The spine is made of 33 individual bones. These bones are called vertebrae. The vertebrae are supported by a number of muscles, tendons, and ligaments. There are 24 mobile vertebrae in the spine, which are separated by the inter-vertebral discs. The spine provides structural support for your body allowing movement, whilst protecting your spinal cord and the nerves.
The spine has a number of key components:
Vertebral body: The vertebral body is the front part of the vertebra. It is shaped like an ‘hour-glass’. The vertebral body and the intervertebral discs are the main weight bearing structures in the spine.
Pedicles: The pedicles are two short, rounded, bony processes that extend backwards from the vertebral body. They connect the vertebral body to the lamina. The nerves leaving the spine pass underneath the pedicles, through the exit foramen.
Lamina: The lamina is the arch of bone that protects the spinal cord at the back. There are 3 bony processes that come off the lamina: 2 articulating processes and 1 spinous process. There are 2 articulating processes, one that extends upwards and one that extends downwards. Along with the articulating processes from the adjacent levels, these articulating processes form the facet joints.
Spinous process: The spinous process is a piece of bone that comes off the back of the lamina at every level. It provides an attachment for muscles. When you feel down someone’s back, the spinous processes are the bony bits that you can feel in the middle of their spine.
Facet joints: The facet joints are formed by the articulating processes from the vertebrae above and below. These joints allow us to bend backwards and forwards as well as twist and turn. The surfaces of the facet joints are covered with cartilage. As we get older it is normal to get degenerative changes (arthritis) in the facet joints. This can cause stiffness and pain in your lower back. Arthritic facet joints can also become enlarged which can result in trapped nerves causing symptoms in your legs.
The spine seen from the side
Pars interarticularis: The pars is the part of a lamina between the superior and inferior articular processes. A stress fracture through the pars occurs in 6-8% of teenagers (the incidence is higher in very sporty teenagers). A pars fracture will usually heal with rest. A fracture or congenital anomaly of the pars in the lower lumbar spine may result in a spondylolisthesis. A spondylolisthesis is when one vertebral body slips forward relative to the vertebral body below. A spondylolisthesis can result in trapped nerves causing symptoms in your legs.
Ligamentum flavum: The ligamentum flavum is a strong ligament that connects the laminae of the vertebrae. The term “flavum” is used to describe the yellow appearance of this ligament. The ligamentum flavum stabilises the spine so that excessive motion between the vertebral bodies does not occur. As we get older, the ligamentum can become thickened. This can also contribute to nerves being trapped in your lower back causing symptoms in your legs.
Intervertebral discs: The intervertebral discs are found between each vertebral body. The discs are flat, round structures about 1cm thick. A disc is made up of a tough outer ring of tissue called the annulus fibrosis, and an inner jelly-like centre called the nucleus pulposus. The intervertebral discs separate the vertebrae, and act as shock absorbers for the spine: they compress when weight is put on them and spring back when the weight is removed. As we get older our discs become dehydrated. This is also referred to as disc degeneration. This is NOT a disease process but rather a normal part of the spine’s aging process. Disc degeneration does not directly equate to back pain.
Spinal canal: The spinal canal is where the spinal cord and the spinal nerve roots lie. The front wall of the spinal canal is formed by the vertebral body, the side walls by the pedicles and the facet joints, and the back wall by the laminae and the ligamentum flavum.
Spinal cord: The spinal cord runs within the spinal canal from the base of the brain to the level of the first lumbar vertebra. At the end of the spinal cord, the cord fibers separate into the cauda equina and continue down through the spinal canal to the sacrum.
Spinal nerves: There are thirty-one pairs of spinal nerves that branch off the spinal cord. The spinal nerves carry messages back and forth between your body and spinal cord to control sensation and movement. The spinal nerves innervate specific parts of your body. We use this pattern to diagnose the location of a spinal problem based on the distribution of pain, numbness or muscle weakness. The spinal nerves leave the spinal canal by passing through the exit foramen.
The vertebrae are named according to their location within the spine. There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae. Only the top 24 bones move; the vertebrae of the sacrum and coccyx do not move. The vertebrae in each part of the spine have unique characteristic features.
The cervical spine: the main function of the cervical spine is to support the head. The 7 cervical vertebrae are labelled C1 to C7. The cervical spine is very mobile. Much of this mobility comes from the top 2 levels in the cervical spine.
The thoracic spine: the main function of the thoracic spine is to protect the organs of the chest by providing attachment for the rib cage. The 12 thoracic vertebrae are labelled T1 to T12. The thoracic spine has very limited movement.
The lumbar spine: the main function of the lumbar spine is to support the weight of the body. The five lumbar vertebrae are labelled L1 to L5. The lumbar vertebrae are the largest vertebrae in the spine, enabling them to support the weight of the body.
The sacral spine: the main function of the sacrum is to provide attachment for the pelvic bones and protect the pelvic organs. There are 5 sacral vertebrae, which are fused together.
The coccyx: the coccyx does not really have a function. There are 4 bones making up the coccyx, which are fused together. The coccyx is also known as the ‘tailbone’.
In the upright position, an adult spine has an S-shape. These natural curves are maintained by the muscles. Good posture involves training your body to stand, walk, sit, and lie so that the least amount of strain is placed on supporting muscles and ligaments during movement or weight-bearing activities.
The two main muscle groups that affect the spine are the extensor and flexor muscles. The extensor muscles enable us to stand up and lift objects. The extensors are attached to the back of the spine. The flexor muscles are in the front and include the abdominal muscles. These muscles enable us to flex or bend forward. It is important that these muscle groups are in balance with each other.
What Patients Say
Mr Langdon has a calm and reassuringly expert professional manner that inspires confidence. He understood my fear of surgery and provided me with clear information in response to my many questions. He allowed me to take my time and reach a decision that I was happy with.
Mr Langdon took time to explain the procedure to me, also the possible side effects. He gave me every confidence regarding what would happen on the day
Mr Langdon’s manner was professional and friendly – he gave me confidence in the operation and hospital care. December 2020
Very professional and explained in detail all that could and would happen. December 2020
Cannot fault Mr Langdon in any way. February 2021
I felt that every one of my procedures was explained extremely well and prior to my operation. Mr Langdon outlined all of the issues that could occur, I felt very cared for and looked after, especially after my operation. February 2021
From my very first appointment I felt confident that I had chosen the right consultant, he made a plan and he stuck to it & made everything understandable. February 2021
James Langdon was pleasant, listened, explained my problem and possible solutions. Also has a great approach when mentioning I look at and manage my problem to evaluate it as tolerable and carry on or as needed intervention. July 2021
Mr Langdon is a very caring, nice guy who obviously knows his business. July 2021
Mr Langdon was excellent. He came recommended to me through a friend who knows him so I was always confident with his ability. He explained everything perfectly during the 1st assessment. The operation he performed on me was very successful and I am recovering well, and he also checked in on me after the operation a few times and talked me through the recovery. All in all, I’m very happy and satisfied. October 2020
Mr Langdon was brilliant from the start. I saw him at a different clinic first – but then the procedure was at Spire Harpenden. I feel he’s the best consultant I’ve seen in regards to my back – and I’ll certainly recommend him to friends and family for his outstanding knowledge and quick responses. October 2020
Displayed his knowledge perfectly with understanding my issue and needs. October 2020
I read about my consultant prior to booking my appointment with him as I felt he specialised in the treatment that I needed. He was very thorough and gave me lots of information about my procedure. He arranged for me to have my MRI scan ASAP and was booked in for my procedure very quickly. I have a follow up appointment with him in 2 weeks and hope to greet him with some positive results to my treatment. October 2020
First class. October 2020
Mr Langdon is kind, approachable and professional. November 2020
Explained clearly what would happen, good communication skills (eye contact, listened to me). November 2020
Excellent relaxed manner. November 2020
Mr Langdon is very attentive, understanding and patient I didn’t feel rushed at any stage. My decision was based on the straightforward and detailed information I received both verbally and written. Mr Langdon knows his stuff and I would without any hesitation recommend him 100%. I’m early recovery but I’m hopeful and confident that I will get my life back. Thank you James! November 2020
Very professional, willing to explain my questions and concerns. August 2020
Mr James Langdon was extremely helpful and informative. Fantastic bedside manner. July 2020
Mr Langdon has been fantastic. Not only, importantly, inspiring confidence, but practical and down to earth. He always ensured I had the opportunity to ask questions. Feb 2020
Extremely lucky to have Mr Langdon and his team, in every way so professional and so easy to talk with. September 2020
I had every faith in my consultant, that he was advising me and working in my best interest. September 2020
Mr Langdon is a caring person, listened to me and fully explained and discussed everything with me. I had complete confidence in him. September 2020
Once again a massive thank you to Mr Langdon and his team for their outstanding work and making the whole experience bearable. September 2020
I would like to express my sincere thanks and gratitude for curing my pain. For months I have suffered in agony day and night. I was in despair and you were my last hope. Now I am not in pain! I am continually smiling and enjoying life again! March 2020
Mr Langdon was great from start to finish. I know that he saw me at the end of an already full clinic and on top of that arranged an immediate MRI…making him much later than he needed to be in getting home! I was in a great deal of pain and I very much appreciated his help in getting me sorted as fast as possible. He made sure I was early on in the running order of procedures on the day of my treatment and everything was explained well to me both before and afterwards. Cannot fault in any way. Thank you very much.
Very patient took his time explaining the surgery and aftercare. Very knowledge about my condition. Made me feel relaxed and in safe hands as I was very scared of the surgery itself and the possible risks.
Very caring, explained fully what was wrong and what he was going to do. December 2019
He was very professional and helpful before, during and after my minor treatment. December 2019
Mr Langdon was extremely helpful and reassuring. December 2019
Mr Langdon was clear and confident with his communication. This is reassuring for a patient. December 2019
Professional and treated to a high standard. Mr Langdon was excellent, he knew everything on my condition explaining all the options available. December 2019
Mr Langdon’s manner was very polite, professional and efficient, he answered all her questions and came to see her quickly after her epidural. June 2017
I have just completed a 102 mile walk over 7 days. Thank you so much for patching me up and making this experience possible. June 2017
Thank you for your specialist surgical and operational skills as well as your patient friendly approach. The two don’t always go together. We need people like you to maintain such high standards of surgery and care. October 2017
I wanted to take the opportunity to thank you and your team following my surgery. It has been so long since I felt so well and without pain. The surgery and my recuperation has far surpassed my expectations and has made a huge difference to my lifestyle. December 2017
Three months on from my back operation and I am feeling so much better. Thank you for all the kindness and support you showed when I was in such desperate pain. February 2018
Thank you so much for the work that you have done. What an incredible job you have and do. Life changing. March 2018
Thank you for all you have done for me during the last few weeks. I am most grateful not only for the main work but also the extras like telephoning to keep me informed. April 2018
I cannot thank you enough for the success of my back operation. Everyone was so pessimistic and you were so positive. May 2018
I was at all times given all necessary information, listened to, and I had confidence that Mr Langdon would complete the operation successfully. August 2018
Highly skilled and intuitive. October 2018
He was brilliant, I felt so comfortable that he would look after me even though I felt so anxious, and he made sure to give me all the information I needed. Also, every nurse and employee of Spire had nothing but brilliant things to say about Mr Langdon – I didn’t even need to ask. They would look on my notes and see I had Mr Langdon and say I was in excellent hands, and so I felt extremely happy. My partner also has disc problems so I will very much be pointing him to Mr Langdon October 2018
Very understanding and caring chap from start to finish, and a great bedside manner, unusual for some consultants. He is trying hard to understand my problems and working with me on a treatment plan for the present, and the future. November 2018
My consultant is obviously a very competent person and comes across as such. My procedure was fully explained both before and after my surgery. He also has a professional sense of humour, which helped as I was very nervous November 2018
Mr Langdon was always prepared to fully explain what was wrong and what he could do about it, he gave me a lot of confidence to make the decision to operate, and so far so good. Albeit early days. November 2018
Mr Langdon was very professional and helpful, he came in on his day off because my treatment had to be moved. November 2018
Excellent, extremely knowledgeable on his speciality. I managed to get an appointment to see him at very short notice for which I was very grateful. December 2018
Excellent surgeon, great manner, explained procedure well. December 2018
A good sense of humour, understanding and non-judgmental. They explained everything very clearly. January 2019
Mr Langdon, very professional and calm, did not push the treatment on me which I really liked, but advised and let me make up my own mind. January 2019
James Langdon is a really good person to have on your side. He’s smart, attentive and very dedicated. January 2019
I felt very safe with Mr Langdon, he fully explained the procedure, the risks and the recovery. January 2019
A very professional consultant. Showed great care and understood me as a person and patient. Saw me pre procedure and after in recovery room and own room. Visited again before going home in late evening and yet again first thing the next morning. It felt like I was Mr Langdon’s only patient which I know is far from the truth. Unfortunately, I am a nervous patient but could not have been in better hands. Many thanks January 2019
Explained everything in detail, understood my concerns, excellent bedside manner, very professional. January 2019
James Langdon is very patient – he answers questions and really listens to you and explains again if you haven’t quite got something. March 2019
Mr James Langdon was in every way, courteous, clearly good at his particular area of expertise, took time out every day to see me and check that all was ok. Was happy to answer any questions I had. April 2019
Mr Langdon was very understanding about my condition and talked me through every procedure that could help me get more mobile again. I was always at ease with him with his caring attitude. A true professional thanks. April 2019
Mr Langdon gave a full explanation of the procedure and what would happen and what to do afterwards. Perfect. May 2019
Fully informed by Consultant Surgeon and Consultant Anaethetist who put me at ease with procedure. May 2019
I saw Mr Langdon before I had the operation and he explained everything that would happen on the day of the operation. June 2019
Very attentive, understood exactly what I was saying and made me feel confident that what I was doing was the right thing. June 2019
Mr. Langdon gave you complete confidence that all would be well and that he was available if needed at any time. He showed kindness and consideration. June 2019
Calm, professional, helpful. July 2019
Everything went off so smoothly. So pleased that the operation was so successful & the next day I was able to walk around without pain. July 2019
In overall terms he was absolutely brilliant. Clearly he is a brilliant surgeon but also a wonderful and understanding human being who, whilst pointing out the risks involved in the operation, filled me with absolute confidence that if success was possible, it would definitely be achieved – and I am delighted to say that it was. He is certainly a hero to me! It was also abundantly clear that all the staff at the hospital have absolute confidence in him and hold him in the highest regard. August 2019
Excellent, he fitted me in with an early appointment and treated me extremely well. September 2019
Extremely helpful explained everything very clearly. September 2019
Mr Langdon has been very clear and concise about the treatment he would be providing and the possible outcome. He has a very professional manner and I felt very at ease with him. He provided me with lots of information and visited me numerous times after my operation to see how I was and to explain what was done and what I should expect. I would be very happy to see Mr Langdon again in the future should I have a need to. September 2019
Caring conscientious and totally professional in all respects. September 2019
Mr Langdon gave me the confidence to go ahead with surgery that I was very worried about. He is very professional and thoroughly explained all the pros, cons and side effects that could possibly happen. All of the above helped me to make a more informed decision. October 2019
James Langdon was the consummate professional. He explained his diagnosis in plain language that was easy to understand and interpret from a layman’s point of view. He was careful to manage expectations and clear about potential risks keeping them in perspective and proportionate to the circumstances. His manner was direct whilst always retaining a caring attitude listening to the patient and answering questions clearly; even taking time out to follow up with my wife whilst I was still in post Op recovery. Very thorough and I would highly recommend James. October 2019
Fully explained the treatment I required and the reasons why. I felt very confident I was in good hands. October 2019
Professional, inspires confidence. October 2019
He was very understanding explaining everything very carefully and advising me on altering medication for the procedure and when to restart normal regime. November 2019
He was courteous, listened, understood the issue very quickly. Explained everything well and was sure to confirm I understood and asked if I had questions. I didn’t feel hurried. He provided an effective and efficient service. I’d definitely recommend him. November 2019
Professional and approachable. November 2019
Extremely happy. Care was first class throughout the stay and looked after all my needs November 2019
Very approachable, caring, friendly, put me at ease. December 2019
Very approachable and knowledgeable. Felt I was in very safe hands. December 2019
Very professional throughout. December 2019
Mr Langdon diagnosed my problem, explained fully the options I had regarding treatment also all the risks involved if I chose to have an operation. Mr Langdon organised a scan to confirm his diagnosis, and explained to me prior to my operation all that was involved in the procedure. Post operation Mr Langdon visited me in my room to check on my recovery and gave me the opportunity to ask any questions on the operation. I am very satisfied with Mr Langdon and his team on my treatment. December 2019
My marks of 10 across all questions reflect my opinion of James Langdon. Brilliant in all respects, in particular his explanation to a non medical man of my problem and his solution. December 2019
The consultant was fantastic. He explained everything I needed to know at each stage and I felt very confident that I was in good hands. December 2019
Spire Harpenden Hospital
(01582) 714 304