The spine is made up of small bones, called vertebrae, which are stacked on top of one another and create the natural curves of the back. These bones connect to create a canal that protects the spinal cord. The spinal cord extends from the skull to the lower back and travels through the middle of the stacked vertebra. Nerves branch out from the spinal cord through openings in the vertebrae and carry messages between the brain and muscles. Discs sit in between the vertebrae and work as shock absorbers for the spine. Discs have a jelly-like center (nucleus) and an outer ring (annulus). Between the back of the vertebrae are small facet joints that help the spine move. They have a cartilage surface, like a hip or knee joint.


Discs are soft, rubbery pads between the hard bones or vertebrae of the spinal column. They are composed of an outer shell of tough cartilage that surrounds a nucleus made of gel-like cartilage. Discs allow the back to flex or bend and act as shock absorbers. A bulging disc occurs when the outer cartilage of the disc bulges out around its circumference. A herniated or ruptured disc happens when the gel in the nucleus pushes through the outer edge of the disc and back toward the spinal canal, putting pressure on sensitive nerves.

Causes of Bulging or Herniated Discs

  • Age-related wear and tear, disc degeneration
  • Disc dehydration
  • Back or neck strain due to repetitive physical activity or heavy lifting
  • Poor posture
  • A traumatic event causing injury
  • Genetics

Symptoms of Bulging or Herniated Discs

  • In the lumbar spine: pain, numbness, tingling, and weakness in the lower back that extends down the leg
  • In the cervical spine: pain, numbness, tingling, and weakness in the neck, arms, hands, and/or head
  • In the thoracic spine: pain in the upper back, radiating through the stomach or chest


After discussing symptoms and medical history, the DOC orthopedic surgeon will perform a physical examination, which may include tests for muscle weakness, loss of sensation, gait, and reflexes, and X-rays and MRI or CT scan to help to confirm the diagnosis of a bulging or herniated disc.
The human spine is made of 32 separate vertebral segments that are separated by shock absorbing, intervertebral discs. Facet joints between every vertebral segment are covered with protective cartilage. After an injury or when facet joint cartilage wears away and bone rubs against bone, the body may add bone to the damaged area in an effort to support the vertebral column. Bone spurs (osteophytes) form on the ends of bones, especially in the facet joints where bones meet.

Causes of Bone Spurs

  • Age
  • Congenital or heredity
  • Nutrition
  • Life-style, including poor posture
  • Traumatic forces, sports related injuries and motor vehicle accidents

Symptoms of Bone Spurs

  • Dull pain in the neck or lower back when standing or walking
  • Pain radiating into the shoulders if spurs originate in the cervical spine (neck area)
  • Pain radiating into the rear and thigh if spurs originate in the lumbar spine (lower back area)
  • Pain worsens with activity and improves with rest
  • Stiffness


If bone spurs contribute to nerve compression in the spine, the condition may cause neurological symptoms, such as pain, numbness, and/or weakness in one or both arms or legs. The DOC orthopedic surgeon after a physical examination may order X-rays or an MRI to help locate the bone spur and source of pain.
The coccyx is the terminal segment of the spine. Coccydynia occurs when the coccyx or the surrounding tissue is damaged, causing pain and discomfort at the base on the spine, especially when seated.

Causes of Coccydynia

  • Injury, direct trauma
  • Childbirth
  • Repetitive stress
  • Pain from a herniated or degenerative disc
  • Poor posture
  • Overweight or underweight
  • Aging
  • Infection
  • Cancer
  • No identifiable origin

Symptoms of Coccydynia

  • Pain and tenderness in the tailbone region
  • Minor bruising
  • Difficulty standing after sitting


DOC’s healthcare team of orthopedic surgeons, PAs, physical therapists, and pain management specialists will evaluate the guest’s pain and any mobility issues to determine the correct diagnosis. If the diagnosis is coccydynia, the vast majority of guests respond to conservative treatments. More aggressive treatments may be discussed if conservative treatments fail to provide relief.
Kyphosis is a spinal disorder in which an excessive outward curve of the thoracic spine results in an abnormal rounding of the upper back. In the case of a severe curve, the condition is called “hunchback.” The thoracic spine should have a natural curve between 20 to 45 degrees.

Causes of Kyphosis

  • Postural kyphosis associated with poor posture and slouching
  • Scheuermann’s kyphosis caused by structural abnormality
  • Congenital kyphosis which occurred in utero when the spine failed to develop

Symptoms of Kyphosis

  • Rounded shoulders
  • A visible hump on the back
  • Mild back pain
  • Fatigue
  • Spine stiffness
  • Tight hamstrings
  • Weakness, numbness or tingling in the legs
  • Loss of sensation
  • Shortness of breath or other breathing difficulties


The DOC orthopedic surgeon or PA will review the guest’s medical history, general health and symptoms, and examine the back for areas of tenderness. X-rays provide images of dense structures, such as bone, and help to determine bony abnormalities and measure the degree of the kyphotic curve.
Myofascial pain syndrome (MPS) refers to pain and inflammation in the body’s fascia, connective tissue that covers the muscles. Myofascial pain syndrome could involve muscle pain in a single muscle or muscle group.

Causes of Myofascial Pain Syndrome

  • Injury or excessive strain on a muscle, muscle group, ligament, or tendon
  • Trauma to the musculoskeletal system, intervertebral discs
  • Prolonged static postures, lack of activity
  • High body mass index (BMI), obesity
  • Fatigue, sleeplessness and emotional stress
  • Nutritional deficiencies
  • Inflammatory conditions
  • Hormonal changes, post menopause
  • Tobacco use

Symptoms of MPS

  • Specific trigger or tender points that worsen with activity or stress
  • Fatigue
  • Depression
  • Sleep disorders
  • Headaches
  • Behavioral disturbances


Trigger points can be identified by the DOC orthopedic surgeon when pressure is applied to an area of the body that results in pain. Physical therapy methods are considered the best treatments for myofascial pain syndrome. In some chronic cases of myofascial pain, the DOC pain management specialist may prescribe a multidisciplinary combination of therapies and medications to treat existing simultaneous conditions, such as insomnia and depression.
The spine is made of 24 bones called vertebrae. The spinal cord runs through the canal in the center of these bones. Nerve roots split from the cord and travel between the vertebrae into various areas of the body. When these nerve roots become pinched or damaged, the resulting symptoms are called radiculopathy.

Causes of Radiculopathy

  • Wear and tear
  • Arthritis
  • Injury
  • Stenosis
  • Bone spurs
  • Bulging or herniated disc

Symptoms of Radiculopathy

  • Cervical radiculopathy: pain that radiates into the shoulder, muscle weakness and numbness that travels down the arm and into the hand
  • Lumbar radiculopathy: pain, weakness, numbness, abnormal sensations, and/or loss of reflexes in the back and legs
  • Thoracic radiculopathy: pain and numbness that wraps around to the front of the body.
  • Severe symptoms: poor coordination, difficulty walking and paralysis.
  • Diagnosis

    After discussing medical history and general health, the DOC orthopedic surgeon or PA will ask about symptoms and look for muscle weakness, loss of sensation, or any change in reflexes. X-rays provide images of dense structures, such as bone, and an MRI or CT scan will reveal narrowing of the spinal canal and damage to soft tissues and/or the spinal cord and nerve roots.
The sciatic nerve is the longest and largest nerve in the body, measuring three-quarters of an inch in diameter. It originates in the lower back, lumbar spine, and extends with nerve branches all the way to the feet. The sciatic nerve and its nerve branches enable movement and feeling in the thigh, knee, calf, ankle, foot, and toes. When the sciatica nerve becomes compressed or irritated, pain, numbness, and tingling radiates in the leg along the course of the sciatic nerve from the buttocks down the back of the thigh into the calf and foot.

Causes of Sciatica

  • Age related wear and tear
  • Back or neck strain from repetitive physical activity or heavy lifting
  • Poor posture
  • Lower back injury
  • Genetics

Symptoms of Sciatica

  • Sharp, shooting, constant or intermittent pain
  • Pain exaggerated by physical activity or sitting on one position for a long time
  • Pain in the lower half of the body, lower back, hips, buttocks, and legs
  • Leg cramps
  • Numbness, burning, or tingling down the leg
  • Difficulty walking


In order to diagnose sciatica, the DOC orthopedic surgeon or PA will discuss symptoms, family history, and perform a thorough examination to help pinpoint the irritated nerve. X-rays and a CT scan or MRI help to confirm the diagnosis and which nerve roots are affected.
Thirty-three small bones, vertebrae, are stacked on top of one another and create the natural curves of the back and the central canal that protects the spinal cord. Scoliosis causes the bones of the spine to twist or rotate sideways so instead of a straight line down the middle of the back, the spine looks more like the letter "C" or "S." Scoliosis causes a side-to-side curvature of the spine.

Causes of Scoliosis

  • Hereditary factor
  • Spinal infection
  • Spinal injury
  • Birth defect
  • Neuromuscular conditions like muscular dystrophy and cerebral palsy
  • Generally unknown causes

Symptoms of Scoliosis

  • Visible spinal curvature
  • Uneven shoulders or hips
  • Ribs stick out farther on one side than the other
  • Body leans to one side


Spinal curvature is a complex disorder and must be diagnosed by a DOC orthopedic spine surgeon specialist. The curve is measured and diagnosed in terms of severity by the number of degrees. Radiographic tests are required for an accurate and positive diagnosis of scoliosis. X-rays show the structure of the vertebrae and any deformities. A CT scan and/or MRI provide images of the spinal canal, contents and structures.
Spinal arthritis is also referred to as osteoarthritis of the spine, degenerative joint disease, and arthritis of the facet joints. Healthy facet joints are covered with cartilage so the vertebrae can move smoothly against one another where bones meet to form facet joints, joining the vertebrae. Spinal arthritis is characterized by the breakdown of cartilage that cushions the ends of the bones.

Causes of Spinal Arthritis

  • Aging
  • Pressure overload on the joints
  • Injury

Symptoms of Spinal Arthritis

  • First movement morning back and/or neck stiffness and pain
  • Pain subsides during the day
  • Pain and stiffness worsen in the evening
  • Pain that disrupts sleep
  • Steady or intermittent pain aggravated by motion
  • Swelling and warmth in joints, particularly during weather changes
  • Tenderness in affected area
  • Loss of flexibility
  • Difficulty twisting or bending
  • Crepitus, especially in the neck
  • Pinching, tingling or numbness sensation


The DOC healthcare team will assess the guest’s overall health, musculoskeletal status, nerve function, reflexes, and problematic spinal joints. The surgeon may order X-rays to determine cartilage loss, compression fractures and bone spurs, and an MRI to show detailed images of the spinal cord, nerve roots, discs, ligaments, and surrounding tissues and spaces.
There are four major components of the spine: vertebrae, joints, discs, and nerves. The 24 bones of the vertebrae link together to form a tunnel that protects the nerves and spinal cord. Joints are located at each vertebrae and provide flexibility and stability within the vertebral column. Discs are in between the vertebrae and act as shock absorbers and provide flexibility within the vertebral column. Spinal nerves exit and pass into arms and legs from each disc.  Spinal cord compression can occur anywhere from the neck (cervical spine) down to the lower back (lumbar spine).

Causes of Spinal Nerve Compression

  • Osteoarthritis
  • Abnormal spine alignment (scoliosis)
  • Injury to the spine
  • Spinal tumor
  • Bone diseases
  • Rheumatoid arthritis
  • Infection

Symptoms of Spinal Nerve Compression

  • Pain and stiffness in the neck, back or lower back
  • Burning pain that spreads to the arms, buttocks or legs
  • Numbness, cramping or weakness in the arms, hands or legs
  • Pressure on the nerves in the lumbar region
  • Loss of bowel or bladder control


The DOC orthopedic surgeon or PA will ask questions about symptoms and perform a complete physical exam, looking for signs of spinal compression, such as loss of sensation, weakness, and abnormal reflexes. Tests to confirm the diagnosis may include X-rays, providing images of bones and the alignment of the spine, and CT or MRI scans, showing details of the spinal cord and surrounding structures.
The normal wear and tear effects of aging can lead to narrowing of the spinal canal, a condition called spinal stenosis. When the space around the spinal cord narrows, more pressure is put on the spinal cord and the spinal nerve roots. Spinal nerves relay sensation in specific parts of the body and pressure on the nerves can cause pain in the areas that the nerves supply.


Neck, cervical spine:
  • Numbness, tingling and weakness in the arm, hand, shoulders, or legs
  • Changes in fine motor skills
  • Problems with walking and balance
  • Back and neck pain
Lower back, lumbar spine:
  • Numbness, tingling and weakness in the foot or leg that radiates from the lower back to the buttocks and legs
  • Pain or cramping in one or both legs
  • Problems with walking and balance
  • Lower back pain


After discussing symptoms and medical history, the DOC surgeon or PA will examine the back, including range of motion and pain limitations. To confirm the diagnosis of spinal stenosis, the physician may order X-rays to show signs of aging and bone spurs and an MRI to provide images of soft tissues, muscles, discs, nerves, and the spinal cord.
Spondylosis is a medical term that describes any degenerative disease of the spine. Spine degeneration or wear and tear can affect the discs and facet joints between the vertebrae of the spine. The discs are the cartilage cushions and the facet joints are the joints between vertebrae that make the back flexible and enable a person to bend and twist. As the discs in the spine age, they lose water content, dry out, weaken, collapse, and lose height. The smooth, slippery articular cartilage that covers and protects the facet joints may wear away, begin to degenerate, and develop arthritis. When the spine deteriorates, other spine conditions occur.

Causes of Spondylosis

Arthritis of the spine, herniated or bulging discs, an injury to the neck or back, poor posture, physically demanding work, or sports activities can cause spine degeneration.

Symptoms of Spondylosis

  • Pain from a disc that compresses a spinal nerve
  • Stiffness
  • Weakness, numbness or tingling in the arms, hands, fingers, or legs
  • Loss of balance
  • Muscle spasms in the neck or shoulders


The DOC orthopedic surgeon or specialty-trained PA will examine the guest’s spine for tenderness and inflammation and test range of motion, reflexes, strength, flexibility, and gait. X-rays, CT scan and/or MRI may be ordered to detect degeneration of the spine and abnormalities in the spine’s soft tissues.

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