"Doctor I was told that there is a 'GAP' in my Spine, what should I do? "
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| Gap in Spine |
Even till date this remains the most Frequently Asked Question in my Spine out patient clinic !! I was always amazed that why would someone ask such an illogical question, and why wouldn't they Google it. So I went to Google myself and to my surprise I couldn't find any validated data that would answer this question. The primary reason I believe is, this Gap term has no medical relevance but its more of a dialect used primarily in Indian medical practice. So here is my take on Gap in Spine.
The use of MRI was not so rampant in Ortho and Spine out patient clinics in India a few years back, and the diagnosis of Spine problems was primarily based on clinical examination and x-rays which are able to show only the bony structures and not the soft tissue parts.
The spinal column, however, is composed of Vertebrae (bony part) and intervertebral disc (soft part), where the vertebra gives mechanical stability and the disc act as shock absorber and provide with necessary flexibility. There is one intervertebral disc in between two vertebrae (except first and second cervical and the fused sacrum & coccyx). So on an X-ray of the spine what we see is only the vertebrae with empty space in between where is Intervertebral disc is located.
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| X-ray Lumbar spine |
This x-ray picture, I believe is the origin for the word Gap in Spine. Probably before the advent of MRI the diagnosis of Spine problems was based only on the dimensions of intervertebral disc height as seen on an X-ray. And the senior physicians used the term Gap in Spine to explain some pathology in Spine which is easy for a non-medico person to understand.
Today with more and more radiological advances like CT scans, MRI scans, Contrast CT /MRI, we can precisely see the structures like Intervertebral disc, ligaments connecting the vertebrae, Spinal nerves, facet joints etc, and can easily pinpoint the pathology if any.
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| MRI axial image of Lumbar Spine |
So Gap in Spine is just a lay man's term to indicate some spine problem which should be further investigated. As a Physician it is our responsibility to ensure that the patient knows as much as possible about his/her health issue and we should encourage the patient to ask more and more questions and also to gather information from reliable sources over the internet.
Dr. Ketan Deshpande
Endoscopic Spine Surgeon
Saishree Hospital
Aundh, Pune
Website: http://www.saishreehospital.org/
Mail : info@saishreehospital.org
Whats app : 020 67448600
