Conditions and Treatments

Chronic low back pain

Chronic low back pain is an extremely common condition that affects around 35 million Americans. It is the leading cause of disability in people under 45 years of age, and is the most common cause of lost workdays in America. It is also the second most common reason for office visits, with 80% of the population experiencing back pain at some point in their lives. The majority of cases of back pain are secondary to muscle spasms, muscle sprains, or arthritis. However, there are more serious causes of back pain, like spinal stenosis, herniated discs, degenerative disc disease, or spinal deformity that require more specialized care.

Most causes of back pain are treated conservatively with modalities like physical therapy and medications that help with pain and muscle relaxation. However, when back pain is associated with lower extremity symptoms, including numbness, tingling, or weakness, surgery may be recommended. Risk factors for low back pain include muscle strain, trauma, sciatica, disc herniation, disc disease, autoimmune disorders, lumbar stenosis, fractures, infections, or tumors. Each case is diagnosed and treated according to its specific presentation.

Degenerative disc disease

Degenerative disc disease refers to advance wearing of the disc that serves as a cushion between the bones of the spine. As people age, the discs undergo changes, mainly from wear and tear, that eventually result in deterioration of the disc material. Most people develop degenerative disc disease by the age of 60. Symptoms include back pain and weakness or numbness of upper and lower extremities. In advanced cases, some people may have bad posture from back pain or even difficulty walking. A diagnosis may require CT scan, an MRI, and X-rays of the spine. Treatment is tailored to each specific case; however, in the most advanced cases surgery is recommended to replace the degenerative disc.

Flatback syndrome

Flatback syndrome is a condition that occurs when the spine loses its normal curvature and instead presents with a straight or flat configuration. Normally the spine has several front-to-back curves, which are called kyphosis in the thoracic spine and lordosis in the lumbar spine. When there is loss of this curve, the patient is diagnosed with flatback syndrome. Flatback syndrome may be caused by degenerative disc disease, a fracture, or severe autoimmune diseases. It could also result from a prior spine surgery like a laminectomy for spinal fusion, where the normal curve was not maintained. Symptoms include severe lower back pain with muscle contractions, difficulty walking, and in some patients, lower extremity pain, numbness, or weakness. Diagnosis may require X-rays, CT scans, and an MRI of the mid and lower spine. Many patients may benefit from non-operative treatments, including physical therapy, pain medication, and exercise. However, in more advanced cases, surgical correction of the straight back is recommended.

Herniated disc

A herniated disc occurs when the inner portion of the disc, which has a jelly-like constitution, ruptures and protrudes toward the outside, resulting in the compression of one or more nerves. Compression of a nerve, or “pinched nerve,” may result in pain, numbness, tingling, or even a weakness of the arms or legs. Herniated discs can be a result of multiple factors, however, aging, arthritis, degenerative disc disease, smoking, or wear-and-tear are the most common causes. Herniated disks can be present in all age groups and at any given part of the spine, although they are most common in the lower (lumbar) spine, followed by the neck (cervical spine).

A diagnosis may include a CT scan, X-rays, and an MRI of the spine to evaluate the herniated disc. Treatment is usually without surgery for the first 6-8 weeks. However, if pain or weakness continues despite conservative treatment, then surgery may be recommended to remove the piece of herniated disc impinging on the nerve.

Myelopathy

Myelopathy refers to damage to the area of the spinal cord around the neck. The most common cause of myelopathy is the compression or squeezing of the spinal cord, known as cervical spine stenosis. The compression of the spinal cord disrupts normal nerve transmission; therefore there is disruption in the connection between the brain and the limbs. Common symptoms include numbness of the hands, clumsiness of the hands, arm or hand weakness, leg stiffness, loss of balance with difficulty walking, urinary urgency, and neck pain. Common causes include degenerative spine (arthritis), bone spurs, disc bulges, and thickness of ligaments in the spine. Trauma may also be a contributing factor. Diagnosis is made by CT or MRI of the cervical spine. The primary treatment of cervical myelopathy is surgery, which includes decompressing the spinal cord, followed by fixation and fusion to avoid loss of stability at the level of the neck. 

Radiculopathy

Radiculopathy is a medical term to describe a compressed or “pinched” nerve. Depending on the location of the compressed nerve, a person may develop symptoms in the arms, neck, or legs. Mid spine radiculopathy is rare, but when present it results in pain in the middle of the back that travels to the chest or abdomen. Neck and lower spine radiculopathy can cause pain, numbness, or even weakness in the arms or legs. The most common causes of radiculopathy are spinal stenosis, herniated discs, and spondylolisthesis. Diagnosis may require X-rays, CT scans, and an MRI of the spine. Many forms of radiculopathy will respond best to non-surgery measures like medication and physical therapy. When surgery is the best option, it is tailored to the cause of the radiculopathy.

Revision spine surgery

Revision spine surgery is performed on certain patients to correct earlier spine surgery if needed. Revision surgery may be recommended for patients with chronic pain even after prior surgical interventions. The goal of revision spine surgery is to reduce pain and resume normal activities. Revision spine surgery is performed to reduce pain from certain conditions, such as re-herniation of a disc, infection, pseudarthorsis, hardware failure, non-surgery related spine degeneration, flat back syndrome, instability, or adjacent segment degeneration. The treatment options depend on the original type of surgery that a patient underwent. With recent advancements in technology, revision surgery is a safe and effective option, minimizing risk of a re-operation while achieving desirable pain-free outcomes.

Sciatica

Sciatica is the result of the compression of one or more of the nerves that make up the sciatic nerve in the lower (lumbar) spine. The sciatic nerve is the single largest nerve in the body. Classic sciatica symptoms include pain, burning, numbness, tingling, or weakness in one or more extremities; however, it is usually localized on one side. The pain is often sharp and constant, usually worsens when sitting or standing straight, and improves with bending forward.

Causes of sciatica include herniated discs, spinal stenosis, degenerative disc disease, or trauma. Diagnosing sciatica requires X-rays and possible imaging, which might include a CT scan and an MRI of the lumbar spine. For the most part, symptoms of sciatica go away in a few weeks with conservative treatment, including pain medication, heat packs, steroid injections, and/or physical therapy. However, surgery may be considered if the pain does not respond to conservative measures or in cases where there is a significant weakness of the lower extremity.

Scoliosis

Scoliosis is a side-to-side curve in the spine. Degenerative scoliosis is a result of wear and tear on the discs and joints of the spine. It is the most common type of scoliosis in adults, and usually occurs in the lumbar spine. Symptoms include back pain that is worse with standing, back pain that is relieved by lying down, pain down the legs, or numbness and weakness down the legs. A diagnosis may require X-rays, CT scan, and an MRI of the spine. The treatment of degenerative scoliosis will depend on a variety of factors. The surgeon will determine the best treatment for each patient and each situation. Non-operative treatment, including physical therapy, strengthening and stretching exercises, or pain management may be an option for some patients. In more advanced cases, surgical correction of the deformity is recommended.

Spinal cord injury (SCI)

The most common cause of spinal cord injury at the neck or mid back level is trauma; however, the presence of tumors or advance degenerative diseases may also result in a spinal cord injury. When spinal cord injury occurs, partial or complete disruption of the connection between the brain and the limbs occurs, resulting in the reversible weakness or loss of sensation of one or multiple limbs, depending on the level and location of the injury. Specific treatment is tailored to each individual case, and surgery may be necessary to stabilize fractured bones and decompress the injured area in certain cases.

Spinal stenosis

Spinal stenosis is defined as the narrowing of the spinal canal where the spinal cord or nerve roots normally travel through. The reduction in the size of the spinal canal results in compression of the traveling nerves, and thus the presence of symptoms. Most cases of spinal stenosis occur in the lower (lumbar) spine; however, neck (cervical) and mid back (thoracic) stenosis is also common. Symptoms of spinal stenosis depend on the location within the spine. Neck (cervical) spinal stenosis symptoms include numbness, tingling, or pain in the shoulders, arms or hands. Gait instability can also occur in either the upper or lower extremities, as well as problems with coordination in the hands, making it difficult to do fine motor tasks like buttoning a shirt, writing, or typing. There may also be problems with bladder or bowel control.

Lumbar spinal stenosis may present with lower back pain; pain, tingling, or weakness of the legs and feet; and/or bowel or bladder dysfunction. Causes of stenosis are mostly related to degenerative changes associated with aging, which includes arthritis and bone spurs. Other causes include fractures, tumors, infections, or conditions that are present during birth. A diagnosis may require a CT scan or MRI of the spine. Treatment is usually non-surgical and includes anti-inflammatory medication, physical therapy, weight control, or more invasive treatments such as epidural steroid injections. When conservative treatment fails, then surgery is recommended.

Spine deformity disease

Spine deformities refer to loss of the normal curvatures at the neck, mid back, and lower back (cervical, thoracic, or lumbar spine). The normal spine is structurally balanced for optimal flexibility and support of the body’s weight. A spinal deformity occurs when there is loss of that normal structural balance. A spinal deformity can be present as an abnormal front-to-back or side-to-side imbalance of the normal structure of the spine. An abnormal curvature can put the spine out of alignment, therefore adding stress and weight in an effort to preserve the normal body structure. A spinal deformity can present itself as many types of conditions, including loss of balance, curvature of the back (kyphosis), flat-back syndrome, and chin-on-chest syndrome. Curvature of the spine (scoliosis) is also a form of spinal deformity. Each of these conditions can arise from different causes, including congenital deformity, age-related deformity, or a disease process like tumors, infections, or trauma. Symptoms depend on the type of deformity and the location. However, most patients complain of severe intractable pain at any given point in the spine, which may include pain, numbness, and weakness of upper and lower extremities. A diagnosis is made using X-rays, CT scans, and an MRI of the spine. For the most part, treatment is conservative and may include pain medications, physical therapy, and certain braces. However, in more advanced cases surgical correction of the deformity is the only option.

Spine fractures

Spine fractures are an injury in which the vertebra, the primary bone of the spine, breaks in multiple directions. Symptoms include moderate to severe back pain which is worse with movement, numbness, tingling, weakness of arms and/or legs, and loss of bowel or bladder control. Causes and risk factors include trauma and any type of weakened bone, including osteoporosis or tumors.  Imaging like CT scans, X-rays, or MRIs will be performed to diagnose a spine fracture. Treatment depends on the severity of the fracture. Treatment is tailored to the patient’s condition and could include the use of a brace, placement of cement into the vertebral body (which is known as vertebroplasty), or in some cases, a spinal decompression with fixation of the spine.

Spine tumor

Spine tumors include primary tumors of the spinal cord, nerves, or bone. In addition, there may be metastatic disease which is cancer that has spread from other parts of the body to the bones of the spine or disc space surrounding the spinal cord and nerves. There are multiple types of primary and metastatic tumors that can develop in the spine. Symptoms include pain, numbness, tingling, or weakness in upper or lower extremities. If there is only involvement of the bone, there may be fractures, which are associated with excruciating localized back pain. A diagnosis of a spine tumor may require a CT scan, an MRI, and in some instances, bone nuclear studies. Treatment depends on the type of tumor. It may involve surgery, chemotherapy, and/or radiation therapy. In case of fractures associated with metastatic tumors, the placement of cement into the bone can be an effective treatment to alleviate the pain.

Spondylolisthesis & spinal instability

Spondylolisthesis is the presence of an abnormal slip between two continuous vertebral bone levels. Spinal instability occurs when the bones in the spine abnormally move, one on top of the other, as a result of degeneration of the normal structures to keep the spinal column in normal alignment. The result of instability is chronic low back pain when the person moves. As with spondylolisthesis, spine instability results in severe low back pain as the bones abnormally move, creating bone-on-bone rubbing and friction. A normal spinal column should not have slippage or abnormal motion between its bony segments, and should instead all move harmonically as a single unit.  A diagnosis may require CT scans, flexion and extension X-rays, as well as an MRI of the affected spinal segment. Non-surgical treatment is usually recommended for patients as a first line of treatment, however in more advanced cases, or for patients who do not respond with conservative therapy, surgery is recommended in order to avoid further moving or slippage of the spine.