Patient Information

Degenerative disc disease occurs when spinal discs degenerate, or wear down. The discs of the spine cushion the interlocking vertebrae and act as shock absorbers for the back, allowing it to bend, flex and twist. They break down over time as a natural part of the aging process.

Symptoms

• Pain in the low back, buttocks, thighs, or neck
• Pain that worsens when sitting, bending, lifting, or twisting
• Pain that feels better when walking, changing positions, or lying down
• Periods of severe pain that gets better after a few days or months
• Numbness and tingling into the legs or arms
• Weakness in the legs or arms
• Foot drop (inability to raise the foot at the ankle

Non-surgical Treatment
We focus on treating the primary symptom of degenerative disc disease. Ice and non-steroidal anti-inflammatory drugs (NSAIDS) can reduce swelling and alleviate pain. If the damaged disc has resulted from other conditions, such as osteoarthritis, a herniated disc, or spinal stenosis, physical therapy and back strengthening and stretching are often prescribed.

Surgical Options
Surgery may be considered when patients do not respond to conservative treatment and are severely limited in performing activities of daily life.

Spinal fusion can reduce pain by stopping the motion at a painful segment of the spine. The disc is removed from between two vertebrae, then the vertebrae are fused together. This procedure is performed through a single incision in the back.

Another surgical option is artificial disc replacement. Replacing the disc instead of fusing the vertebrae together may allow for more normal motion in the spine. This reduces the chance that other segments of the spine will break down due to increased stress.

The spinal bones (vertebrae) are separated by discs, which cushion the spine and allow movement between the vertebrae. A herniated disc, often called a slipped disc, occurs when a part of the vertebrae pushes into the adjoining disc, putting pressure on the nearby nerves and causing pain or other symptoms. Discs may move out of place (herniate) or break open (rupture) as a result of an injury or strain. This causes pressure that can lead to pain, numbness, or weakness.

Symptoms

• Pain in one or both legs (buttocks, thigh, and calf)
• Numbness, tingling, or weakness in the legs or feet or in one or both arms
• Inability to find comfort even lying down
• Sudden aching or twisted neck that cannot be straightened without severe pain
• Bowel or bladder changes and/or numbness in the groin.

Non-surgical Treatment
We begin with conservative treatment, such as pain medication, physical therapy, or a combination of both. Drug therapy may include non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, nerve pain medications, muscle relaxers, or epidural cortisone injections.

Surgical Options
Patients whose symptoms are not improved by conservative therapy may benefit from surgery. Additionally, patients who experience progressive muscle weakness from a compressed nerve can get relief from surgery.

A laminectomy removes some of the bone over the spine and the problem disc. Spinal fusion is a technique in which two vertebrae (back bones) are fused together with bone grafts or metal rods. By fusing the vertebrae, the painful motion is eliminated. A microdiscectomy may also be done to remove the fragments of a herniated disc through a small incision.

Spinal stenosis is a narrowing of the spinal canal that occurs most often in the lower back (lumbar), or the neck (cervical) region of the spine. The spinal canal is the small space that holds the nerve roots and spinal cord. When that space becomes narrower, it can squeeze the nerves and the spinal cord, causing pain and other symptoms.

Some people are born with a narrow spinal canal, but most often spinal stenosis is a result of aging. Some medical conditions can cause spinal stenosis, including osteoarthritis, rheumatoid arthritis, spinal tumors, trauma, and having a previous spinal surgery.

Symptoms

• Numbness, weakness, cramping, or pain in the legs and thighs
• Radiating pain down the leg
• Abnormal bowel and/or bladder function
• Decreased sensation in the feet causing difficulty placing the feet when walking
• Loss of sexual function
• Partial or complete paralysis of the legs

Non-surgical Treatment
We typically treat spinal stenosis with a combination of pain medication and physical therapy. Drug therapy may include nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, antidepressants, anti-seizure drugs, opioids, or cortisone injections.

Physical therapy may also be prescribed to build strength and endurance, maintain flexibility in the spine, improve balance, and control pain. Other treatments may include wearing a lumbar brace to help stabilize the spine and alleviate pain.

Surgical Options
For patients whose symptoms are not improved by conservative therapy, we may recommend surgery. Depending on your condition, we may recommend a laminectomy for spinal decompression and may also recommend fusion surgery to stabilize the spine.

Surgical treatments are aimed at relieving pressure on the spinal cord and nerve roots.

A decompression laminectomy removes bony spurs or increased bone mass in the spinal canal, freeing up space for the nerves and spinal cord. Spinal fusion is a technique in which two vertebrae (back bones) are fused together. This provides stronger support for the spine, and is almost always done after decompression laminectomy.

Spondylolisthesis is a condition of the spine in which a vertebra slips out of alignment, moving forward on the vertebra below. The condition is usually caused by degenerative disease, such as arthritis. Other causes include bone diseases, trauma, and stress fractures, which may occur during sports that put a lot of pressure and stress on the back or overstretch the spine. Gymnasts, weight-lifters, and football players are at increased risk. Spondylolisthesis can also result from a congenital disorder of the spine.

Symptoms

• Low back pain
• Stiff back
• Muscle spasms of the hamstring
• Changes in posture and/or gait
• Narrowed spinal canal

Non-surgical Treatment
Treatment for spondylolisthesis varies depending on how severe the symptoms are. We usually begin with physical therapy. Many patients see improvement with stabilization, strengthening and stretching exercises. Over-the-counter pain medication such as non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate pain and reduce inflammation. Epidural steroid injections can provide relief from pain if over-the-counter medications don’t work.

Surgical Options
If the patient’s symptoms are not relieved by conservative treatments, surgery might be recommended.  A decompression laminectomy removes bony spurs in the spinal canal, freeing up space for the nerves and spinal cord. Spinal fusion is a technique in which two vertebrae (back bones) are fused together. This provides stronger support for the spine, and is almost always done after decompression laminectomy.

Spinal compression fractures occur when small hairline fractures in the spinal bones eventually cause a vertebra to collapse. The tiny fractures may permanently alter the strength and shape of the spine, causing patients to lose height. Most occur in the front of the vertebra, which causes the front part of the bone to collapse, resulting in a wedge-shaped vertebra. This causes patients to stoop forward, a condition called kyphosis, or dowager’s hump.

Most compression fractures in women over the age of 50 are related to osteoporosis. It is also a symptom of patients with cancer that has spread to their bones. A common symptom of spinal compression fractures is back pain. But many of these fractures are never diagnosed because patients think back pain is a regular sign of aging and don’t seek treatment.

Symptoms

• Sudden back pain
• Loss of height
• Curved or humped spine
• Pain that worsens with standing or walking

Non-surgical Treatment
We treat the majority of spinal compression fractures with pain medication, reduction in activity, medication to stabilize bone density, and back bracing to minimize motion during the healing process. Pain medications may include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Narcotics and muscle relaxants are often prescribed for short periods of time, and antidepressants can also help relieve nerve-related pain. If osteoporosis has caused the fracture, treatment generally includes bone-strengthening drugs such as bisphosphonates to help stabilize or restore bone loss and prevent further fractures.

Surgical Options
Surgery is only recommended when chronic pain from a spinal compression fracture persists despite non-surgical treatments. Surgery may include spinal fusion surgery or minimally invasive surgery such as vertebroplasty. In vertebroplasty, a small incision is made in the back and an acrylic bone cement is inserted into the spinal bone. Once it hardens, it helps stabilize the vertebra and spine. Most patients go home the same day or after one night’s stay in the hospital.