Common Spinal Conditions and Treatments
Here are just a few of the most common conditions and a breakdown of treatments available at the Floyd Memorial Spine Center:
- Degenerative Disc Disease is a normal part of aging that often occurs along with spinal stenosis. Over time, stressors and minor injuries cause the spinal discs to gradually degenerate, shrinking the space between discs and causing instability and nerve compression. Conservative rehabilitation and pain management treatments are typically successful.
- Herniated/Ruptured/Bulging or Slipped Discs can occur as a result of injury or a fall, repetitive motion, or as part of the normal aging process. Rehabilitation and pain management treatment are typically effective, but in severe cases, surgical intervention is appropriate.
- Kyphosis is an exaggerated forward rounding of the spine. It is typically found in older women, but may occur at any age. When seen in the older population, it is normally a result of degenerative changes and/or osteoporosis. When seen in younger patients, it may be related to posture or, if related to developmental problems, it is most commonly referred to as Scheuermann’s disease. With severe kyphosis, there may be fractures of the vertebrae. The most common types of treatment may include a brace, physical therapy and, in severe cases, surgery.
- Osteoporosis typically occurs in postmenopausal women and may contribute to painful vertebral fractures. Surgical procedures such as Vertebroplasty and Kyphoplasty are usually effective treatments if caught early. Physical therapy may also be beneficial to strengthen muscles, reduce pain and return the patient to their prior mobility level.
- Sciatica is a painful condition resulting from irritation of the sciatic nerve. The irritation is often caused by pressure on the sciatic nerve resulting from an abnormally tight piriformis muscle in the buttocks, slipped disc, degenerative disc disease, stenosis or a tumor. Treatments include anti-inflammatory medications, physical therapy and, in severe or persistent cases, surgical intervention.
- Scoliosis is a sideways curvature of the spine that occurs during growth spurts before puberty or as a result of arthritis, spinal injury or other spinal disorders. Most cases are mild, but severe cases can be disabling, resulting in a need for bracing or surgical intervention where rods, screws, wires and hooks are used to correct the curvature. Physical therapy is also indicated to stretch and strengthen the muscles of the back to reduce the progression of the curve and pain.
- Spinal Stenosis is the narrowing of the spinal canal that often accompanies degenerative disc disease and is typically seen in people over 60. It progresses slowly over time and causes back and leg pain during activity. Conservative treatments are often effective for spinal stenosis.
- Spondylolisthesis occurs when one vertebra slips forward on the vertebra below it. The severity of the slip determines treatment methods, but in most cases physical therapy can help strengthen the muscles of the back, reducing pain and enabling them to compensate for the slippage. Pain management may also be used short-term to control pain, relieve spasms and decrease inflammation.
Cervical and Lumbar Artificial Disc Replacement
Symptoms: Cervical disc compression (pressure on the spinal cord) creates neck pain, weakness and twitching in the hands and arms and trouble grasping objects. Lumbar spine compression creates axial back pain (center of back) buttock and leg pain, tingling and numbness in the feet and weakness in lower extremities.
Ideal cervical candidates are between 18 and 60 years of age with symptomatic cervical degenerative disc disease, and have ineffectively tried conservative treatments such as physical therapy, rehabilitation and pain management for at least six months.
Ideal lumbar artificial disc replacement candidates are between 20 and 60 years-of-age with one or two level degenerative disc disease. Based on the pre-op evaluation, the facet joint in the back of the spine should be intact and there should be no instability such as spondylolysthesis or spondylolysis.
Surgical Treatment: Anterior cervical discectomy surgery involves entering from the front of the neck, removing the herniated disc, decompressing the spinal cord and nerve roots and replacing the disc with an artificial disc device (ProDisc-C or Mobi-C). The devices have been shown to reduce pain, preserve motion and improve function while also easing degenerative disc disease on the adjacent vertebrae.
The cervical devices have also proven to provide a wider range of motion than the commonly used anterior cervical disc decompression and spinal fusion procedure, which joins the two vertebrae with a titanium plate. While still an effective surgery for relieving pain, a major problem with spinal fusion is that the adjacent discs tend to develop extra deterioration.
With the ProDisc-C procedure, the artificial disc replacement device has shown to not have the added strain on the adjacent discs. This surgery is becoming more available to patients as insurance companies are starting to cover the cost of the procedure.
Lumbar artificial disc replacement with the Prodisc-L implant involves making a small incision in the abdomen and getting to the spinal cord from the front. The damaged disc is removed and replaced with a device comprised of two metal plates with a half ball polyethylene component that allows the plates to move in a natural way, keeping the patient’s range of motion intact.
The Mobi-C device is an artificial disc for the cervical spine, or neck, that is composed of three parts: two metal plates and a plastic insert in the middle. The plates are made of a mix of metals commonly used in spine surgery (cobalt, chromium and molybdenum). The plates have teeth on the top and bottom that help hold the plates to the vertebrae. The teeth are pressed into the bone with no cutting out of the bone, which makes the Mobi-C design and technique bone sparing. The outside of the plates are sprayed with a coating (hydroxyapatite) that helps the vertebrae to grow and attach to the metal plates for long term stability. The plastic insert is made from polyethylene. The insert is flat on the bottom and round on the top, and is made to move as you move your neck.
The Mobi-C device allows for increased range of motion in all directions for the patient. it matches the disc height to the levels above and below which makes it ideal for adjoining disc issues. The device comes in many different sizes to accommodate all patients. It is currently the only FDA approved device for two-level (more than one affected adjoining disc) disc indications.
Typically, patients are able to return home with physical therapy, and get back to normal activities within six to eight weeks.
Kyphoplasty is a minimally invasive, image-guided procedure performed to correct a fractured, collapsed verteba. Although trauma and other conditions can cause compression fractures in the vertebra, osteoporosis is the major contributor. The fracture causes intense pain and loss of daily function. Kyphoplasty involves inserting a balloon device directly into the fracture under the guidance of a specialized X-ray for precise placement, and then filling that space with a paste-like cement that hardens quickly to re-establish the original height of the collapsed vertebra. This helps to relieve pain, straightens the spine and prevents further damage in about 90 percent of patients.
The back part of the vertebra that covers the spinal canal is called the lamina. Laminectomy, also known as decompression surgery, is the removal of the lamina to enlarge the spinal canal. The procedure is most commonly performed on the vertebrae in the low back and in the neck. Widening the canal relieves the pressure on the spinal cord or nerves that is usually caused by a herniated disc or spinal stenosis. Conservative treatments, such as medication and physical therapy, must prove ineffective before this surgery will be performed.
Symptoms: An awkward gait, or walk, extreme pain in the lower back, numbness and tingling in the fingers, muscle spasms and restless legs at night are signs of spinal stenosis, or narrowing of the spinal canal. MRI is typically required to discover the condition.
Surgical Treatment: A cervical laminoplasty is the widening of the spinal canal in the neck (upper spine) and stabilizing of one or more vertebrae. The surgeon goes in through the back of the neck, creates a small fracture one side of the vertebra and cuts the other side in order to form a hinge or door. A metal mini-plate is then attached to the vertebra to hold the door open. This allows extra space in the canal so that the cord becomes decompressed and stops the progression of damage, allowing for recovery of function over time.
Physical therapy is recommended for most patients after surgery to help strengthen supporting muscles and correct the gait.
Lumbar fusion is a surgical procedure to take pressure off the lumbar spine, remove the degenerated disc, insert a spacer into the disc space and connect the two or more vertebrae with rods and screws enhanced with bone grafting material in order to stabilize them and ultimately relieve low back pain. Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Lumbar Interbody Fusion (PLIF) are both minimally invasive methods to perform a lumbar fusion.
TLIF: This surgical technique requires the surgeon to approach the spine from the back, allowing access to the disc without moving the nerves. The foramen is located on the side of the spine and is the point where nerves branch off the spinal cord into the body. The surgeon makes an incision lined up with the foramen and removes a portion of the facet to access the disc, decompress the disc, insert the spacer, apply the surgical implant and place the bone graft material. As the bone graft heals, it fuses the vertebrae together and makes the spine segment stable.
PLIF: The spine surgeon approaches the spine from the back, or posterior, accesses the disc through the back of the vertebra called the lamina, removes the portion of the facet joints that are pushing against the spinal cord and nerve roots and removes the disc completely. Then two spacers are inserted with bone graft and augmented with screws and rods.
Sacroiliac Joint Fusion (SI Joint Fusion)
Symptoms: Lower back, hip, buttock and thigh pain, weakness and a cold sensation to the toes, unable to stand up straight, leg gives out when pressure is applied, muscle spasms and walking with a limp. When a sacroiliac joint block can be performed and if it temporarily relieves pain, the problem more than likely is originating in the sacroiliac joint, which is the connection between the sacrum and ilium bones of the pelvis. When the ligaments weaken or tear, the pelvis becomes unstable. When these ligaments become damaged, they may have excessive motion, which inflames and disrupts the joint and the surrounding nerves.
Surgical Treatment: The procedure involves making a one and a half inch incision in the lower back along the side of the buttock. X-rays provide the ability to precisely place three titanium rods in the joint to stabilize it while providing protection to the surrounding tissues. According to research, up to 25 percent of all low back pain is related to the SI joint, but the diagnosis of SI joint disease is frequently overlooked. Recent studies have found that 75 percent of all post-lumbar surgery patients may have SI joint dysfunction.
Scoliosis is a three dimensional deformity which can cause a lateral (sideways) curvature of the spine, along with rotation of the vertebrae. It affects approximately two to three percent of the U.S. population, or roughly seven million people.
Types of scoliosis include:
- Congenital scoliosis – Occurring in babies born with spinal deformity due to a failure to develop correctly. Of these children 25 to 30 percent also have birth defects of the heart and kidneys, so it is extremely important for their pediatrician to check these organs. Early diagnosis and treatment is critical. Signs of skin dimpling, abnormal discoloration of the skin or hair patches are clues for the diagnosis of scoliosis.
- Neuromuscular scoliosis – A condition seen in patients with a history of neuromuscular disease such as polio, cerebral palsy, myopathy or spina bifida. These underlying conditions cause inadequate muscular support to the spine, resulting in curvature.
- Degenerative scoliosis – This type is mainly seen in women over the age of 40 who have a combination of multiple level disc degeneration, their hips or shoulders are not even and lean toward one side and they have mild to moderate osteoporosis or osteomalacia (softening of the bones due to a lack of vitamin D). Treatment consists of physical therapy, aquatic therapy, bracing and/or epidural blocks. If non-surgical treatment fails, spinal decompression and/or fusion surgery to join the vertebrae together is suggested.
- Idiopathic scoliosis – The most common form of scoliosis which occurs in adolescents between 10 years of age and early teens, with no known cause. It appears more frequently in females with a family history of the disease. Idiopathic scoliosis is diagnosed by:
- School screening
- Adams forward bend test administered by a school nurse or pediatrician
- Noticeable shoulder asymmetry – when walking, one shoulder is higher than the other, and the shoulder blade is more prominent on one side
- Parents complain that their child’s clothes “hang funny” or pant legs drag on one side
Idiopathic scoliosis can be diagnosed with an X-ray if the sideways curvature of the spine is more than ten degrees. The most common curve pattern is an S type pattern. There is a chance for scoliosis to progress or worsen while the adolescent grows taller. An X-ray evaluation of the pelvis can show if the bones are still growing and if the curvature can progress. The use of the Risser sign, which shows the level of maturity in the growth plate, or cartilage cup, on the top of the iliac bone (pelvic bone), can help determine how much more the child will grow and predict the progression of scoliosis.
Treatment: Overall, to treat idiopathic scoliosis, if the curvature is less than 25 degrees, your surgeon will observe with X-rays every six months and ask the patient to be physically active. If curvature is between 25 – 50 degrees and the child is still growing, many can benefit from wearing a brace. Conservative treatment with muscle stimulation, physical therapy and massage has sometimes shown to be effective. Surgery may be necessary if the curve is more than 50 degrees.
Most cases of scoliosis are mild, but progression of the condition can lead to severe and disabling consequences, including lung and heart problems and back pain.
If you believe that you or a loved one is suffering from scoliosis, it is important to see your pediatrician or family physician, who may refer you for specific treatment.
Spondylolisthesis is a condition where one vertebra slips forward or backward on another vertebra and frequently occurs in the lower back. It can lead to deformity of the spine and narrowing of the spinal canal or spinal stenosis. The condition typically stems from a degenerative condition although it may be the result of trauma or a congenital issue. The slippage can be seen on a lateral X-ray and nerve compression can typically be seen with a CT scan or MRI.
- Cramping or tight pain in lower back which often worsens after exercise
- Feeling of instablilty or movement in the back with bending
- Spasms or tightness of the hamstrings and decreased range of motion
- Numbness, tingling or weakness in the legs
- A catching sensation in the back
- Loss of bowel control or bladder function
Non-surgical Treatment: Most patients can be treated without surgery. Anti-inflammatory medications can help control pain, physical therapy may be required to help strengthen the muscles around the spine to improve stability or epidural steroid injections can help decrease inflammation and pain.
Surgical Treatment: With stable spondylolisthesis the surgeon may perform a decompression of the affected nerve(s) or root(s).
Unstable spondylolisthesis is treated with a decompression and fusion procedure to attach the affected vertebrae together. It is important for the spine to be stabilized so that any abnormal motion can be stopped.