Spine

Since symptoms such as back pain, neck pain, limb pain, and numbness are not specific to degeneration, doctors must first consider more serious causes, including infection, tumour, trauma, inflammatory disease, or other neurological conditions. Red flags such as fever, weight loss, a history of cancer, significant trauma, progressive weakness, or bowel and bladder disturbance require prompt evaluation.

Clinical assessment starts with a careful history and physical examination. Important findings include the pattern of pain, neurological deficit, walking ability, spinal alignment, and provocative tests such as Spurling’s test or straight-leg raise. Imaging is used when symptoms persist, neurological signs are present, or serious disease needs to be excluded. X-rays can show alignment, disc height loss, spondylolisthesis, and instability on flexion-extension views. MRI provides more detail about discs, nerves, the spinal cord, bone marrow, and soft tissues, but findings must always be interpreted alongside the patient’s symptoms as asymptomatic abnormalities are common. CT, myelography, bone scan, PET scan, blood tests, or electrodiagnostic studies are reserved for selected cases.

Treatment depends on symptom severity, neurological status, functional limitation, and the likely pain generator. Non-specific neck or back pain usually responds poorly to surgery. For most patients, first-line treatment includes education, staying active, physiotherapy, posture training, core strengthening, flexibility exercises, appropriate pain relief, and avoidance of prolonged bed rest. Selected patients may benefit from medications for nerve pain or from injections such as epidural steroid injections, facet joint injections, or nerve blocks, especially when the suspected source of pain is unclear.

Surgery may be considered when there is progressive neurological deficit, spinal cord or nerve compression, disabling pain despite adequate conservative treatment, significant instability, or deformity. The main surgical goals are to decompress affected nerves or the spinal cord, stabilise unstable segments, and correct important deformity when necessary. Common procedures include decompression, discectomy, and fusion. Age alone is not a contraindication to surgery; decisions should be based on overall health, severity of symptoms, expected benefits, and surgical risks.

Spinal degeneration is influenced by both unavoidable and modifiable factors, including genetics, ageing, posture, physical conditioning, repetitive overload, injury and smoking. Although degeneration cannot be completely stopped or reversed, symptoms can often be controlled. Patients can reduce avoidable risks by stopping smoking, avoiding repeated excessive loading, maintaining regular exercise, strengthening spinal support muscles, and seeking timely medical advice when symptoms worsen. The aim of treatment is not simply to treat imaging findings, but to relieve pain, protect neurological function, and help patients maintain normal daily activities.