathophysiology and biomechanics. Neurosurgery. 2007;60(1Suppl 11):S7–13.PubMedGoogle Scholar
  6. 6.
    Lestini WF, Wiesel SW. The pathogenesis of cervical spondylosis. Clin Orthop relat Res. 1989;239:69–93.Google Scholar
  7. 7.
    Adams RD, Victor M. Disease of the spinal cord, peripheral nerve and muscle. In: Adams RD Victor M. eds Principles of Neurology. 5th ed. New York, McGraw-Hill, Health Professionals Division. 1993: 1100.Google Scholar
  8. 8.
    Brain NR, Northfield D, Wilkison M. The neurological manifestations of cervical spondylosis. Brain. 1952;75:187–225.CrossRefPubMedGoogle Scholar
  9. 9.
    Heller J. Chronic neck pain. Spine – retrieved on 30 April 2008.
  10. 10.
    Good D. Numb and clumsy hands in cervical spondylosis. Surg Neurol. 1988;22:285–291.CrossRefGoogle Scholar
  11. 11.
    Denno JJ, Meadows GR. Early diagnosis of cervical spondylotic myelopathy. A useful clinical sign. Spine (Phila Pa 1976).1991;16:1353–1355.CrossRefGoogle Scholar
  12. 12.
    Watson JC, Broaddes WC, Smith MM, Kube WS. Hyperactive pectoralis reflex as an indication of upper cervical spinal cord compression. Report of 15 cases. J Neuro Surg. 1999;86:159–61.Google Scholar
  13. 13.
    Swagerty DL Jr. Cervical spondylotic myelopathy: a cause of gait disturbance and falls in the elderly. Kans Med. 1994;95(10:226–7;229.PubMedGoogle Scholar
  14. 14.
    Schwarz SS, Evans RW. Cervical spondylotic myelopathy. MedLente Neurology, 1992. updated July 12, 2014. Retrieved 3 March 2015.
  15. 15.
    Kawabori M, Hida Y, Yano S, Iwasaki Y. Cervicogenic headache caused by lower cervical spondylosis. No Shinkeu Gika. 2001;37(5): 491–5.Google Scholar
  16. 16.
    Pollmann W, Keidel M, Pfaffenrath V. Headache and the cervical spine: a critical review. Cephalagia. 1997;17(8):801–16.CrossRefGoogle Scholar
  17. 17.
    Rana SS. Diagnosis and management of cervical spondylosis. Clinical presentation. accessed 26 September 2015.
  18. 18.
    Umerah BC, Mukherjee BK, Ibekwe O. Cervical spondylosis and dysphagia. L Laryngol Otol. 1981;95(11):1179–83.CrossRefGoogle Scholar
  19. 19.
    Kanbay M, Seleuk H, Yilmaz U. Dysphagia-caused by cervical osteophytes: a rare case. J Al Geriatr Soc. 2006;54(3):1147–8.CrossRefGoogle Scholar
  20. 20.
    Sobol SM, Reginald R. Anterolateral extrapharyngeal approach for cervical osteophyte-induced dysphagia. Literature review. Ann Oral Rhinol Laryngol. 1984;93(5Pt 1): 498–504.CrossRefGoogle Scholar
  21. 21.
    Young WT. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000, 62(5): 1064–1070.PubMedGoogle Scholar
  22. 22.
    Al-Shatoury HAH, Galhom AA, Wagner FC. Cervical spondylosis 2007.e medicine.
  23. 23.
    Fehlings MG, Skat G. A review of the pathophysiology of cervical spondylotic myelopathy with insights for potential novel mechanisms drawn from traumatic spinal cord injury. Spine (Phila Pal.1976); 1998;23(24):2730–7.CrossRefGoogle Scholar
  24. 24.
    McCormack WE, Steinmetz MP, Benzel EC. Cervical spondylotic myelopathy: make the differential diagnosis then refer for surgery. Cleve Clin J Med. 2003;70(10): 899–904.CrossRefGoogle Scholar
  25. 25.
    Fukushima T, Takaski I, Taoka Y, Takta S. MRI study of spinal plasticity in patients with cervical compression myelopathy. Spine. 1991;16:534–538.CrossRefGoogle Scholar
  26. 26.
    Bressler HB, Keye WJ, Rochon PA, Badley E. The prevalence of low back pain in the elderly: A systematic review of the literature. Spine. 1999;24(17):1813–1819.CrossRefPubMedGoogle Scholar
  27. 27.
    Thomas E, Silman AL, Croft PR, Macfarlane C. Predicting who develops chronic low back pain in primary care: a prospective study. Br Med J. 1999;318:1662–7.CrossRefGoogle Scholar
  28. 28.
    Docking RE, Fleming J, Brayne C, Zhao J, Macfarlane GJ, Jones GT. On behalf of the Cambridge City ovr-75s Cohort Study collaboration. Epidemiology of back pain in older adults: prevalence and risk factors for back pin onset. Rheumatology. 2011.
  29. 29.
    Deyo RA, Weinstein JN. Low back pain. New Eng J Med 2001;344(5): 363–6369.CrossRefPubMedGoogle Scholar
  30. 30.
    Hart LG, Deyo RA., Cherkin DR. Physician office visits for low back pain, frequency, clinical evaluation and treatment patterns. US National Survey. Spine. 1995;20:31–9.Google Scholar
  31. 31.
    Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268: 760–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Boyajean-O’Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome. An Osteopathic Approach. J Am Osteopath Assc. 2008;108(11):657–664.CrossRefGoogle Scholar
  33. 33.
    Te Poorten BA. The piriformis muscle. J Am Osteopath Assoc 1969;69:150–160.Google Scholar
  34. 34.
    Foster MR. Piriformis syndrome. Orthopedics 2002;25:821–825.PubMedGoogle Scholar
  35. 35.
    Erdem LO, Erdem CZ, Gundogdu S, CAgavi F, Katayci M, Aclkgoz B. The role of three dimensional MR myelography in lumbar discogenic disease. Tani Girisim Radyol. 2004;10(3):189–95.PubMedGoogle Scholar
  36. 36.
    Hutchinson C, Hanger C, Wilkinson T, Sainsbury R, Pithie A. Spontaneous spinal infections in older people. Int Med J. 2009;845–848.Google Scholar
  37. 37.
    Akutota V, Lento P, Sowa G. Pathogenesis of lumbar spine stenosis pain.: why do an asymptomatic stenotic patient flare? Phys Med Rehabil Clin North Amer. 2003;4:17–28.CrossRefGoogle Scholar
  38. 38.
    Katz JN, Dalgas M, Struki G, Katz NP, Bayley J, Fossela H, et al. Degenerative lumbar spinal stenosis: diagnostic value of the history and physical examination. Arthritis Rheum. 1995;38:1236–41.CrossRefPubMedGoogle Scholar
  39. 39.
    Hilibrand AS, Rand N. Degenerative lumbar stenosis: diagnosis and management. J Am Acad Orthop Surg. 1999;7:239–49.CrossRefPubMedGoogle Scholar
  40. 40.
    Truumees E. Spinal stenosis: pathophysiology, clinical and radiologic classification. Instrcourse Lect. 2005;54:287–302.Google Scholar
  41. 41.
    Schaberg J, Gainor BJ. A profile of metastatic carcinoma of the spine. Spine. 1985;10 (1):19–20.CrossRefPubMedGoogle Scholar
  42. 42.
    Orthoinfo. Acute spondylolisthesis in the low back. Retrieved 6 March 2015.
  43. 43.
    Manchikanti L, Manchikanti KN, Cash KA, Singh V, Giordano J. Age-related prevalence of facet-joint involvement in chronic neck and low back pain. Pain Physician. 2008;11(1):67–75.PubMedGoogle Scholar
  44. 44.
    Hicks GE, Morone N, Weiner DK. Degenerative lumbar disc and facet disease in older adults: prevalence and clinical correlates. Spine(Phila Pa. 1976):2009;34(12):1301–6.CrossRefGoogle Scholar
  45. 45.
    Jackson RP. The facet syndrome, myth or reality? Clin Orthop. 1992;279:110–121.Google Scholar
  46. 46.
    Lippitt AB. The facet joint and its role in some pain management with facet joint injections. Spine. 1984;9:746–750.CrossRefPubMedGoogle Scholar
  47. 47.
    Maus T. Imaging the back pain patient. Phys Med Rahabil Clin N Am. 2010;21(4):725–66.CrossRefGoogle Scholar
  48. 48.
    Rudy TE, Weiner DK, Lieber SJ, Slaboda J, Boston JR. The impact of chronic low back pain on older adults. Pain. 2007;131(3): 293–301.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Arthritis Research UK: OA Nation 2012: The most comprehensive UK report of people with osteoarthritis. 2012 UK: Arthritis Research.Google Scholar
  50. 50.
    Verne RK. Deaths in older adults in England.2010. National End of Life Intelligence Network: Leicester.Google Scholar
  51. 51.
    Thomas E, Peat G, Harriss L, Wilkie R, Croft PR. The prevalence of pain and pain interference in general population of older adults.: cross sectional findings from North Staffordshire Osteoarthritis Project (NorStOP). Pain. 2004;110:361–368.CrossRefPubMedGoogle Scholar
  52. 52.
    Gibson SJ, Farrell M. A review of age differences in the neurophysiology of nociception and perceptual experience of pain. Clin J Pain. 2004;20(4):227–39.CrossRefPubMedGoogle Scholar
  53. 53.
    Gibson SJ, Katz B, Corran TM, Farrell MJ, Helme Rd. Pain in older persons. Disabil Rehabil. 1994;16(3):127–39.CrossRefPubMedGoogle Scholar
  54. 54.
    Wittink HM, Rogers WH, Lipman AG, McCarberg BH, Ashburn MA, Oderda GM, et al. Older and younger adults in pain management programs in the United States: differences and similarities. Pain Med. 2006;7(2):151–63.CrossRefPubMedGoogle Scholar
  55. 55.
    Helme RD, Gibson SJ. Pain in older people. In:Crombie IK, editor. Epidemiology of Pain. Seattle: IASP Press;1999.pp 103–112.Google Scholar
  56. 56.
    Knauer SR, Freburger JK, Carey TS. Chronic low back pain among older adults: A population-based perspective. J Aging Health. 2010;22(8):1213–1234.CrossRefPubMedGoogle Scholar
  57. 57.
    Weiner DK, Haggerty CL, Itchevsky SB, Harris T, Sinomsick EM, Nevitt M, et al. How does low back pain impact physical functioning independent well-functioning older adults? Evidence from the Health ABC cohort and implications for the future. Pain Med. 2003;4(4):311–20.CrossRefPubMedGoogle Scholar
  58. 58.
    Telci EA, Yagci N, CAN T, Cavlak U. The impact of chronic low back pain on physical performance, fear avoidance beliefs and depressive symptoms: A comparative study on Turkish elderly population. Pak J Med Sci. 2013;29(2):560–564.Google Scholar
  59. 59.
    Van Tuldar MW, Koes B, Bombardier C. Low back pain Clin Rheumatol. 2002;16:761–75.Google Scholar
  60. 60.
    Mosher HP. Exostoses of the cervical vertebrae as a cause for inability to swallow solids. Laryngoscope, St Louis.1926;36:181–182.Google Scholar
  61. 61.
    Peer MD, Berger G, Arut H. Dysphagia due to cervical osteophytes in spinal cord injury. Arch Phys Med Rehab 1986;67:658.Google Scholar
  62. 62.
    Resnick D, Niwayama G. Radiographic and pathological features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiol 1976;119:559–560.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

Personalised recommendations