[vc_row][vc_column][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]Spinal stenosis

Is a process where compression is applied to nerve tissue.  This may cause debilitating pain and/or weakness.  Spinal stenosis can occur as an age related arthritic process, acute injury, spinal tumor, are any process which causes compression of nerve tissue.  Spinal stenosis can occur in the neck, mid back, and low back regions of the spine.  The symptoms produce depends on the location of spinal stenosis.  For instance, stenosis in the neck or cervical region can produce a condition known as cervical myelopathy, which causes difficulty walking and loss of fine finger movement in the hands.  However stenosis in the lumbar spine may result in leg pain and leg weakness.  No matter what location spinal stenosis occurs it creates a dysfunction in the body’s ability to carry messages from the brain to the muscle skeletal system.  If this pathway is disrupted over time it can result in permanent loss of function.  This is seen in long-standing cases of cervical myelopathy which result in permanent and inability to walk or ambulate.

Symptoms of spinal stenosis:

• Arm or leg pain
• Arm or leg weakness
• Muscle atrophy
• Arm or leg numbness and tingling
• Difficulty walking a distance
• Difficulty performing fine movements with the hands
• Loss of balance
• Loss of bladder or bowel control

Treatment options for spinal stenosis:

Generally, it is advised to have conservative care as a first line treatment option for most spinal related conditions.  This may include but not limited to physical therapy, nonsteroidal anti-inflammatories (ibuprofen or naproxen), therapeutic cervical traction, chiropractic care, and epidural steroid injections.

When conservative methods fail to improve patient’s symptoms or the patient’s condition is too severe to treat conservatively due to jeopardy of nerve injury, then surgical treatment options are recommended.

Surgical treatment options:

• Cervical laminectomy decompression
• Cervical laminoplasty decompression
• Anterior cervical discectomy and fusion
• Anterior cervical disc replacement
• Anterior corpectomy and fusion
• Thoracic laminectomy decompression
• Thoracic laminectomy decompression and fusion
• Lumbar laminectomy decompression
• Lumbar laminectomy decompression and fusion
• Direct lateral lumbar fusion with indirect decompression
• Anterior lumbar decompression and fusion
• Anterior lumbar decompression and disc replacement

Radiculopathy

Collapsed disc

The height of a disc may decrease over time.  The ability to absorb shock after the height has collapsed is diminished.  This may result in neck or low back pain and a pinched nerve causing radiating extremity pain.

Herniated disc

The disc serves as a shock absorbing cushion between vertebral bodies in the spine.  When disc material is injured and pushed out from the space where it normally resides it may compress nerve tissue.  Additionally, the material contained within the disc space results and an inflammatory reaction once herniated.  Compression of nerve tissue can present as radiating pain, numbness and tingling in the extremities.  Disc herniations can also cause neck and low back pain.

Spondylolisthesis

It is a condition where one vertebral body has shifted, typically in the forward direction.  This typically results in compression of nerve tissue leading to extremity pain numbness tingling or weakness.  Additionally the spondylolisthesis can result in neck or back pain.  This condition may progress over time due to instability.  Treatment options initially are conservative.  When conservative options fail to make significant improvements to the patient’s life we recommend surgical stabilization of the spondylolisthesis.

Scoliosis

Scoliosis is an abnormal curvature of the spine.  The curve may be fixed or mobile.  There are many causes such as congenital, neuromuscular, injury, infection, or degenerative.  Symptoms may include high riding shoulder and/or hip, neck pain, mid back pain, low back pain, and numbness.  Treatment options may vary depending on the severity of the curve to the spine.  Initially a focus on conservative care is done.  Complex surgical scoliosis correction surgery can be performed.  Certain minimally invasive procedures and techniques can be utilized to minimize risk of complications during spinal reconstruction.

Kyphosis

Kyphosis is an abnormal rounding of the upper back that often develops in adolescence or young adulthood. Though a small curve in the upper back is typically normal, kyphosis involves an excessive spinal curve that creates discomfort and pain. These abnormalities in curvature of the spine could cause poor posture, age-related weakness and kyphosis. This condition is sometimes referred to as “hunchback” or “roundback.”

Post laminectomy syndrome

This condition is also referred to as “failed back syndrome.” Many factors can contribute such as residual or recurrent spinal disc herniation, post-operative pressure spinal nerve compression, altered joint mobility, scar tissue, spinal muscular deconditioning, etc.

Common symptoms include pain involving the back or legs. Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities.

The treatments of post-laminectomy syndrome include physical therapy, low force chiropractic care, stimulators, minor nerve blocks, NSAID medications, membrane stabilizers, spinal cord stimulation, etc. Use of epidural steroid injections may be minimally helpful in some cases.

Vertebral compression fracture

A vertebral compression fracture occurs when the vertebra become compressed due to trauma. Many times the trauma necessary to break the bones of the spine is quite substantial. In patients that are elderly or cancer patients, bones can become fragile and break with little to no force. Though the lower spine is typically the most common area to fracture, it could happen at any part of the spine.

Procedures

Laminectomy

This is a surgical procedure that decompresses nerve tissue by removing part of the bony process in the spine called the lamina.  This procedure can alleviate symptoms caused by nerve compression, such as muscle weakness, arm pain, and or leg pain.  This technique can be performed using traditional methods such as open or minimally invasive techniques such as a microlaminectomy.

Discectomy

This is a surgical procedure that decompresses nerve tissue by removing part of the disc.  This procedure can alleviate symptoms caused by nerve compression, such as weakness, arm or leg pain.  This technique when performed posteriorly requires removal of part of the lamina to gain access to the disc space.  By removing part of the disc and/or offending agent the nerve is decompressed, thus abating symptoms.

Microdiscectomy

This surgical procedure can decompress nerve tissue by removing part of the test.  This procedure can alleviate symptoms caused by nerve compression, such as weakness, arm pain or leg pain.  This surgery utilizes minimally invasive techniques to spare the removal of paraspinal muscles, which improves patient’s postop recovery and pain.  The goal of this technique is to improve symptoms by removal of disc material that compresses the nerves.

Microlaminectomy

This surgical procedure decompresses nerve tissue by removing part of the lamina a bony structure of the spine.  This surgery utilizes minimally invasive techniques to spare the muscle around the spine which improves the patient’s postop recovery and pain.  The goal of this technique is to decompress nerve tissue to improve patient’s function.

Minimally invasive lumbar fusion

This surgical procedure stabilizes segments of the spine and decompresses nerve tissue.  Decompression of nerve tissue is performed with both a laminectomy and discectomy during this procedure.  Hardware which stabilizes the spine and facilitates the growth of bone across this segment being fused is placed.  This procedure is performed to improve not only pain in the extremity or weakness but also low back pain.  The minimally invasive techniques utilized to provide the patient with minimal postop recovery, blood loss, muscle removal, and pain.

Complex lumbar fusion

The surgical procedure is utilized to reconstruct deformities within the spine.  This may involve osteotomies are removal of bony structures.  Typically this procedure is done utilizing open techniques and minimally invasive techniques.  The goals of this procedure can include decompression of nerve tissue and to provide global alignment.

Anterior cervical discectomy and fusion

This surgical procedure was developed and the 1950s which was then popularized in the 1980s and is largely used today to treat pathology in the neck or cervical spine.  A decompression of nerve tissue in removal of disc material is performed.  A spacer is placed in the disc space which allows to maintain height and improve alignment.  Bone will grow across the segment to produce a fusion in the postop period.

Anterior cervical fusion with corpectomy

This procedure requires a removal of one or more vertebral bodies in order to decompress the spinal cord.  A spacer is placed to span the segment and creates stability of the anterior column.  This procedure is reserved for severe compression of the spinal cord.

Cervical disc replacement

This procedure utilizes the anterior approach to the cervical spine in order to remove disc material and decompress nerve tissue.  A spacer is placed in the disc space which preserves motion.  Theoretically a motion preserving device, such as a disc replacement, will offload biomechanical forces that would otherwise apply to the adjacent segments.

Lumbar disc replacement

This procedure utilizes the anterior approach to the lumbar spine through the retroperitoneal space.  He requires disc material and nerve decompression to be obtained.  A spacer is placed in the disc space which preserves motion.  Motion preserving device is theoretically offload biomechanical forces that would be otherwise applied to adjacent segments.

Thoracic laminectomy

This procedure is performed to decompress nerve tissue in the thoracic or mid back region.  These procedures can be done minimally invasive.

Thoracic fusion

This procedure is utilized to stabilize our restore alignment in the mid back her thoracic spine.  This procedure can be performed minimally invasive.

Posterior cervical spinal fusion

This procedure is performed to re-store alignment, and stabilize the neck or cervical spine.  It is oftentimes performed in conjunction with the laminectomy.

Vertebral augmentation

This procedure is typically performed to stabilize fracture fragments of the spine.  A small skin incision is made to allow a needle to pass through the bony structure called the pedicle to gain access to the fracture site and the vertebral body.  A cement substances placed through the needle which stabilizes the fracture fragments and reduce his pain.  This procedure can be done awake.

Kyphoplasty

This procedure is performed to treat fractures of the vertebral body.  A small skin incision is made large enough to allow a needle to access the bony process or pedicle in order to gain access to the fracture site within the vertebral body.  Through the needle a water filled balloon device is deployed which restores height loss from the fracture.  The cavity created from the water balloon is then filled with cement.  This stabilizes the fracture fragments and reduce his pain.

Interventional spinal procedures

Epidural steroid injections

This procedure is utilized to deliver a corticosteroid to this space surrounding the nerve tissue.  The goal is to decrease pain by decreasing the inflammatory process and irritation around the nerve.

Medial branch blocks

This procedure places a temporary numbing medicine around the joints in the spine.  This is a diagnostic procedure which helps localize the source of pain.  A radiofrequency ablation may be offered to patients who have improved pain after a medial branch block.

Radiofrequency ablation

This procedure desensitizes a painful joint by placing a needle which transmit radiofrequency energy.  This procedure takes approximately 5-10 minutes to perform.

Conservative treatment options:

Therapeutic exercises and stretching: Core strengthening, chiropractic care, physical therapy and massage therapy, to name a few.  Low impact exercises are recommended such as walking, water aerobics, swimming, elliptical yoga and Pilates.

Medications: Anti-inflammatories over-the-counter ibuprofen or naproxen.  Prescription strength non-steroidal anti-inflammatories may be used when over-the-counter medications are ineffective.

Steroid injections: These injections aim to decrease pain or compression of a nerve by decreasing inflammation.[/vc_column_text][/vc_column][/vc_row]