SPINE CONDITIONS

 Back Pain

Back pain is one of the most common conditions affecting adults. There are many causes of back pain including muscle strain, herniated disc, lumbar spinal stenosis and osteoarthritis. Evaluation of back pain is based on the patient's symptoms, history of injury, physical examination and any diagnostic studies.

Any patient with neurological symptoms such as numbness, weakness, or bowel or bladder dysfunction, should seek medical care immediately. Otherwise, pain medications such as ibuprofen or naproxen are good first line home treatments. Back pain lasting more than 2-3 days should be evaluated by a physician.

Some patients undergo conservative treatment for back pain such as physical therapy, weight reduction, steroid injections or medications. Doctors may choose to have patients undergo further evaluation with other diagnostic tests such as: CT scan, discography, electromyography, MRI, myelogram, or x-rays.

Surgery is reserved for those individuals who experience debilitating back and leg pain, worsening neurological deficits, bowel or bladder dysfunction, difficulty standing or walking, or who fail to benefit from medications or physical therapy. Neurosurgeons decide the best surgical approach based on each patient's individual condition. For some, this means spinal fusion with, meaning fusing the vertebrae together and stabilizing the spinal column with screws and rods. The goal of this procedure is to prevent the disc from herniating again. As with most surgeries, patients may require physical therapy during the recovery period to regain their mobility.

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 Degenerative Disc Disease

Spinal discs are round, jelly like structures that act as a cushion between vertebral bodies, the bones that make up the spinal column. Degenerative disc disease describes the changes in those discs that typically occur with age. These changes can be caused by loss of fluid in the discs or cracks in the outer coat of the disc. Risk factors for degenerative disc disease include smoking, obesity, and injury.

Degenerative disc disease can occur anywhere in the spinal column but occurs most frequently in the neck (cervical) or lower (lumbar) spine. Depending on the location of the discs involved, degenerative disc disease can result in neck pain, back pain, numbness, tingling, disc herniation, or spinal stenosis. Some patients with degenerative disc disease may not have any symptoms at all.

Degenerative disc disease is diagnosed based on a patient's history, physical exam and imaging studies such as x-ray, MRI or CT scan. Treatment is generally guided by severity of symptoms and begins with non-invasive treatments such as ice or heat, pain medications, or physical therapy. Surgery is reserved for those patients who do not experience significant relief from the conservative therapies. Surgical options include artificial discs, discectomy, and minimally invasive microdiscectomy.

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 Disc Herniation

The spine is made up of a chain of bones called vertebrae. Between each vertebra are flat, round discs of a jelly like substance whose purpose is to act as shock absorbers. The vertebra and discs are held together by thick ligaments. A herniated disc occurs when a portion of the jelly like material pushes out into the spinal canal. This causes pressure on the spinal nerves, which often results in pain. This occurs more often in the lower (lumbar) spine but can occur in other parts as well.

Risk factors for disc herniation include strain or injury, age and family history. Symptoms of a herniated disc vary depending on the severity of the herniation and its location. Some individuals experience no symptoms while others may have numbness, weakness or pain.

Sciatica is one type of herniated disc. Sciatica describes a herniated disc in the lower back which causes pressure on the sciatic nerve. This pressure results in pain, burning, numbness or tingling that radiates from the buttock into the leg and, sometimes, the foot. Typically one side of the body is affected. Pain may be worse with standing, walking or sitting.

If the disc herniation is in the neck, symptoms usually are pain between the shoulder blades and radiating down one arm or numbness or tingling in the shoulder or arm.

Physicians usually diagnose disc herniation based on a patient's history, symptoms, physical examination and diagnostic studies such as X-ray, CT scan or MRI. Other studies also exist that evaluate nerve and muscle function. Treatment of herniated discs depends on the duration and severity of symptoms. Non-invasive treatments such as rest, pain medications, steroids, injections, stretching or physical therapy will usually be tried first. Surgery is reserved for those patients who do not experience significant relief from conservative treatments.

Several surgical options exist and your surgeon will choose the one that best fits your condition. The surgical options include: artificial disc surgery (replacing the damaged disc with a synthetic one), discectomy (removal of the damaged portion of the disc), laminectomy (removal of part of the vertebra to give the spinal column more room), laminotomy (an opening made in part of the vertebra to relieve pressure from the spinal nerves), spinal fusion (grafting bone into the spine to join two or more vertebra and stabilize the spine).

As with any surgery, patients may require physical therapy during the recovery period to regain mobility. It is also important to avoid those movements that may cause another herniated disc as you may be more prone to developing this condition. Squat to lift heavy objects and do not take on more than you can comfortably handle. Exercise, maintaining a healthy weight and eliminating tobacco use are also important factors in keeping your spine healthy.

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 Neck Pain

Neck pain is a very common symptom and can result from a variety of causes. Primary care doctors may refer patients to be evaluated by a neurosurgeon if the neck pain can be treated surgically and if they are experiencing any of the following symptoms: headache associated with neck pain, pain shooting down one arm, numbness or tingling in the arms or hands, leg weakness or loss of coordination, pain that does not respond to pain medications. The common causes of neck pain are degeneration of the discs that cushion the spinal column, narrowing of the spinal canal (spinal stenosis), arthritis and, rarely, tumors or meningitis. Age and injury, such as whiplash, can be major factors in the development of neck pain. Pressure on the nerves in this region of the neck can lead to significant disability and should be treated promptly.

Neck pain is usually evaluated by reviewing the patient's symptoms, performing a physical exam and reviewing any diagnostic studies such as CT scan, MRI, Electromyography (EMG) or X-rays. Typically, neurosurgeons will try the most conservative approach to treating a patient's neck pain. This usually includes pain medications, cervical collars, pain injections or steroids. Surgery may be necessary for those patients who do not experience significant relief from conservative treatments or for those patients who are experiencing worsening neck pain.

Several different surgical techniques can be used to treat neck pain depending on the cause of the condition. Spinal fusion or Anterior Cervical Discectomy and Fusion, Minimally Invasive Spine Surgery and Cervical Laminectomy are just a few examples. Outcomes vary and depend on the severity of the condition as well as several other factors. Patients may require physical therapy after surgery to help in the recovery process.

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 Odontoid Fractures

Odontoid fractures refer to a fracture involving the second vertebra which is high in the neck, near the base of the skull. Odontoid fractures can be dangerous or fatal because of their proximity to the critical brainstem. In older patients, these fractures are often the result of minor trauma. In younger patients, these fractures generally result from high force trauma such as fall from height or motor vehicle accident. Symptoms of an odontoid fracture include: neck pain, limited mobility of the neck, and numbness of the arms.

Depending on the type of odontoid fracture, patients may need surgery to fuse the odontoid bone and prevent damage to the spinal column or brainstem. Patients who do not need surgery may be placed in a "halo" to immobilize them and allow the fracture to heal.

 Sciatica

Sciatica describes a pattern of pain, weakness, numbness or tingling that starts in the buttock and radiates down a leg. It is generally caused by injury to the sciatica nerve. Sciatica is often caused by herniated discs, muscle injuries, pelvic fractures or tumors.

Sciatica can vary in severity from mild to debilitating. Often, the pain worsens with sitting or standing, at night, coughing, or bending. A diagnosis of sciatica is made based on a patient's history, symptoms and physical exam. Diagnostic studies such as blood tests, x-rays or MRIs may be useful to determine the underlying cause of the sciatica.

Treatment is based on the severity of symptoms and underlying cause. For some patients, no treatment is necessary. For others, conservative therapies such as heat or ice, pain medications, steroid injections or physical therapy may be recommended. If these options do not provide satisfactory relief, you may need to see a neurosurgeon to explore surgical treatment options for the underlying cause of your sciatica.

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 Spinal Cord Injury (Spinal Trauma)

Spinal trauma describes any injury to the spinal column or spinal cord. This includes fractures of the vertebrae and injury to the spinal cord. Spinal cord injury can be one of the most devastating types of trauma because it can impair the spinal cord's ability to facilitate communication between the brain and the rest of the body. Major causes of spinal trauma include falls, auto accidents and gunshots.

The higher on the spinal cord the injury, the more loss of function the patient will experience. Loss of function also varies with severity of spinal cord injury which can range from complete to incomplete. Spinal cord injury can be diagnosed with a physical examination and correlating radiographic studies (x-ray, CT scan, MRI).

Surgery may be a treatment option depending on the mechanism of injury and if it is possible to relieve some of the pressure on the spinal cord. Patients with spinal cord injury are vulnerable to many secondary medical complications as a result of their neurological deficits and mobility challenges. Patients whose spinal trauma is limited to vertebral fractures generally have better clinical outcomes.

To avoid spinal trauma, it is advisable to wear protective gear such as helmets, avoid dangerous heights, always wear a safety belt, dive only where marked safe (adequate depth) and always practice firearm safety.

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 Spinal Arthritis (Spondylosis)

As we age, we can all experience breakdown of the cartilage that cushions the joints of our body. This painful condition is known as arthritis and is known as Spondylosis when it occurs in the spine. Spondylosis can result in disc degeneration, pinched nerves and narrowing of the spinal nerve canals. Heavy lifting, sitting for long periods of time or bending may exacerbate the pain. Patients may experience pain, stiffness, weakness, numbness or limitation in their mobility. This condition can be diagnosed by MRI. Initial treatment for Spondylosis or Spinal Arthritis is anti-inflammatory medications. Other treatment options include epidural steroid injections, physical therapy and weight management. In some cases, surgery may be indicated to relieve pressure on the spinal cord.

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 Spinal Stenosis

Spinal stenosis is the narrowing of the canal through which the spinal cord passes. This narrowing causes compression of nerves which can result in pain, pain radiating down the leg (Sciatica), loss of bowel or bladder function, numbness or weakness. The incidence of spinal stenosis increases with age.

Spinal stenosis is diagnosed based on a patient's history, symptoms, physical examination and diagnostic studies such as X-rays, CT scan, MRI or myelogram. Treatment is decided based on the severity of the patient's symptoms and the degree of narrowing and nerve compression. First line treatment for spinal stenosis includes non-invasive measures such as pain medications, steroid injections and physical therapy. Surgery for spinal stenosis is reserved for those patients who have debilitating disease, neurological deficits, loss of bowel or bladder functions or difficulty with balance and who have not experienced significant relief from the non-invasive treatment options previously mentioned.

Several surgical approaches exist and your neurosurgeon will choose the one best suited for your condition. The surgical options include: decompressive laminectomy, foraminotomy (an opening made into part of the vertebra to give more room for nerves to pass through), laminotomy (an opening made into the back portion of a vertebra to create more space for the spinal canal), spinal fusion (fusing vertebrae together to improve spinal column stability).

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 Spinal Tumors

Spinal tumors are abnormal growths arising from within the spinal cord or spinal column. These tumors can be benign or malignant and they can also be primary (meaning arising directly from the spinal column or cord) or metastatic (meaning they have spread to the spine from a primary tumor located elsewhere in the body).

Different types of primary spinal tumors include meningiomas, schwannomas, neurofibromas, ependymomas, lipomas, and astrocytomas. Even benign spinal tumors can be complicated to remove because of the very delicate nerves in the area. The spinal column is the most common site for metastatic bone disease. Metastatic spinal tumors usually come from primary tumors in the lung, breast or prostate as well as many others.

As with most cancers, the cause is largely unknown. There are, however, some individuals with genetic tendency or compromised immune systems who are more likely to develop spinal tumors. Symptoms of a spinal tumor vary greatly and depend on the size, location and type of tumor. Symptoms usually arise from the tumor pushing against nearby nerves, blood vessels and bones. Symptoms can include: pain, weakness, numbness, difficulty walking, decreased sensation, loss of bowel or bladder function or paralysis.

Spinal tumors are generally diagnosed based on a patient's history, symptoms, physical examination and diagnostic studies. These studies include X-rays, CT scans, MRI, and biopsy. Treatment options depend on the patient's overall health as well as the size, type and location of tumor. The options include: observation, chemotherapy, radiation therapy, or surgery. The goal of surgery is to remove as much tumor as possible with the goal of alleviating symptoms, stabilizing the spine and preserving neurological function.

As with many surgeries, physical rehabilitation may be required in the recovery period to regain mobility. Outcomes depend on the overall health of the patient as well as the type and severity of tumor removed.

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 Spondylolisthesis

Spondylolisthesis refers to a condition in which one vertebra (the bone that makes up the spinal column) slips out of position and onto the bone below it. In adults, this is usually a result of arthritis, bone disease or bone fractures and typically occurs in the lower back. Symptoms range from mild to debilitating depending on the degree of slippage and the surrounding structures affected. The defect can cause deformity of the spine. Symptoms of spondylolisthesis include: muscle stiffness, thigh/buttock pain, tenderness in the area of the slippage. If nerves are compressed by the slipped vertebra, this can result in more severe symptoms. A diagnosis of spondylolisthesis can be made by taking a patient's history, performing a physical exam and reviewing diagnostic images such as x-ray, CT scan or MRI.

Treatment is designed based on the severity of a patient's condition. Non-invasive treatment options such as exercises, pain medications, bracing or physical therapy will generally be tried first. If these therapies do not provide adequate relief, patients may need evaluation by a neurosurgeon to explore surgical options.

Surgical treatment generally involves stabilizing the position of the vertebrae with spinal fusion. Results are generally very good, especially for patients who avoid further injury to the spinal column and are in good overall health.

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 Vertebral Compression Fractures

Vertebral compression fracture is a common condition, largely caused by osteoporosis or lost bone density that occurs with increasing age. Vertebral compression fractures occur in both men and women but are much more common in women. It is estimated that 1 in 4 American post-menopausal women experience a vertebral compression fracture at some time.

A vertebral compression fracture is a result of collapse of the vertebral body, the chain of bones that make up the spinal column. This collapse can cause pain, deformity and diminished height. For those patients with osteoporosis, vertebral fractures can occur with even minor strain. In most people with normal bone density, however, vertebral compression fractures occur only with significant trauma such as a hard fall. In some cases, a tumor within the vertebral body can weaken the bone and lead to a compression fracture.

The symptoms associated with a vertebral compression fracture depend on the location of the vertebral body affected. These symptoms can include: back pain, pain exacerbated by standing or walking, pain alleviated by lying on the back, limited back mobility, height loss, or deformity. Vertebral compression fractures can lead to spinal instability, kyphosis or "hunching" of the back or neurological complications related to pressure placed on the spinal cord or nerves.

Doctors will often use imaging, such as x-rays, CT scans or MRIs to further evaluate the vertebral compression fracture and to design the best treatment plan. Treatment options include rest, pain medications, bracing and medications to improve bone density. When surgery is required, surgeons can choose between vertebroplasty and kyphoplasty, two types of minimally invasive spine surgeries, to treat the condition. Vertebroplasty is the insertion of acrylic bone cement into the collapsed vertebra to stabilize it. Kyphoplasty is a similar procedure but also involves the injection of cement into balloons placed within the fractured vertebra. These balloons help to restore the lost height of the spine. These procedures are not for every vertebral compression fracture, however. For some, the fracture is best treated with the more conservation measured mentioned earlier.

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