An Overview of the Intricate Spine
The human spinal column is a biomechanical marvel which provides flexibility for movement, support for weight bearing and protection of nerve fibers (neurological tissues). The spinal column surrounds and protects the spinal cord, which is the main pathway of communication between the brain and the body. The spinal column also protects the nerve roots and part of the autonomic nervous system.
The dynamics and supportive properties of the intricate human spine are provided by:
• an intricate network of blood vessels
• countless specialized nerve endings
• hundreds of small nerve fibers which connect to structures of the spine
• more than 220 specialized ligaments
• over 120 individual muscles
• more than 50 joints
• 24 presacral vertebrae movable
• 5 sacral and 3-5 coccygeal vertebrae non-movable
• 31 pairs of spinal nerves
• 23 intervertebral discs
The spine has three major types of joints:
The vertebral column consists of 24 presacral (movable) vertebrae
• 7 cervical vertebrae
• 12 thoracic vertebrae
• 5 lumbar vertebrae
One quarter of the spine's length is comprised of cartilage and intervertebral discs.
When we're born, our spines consist of 33 individual vertebrae. As we age, some of these vertebrae fuse together. The five vertebrae composing our sacrum become one bone and the coccygeal vertebrae - which can vary from three to five bones - fuse together as one. Thus, the tailbone is formed.
The sacrum and coccyx are composed of fused vertebrae and are also considered part of the spinal column.
The cervical vertebrae are the most mobile of the 24 presacral spinal vertebrae.
The 12 thoracic vertebrae articulate with 12 pair of ribs. The thoracic spine is designed for a minimum of movement, thus providing protection for the internal organs.
The large stocky lumbar vertebrae are designed to support the weight of the body
Spinecare and Back Pain Facts
The presence of degenerative disc and facet (spinal joint) pathology in older adults is ubiquitous, regardless of clinical status, with greater than 90% demonstrating some level of degeneration (1)
Experts estimate that as many as 80% of the population will experience a back problem at some time in their lifetime (2).
One-half of all working Americans admit to having back pain symptoms each year (2).
The Journal of the American Medical Association reports that direct spinecare costs reached $85.9 billion in 2005 (3)
An estimated 31 million Americans experience low-back pain at any given time (4).
Low back pain was shown to be a major problem throughout the world, with the highest prevalence among female individuals and those aged 40-80 years (5).
A global review of the prevalence of low back pain in the adult general population published in 2000 showed point prevalence of 12-33% and 1-year prevalence of 22-65% (6).
In the United States, the National Arthritis Data Workgroup reviewed national survey data showing that each year some 15% of adults report frequent back pain or pain lasting more than two weeks (7).
In Canada, Finland and the United States, more people are disabled from working as a result of musculoskeletal disorders (MSDs) - especially back pain - than from any other group of diseases (8, 9).
As many as 80% of adults in the United States experience at least 1 episode of low back pain during their lifetime, and 5% experience chronic problems (10).
About one fourth of U.S. adults report low back pain in the past 3 months (12).
Lumbar disc degeneration is the most common cause of low back pain (13).
Back injuries represent one of the most common causes for disability. • Using the estimate of 5.6%, the population of North American adults is roughly 178 million. Thus, roughly 10 million people are experiencing low back pain on any given day (14).
Low back pain (LBP) is the second most common cause of disability in US adults and a common reason for lost work days (15, 16).
Low back pain in the US is costly, with total costs estimated to be between $100 and $200 billion annually, two-thirds of which are due to decreased wages and productivity (17).
More than 80% of the US population will experience an episode of LBP at some time during their lives (18).
Out of all 291 conditions studied in the Global Burden of Disease 2010 study, low back pain (LBP) ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (DALYs). The global point prevalence of LBP was 9.4% (95% CI 9.0 to 9.8). (19) Low back pain is the single leading cause of disability worldwide, according to the Global Burden ofDisease 2010 (19).
Over 65 million Americans experience back pain every year. • Point prevalence of global low back pain is approximately 659,309,321 based on calculation performed in June of 2015 based on statistics provided in the Global Burden of Disease 2010 study (19).
Back pain ranks second to headaches as the most frequent location for pain.
A 50-year- old woman has a 40% chance of having a vertebral compression fracture in her lifetime (20).
Between the years 1998 and 2011, the number of spinal fusion procedures has more than doubled, from 204,000 in 1998 to 457,000 in 2011 (21).
The global spinal fusion devices market is expected to grow at a compound annual growth rate of 5.3 percent through 2024 reaching a projected worth of 17.3 billion dollars (22).
Vertebral compression fractures (VCFs) are the most common fracture in patients with osteoporosis affecting about 750,000 individuals annually in the United States. Approximately 25% of all postmenopausal women will develop a VCF during tier lifetime (23).
"The spine is the third most common site for cancer cells to metastasize, following the lung and the liver. This amounts to 70% of all osseous metastases. Approximately 5-30% of patients with systemic cancer will have spinal metastasis; some studies have estimated that 30-70% of patients with a primary tumor have spinal metastatic disease at autopsy" (24).
Spinal Cord Injury Facts and Statistics
• Approximately 250,000 Americans have spinal cord injuries
• Approximately 11,000 new spinal cord injuries occur in the USA each year
• Approximately one half of all spinal cord injuries in the USA result in quadriplegia
• The average age of individuals with spinal cord injury in the USA is 31 Spinal cord injuries in the US are most commonly causes by:
Vehicular accidents 35-40%The number of people in the United States who are alive in 2012 who have SCI has been estimated to be approximately 270,000 persons, with a range of 236,000 to 327,000 persons.
Sports-related activities 5-10%
Overall, 80.6% of spinal cord injuries reported to the national database have occurred among males.
Source: The University of Alabama National Spinal Cord Injury Statistical Center - March 2002
1. Hicks, G. E., Morone, N., & Weiner, D. K. (2009). Degenerative lumbar disc and facet disease in older adults: Prevalence and clinical correlates. Spine (Phila PA 1976), 34(12), 1301-1306. Doi:101097/BR.0b03181a18263
2. Vallfors B. (1985). Acute, subacute and chronic low back pain: Clinical symptoms, Absenteeism andWorking Environment. Scandinavian Journal of Rehabilitative Medicine, Suppl 1985; 11: 1-98.
3. Martin, B., & Deyo, R. A. (2008). Original contribution expenditures and health status among adults with back and neck problems, JAMA, 299(6), 656-664. doi:10.10001/jama.299.6.656
4. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine, 331: 69-116.
5. Hoy, D., Bain, C., Williams, G., March, L., Brooks, P., Blyth, F., Woolf, A., Vos, T., & Buchbinder, R. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64 (6), 2028-2037. doi:10.1002/art.34347
6. Walker, B. F. (2000). The prevalence of low back pain: A systemic review of he literature form 1966- 1998. Journal of Spinal Disorders, 13, 205-217.
7. Lawrence, R. C., Helmick, C. G., Arnett, F. C., Deyo, R. A., Felson, D. T., Giannini, E. H., Heyse S. P., Hirsch, R., Hochberg, M. C., Hunder, G. G., Liang, M. H., Pillemer, S. R, Steen, V. D., & Wolfe, F. (1998).
Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis & Rheumatism, 41: 778-799.
8. Badley, E. M., Webster, G. K., & Rasooly. I. (1995). The impact of musculoskeletal disorders in the population: Are they just aches and pain? Findings from the 1990 Ontario Health Survey. Journal of Rheumatology. 22: 733-739.
9. Battié, M. C., Videman, K. T., (1997). Epidemiology of the back. In: Pope MH editor. Musculoskeletal Disorders in the Workplace: Principles and Practice St. Louis MO: Mosby-Year Book Inc. p 253-268.
10. Modic, M. T. , Ross, J. S. (2007). Lumbar degenerative disk disease. Radiology. 245(1), 43-61.
11. Pearce, R. H., Grimmer, B. J., Adams, M. E. (1987). Degeneration and the chemical composition of the human lumbar intervertebral disc. Journal of Orthopedic Research, 5(2):198-205.
12. Deyo, R. A., Mirza, S. K., & Martin, B. I. (2006). Back pain prevalence and visit rates: Estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976), 31(23), 2724-2727
13. Suthar, P., Patel, R., Mehta, C. & Patel, N. (2015). MRI evaluation of lumbar disc herniation. Journal of Clinical Diagnotic Research, 9(4), TCO4-9. doi: 10.7860/JCDR/2015/11927.5761.
14. Loney, P. L., & Stratford, P. W. (1999). The prevalence of low back pain in adults: A methodical review of the literature. Journal of the American Physician Therapy Association, 79(4), 384-396
15. Stewart, W., F., Ricc,i J, A., Chee, E., Morganstein, D., & Lipton R. (2003). Lost productive time and cost due to common pain conditions in the US workforce. JAMA, 290(18), 2443- 2454.
16. Ricci J. A., Stewart, W. F., Chee, E., Leotta, C., Foley, K., & Hochberg, M. C. (2006). Back pain exacerbations and lost productive time costs in United States workers. Spine 31(26) 3052-3060.
17. Katz, J. N. (2006). Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. Journal of Bone and Joint Surgery, 88 (suppl 2), 21- 24.
18. Rubin, D. I. (2007). Epidemiology and risk factors for spine pain. Neurological Clinics, 25(2) 353- 371.
19. Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A. Bain, C. …Buchbinder, R. (2014). The global burden of low back pain: Estimates form global burden of disease 2010 study. Annuals of Rheumatoid Disorders.doi:101136/annrheumdis-2013- 204428
20. Tsuda, T. (2017). Epidemiology of fragility fractures and fall prevention in the elderly: A systematic review of the literature. Current Orthopedic Practice, 28(6), 580-585.
21. Beckers Spine Review (2017). Retrieved from https://beckerspine.com
22. Wood, M. (2017). Global spinal fusion devices market to hit $17.3B by 2024: 3 observations. Beckers Spine review. Retrieved from https://www.beckersspine.com/orthopedic-a- spine-device- a-implant-news/item/39591-global- spinal-fusion- devices-market- to-hit- 17-3b- by-2024- 3-observations.html
23. American Academy of Neurological Surgeons (2017). Retrieved from
http://www.aans.org/en/Patients/Neurosurgical-Conditions- and-Treatments/Vertebral- Compression-Fractures
24. Tse, V. (2016). Spine metastasis. Medscape. Retrieved from
BY THE NUMBERS
Musculoskeletal Back Pain
Back and neck disorders, injuries, and disk disorders
Inform a Colleague
Expand and Educate Your Spinecare Network
Welcome to the Inform a Colleague area of the Academy Website. The American Academy of Spine Physicians (AASP) strives to implement new and more efficient methods for members to communicate with other healthcare professionals. One of the most effective tools is the online "Inform a Colleague" function. This function can be used to expand and educate your spinecare referral network. It also represents a resource to conveniently inform others about trends in spinecare and about offers of organizations such as the American Academy of Spine Physicians (AASP), the International Spine Association (ISA). The link library also contains an application for membership with the AASP.
The online "Inform a Colleague" feature provides an invaluable time-saving service for keeping spinecare professionalsup-to-date, expanding the spinecare network, stimulating interdisciplinary referrals and for inviting colleagues to join the AASP. The library of links is always being updated with useful information and resources. The linked messages can be used to
**Edit1 and/or add text where appropriate** (Inform one or more colleagues)
Free AASP eNewsletter Signup
Join / Renew
This level of membership is for physicians (MD, DC, DO) whose practice/interest includes patients with spinal disorders. ($295)
This level of membership is for allied healthcare professionals involved in spinecare and/or spine research. This includes physical therapists, massage therapists, exercise physiologists, nurse practitioners, nurses, physician's assistants, diagnostic technicians, surgical technicians, exercise instructors, personal trainers and individuals who hold a PhD and work in the field of spinecare. ($150)
This level of membership is for residents, fellows and students who have an interest in spinecare. ($35)
Membership will automatically renew each calendar year starting from the date of membership renewal or membership acceptance unless the AASP is specifically notified in writing by the member at least 30 days prior to their renewal date. Please address all correspondence to the AASP Office of Member Services.
Review the accuracy of your contact information and practice profile information including your email address. To update your profile online go to www.spinephysicians.org and login using your unique member ID and PIN as noted below.
Please notify the AASP if you no longer meet membership criteria.
This includes maintaining an active license to practice.
American Academy of Spine Physicians