Spinal Conditions We Treat

A cervical disc herniation occurs when disc material protrudes into the spinal canal causing compression of the nerve roots or spinal cord. This typically results in arm pain, shoulder pain, chest pain, neck pain numbness/tingling and possibly headaches depending on nerve involved. If the spinal cord is involved, symptoms may include balance issues, hand weakness and loss of dexterity. Surgical treatment depends on the location of the disc and may be approached from the back of the neck where a foraminotomy is performed (motion preserving), from the front of the neck with a cervical disc replacement (motion preserving), anterior cervical discectomy and fusion or ACDF where the disc is removed and replaced with a graft (fusion).

Cervical stenosis is usually caused by degeneration or arthritis causing overgrowth of the facet joints, bone spur formation and hypertrophy of the ligaments in the spine. It is typically an ongoing process. This combination of factors causes narrowing of the spinal canal and compresses the spinal cord. Spinal cord compression on the MRI shows as myelomyelacia which signifies malfunction in the tracts. Symptoms include worsening balance, loss of dexterity in the hands, numbness and tingling in the fingers, neck pain and arm pain. This condition rarely improves without intervention (Symptoms of myelopathy). Surgical treatment will depend on many factors such as: the primary contributing pathology to stenosis if int he front or the back, integrity of the facet joints and the severity of neck pain. Options include a laminoplasty whereby the canal is opened from the back and held with a small plate (motion preserving), cervical disc replacement (motion preserving), skip laminectomy (motion preserving), laminectomy and fusion (fusion) from the back or anterior cervical discectomy and fusion from the front of the neck (fusion).

Cervical radiculopathy (nerve root compression) can be caused by a disc herniation or in some cases arthritis affecting the foramen where the nerve exits. Treatment options are similar to those of a cervical disc herniation. It is important to note that there is a lot of overlap in spine pathology and patient commonly have more than one pathology or inciting factor.

Lumbar disc herniation occurs when a disc in the lumbar spine ruptures and impinges on the exiting nerve root. This results in sciatica or pain shooting down the buttock, thigh, leg and foot. It may be associated with numbness and tingling and sometimes weakness. Surgical treatment involves removing the disc from. the back, otherwise known as lumbar discectomy. And this may be performed using a surgical high resolution microscope or ultra-minimally invasively with endoscopic spine surgery.

Similar to cervical stenosis, lumbar spinal stenosis is typically a wear and tear disease. Degeneration and arthritis causing overgrowth of the facet joints, disc herniations, bone spur formation and ligament hypertrophy all result in narrowing of the spinal canal and compression of the nerve roots. Classic symptoms referred to as claudication include pain and/or numbness tingling in the buttocks, thigh and leg areas which gets worse with walking and better with rest. Patients classically prefer leaning over such as on a shopping cart and sitting down which flexes the lower back and expands their canal allowing more space for the nerve roots. Treatment usually includes a decompression such as a laminectomy or less invasive laminotomy with a microscope or endoscopically (motion preserving). In some cases where there may be associated instability, a fusion surgery may be indicated.

Degenerative disc disease refers to degeneration in the disc cushioning between two vertebra. It may be isolated or as part of the spectrum of spine arthritis and degeneration (wear and tear). When isolated it most commonly causes back pain that is worse with sitting down and improves with standing. Occasionally, leg pain (sciatica) may be present. Treatment may involve decompression, lumbar disc replacement (motion preserving) or rarely fusion in specific situations.

Spondylolisthesis refers to slippage of one vertebra over the other. The two most common etiologies are degenerative and isthmic. Degenerative spondylolisthesis results from arthritis (wear and tear) of the facet joints and disc space resulting in spinal instability and slippage of one vertebra over the other. Isthmic generally refers to missing vertebral bone resulting in slippage and instability (Imaging report may mention “fracture” or spondylolysis). Historically, spondylolisthesis was treated with fusion due to the degree of instability. However more recent advanced decompression techniques allow for motion preserving treatment.

A thoracic disc herniation is relatively rare compared to lumbar disc herniation. When it happens, it causes compression of the spinal cord. Symptoms may include trouble with balance, subjective weakness in the legs, numbness or tingling, knee buckling, bowel or bladder control issues and others. Treatment for thoracic disc herniation is usually surgical and involves decompression which may be done minimally invasively in certain cases.

Schuermann’s kyphosis is generally considered to be part of the idiopathic family, as in the clear exact causes are unknown. It typically presents with an increased “hump-type” deformity. It usually presents at a younger age (30’s or earlier). Bracing is usually effective for curves smaller than 70 degrees and at a certain age. When surgery is needed, posterior spinal fusion to correct the hump back is typically indicated.

Adolescent Idiopathic scoliosis (AIS), otherwise known as juvenile idiopathic or early onset scoliosis in younger patients, is a condition characterized by curvature of the spine. It is a three-dimensional deformity of the spine often resulting in visible curvature with shoulder or waist asymmetry. Although it runs in families, genetic inheritance is not clear cut. Treatment depends on two factors, the magnitude of the curve as well as age (amount of growth left). Curves are known to progress with growth spurts. For curves measuring less than 25, we monitor with serial X-rays. For curves in the 25-40 range we treat with bracing if further growth is expected. For curves larger than 50 we start talking about surgery which involves fusion or guided growth. Our experienced team can help you guide throughout the whole process and we longitudinally follow our patients for long periods of time.

Degenerative scoliosis involves a completely different pathology. Arthritis or wear and tear of the spine causes incompetence of the facet joins and disc which results in twisting and slippage of the vertebrae. This often results in instability and spinal stenosis. When all nonoperative modalities have failed, surgery to stabilize the spine is often indicated. Degenerative scoliosis surgery is complex and level selection is complicated and a matter of debate. It is otherwise known as “spinal deformity” or failed back when patients had previous surgeries.

Neuromuscular scoliosis is a specific type of scoliosis which occurs which occurs in the setting of neurologic disorders or connective tissue disease such as cerebral palsy, Marfan Syndrome or other conditions. Surgery is dependent on many factors including curve magnitude, interference with ability to perform hygiene and neurologic symptoms.

Failed back syndrome occurs when patients have had previous spinal surgeries but continue to have back pain, leg pain or other neurologic symptoms. Most common causes include non union (when the bone did not heal), proximal junctional kyphosis (when the level above or below a fusion degenerates) or being fused in a “flat” spinal position. Surgery will depend on the cause of the symptoms and may include decompression or a fusion.

Spinal tumors compromise a wide variety of diseases ranging from benign to malignant, primary (originates in the spine which is rare) or metastatic (tumor started somewhere else and metastasized the spine). Treatment is usually carried out as part of a multi-disciplinary effort involving medical oncologist, radiation oncologists and spine surgeons. Depending on the tumor pathology medications and/or radiation may suffice. In the case of severe spinal cord compression or non-favorable tumor biology (tumor not responsive to radiation or chemotherapy), surgery may be indicated.

Osteoporotic fractures of the spine happen when the bone is weakened enough for a fracture to happen with low energy trauma (in certain cases may be as low as coughing). Treatment for compression fractures is rarely surgical unless in severe cases. In most cases, we focus on treating the osteoporosis in collaboration with our bone health experts. Certain minimally invasive procedures are offered to help alleviate the pain.

Spinal trauma and fractures occur when an injury is impacted to the spine. Treatment is dependent on the type of fracture, the presence of neurologic injury and associated injuries.