December 2017 Edition. Volume XVII

Genomic spine disorders have a basis in heredity which is something beyond the control of the individual. Typically, the patient with a underlying genomic spine disorder can, however, determine their future progress based on their willingness to commit to self-administered spine health programs. In this regard the keys to success involve the following:

Number one on the list is to not be a cigarette smoker. It has been well established that cigarette smokers have up to a 3 to 4 times higher incidence of disc degeneration than normal individuals. Number two on the list is good nutrition and a daily self-administered health program involving optimal body weight associated with good muscle tone and flexibility based on exercise, particularly swimming, the maintenance of good core body strength, the frequent utilization of safe spinal traction and exercise devices such as a Roman Chair:

Remarkably, there are many professional athleteswho have underline genomic spine disorders.  These are the individuals, however, who live by the spine health recommendations outlined above.

Libby Photo  Meet Douglas Libby(name used with permission). He and his family are classic examples of the genomic spine disorder, which has been radiologically identified as being juvenile discogenic disease (JDD). A lateral view of Mr. Libby’s spine on MRI demonstrates a number of important features of the genomic spine disorder JDD. These include the presence of multi–level degenerative disc disease associated with multi–level endplate deformities which represent the persistence of congenital embryologic structures, elongation deformities of the vertebrae reflecting long-standing degenerative disease, in addition to other congenital abnormalities such as intraosseous hemangiomas, scoliosis and spinal deformities.

Libby Lat

In 1983 Mr. Libby became neurologically impaired and required surgical decompression.  He then did well until 1993 when he again became neurologically impaired and once again did well following additional surgical decompression.  In 2006 he redeveloped lateral spinal stenosis at L5-S1 on the right and, once again, did well with surgical decompression.  The point of this is that with the right type of surgery, which allowed this patient to continue to have MRI studies in order to make a specific diagnosis he has continued to live an active lifestyle. Mr. Libby is a non-smoker and has been diligent in maintaining good back health.

Hob JDD Cg PO 4 years Hob Graft & Cage 300pThe patient to the left also has JDD.  In addition to surgical decompression a posterior intervertebral titanium cage (green dot over cage shadow) was placed for the purpose of restorative surgery. In addition posterior free fat grafts (blue dot), which have now become normal fat, were placed at the end of the procedure to decrease postsurgical scarring and decrease the risk of nerve injury should there be a need for future surgery. Note that the amount of metallic artifact is minimal allowing a satisfactory imaging study.  If the back looks like a “junkyard” on imaging it is very difficult to know where salvage surgery needs to be carried out.

 

JDD MatJDD Mat FragmentShown here is a case involving a world class athlete with a mild nderlying genomic spine disorder.  He experienced the sudden onset a very large extruded. Following a minimally invasive disc excision he has continued to be a successful world class athlete.

The Bottom Line

When one considers all of the potential birth liabilities that exist, having a genomic spine disorder really isn’t so bad if you pick it up early, don’t smoke, and start making deposits in your “spine savings account” on a regular basis.  If you are a professional athlete one needs to make a greater investment in the rehabilitation process.

The next important consideration is the prudent avoidance of surgeries that will create more problems than they will solve.  Multi-level rigid instrumented fusions performed in individuals with genomic spine disorders as a treatment for pain typically provides only transient relief of back pain (a not very good reason to have back surgery in the first place). in most individuals  When progressive neurologic impairment, deformity, or instability produces a legitimate need for surgical intervention this must then be appropriate to the problem.  When surgery is elective it should be performed only when all other reasonable non-surgical therapies have been carried out first.

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