Conditions

CONDITIONS OF THE SPINE


The spinal column is the body’s main support structure. Its thirty-three bones, called vertebrae, are divided into five regions: cervical, thoracic, lumbar, sacral and coccygeal.

This condition is an irritation or compression of one or more nerve roots in the cervical spine. Because these nerves travel to the shoulders, arms and hands, an injury in the cervical spine can cause symptoms in these areas. Cervical radiculopathy may result from a variety of problems with the bones and tissues of the cervical spinal column.

This condition is a weakening of one or more vertebral discs, which normally act as a cushion between the vertebrae. This condition can develop as a natural part of the aging process, but it may also result from injury to the back.

This condition is a detereoration of the facet joints, which help stabilize the spine and limit excessive motion. The facet joints are lined with cartilage and surrounded by a lubricating capsule that enables the vertebrae to bend and twist.

One of the most common symptoms of a cervical herniated disk includes arm pain. Cervical herniated disk is most common in adults in the 30 – 50 year old age group. While cervical herniated disc may start from trauma or injury to the cervical spine, the symptoms, including arm pain, commonly start spontaneously.

In cervical herniation the herniated disc material “pinches” or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present.


This rupture of a vertebral disc can be caused by the normal wear of aging or by traumatic injury. A herniated disc can push painfully against a nerve root, sending pain down the sciatic nerve and resulting in a burning, tingling and/or numbing sensation from the lower back down to one or both feet.

This rupture of a vertebral disc can be caused by the normal wear of aging or by traumatic injury. A herniated disc can push painfully against a nerve root, sending pain down the sciatic nerve and resulting in a burning, tingling and/or numbing sensation from the lower back down to one or both feet.

SCIATICA
Sciatica presents itself as a set of symptoms including pain that may be caused by general pressure on and/or irritation of one of five spinal nerves roots that give rise to each sciatic nerve, or by compression or irritation on the left or right or both sides of the sciatic nerves. Usually pain is felt in the lower back, buttock, and/or various parts of the leg and foot.

In addition to pain, there may be numbness, muscular weakness, a pins and needle feeling and/or tingling and difficulty in moving or controlling the leg. Commonly the symptoms are felt on one side of the body.

When people talk about Sciatica they often refer to it as a diagnosis when Sciatica itself is actually a set of symptoms that can give an indication of the underlying cause for these symptoms.


The term “sciatica” refers to nerve pain in the legs that arises from irritation of the lower spinal nerves resulting from diagnsoses such as disc herniations,stenosis (crowding of the nerves from arthritic changes of the spine) or tears in the disc that result in chemical irritation of the nerves. It is caused by pressure on, or irritation of, one of the five spinal nerve roots that give rise to the sciatic nerve in the legs. Sciatica can also be caused by direct compression or irritation on the left or right or both sides of the sciatic nerves. Usually pain begins in the lower back and buttock, then travels to various parts of the leg and foot. In addition to pain, there may be weakness, numbness, burning or tingling and difficulty controlling the leg. Commonly, the symptoms are felt on one side of the body following specific nerve distributions. The location of the pain and the pattern it follows allows your physician to determine which nerve is likely compressed or damaged.

Sciatica is actually a constellation of symptoms that can give an indication of the underlying cause for these symptoms. When a disc is torn from aging or trauma, a disc herniation may result. A disc herniation in the spine is sometimes referred to as a blown, ruptured, or slipped disc. In fact, what usually happens is the outer dense ring of the disc tears allowing the central, gelatinous portion (nucleus) of the disc to herniate through the defect. At times, the disc may tear without a frank herniation of the nucleus. In that instance, chemicals from the disc, which are inflammatory to the nerves, can cause a chemical irritation of the nerves (radiculitis). This tear in the disc ring may result in the release of inflammatory chemical mediators which cause severe pain, even in the absence of nerve root compression. This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniations, protrusions, bulges, or disc tears.

This architectural damage to the disc results in compromised function of the disc. Over time a frank herniation can occur or the disc may wear due to the compromised integrity/strength of the disc. This wearing out of the disc is termed degenerative disc disease. It essentially means arthritis of the spinal disc. If a fragment of disc compresses the nerves or the chemicals from the disc irritate or inflame the nerves, sciatica or radiculopathy (nerve pain) can result.

In most cases spinal disc herniations causing sciatica or radiculopathy do not require surgery, several procedures that are commonly used to correct this issue include:

Patient education on proper body mechanics
Physical therapy, to address mechanical factors
Anti-inflammatory medication
Oral steroids
Epidural Steroid(cortisone) injection
Intravenous sedation, analgesia-assisted traction therapy
Weight control
Tobacco cessation
Lumbosacral back support
When non-operative treatment fails to improve the symptoms sufficiently or if the pain or symptoms are disabling and unremitting, invasive treatment may be required. Severe nerve deficits/weakness and unremitting pain may warrant surgery.

Surgery is indicated when there is Cauda equina syndrome (loss of bowel and/or bladder control from large disc herniations at the level of the Cauda Equina), excruciating, uncontrollable pain, progressive neurologic deficit, and failure of non-surgical treatment. Microdiscectomy in which the herniated fragment is removed to alleviate nerve compression has a 76 to 93% success rate and 10% reoperation rate at long-term follow up. Positive prognostic factors of surgical outcome include no work-related injury, absence of back pain, pain extending to the foot, leg pain with extension of the knee, absence of back pain on straight leg raising testing, and large disc herniation (more likely to resorb).

At the Orthopaedic & Spine Institute, our uniquely trained spine surgeons have expertise in all methods of treating sciatica/radiculopathy. Conservative efforts are always exhausted prior to surgical consideration unless there is unbearable pain or neurologic symptoms that dictate a more invasive approach. When those efforts fail, our surgeons can perform minimally invasive or open surgical procedures to most effectively treat your condition. If you suffer from back pain or Sciatica, call us today. We can help! Call today (210) 48-SPINE/(210) 487-7463


Metastatic Cancer- 50-85% of cancer patients develop spread of their cancer to the skeletal system (bones). The spine is the most common site of bony spread as it is supplied by a rich plexus (highway) of veins carrying blood from the organs to the remainder of the body. Tumors of the spine may result in fracture, nerve or spinal cord compression, and severe pain and dysfunction. Based on the type, location, and dysfunction related to metastatic cancer of the spine various treatment options exist. This treatment may range from chemotherapy, radiation, minimally invasive, traditional open surgery, or a combination of these treatments.

About two percent of people are affected by this deformation of the spine, which causes the normally straight spine to curve.

Spinal Infection (Discitis/Vertebral Osteomyelitis)- Spinal infections can occur in the bone (osteomyelitis) or the soft tissue (discitis). Discitis, or disc space infection, is an inflammation of the intervertebral disc—the “cushion” in between the vertebrae of your spine. It can occur in adults, but it is more common in children. The exact cause is the subject of debate, but most researchers believe that discitis is caused by infection that probably begins in one of the vertebral end plates. These end plates are on the top and bottom of each vertebra and give nutrition to the disc. The end plate can become infected and the infection can then spread into the disc. It’s also possible that the infection begins elsewhere and travels to the disc. This results when infections elsewhere travel through the bloodstream to the spine. Ear infections, urine infections, and skin infections are some examples of infections that could lead to transient bacteremia and perhaps discitis. Once the disc becomes infected, it’s difficult for it to fight the infection. The disc is the largest avascular organ in the body; avascular means that they do not have their own blood supply. That’s why the discs have to get their nutrition and blood supply—including white blood cells to fight infection—from diffusion through the vertebral end plates. This is an inefficient way to fight infection. Most cases of discitis can be treated with antibiotic therapy, but in some instances, surgery may be required. When the vertebral bones are involved, this is termed osteomyeliits. Osteomyelitis can lead to destruction and weakening of the bone and subsequent fracture. This can lead to spinal nerve or spinal cord compression and the need for surgical intervention to remove infected tissue and stabilize the spine. These conditions can also occur after surgery when the surgical site becomes infected. This can lead to a difficult problem to treat and may require a combination of long term antibiotics and surgical revision with removal of spinal implants when deemed safe.

Spinal stenosis is a narrowing of the spinal canal. It occurs when the channels that your spinal cord and nerve roots travel through become narrower resulting in compression (squeezing) of your spinal cord and/or nerve roots. ” It can lead to pain in your lower back, legs, neck, arms, or hands depending on where in your spine the spinal cord and/or nerves are getting squeezed. It occurs most commonly in your low back (lumbar spine) or in your neck (cervical spine). In the lower back, it’s called lumbar spinal stenosis. In the neck, it is termed cervical spinal stenosis. Spinal stenosis is quite common because arthritic changes in the spine—like this narrowing—are a natural part of growing older. At times symptoms are non-existant or mild requiring no treatment. However, in some patients, persistent pain may require physical therapy, medications, injections, or even surgery to decompress the nerves if conservative measures fail.

Spinal stenosis is a narrowing of the spinal canal. It occurs when the channels that your spinal cord and nerve roots travel through become narrower resulting in compression (squeezing) of your spinal cord and/or nerve roots. ” It can lead to pain in your lower back, legs, neck, arms, or hands depending on where in your spine the spinal cord and/or nerves are getting squeezed. It occurs most commonly in your low back (lumbar spine) or in your neck (cervical spine). In the lower back, it’s called lumbar spinal stenosis. In the neck, it is termed cervical spinal stenosis. Spinal stenosis is quite common because arthritic changes in the spine—like this narrowing—are a natural part of growing older. At times symptoms are non-existant or mild requiring no treatment. However, in some patients, persistent pain may require physical therapy, medications, injections, or even surgery to decompress the nerves if conservative measures fail.

Spinal stenosis is a narrowing of the spinal canal. It occurs when the channels that your spinal cord and nerve roots travel through become narrower resulting in compression (squeezing) of your spinal cord and/or nerve roots. ” It can lead to pain in your lower back, legs, neck, arms, or hands depending on where in your spine the spinal cord and/or nerves are getting squeezed. It occurs most commonly in your low back (lumbar spine) or in your neck (cervical spine). In the lower back, it’s called lumbar spinal stenosis. In the neck, it is termed cervical spinal stenosis. Spinal stenosis is quite common because arthritic changes in the spine—like this narrowing—are a natural part of growing older. At times symptoms are non-existant or mild requiring no treatment. However, in some patients, persistent pain may require physical therapy, medications, injections, or even surgery to decompress the nerves if conservative measures fail.

In this condition, damage to bones or joints causes vertebrae to slip forward and distort the spinal cord. This animation will show two types of spondylolisthesis, degenerative and isthmic.

Back pain is a very common complaint. 80% of adults will experience back pain at least once during their lifetime. It occurs most commonly in the lower back (lumbar spine). Most back pain results from sprains and strains caused by stressful movements. If your back pain is caused by a muscle sprain or strain, it will typically heal over time with over-the-counter or prescription medications, heat, ice, massage, or rest. Sometimes, though, back pain is caused by a more severe spinal condition, such as a herniated disc or spinal instability. Depending on the severity of your pain and its cause, you may require more involved treatment, such as physical therapy, injections, or even surgery. As we age, our discs may become arthritic. This is known as degenerative disc disease. It may not cause severe pain or other symptoms, but when the degeneration becomes advanced, low back pain may occur.

Typically, discogenic pain (pain from the spinal discs) is associated with activities that increase the pressure within the intervertebral disc. Sitting, bending forward, coughing and sneezing can increase low back discogenic pain. Leg pain caused by pinching of the nerves in the low back (called radiculopathy) may also accompany low back discogenic pain; especially while sitting, standing or walking. Discogenic low back pain typically affects people in their 30’s-50’s and can severely impair their ability to function or work. Just like other parts of the body, each intervertebral disc has a nerve supply. Discs are comprised of two parts; the annulus fibrosus (outer ring-like structure) and nucleus pulposus (gel-like interior). The nucleus pulposus has no nerve endings. However, the outer third of the annulus fibrosus contains nerve fibers. One type of discogenic disorder is called Internal Disc Disruption (IDD). IDD occurs when the disc tears. This allows the chemicals within the nucleus to cause inflammation and pain of the annular nerves. Inflammatory factors become deposited in the tears/fissures in some patients while in others, this deposition is minimal or non-existant.

Some studies have shown that in those with the most severe pain, there are a host of inflammatory factors in the painful discs. Whereas others may have degenerative/arthritic changes of the discs but little to no inflammatory factors within the tears, and thus, no pain. In those with debilitating and life-altering pain that has failed conservative treatment, the doctor may order a provocative discogram or discography. During this sterile procedure, the suspect discs are injected with a contrast dye to make each disc visible under fluoroscopy. Provocative discography helps the doctor to see the shape and size of the intervertebral disc, but more importantly, to help locate the source of the patient’s pain. The injection of the contrast dye alters the pressure within the disc and may ‘provoke’ or reproduce the patient’s pain pattern; thereby helping to isolate a particular disc as a pain generator. If conservative measures fail to address pain and dysfunction, your doctor may discuss surgical alternatives to help alleviate your pain.


Neck pain, either temporary or permanent, is a common complaint. It can occur as a result of a strain or sprain or aging of the cervical spine. Arthritic changes in the cervical spine (neck) can result in abnormalities of the discs and subsequent instability, spinal nerve or even, spinal cord compression. These conditions, depending on which part of the spine is affected, can result in pain that radiates to the neck, shoulders, arms, and hands. If the spinal cord is affected, balance, coordination, and bowel and bladder control may even be compromised. Most cases require conservative measures to address muscular discomfort via therapy, anti-inflammatory medications, and activity modification. However, in some cases of nerve and/or spinal cord compression with significant symptoms or instability resulting in severe neck pain, surgical intervention may be required to decompress and/or stabilize the cervical spine.