Whole Spine Hub: Lumbar, Cervical and Thoracic Assessment & Management

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Introduction

The spine is a complex, load-bearing structure designed to provide stability, allow movement, and protect the nervous system.

It is divided into three anatomical regions (not including the pelvis):

Lumbar spine (lower back)

Thoracic spine (mid back)

Cervical spine (neck)

Each region has distinct anatomy, biomechanics, and nerve supply. As a result, symptoms vary depending on the level involved.

This section provides structured explanations of common spinal conditions, how they present, when they require urgent attention, and how they are assessed and managed.

Understanding the Three Regions of the Spine

Although the spine functions as a single system, each region behaves differently.

Each section has is own condition hub page with the link at the end of each section

The three sections on the spine. The lumnarspine, the thoracic spine and the cervical spine

Lumbar Spine (Lower Back)

The lumbar spine carries the greatest mechanical load and is the most common source of:

Non Specific Low Back Pain (NSLBP)
Lumbar Slipped Disc
Sciatica
Lumbar Degenerative Disc Disease (DDD)
Lumbar Spinal Stenosis
Lumbar Facet Joint Pain
Lumbar Discitis
Sacral Insufficiency Fracture
Cauda Equina Syndrome
Lumbar Spondylolisthesis/Retrolithesis

Leg symptoms often arise from irritation of lumbar or sacral nerve roots.

Explore Lumbar Spine Conditions

Thoracic Spine (Mid Back)

The thoracic spine connects to the rib cage and is generally more stable.

Thoracic presentations may include:

Mid-back pain
Rib joint dysfunction
Postural overload syndromes
Thoracic disc irritation (less common)

Because thoracic pain is less common than lumbar or cervical pain, careful assessment is important to rule out non-spinal causes.

Explore Thoracic Spine Conditions

Cervical Spine (Neck)

The cervical spine supports the head and allows a high degree of movement.

Common cervical presentations include:

Neck pain
Cervical disc herniation
Cervical radiculopathy (“trapped nerve in the neck”)
Cervical spinal stenosis
Cervicogenic headache

Arm symptoms arise when cervical nerve roots are irritated.

👉 Explore Cervical Spine Conditions

(Internal link to Cervical Hub)

How Spinal Symptoms Are Assessed

Spinal diagnosis is not based on imaging alone.

A structured clinical assessment includes:

Detailed history of symptom behaviour
Neurological examination (strength, reflexes, sensation)
Movement testing
Load response analysis
Functional limitations
Red flag screening

This allows me to determine:

Whether symptoms are disc-related, joint-related, nerve-related, muscular, or sensitisation-driven
Whether imaging is required
Whether conservative management is appropriate
Whether medical referral is necessary

I treat the clinical pattern — not just the scan.

When Spinal Symptoms Require Urgent Attention

Most spinal pain is not dangerous and improves with structured conservative care.

However, urgent medical assessment is required if you develop:

New bladder or bowel disturbance
Saddle or groin numbness
Rapidly worsening limb weakness
Severe pain with systemic illness (fever, unexplained weight loss)
Significant trauma followed by spinal pain

If unsure, seek urgent medical advice via your GP, NHS 111, or emergency services.

Imaging and Spinal Conditions

MRI scans are excellent at showing structure, but structural findings do not always correlate with symptoms.

Disc bulges and degenerative changes are common, particularly with age.

Imaging is typically considered when:

Symptoms fail to improve
Progressive neurological deficit develops
Red flag features are present
Surgical decisions are being considered

Assessment determines whether imaging is necessary.

Management Principles Across All Spinal Regions

Although each region has distinct anatomy, management principles are similar:

Reduce irritation
Maintain safe movement
Gradually rebuild strength and load tolerance
Restore confidence
Prevent recurrent flare-ups

Most spinal conditions improve with structured conservative management.

Summary

The spine functions as a coordinated system, but symptoms vary depending on the region involved.

Understanding whether symptoms arise from the lumbar, thoracic, or cervical spine is the first step in determining appropriate management.

Clear assessment allows proportionate treatment, safe monitoring, and appropriate escalation when required.

Use the regional sections above to explore specific spinal conditions in more detail.