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Spine Health

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CONDITIONS
Cauda Equina Syndrome

Cauda Equina Syndrome is a surgical emergency that occurs when the nerve roots of the cauda equina (collection of nerves at the end of the spinal cord) are compressed, resulting in loss of sensation and movement to the lower extremities.

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The nerve roots that control bladder and bowel function may also be affected, causing an loss of control of stopping or starting urination or bowel movements.  Cauda equina syndrome can be caused by a herniated disc, spinal stenosis, trauma, infection such as epidural abscess, or cancerous conditions that cause narrowing of the spinal canal. Treatment involves surgical decompression, laminectomy, and possible stabilization or fusion performed on an urgent basis.

 

Herniated Disc : “Slipped Disc”

The block-like bones (vertebrae) that form the spinal column are cushioned by shock absorbing and stabilizing discs.  The disc is composed of a tough outer layer (the annulus fibrosus) and a gel-like center (the nucleus pulposus).

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Over time or with an acute traumatic event, the annulus fibrosis may become less stable making it vulnerable to injury and herniation.  A herniated disc occurs when the nucleus pulposus (center) breaks through the tough outer ring, or annulus fibrosis layer, causing irritation or compression of the spinal cord or nerve roots.  In cervical conditions, symptoms include numbness, tingling, and weakness to the shoulders, arms, forearm and/or hand; lumbar problems often affect the low back, buttocks, groin, thighs, legs and/or feet.  Medication management and interventional pain management such as epidural steroid injections may alleviate the radicular or sciatic pain.  In cases where the pain has progressively worsened and/or there is loss of strength and/or sensation despite efforts with conservative treatements, then surgery may be needed.  The simplest surgery is a minimally invasive discectomy which may be performed as an outpatient procedure.

 

Myelopathy: Dysfunction of the Spinal Cord

Myelopathy is a very serious condition, frequently surgical, caused by compression of the spinal cord in the cervical spine due to stenosis that creates pressure on the spinal cord.  Any condition that can cause stenosis may cause myelopathy.

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The pressure may cause nerve cell death and changes on the appearance of the spinal cord on MRI studies. The most common symptom is difficulty with walking due to weakness in the lower extremities.  Symptoms can include loss of balance, problems with walking, loss of coordination in the arms, hands or legs, dexterity problems, handwriting deterioration, or loss fine motor skills (problems picking up small coins from a table top, ability to use buttons on shirts, hooks on bras, buckles on belts and watches).  Exaggerated reflexes may also occur, resulting in compromised smooth function of muscles in the arms or legs. Severe myelopathy is a surgical condition that may be treated with a laminoplasty, laminectomy with or without fusion.  On occasion, the complete removal of the vertebral body, or corpectomy, in conjuction with a fusion is a necessary part of the decompression to relieve pressure on the spinal cord.

 

Radiculopathy: Nerve Root Dysfunction

Radiculopathy is caused by direct pressure from a herniated disc, degenerative disc disease, or spinal stenosis, which results in irritation or inflammation of one or more nerve roots in the lumbar or cervical spine.

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Symptoms may include pain, numbness, weakness, or tingling and can vary depending on the level of the problem. Treatment includes physical therapy, medication management, and epidural steroid injections.  In cases of strength loss or numbness and tingling that fail to respond to the non-operative treatments, decompression or laminectomy, or foraminotomy procedures might be necessary to definitively treat the areas of stenosis.

 

Sacroiliac Joint Pain (SI Joint)

The sacroiliac joint (SI joint) is the junction of the triangular-shaped sacrum and the pelvis. Structurally and mechanically, it is like a keystone that connects the torso to the pelvic ring/arch and legs.

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These joints have limited mobility, but like any joint, may be susceptible to arthritic changes over time, especially in patients who have had prior lumbar fusions. Pain is often in the buttocks with radiation into the thigh or groin but can also be present in the low back.  Specific maneuvers on physical examination are required for proper and accurate diagnosis of this condition. Physical therapy and sacroiliac injections may be effective.  When conservative methods fail, minimally invasive SI joint fusion may be performed on an outpatient basis or with a 23 hour overnight stay at the hospital or surgery center.

 

Spinal Stenosis: Narrowing of the Spinal Canal

Spinal stenosis occurs when the space around the spinal cord or openings (neural foramina) where the spinal nerve exit narrows.  This results in pressure on the spinal cord and the spinal nerve roots, which can cause pain, numbness, or weakness.

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In the cervical spine symptoms can occur in the shoulders, arms, and hands.  Similarly, in the lumbar spine, symptoms occur in the low back, buttocks, and legs. Medication management, physical therapy and interventional pain injections are important methods of treatment.  Severe cases that do not respond to conservative treatments may require surgical laminectomy and decompression.  In some instances, this may be done in the outpatient setting or with a minimal hospitalization.

 

Spondylosis: Degenerative Disc Disease

Degenerative disc disease is a form of arthritis of the discs.  Normally, the spinal discs acts as shock absorbers for the spine, allowing it to bend and twist.

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  The condition may develop with age or with normal “wear and tear” of the spine.  With aging and repetitive trauma, the disc may lose fluid and become dehydrated, causing a loss of the normal “shock absorber” function of the disc.  These age-related changes can lead to disc herniation, spinal stenosis, scoliosis, instability (see spondylolisthesis), and bone spurs, which can put pressure on the spinal cord and nerve roots. Other symptoms include numbness, tingling, and weakness to the shoulders, arms, forearm and/or hand in cervical degenerative disc disease; lumbar problems often affect the low back, buttocks, groin, thighs, legs and/or feet.  Sitting upright puts the most pressure on the discs and may worsen symptoms, while lying down tends to relieve the pain. Treatment involves physical therapy, medication management, and interventional pain management/injections.  If non-operative methods fail, then surgical treatments include discectomy, laminectomy, fusion or artificial disc replacement.

 

Spondylolisthesis: Instability of the Spinal Column

Spondylolisthesis occurs when there is a forward-to-backward or side-to-side slippage of one vertebral body in relations to the one below it.  This often occurs in the lumbar spine but can also affect the cervical spine.

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Since the spinal canal is formed by the stacking of the vertebrae (like LEGO blocks), any change in the alignment of adjacent vertebrae will result is stenosis of the shared spinal canal, where the spinal cord and nerve roots have to travel through.  The slippage of the vertebrae may be caused by congenital conditions, anatomy variations, or degenerative wear and tear changes.  The pressure exerted on the nerve roots or spinal cord, as well as loss of normal relationships between the facet joints may result in axial spine pain and radicular or radiating pain into the arms or legs.  Not all cases of spondylolisthesis require surgery.  In many cases, a comprehensive core strengthening  program with physical therapy, yoga and Pilates may effectively provide the appropriate postural and truncal stability needed to alleviate the pain.  When conservative treatments fail, surgical decompression and fusion allow for restoration of proper alignment, relief of pressure on the spinal cord and nerves, and stabilization of the “hypermobility” that is the causative pathology of this condition.  Artificial disc replacement, or motion preservation/restoration techniques are NOT options for this diagnosis.

 

Vertebral Fracture

A spinal fracture, or broken bone, may be due to low energy or high-energy collisions. In osteoporosis, the bones become brittle and weak making it susceptible to fractures even from simple activities such as bending over or coughing.

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Other fractures are due to high-energy impact, such as motor vehicle accidents. Stable fractures that do not compromise spinal cord or nerve function may be treated with immobilization or bracing, while unstable high-energy fractures, or those with neurological compromise need to be treated surgically on an urgent basis.

 

Tumor or Infection

These conditions require coordinated diagnosis and treatment from your physician team, including internal medicine, oncology, infectious disease and surgical consultants.

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When these conditions result in severe stenosis, instability of the spinal column, neurological compromise, cauda equina syndrome, and the other members of the physician team deem it appropriate, surgery is usually required.  Other treatments such as chemotherapy, radiation therapy, antibiotic treatments all need to be thoroughly discussed among physician team members.

 

Whiplash or Strain

Overuse or rapid acceleration-deceleration such as car accidents may cause a sprain or strain of the muscles and ligaments in the neck or low back.

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Symptoms may include pain, swelling, loss of motion, tenderness and muscle spasm. This condition can be treated with rest, ice/heat, medication (anti-inflammatory, narcotic, muscle relaxants), physical therapy, and TIME.  It is not a surgical condition unless there has been radical destruction of the interspinous ligaments resulting in gross instability of the spinal column.