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Learn how the spine supports our health.

 

Anatomy of the Spine

Spinal Anatomy Read Description

Spinal Anatomy



The spinal column is one of the most vital parts of the human body, supporting our trunks and making all of our movements possible. Its anatomy is extremely well designed, and serves many functions, including:

  • Movement
  • Balance
  • Upright posture
  • Spinal cord protection
  • Shock absorption

All of the elements of the spinal column and vertebrae serve the purpose of protecting the spinal cord, which provides communication to the brain and mobility and sensation in the body through the complex interaction of bones, ligaments and muscle structures of the back and the nerves that surround it.

The normal adult spine is balanced over the pelvis, requiring minimal workload on the muscles to maintain an upright posture.

Loss of spinal balance can result in strain to the spinal muscles and spinal deformity. When the spine is injured and its function impaired, the consequences may be painful and even disabling.

Regions of the Spine Read Description

Regions of the Spine

Humans are born with 33 separate vertebrae. By adulthood, we typically have 24 due to the fusion of the vertebrae in the sacrum.

  • The top 7 vertebrae that form the neck are called the cervical spine and are labeled C1-C7. The seven vertebrae of the cervical spine are responsible for the normal function and mobility of the neck. They also protect the spinal cord, nerves and arteries that extend from the brain to the rest of the body.
  • The upper back, or thoracic spine, has 12 vertebrae, labeled T1-T12.
  • The lower back, or lumbar spine, has 5 vertebrae, labeled L1-L5. The lumbar spine bears the most weight relative to other regions of the spine, which makes it a common source of back pain.
  • The sacrum (S1) and coccyx (tailbone) are made up of 9 vertebrae that are fused together to form a solid, bony unit.

Spinal Curvature Read Description

Spinal Curvature

When viewed from the front or back, the normal spine is in a straight line, with each vertebra sitting directly on top of the other. Curvature to one side or the other indicates a condition called scoliosis.

When viewed from the side, the normal spine has three gradual curves:

  • The neck has a lordotic curve, meaning that it curves inward.
  • The thoracic spine has a kyphotic curve, meaning it curves outward.
  • The lumbar spine also has a lordotic curve.

These curves help the spine to support the load of the head and upper body, and maintain balance in the upright position. Excessive curvature, however, may result in spinal imbalance.

Elements of the Spine Read Description

Elements of the Spine

The elements of the spine are designed to protect the spinal cord, support the body and facilitate movement.

A. Vertebrae
The vertebrae support the majority of the weight imposed on the spine. The body of each vertebra is attached to a bony ring consisting of several parts. A bony projection on either side of the vertebral body called the pedicle supports the arch that protects the spinal canal. The laminae are the parts of the vertebrae that form the back of the bony arch that surrounds and covers the spinal canal. There is a transverse process on either side of the arch where some of the muscles of the spinal column attach to the vertebrae. The spinous process is the bony portion of the vertebral body that can be felt as a series of bumps in the center of a person's neck and back.

B. Intervertebral Disc
Between the spinal vertebrae are discs, which function as shock absorbers and joints. They are designed to absorb the stresses carried by the spine while allowing the vertebral bodies to move with respect to each other. Each disc consists of a strong outer ring of fibers called the annulus fibrosis, and a soft center called the nucleus pulposus. The outer layer (annulus) helps keep the disc's inner core (nucleus) intact. The annulus is made up of very strong fibers that connect each vertebra together. The nucleus of the disc has a very high water content, which helps maintain its flexibility and shock-absorbing properties.

C. Facet Joint
The facet joints connect the bony arches of each of the vertebral bodies. There are two facet joints between each pair of vertebrae, one on each side. Facet joints connect each vertebra with those directly above and below it, and are designed to allow the vertebral bodies to rotate with respect to each other.

D. Neural Foramen
The neural foramen is the opening through which the nerve roots exit the spine and travel to the rest of the body. There are two neural foramen located between each pair of vertebrae, one on each side. The foramen creates a protective passageway for the nerves that carry signals between the spinal cord and the rest of the body.

E. Spinal Cord and Nerves
The spinal cord extends from the base of the brain to the area between the bottom of the first lumbar vertebra and the top of the second lumbar vertebra. The spinal cord ends by diverging into individual nerves that travel out to the lower body and the legs. Because of its appearance, this group of nerves is called the cauda equina - the Latin name for "horse's tail." The nerve groups travel through the spinal canal for a short distance before they exit the neural foramen.

The spinal cord is covered by a protective membrane called the dura mater, which forms a watertight sac around the spinal cord and nerves. Inside this sac is spinal fluid, which surrounds the spinal cord.

The nerves in each area of the spinal cord are connected to specific parts of the body. Those in the cervical spine, for example, extend to the upper chest and arms; those in the lumbar spine the hips, buttocks and legs. The nerves also carry electrical signals back to the brain, creating sensations. Damage to the nerves, nerve roots or spinal cord may result in symptoms such as pain, tingling, numbness and weakness, both in and around the damaged area and in the extremities.

Spinal Muscles Read Description

Spinal Muscles

Many muscle groups that move the trunk and the limbs also attach to the spinal column. The muscles that closely surround the bones of the spine are important for maintaining posture and helping the spine to carry the loads created during normal activity, work and play. Strengthening these muscles can be an important part of physical therapy and rehabilitation.

Nervous System Read Description

Nervous System

All of the elements of the spinal column and vertebrae serve the purpose of protecting the spinal cord, which provides communication to the brain, mobility and sensation in the body through the complex interaction of bones, ligaments and muscle structures of the back and the nerves that surround it.

The true spinal cord ends at approximately the L1 level, where it divides into the many different nerve roots that travel to the lower body and legs. This collection of nerve roots is called the cauda equina, which means "horse's tail," and describes the continuation of the nerve roots at the end of the spinal cord.

Symptoms

Symptoms Overview Read Description

Symptoms Overview

Back Pain, neck pain and symptoms caused by a spinal condition are a common problem for many adult Americans. The different parts of the spine are normally well balanced and able to handle the movements, stresses, and strains of the body gracefully. However, when parts of the neck or back are injured or start to wear out, it can be a significant source of pain and discomfort.

When describing symptoms to your doctor use adjectives like dull, aching, hot, or throbbing and make sure to include the duration of these symptoms.

Below are some common symptoms. To learn more, click on the symptom that you have been experiencing:

If any of the following symptoms occur, contact a doctor immediately:

  • Pain is worse when you cough or sneeze
  • Pain or numbness travels down one or both legs
  • Pain awakens you from sleep
  • You are finding it difficult to pass urine or have a bowel movement
  • Pain is accompanied by loss of control of urination or bowel movements

These important symptoms could signal nerve damage or other serious medical problems. There are many other conditions that could be causing these problems, but an early and accurate diagnosis is vital for successful treatment.

Back Pain Read Description

Back Pain

Where Back Pain Begins

Back pain is the body's natural response to injury or degenerative conditions of the spine. Usually, it's resolved by time and non-surgical treatment, but it's also important to know which conditions warrant a call to the doctor.

The back is one of our most important anatomic structures, providing support and facilitating mobility and balance for the entire body, as well as protecting the spinal cord. Because of the loads placed on it each and every day, it's no surprise this well-designed structure, consisting of bones (vertebrae), discs, muscles, tendons, ligaments and nerves, is particularly susceptible to injury and other conditions that may have you reaching for the heating pad - or your doctor's phone number.

When you feel pain, it's your body's natural reaction to signals transmitted from the pain source, which travel through the nerves in the spinal cord and up to the brain, where they are perceived as pain.

Acute Pain vs. Chronic Pain

Acute pain is commonly described as sharp and severe; it tends to come on suddenly but also improve with time and short-term conservative treatment, such as medication, exercise, physical therapy or rest.

Chronic pain is commonly described as a deep, aching, dull or burning pain, and may be accompanied by numbness, tingling and/or weakness that extends into the extremities. Chronic pain tends to last a long time and is not relieved by conservative care.

What's Causing My Back Pain?

Many sudden attacks of acute back pain are the result of overstretched muscles (strains) or ligaments (sprains). The pain may be most severe immediately after injury, or it may worsen gradually over a few hours. In most instances, back pain as a result of strain or sprain can be resolved following a conservative course of treatment - usually within two to six weeks - provided there are no serious underlying medical conditions.

Common causes of strains and sprains that can trigger acute back pain include:

  • Improper lifting
  • Sudden, strenuous physical effort
  • Accident, sports injury or fall
  • Sleeping position and/or pillow positioning
  • Poor sitting or standing posture
  • Bending forward too long
  • Hiking" your shoulder to hold the phone receiver to your ear
  • Carrying a heavy purse, briefcase or backpack
  • Stress and muscle tension

Physical conditions that can possibly contribute to the onset of acute back pain include:

  • Lack of muscle tone
  • Excess weight
  • Pregnancy

Other causes of back pain include:

Mechanical Disorders: Many people who suffer from back problems are experiencing mechanical pain, which means that a specific part of their spine, such as an intervertebral disc, a ligament, or a joint is damaged and is not working correctly. Examples of spinal mechanical disorders include degenerative disc disease, herniated disc, spondylolysis/spondylolysthesis, arthritis and spinal stenosis.

Developmental Disorders: Developmental disorders of the lower back are caused by abnormalities in the formation and growth of the skeleton. Although the treatment for many of these conditions is conservative, surgery may be required to keep some disorders from worsening, and in order to prevent long-term disability and or deformity. Scoliosis and kyphosis are examples of developmental disorders of the spine.

Inflammatory and Infectious Disorders: Infections of the spinal column are not common, but they are important because they are difficult to diagnose and there are serious consequences in the delay of an accurate diagnosis.

Tumors: Cancers and tumors of the spine and spinal cord are relatively rare. The most common symptom that patients with a spinal tumor have is pain. Because back pain is very common, it is also not a specific symptom of any one disease or medical condition.

Trauma: Trauma to the spine refers to injury that has occurred to the bony elements, soft tissues and/or neurological structures, resulting in instability of the vertebral column and actual or potential neurological injury.

When Should I See My Doctor?

When your back hurts, the first step is to assess the severity and cause of your back pain to determine whether you need to see a physician.

Consult a physician immediately if you:

  • Are experiencing back pain as a result of a physical trauma involving your spine, such as a fall or car accident
  • Are experiencing numbness in, or having difficulty moving, your extremities
  • Experience bladder control loss or impairment
  • Develop a fever or severe headache
  • Are over 60 and have been taking steroids for a long period of time
  • Experience chest pain or pain in the left arm
  • Are pregnant
  • In instances of acute back pain, do not experience any improvement after 72 hours of self-treatment at home
  • Have experienced chronic back pain for more than 6 weeks

If you are experiencing back pain, talk to your doctor about appropriate treatment options. Identifying the cause of your back pain, alleviating the pain - either at home or with your physician's help - and avoiding re-injury are key to the healing process.

Neck Pain Read Description

Neck Pain

The cervical spine is designed to handle a great deal of stress; however, there are a number of degenerative changes that can take place in the vertebrae and discs, resulting in neck pain and other symptoms.

Neck pain and other symptoms caused by a cervical (neck) spine disorder are a very common problem for many adult Americans. The neck, or cervical spine, is made up of seven vertebrae separated by shock-absorbing intervertebral discs and supported by muscles and ligaments, and also is rich in spinal nerves and nerve roots.

When you feel pain, it's a reaction to signals transmitted throughout your body. These signals are sent from the pain source through the nerves in the spinal cord and into the brain, where they are perceived as pain. In addition to causing neck pain, problems that originate in the cervical spine may result in pain and other symptoms, such as tingling, numbness and muscle weakness, which extend into the shoulders, arms and hands.

Acute Pain vs. Chronic Pain

Acute pain is commonly described as sharp and severe; it tends to come on suddenly but also improve with time and short-term conservative treatment, such as medication, exercise, physical therapy or rest.

Chronic pain is commonly described as a deep, aching, dull or burning pain, and may be accompanied by numbness, tingling and/or weakness that extends into the extremities. Chronic pain tends to last a long time and is not relieved by conservative care.

What's causing my neck pain?

The intervertebral discs of the cervical spine are very important for the normal mobility and function of your neck. Over time, age, genetics and everyday wear-and-tear can contribute to deterioration of these discs, which, when healthy, act as "cushions" for the individual bones of the spine, or vertebrae.

Each disc is made up of two parts:

  • The nucleus pulposus – the soft, gel-like center of the disc.
  • The annulus fibrosis – strong, fibrous outer ring that surrounds and supports the nucleus pulposus .

Over time, intervertebral discs can become dried out, compressed or otherwise damaged, due to age, genetics and everyday wear-and-tear. When this happens, the nucleus pulposus may push through the annulus fibrosis. Disc degeneration also may result in bone spurs, also called osteophytes , or spinal stenosis, the narrowing of the area of the spine where the nerve leaves the spine and travels to the rest of the body.

If disc or bone material pushes into or impinges on a nearby nerve root and/or the spinal cord, it may result in pain, numbness, weakness, muscle spasms and loss of coordination, both at the site of the damage and elsewhere in the body, since most the nerves for rest of the body (e.g., arms, chest, abdomen and legs) pass from the brain through the neck.

These symptoms and the conditions that cause them are collectively referred to as degenerative disc disease, if the condition has become chronic over time. Similar symptoms, however, may occur suddenly if the disc nucleus dislodges acutely and causes nerve root compromise, a condition referred to as a herniated disc.

When should I see my doctor?

If you are experiencing neck pain, talk to your doctor about appropriate treatment options. Identifying the cause of your neck pain, alleviating the pain – either at home or with your physician's help – and avoiding re-injury are key to the healing process.

Consult a physician immediately if you:

  • Are experiencing back pain as a result of a physical trauma involving your spine, such as a fall or car accident
  • Are experiencing numbness in, or having difficulty moving, your extremities
  • Experience bladder control loss or impairment
  • Develop a fever or severe headache
  • Are over 60 and have been taking steroids for a long period of time
  • Experience chest pain or pain in the left arm
  • Are pregnant
  • In instances of acute neck pain, do not experience any improvement after 72 hours of self-treatment at home
  • Have experienced chronic back pain for more than 6 weeks

Arm Pain Read Description

Arm Pain

Degenerative conditions in the vertebrae of your lumbar spine, or low back, are a common source of leg pain.

If you are experiencing arm pain, the source of your discomfort may not actually be in your arm, but in your neck. The neck, or cervical spine, is made up of seven vertebrae separated by shock-absorbing intervertebral discs and supported by muscles and ligaments, and also is rich in spinal nerves and nerve roots.

When you feel pain, it's a reaction to signals transmitted throughout your body. These signals are sent from the pain source through the nerves in the spinal cord and into the brain, where they are perceived as pain. Problems that originate in the cervical spine may result in pain and other symptoms, such as tingling, numbness and muscle weakness, which may be localized in the neck and/or extend into the shoulders, arms and hands. The medical term for symptoms that radiate into the extremities is radiculopathy, derived from the Latin words " radix ," or roots, and " pathos ," which means disease.

Acute Pain vs. Chronic Pain

Acute pain is commonly described as sharp and severe; it tends to come on suddenly but also improve with time and short-term conservative treatment, such as medication, exercise, physical therapy or rest.

Chronic pain is commonly described as a deep, aching, dull or burning pain, and may be accompanied by numbness, tingling and/or weakness that extends into the extremities. Chronic pain tends to last a long time and is not relieved by conservative care.

What's Causing My Arm Pain?

The intervertebral discs of the cervical spine are very important for the normal mobility and function of your neck. When healthy, these discs act as "cushions" for the individual bones of the spine, or vertebrae.

Each disc is made up of two parts:

  • The nucleus pulposus - the soft, gel-like center of the disc.
  • The annulus fibrosis - the strong, fibrous outer ring that surrounds and supports the nucleus pulposus.

Over time, intervertebral discs can become dried out, compressed or otherwise damaged, due to age, genetics and everyday wear-and-tear. When this happens, the nucleus pulposus may push through the annulus fibrosis . Disc degeneration also may result in bone spurs, also called osteophytes , or spinal stenosis, the narrowing of the area of the spinal canal.

If disc or bone material pushes into or impinges on a nearby nerve root and/or the spinal cord, it may result in pain, numbness, weakness, muscle spasms and loss of coordination, both at the site of the damage and elsewhere in the body, since most of the nerves for the rest of the body (e.g., arms, chest, abdomen and legs) pass from the brain through the neck.

These symptoms and the conditions that cause them are collectively referred to as degenerative disc disease, if the condition has become chronic over time. Similar symptoms, however, may occur suddenly if the disc nucleus dislodges acutely and causes nerve root compromise, a condition referred to as a herniated disc.

When Should I See My Doctor?

If you are suffering from chronic arm pain or pain as a result of a physical trauma involving your neck, such as a fall or car accident, you should seek treatment from a physician.

Consult a physician immediately if you:

  • Are experiencing numbness in, or having difficulty moving, your extremities
  • Experience bladder control loss or impairment
  • Develop a fever or severe headache
  • Are over 60 and have been taking steroids for a long period of time
  • Experience chest pain or pain in the left arm
  • Are pregnant
  • In instances of acute back pain, do not experience any improvement after 72 hours of self-treatment at home
  • Have experienced chronic leg pain for more than 6 weeks

If you are experiencing arm pain, talk to your doctor about appropriate treatment options. Identifying the cause of your arm pain, alleviating the pain - either at home or with your physician's help - and avoiding re-injury are key to the healing process.

Leg Pain Read Description

Leg Pain

Degenerative conditions in the vertebrae of your lumbar spine, or low back, are a common source of leg pain.

If you are experiencing leg pain, the source of your discomfort may not actually be in your leg, but in your lower back, or lumbar spine. The lumbar spine is a common source of back pain because it bears more body weight than any other section of the spine and is also subject to a significant amount of stress and force, be it from lifting a load of laundry or blocking a tackle.

When you feel pain, it's a reaction to signals transmitted throughout your body. These signals are sent from the pain source through the nerves in the spinal cord and into the brain, where they are perceived as pain. Problems that originate in the lumbar spine may result in pain and other symptoms, such as tingling, numbness and muscle weakness, which may be localized in the lower back and/or extend into the hips, buttocks and/or legs. The medical term for symptoms that radiate into the extremities is radiculopathy, derived from the Latin words " radix ," or roots, and " pathos ," which means disease.

Acute Pain vs. Chronic Pain

Acute pain is commonly described as sharp and severe; it tends to come on suddenly but also improve with time and short-term conservative treatment, such as medication, exercise, physical therapy or rest.

Chronic pain is commonly described as a deep, aching, dull or burning pain, and may be accompanied by numbness, tingling and/or weakness that extends into the extremities. Chronic pain tends to last a long time and is not relieved by conservative care.

What's Causing My Leg Pain?

The five vertebrae of the lumbar spine (L1-L5), located directly below the thoracic spine (mid-back) and directly above the sacrum, are separated by shock-absorbing intervertebral discs and supported by muscles and ligaments. These discs are very important for the normal mobility and function of your back. Over time, age, genetics and everyday wear-and-tear can contribute to deterioration of these discs, which, when healthy, act as "cushions" for the individual bones of the spine, or vertebrae.

Each disc is made up of two parts:

  • The nucleus pulposus - the soft, gel-like center of the disc.
  • The annulus fibrosis - the strong, fibrous outer ring that surrounds and supports the nucleus pulposus.

Over time, intervertebral discs can become dried out, compressed or otherwise damaged, due to age, genetics and everyday wear-and-tear. When this happens, the nucleus pulposus may push through the annulus fibrosis . Disc degeneration also may result in bone spurs, also called osteophytes , or spinal stenosis, the narrowing of the area of the spine where the nerve leaves the spine and travels to the rest of the body.

If disc or bone material pushes into or impinges on a nearby nerve root and/or the spinal cord, it may result in pain, numbness, weakness, muscle spasms and loss of coordination, both at the site of the damage and elsewhere in the body. Sciatica - often described as pain that begins in the hip and buttocks and continues all the way down the leg - is one example of a radicular symptom that may be caused by damage or deterioration in the lumbar spine.

These symptoms and the conditions that cause them are collectively referred to as degenerative disc disease, if the condition has become chronic over time. Similar symptoms, however, may occur suddenly if the disc nucleus dislodges acutely and causes nerve root compromise, a condition referred to as a herniated disc.

When Should I See My Doctor?

If you are suffering from chronic leg, buttock or hip pain or pain as a result of a physical trauma involving your lower back, such as a fall or car accident, you should seek treatment from a physician.

Consult a physician immediately if you:

  • Are experiencing numbness in, or having difficulty moving, your extremities
  • Experience bladder control loss or impairment
  • Develop a fever or severe headache
  • Are over 60 and have been taking steroids for a long period of time
  • Experience chest pain or pain in the left arm
  • Are pregnant
  • In instances of acute back pain, do not experience any improvement after 72 hours of self-treatment at home
  • Have experienced chronic leg pain for more than 6 weeks

If you are experiencing leg pain, talk to your doctor about appropriate treatment options. Identifying the cause of your leg pain, alleviating the pain - either at home or with your physician's help - and avoiding re-injury are key to the healing process.

Diagnosis/Conditions Treated

Diagnosis Overview Read Description

Diagnosis

What's causing my back or neck pain? It's a common question, and a visit to your doctor is an important first step to get an answer.

You should know that the diagnosis of back, neck, leg or arm pain isn't always easy. The human spine is very complex, so it can be difficult for your doctor to pinpoint the exact cause of low back pain or other symptoms. Below are some common spinal conditions.

The history of the pain and any activities that may have triggered your symptoms are important factors in diagnosis and treatment.

Degenerative Disc Disease (DDD) Read Description

Degenerative Disc Disease (DDD)

 

Herniated Disc

Although it's a normal part of the aging process, degenerative disc disease can cause painful symptoms. Fortunately, there are minimally invasive treatment options that help provide relief and keep you active.

What Is Degenerative Disc Disease (DDD)?

Degenerative disc disease (DDD) is part of the natural process of growing older. As we age, our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The outer fibers that surround the disc, called the annulus fibrosis, become brittle and are more easily torn. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, starts to dry out and shrink. The combination of damage to the intervertebral discs, the development of bone spurs and the gradual thickening of the ligaments that support the spine can all contribute to degenerative arthritis of the lumbar spine.

To a certain degree, this process happens to everyone. However, not everyone who has degenerative changes in their lumbar spine has pain. Many people who have "normal" backs have MRIs that show disc herniations, degenerative changes, and narrowed spinal canals. Every patient is different, and it is important to realize that not everyone develops symptoms as a result of degenerative disc disease.

What Are The Symptoms Of Degenerative Disc Disease?

When degenerative disc disease becomes painful or symptomatic, it can cause several different symptoms due to the compression of the nerve roots. Depending on where your degenerative disc is located, it could cause:

  • Back pain
  • Radiating leg pain
  • Neck pain
  • Radiating arm pain

These symptoms are caused by the fact that worn out discs are a source of pain because they do not function as well as they once did, and as they shrink, the space available for the nerve roots also shrinks. As the discs between the intervertebral bodies start to wear out, the entire lumbar spine becomes less flexible. The result can be back pain and stiffness, especially towards the end of the day.

How Is Degenerative Disc Disease Diagnosed?

The diagnosis of degenerative disc disease begins with a complete physical examination. Your doctor will examine your back for flexibility, range of motion, and the presence of certain signs that suggest your nerve roots are being affected by degenerative changes in your back. This often involves testing the strength of your muscles and your reflexes to make sure that they are still working normally. You will often be asked to fill out a diagram that asks you where your symptoms of pain, numbness, tingling and weakness are occurring.

A series of x-rays is also usually ordered for a patient with back pain. If degenerative disc disease is present, the x-rays will often show a narrowing of the spaces between the vertebral bodies, which indicates the disc has become very thin or has collapsed. Bone spurs also can form around the edges of the vertebral bodies and also around the edges of the facet joints in the spine. These bone spurs can be seen on an x-ray, and are also called osteophytes. As the disc collapses and bone spurs form, the space available for the nerve roots starts to shrink. The nerve roots exit the spinal canal through a bony tunnel called the neural foramen, and it is at this point that the nerve roots are especially vulnerable to compression.

In many situations, doctors will order a MRI or a CT scan (CAT scan) to evaluate the degenerative changes in the lumbar spine more completely. A MRI is very useful for determining where disc herniations have occurred and where the nerve roots are being compressed. A CT scan is often used to evaluate the bony anatomy in the spine, which can show how much space is available for the nerve roots and within the neural foramina and spinal canal.

How Is Degenerative Disc Disease Treated?

Your doctor will discuss with you the treatment options appropriate for your diagnosis.

For most people who do not have evidence of nerve root compression with muscle weakness, conservative, non-surgical therapies, such as medication, rest, exercise and physical therapy, are typically recommended.

Surgery is offered only after conservative treatment has have failed to adequately relieve the symptoms of pain, numbness and weakness over a significant period of time.

The benefits of spine surgery, however, must be weighed against the risks. Your surgeon will be able to discuss the risks and benefits of surgery with you, and the likely results of operative versus non-operative treatment.

Herniated Discs Read Description

Herniated Discs

 

A herniated disc, also called a bulging disc, ruptured disc or slipped disc, occurs when the inner core of the spinal disc pushes out through the outer layer of the disc.

What Is A Herniated Disc?

Herniation describes an abnormality of the intervertebral disc that is also known as a "slipped," "ruptured" or "bulging" disc. This process occurs when the inner core ( nucleus pulposus ) of the intervertebral disc bulges out through the outer layer of ligaments that surround the disc ( annulus fibrosis ). This tear in the annulus fibrosis causes pain in the back at the point of herniation. If the protruding disc presses on a spinal nerve, the pain may spread to the area of the body that is served by that nerve.

Four Degrees of Disc Herniation:



Nuclear Herniation, Disc Protrusion, Nuclear Extrusion, and Sequestered Nucleus

What Are The Symptoms Of A Herniated Disc?

Usually, the main symptom is sharp, acute pain. In some cases, there may be a previous history of localized low back pain, with pain also extending down the leg served by the affected nerve. This pain is usually described as a deep, sharp pain, which gets worse as it moves down the affected leg. The onset of pain with a herniated disc may occur suddenly or it may be preceded by a tearing or snapping sensation in the spine, which may be attributed to a sudden rupture in the annulus fibrosis .

How Is A Herniated Disc Diagnosed?

A patient with a herniated disc will usually complain of low back pain that may or may not radiate into different parts of the body, such as the leg. They will often demonstrate a limitation in range of motion when asked to bend forward or lean backwards, and they may lean to one side as they try to bend forward. Patients will sometimes walk with a painful gait, flexing the affected leg so as not to put too much weight on the side of the body that hurts. Straight leg raising may be a positive indication of tension on the nerve root.

Abnormalities in the strength and sensation of particular parts of the body that are found with a neurological examination performed by a doctor provide the most objective evidence of nerve root compression. An MRI is the test of choice for diagnosis of a herniated disc, but a CT scan (CAT scan) also may be helpful because it provides better visualization of the bony anatomy of the spinal column that indicates where the source of pressure on the nerve root is located.

How Is A Herniated Disc Treated?

Treatment for the vast majority of patients with a herniated disc does not normally include surgery. Most patients will respond to conservative therapy, such as medication, rest and physical therapy. Treatment is most effective when a patient and a doctor have a good relationship and the patient understands the rationale behind the prescribed treatment.

The primary element of conservative treatment is controlled physical activity. Usually treatment will begin with a modification of activity and then a gradual return to protected activities. Sitting, bending, lifting and twisting are not beneficial for this condition because they put a large amount of stress and pressure on the lumbar spine, which may increase the pressure on the affected nerve root. The appropriate use of medication is an important part of conservative treatment. This can include anti-inflammatory drugs, analgesics and muscle relaxants. Your doctor also may recommend an anti-inflammatory spinal injection for the area of the affected nerve root to lessen swelling and irritation caused by the damaged disc.

Surgery is typically recommended only after physical therapy, rest, and medications have failed to adequately relieve the symptoms of pain, numbness and weakness over a significant period of time.

The benefits of spine surgery, however, must be weighed against the risks. Your surgeon will be able to discuss the risks and benefits of surgery with you, and the likely results of operative versus non-operative treatment.

Osteoporosis Read Description

Osteoporosis

Often called "the silent disease," osteoporosis is a bone condition characterized by decreased bone mass and the subsequent deterioration of bone tissue.

Osteoporosis

What Is Osteoporosis?

Osteoporosis is a bone condition characterized by decreased bone mass and the subsequent deterioration of bone tissue. Often called "the silent disease", this progressive condition causes bones to become more porous, thin and brittle, thus more susceptible to fracture. The spine can be particularly vulnerable – vertebral compression fractures may occur in those whose osteoporosis has reached the advanced stage.

Men, women and in rare cases even children can develop osteoporosis; however, the condition is most prevalent in older adults. An estimated 44% of Americans over age 50 – some 44 million people – have been diagnosed with the condition or identified at increased risk for osteoporosis due to low bone mass. Of those diagnosed with osteoporosis, 80% are women.

The exact cause of osteoporosis is unknown; however, there are a number of established risk factors. Age, nutrition, lifestyle and genetics, as well as certain medical conditions and medications, can all play a part.

Age
During childhood and early adulthood, the body creates new bone faster than it can absorb existing bone, a process that starts to reverse around age 30. Bone loss in women speeds up when the production of estrogen slows down, usually between the ages of 45-55. Likewise, men begin to experience bone loss as their production of testosterone declines, generally around age 45-50.

One of the reasons women are more likely to develop osteoporosis, and develop it earlier, is that their bones are typically smaller and lighter than men's, so there is less bone mass to begin with. People who do not achieve ideal bone thickness when they are young also are more likely to develop the condition.

Nutrition
Bone strength is a product of both bone mass and density. Bone density depends, in part, on the amount of calcium, phosphorus and other minerals the bone contains. Bones deficient in these minerals tend to be weaker with less internal supporting structure, which makes them more porous and fragile.

Excessive dieting or eating disorders, such as anorexia nervosa, may contribute to bone loss. Studies have shown that cola drinks, which contain phosphoric acid, also may interfere with bones' ability to absorb calcium.

Lifestyle
People who get little or no exercise are at risk for developing osteoporosis. Weight bearing exercises, such as walking, jogging and weight lifting, work muscles and bones against gravity, which helps maintain their strength and density. Smoking increases the loss of bone density, and heavy alcohol consumption may inhibit bone formation.

Genetics
People who have a parent or sibling with osteoporosis have a 60% to 80% chance of developing the condition, as well. People of Asian or European descent are those most likely to develop osteoporosis; people of African descent the least likely.

Small-framed, thin people also are at greater risk. Smaller bones mean less bone mass. And thin people have less body fat - fat cells produce estrogen, which can help prevent bone loss in women after menopause.

Medical Conditions and Medications
Several medical conditions, including hyperthyroidism, Cushing's syndrome and hyperparathyroidism, increase the risk of osteoporosis. Some medications also may contribute to bone thinning. They include:

  • Corticosteroids (for treating asthma and chronic obstructive pulmonary disease);
  • Endometriosis medications;
  • Aromatase inhibitors (for treating breast cancer);
  • Thyroid replacement medications;
  • Antacids containing aluminum (if overused).

What Are The Symptoms of Osteoporosis?

Unfortunately, the reason osteoporosis is called the "silent disease" is that it has no physical symptoms in its early stages. As the condition progresses, the following symptoms that indicate weakening bones may occur:

  • Lower back or neck pain;
  • Bone pain or tenderness;
  • Curved backbone or stooped posture ("dowager's hump")
  • Gradual loss of height
  • Fractures from minor trauma, especially in the hip, spine or wrists.

How Is Osteoporosis Diagnosed?

Early diagnosis is critical. If you believe you are at risk for osteoporosis or have experienced any of the above symptoms, contact your physician. He or she will make a diagnosis based on your medical history, a physical examination and a bone density test – a painless, accurate and non-invasive procedure that measures bone thickness.

How Is Osteoporosis Treated?

Although there is no cure for osteoporosis, there are a variety of treatment options that have the potential to reduce, stop or even reverse bone loss. Even small changes in diet, exercise and medication may help prevent the more serious consequences of the condition, such as broken bones. There also are a number of osteoporosis prevention and/or treatment medications currently approved by the U.S. Food and Drug Administration.

Consult with your physician to determine which treatment plan is best for you, and follow the program he or she recommends to rebuild and maintain bone health.

Spondylolisthesis Read Description

Spondylolisthesis

Spondylolisthesis occurs when one vertebra slips forward in relation to adjacent vertebrae. The condition can be a source of back pain, leg pain and other symptoms.

What Is Spondylolisthesis?

Spondylolisthesis occurs when one vertebra slips forward on the adjacent vertebrae. The condition may be congenital (hereditary), or the result of physical stresses on the spine or spinal degeneration. It may produce both a gradual deformity of the lower spine and also a narrowing of the vertebral canal, and can cause back pain, leg pain and other symptoms.

There are five types of spondylolisthesis*:

Type I is called dysplastic spondylolisthesis and is secondary to a congenital defect of either the superior sacral or inferior L5 facets or both with gradual slipping of the L5 vertebra.

Type II , isthmic or spondylolytic, in which the lesion is in the isthmus or pars interarticularis , has the greatest clinical importance in persons under the age of 50. If a defect in the pars interarticularis can be identified but no slipping has occurred, the condition is termed spondylolysis. If one vertebra has slipped forward on the other (horizontal translation), it is considered spondylolisthesis.

Type II can be divided into three subcategories:

  • Type II A is sometimes called Lytic or stress spondylolisthesis and is most likely caused by recurrent microfractures caused by hyperextension. It is also called a "stress fracture" of the pars interarticularis and is much more common in males.

  • Type II B probably also occurs from microfractures in the pars. However, in contrast to Type II A, the pars interarticularii remain intact but stretched out as the fractures fill in with new bone.

  • Type II C is very rare and is caused by an acute fracture of the pars. Nuclear imaging may be needed to establish a diagnosis.

Type II A

Type II B

Type II C

Type III is a degenerative spondylolisthesis, and occurs as a result of the degeneration of the lumbar facet joints. The alteration in these joints can allow forward or backward vertebral displacement. This type of spondylolisthesis is most often seen in older patients. In Type III, degenerative spondylolisthesis there is no pars defect and the vertebral slippage is never greater than 30%.

Type IV , traumatic spondylolisthesis, is associated with acute fracture of a posterior element (pedicle, lamina or facets) other than the pars interarticularis.

Type V , pathologic spondylolisthesis, occurs because of a structural weakness of the bone secondary to a disease process such as a tumor or other bone disorder.


Type IV

Type V

What Are The Symptoms Of Spondylolysthesis?

The most common symptom of spondylolisthesis is low back pain. Many times a patient can develop the lesion (spondylolysis) between the ages of five and seven and not present symptoms until they are 35-years-old, when a sudden twisting or lifting motion will cause an acute episode of back and leg pain.

Usually the pain is relieved by extension of the spine and made worse when flexed. The degree of vertebral slippage does not directly correlate with the amount of pain a patient will experience. Fifty percent of patients with spondylolisthesis associate an injury with the onset of their symptoms.

In addition to back pain, patients may complain of leg pain. In this instance, there can be associated narrowing of the area where the nerves leave the spinal canal that produces irritation of a nerve root.

Many patients with spondylolisthesis will have vague symptoms and very little visible deformity. Often, the first physical sign of spondylolisthesis is tightness of the hamstring muscles in the legs. Only when the slip reaches more than 50 percent of the width of the vertebral body will there begin to be a visible deformity of the spine.

There may be a dimple at the site of the abnormality. Sometimes there are mild muscle spasms and usually some local tenderness can be felt in the area. Range of motion is often not affected, but some pain can be expected on hyperextension. Laboratory test results are normal in patients with one or both disorders.

How Is Spondylolisthesis Diagnosed?

To determine if spondylolysis is the cause of your symptoms, your doctor may, in addition performing a physical exam, recommend a diagnostic test such as an x-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI). The diagnosis of spondylolisthesis is confirmed by noting the forward position of one vertebral body on another.

A spondylolisthesis also is graded according to the amount that one vertebral body has slipped forward on another. A grade I slip means that the upper vertebra has slipped forward less than 25 percent of the total width of the vertebral body, a grade II slip is between 25 and 50 percent, a grade III slip between 50 and 75 percent, a grade IV slip is more than 75 percent, and in the case of a grade V slip, the upper vertebral body has slid all the way forward off the front of the lower vertebral body, a condition called spondyloptosis.

How Is Spondylolysthesis Treated?

Your doctor will be able to discuss with you what your diagnosis means in terms of treatment options. For most people without any signs of nerve compression or other neurologic impairment, the first line of treatment consists of non-surgical therapies such as medication, rest and physical therapy. Bracing and epidural spinal injections also may be recommended.

Spine surgery is typically considered only after conservative therapies fail to adequately relieve symptoms over a significant period of time, or if evidence of nerve involvement, such as numbness or tingling, muscle weakness or bowel or bladder impairment, develops.

Surgical procedures that may be recommended for the treatment of spondylolisthesis include:

  • Spinal decompression, a procedure in which bone is removed to eliminate nerve pressure
  • Spinal fusion, a procedure in which bone graft material is placed between vertebrae to join – or fuse together – the vertebrae to restore spinal stability

The procedures are typically performed together as part of the same surgery, the overall goal of which is to stop the slippage, remove the source of irritation and inflammation and restore the stability of the spine.

The benefits of spine surgery, however, must be weighed against the risks. Discuss with your surgeon the risks and benefits of surgery, and the potential results of operative versus non-operative treatment.

*Seimon, LP. Low Back Pain: Clinical Diagnosis and Management. Norwalk: Appleton-Century-Crofts, 1983.

Stenosis Read Description

Stenosis

Spinal stenosis is a condition caused by the gradual narrowing of the spinal canal.

What Is Spinal Stenosis?

The narrowing of the spinal canal, called spinal stenosis, can happen as a result of the degeneration of both the facet joints and the intervertebral discs. In this condition, bone spurs, called osteophytes, which develop because of the excessive load on the intervertebral disc, grow into the spinal canal.

The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. The ligaments of the spinal column, especially the ligamentum flavum , become stiff, less flexible and thicker with age, which also contributes to spinal stenosis. These processes narrow the spinal canal and may begin to impinge and put pressure on the nerves roots and spinal cord, creating the symptoms of spinal stenosis.

Stenosis may occur in the central spinal canal (central stenosis) where the spinal cord or cauda equina are located, in the tract where the nerve root exits the central canal (lateral recess stenosis) or in the lateral foramen (foraminal stenosis) where the individual nerve roots exit out to the body.

Some distortion of the spinal canal will occur in virtually every person as they age, but the severity of the symptoms will depend on the size of a person's spinal canal and the encroachment on the neural elements. The rate of deterioration varies greatly from person to person, and not everyone will feel symptoms.

Spinal stenosis may be caused by a number of processes that decrease the amount of space in the spinal canal available for the neural elements. Degenerative causes are the most common, but there are a few unusual causes of stenosis. These include calcium pyrophosphate crystal deposition, amyloid deposition, and intradural spinal tumors.

What Are The Symptoms Of Spinal Stenosis?

Some people with degenerative disease of the lumbosacral spine may be totally asymptomatic, some may complain of mild discomfort in the low back, and others may not even be able to walk.

Patients who have significant spinal stenosis typically will begin to notice pain in the buttocks, thigh or leg that develops with standing or walking, and improves with rest. In some cases, a patient will complain of leg pain and weakness without having any back pain. More severe symptoms of the disorder include numbness, a tingling sensation and/or weakness in the lower extremities.

Certain positions can alleviate the symptoms of spinal stenosis by increasing the amount of space available for the nerves. These positions usually involve flexion of the lumbar spine and forward bending. Any position that flexes the lumbar spine is often associated with resolution of symptoms. For instance, patients with spinal stenosis can ride a bike and walk up an incline or flight of stairs without any pain. They can also often walk for extended distances if they have something to lean on, like a shopping cart. However, if they are walking down an incline or flight of stairs, or if they have to give up the shopping cart, their symptoms often reappear.

The presentation and severity of the symptoms of spinal stenosis depends on the several factors, including the original width of the spinal canal, the susceptibility of the nerves involved, and the unique functional demands of the patient and the pain tolerance of each individual.

How Is Spinal Stenosis Diagnosed?

The diagnosis of spinal stenosis begins with a complete history and physical examination. The doctor will determine what symptoms are present, what makes them better or worse, and how long they have been present. A physical examination is essential for determining how severe the condition is, and whether or not it is causing weakness or numbness in certain parts of the body.

Abnormalities in the strength and sensation of particular parts of the body that are found with a neurological examination provide the most objective evidence of chronic nerve root compression caused by spinal stenosis. Routine radiographs of the lumbar spine are very helpful in determining the amount of degeneration that is present in the spine, which gives an indirect indication of whether or not spinal stenosis is present. These S-rays are also used to determine if certain parts of the spine are unstable, which may be contributing to the symptoms of stenosis.

A computed tomography (CT or CAT) scan provides excellent visualization of the bony anatomy of the spinal column and is an indispensable tool for determining where the stenosis is located. This test is often performed in conjunction with a myelogram, which involves injecting dye into the space occupied by the spinal cord and nerve roots to determine how well the cerebrospinal fluid is able to travel along the nerve roots. An EMG or electromyographic test may help to determine which nerve root in particular is not working normally in the situation where several nerve roots may be involved.

How Is Spinal Stenosis Treated?

Your doctor will be able to discuss with you what your diagnosis means in terms of treatment options. For most people who do not have evidence of nerve root compression with muscle weakness, the first line of therapy includes non-steroidal anti-inflammatory drugs and physical therapy.

Surgery is offered only after physical therapy, rest, and medications have failed to adequately relieve the symptoms of pain, numbness and weakness over a significant period of time.

The benefits of spine surgery, however, must be weighed against the risks. Your surgeon will be able to discuss the risks and benefits of surgery with you, and the likely results of operative versus non-operative treatment.

Vertebral Compression Fractures Read Description

Vertebral Compression Fractures

Back pain is not just another inevitable aspect of growing older. It could be a sign of stress fractures within your spine called vertebral compression fractures.

What Is A Vertebral Compression Fracture?

Spinal fractures occur when the normal vertebral body is "squashed", or compressed in height. When the load on a vertebra exceeds its stability or inherent strength, the bone can collapse. Pain, limited mobility, height loss and spinal deformity are often the result. In severe cases, part of the vertebral body may protrude into the spinal canal and put pressure on the spinal cord and nerves. Organ function, including that of the bowel or bladder, also may be compromised.

Vertebral compression fractures can happen for a number of reasons: trauma from a fall or a car accident; bone thinning due to osteoporosis or even the spread of a tumor into the spine.

Knowing how to prevent, recognize and treat vertebral compression fractures is critical for maintaining good spinal health. Here is some information to help you learn more about this type of spinal injury.

What Causes Vertebral Compression Fractures?

Osteoporosis
There is no one single cause; however, the vast majority of vertebral compression fractures are the result of osteoporosis, a condition that causes bones to progressively become more thin and fragile. When bones are brittle, even everyday activities and minor traumas, such as lifting a laundry basket, missing a step, or even coughing or sneezing, can cause these tiny fractures.

Osteoporosis-related compression fractures can occur anywhere in the spine, but are most often found in the lower vertebrae of the upper back. The vertebral bone tends to collapse toward the front of the spine, creating wedge-shaped vertebrae that cause the spine to curve forward (kyphosis), eventually leading to the "dowager's hump" frequently associated with the advanced stage of the disease. Learn more about osteoporosis.

Tumors
Tumors growing in or near the spine are another cause of compression fractures. Doctors frequently monitor those diagnosed with certain types of cancer, including multiple myeloma or lymphoma, for spinal breakage. Tumors also may spread to the spine as a result of cancer in other organs and areas of the body, such as the breasts, lungs and intestines.

Trauma
People with strong, healthy bones also can sustain compression fractures from a hard fall or blow to the back or torso. Vertebrae can withstand a good deal of shock; however, if the force on the spine is too great, they can break.

What Are The Symptoms of Vertebral Compression Fracture?

The primary physical symptoms of vertebral fracture include one or more of the following:

  • Sudden onset of back pain
  • Increase in pain when standing or walking
  • Variable pain relief when lying down
  • Limited spinal mobility
  • Weakness or numbness in the affected areas
  • Height loss
  • Deformity and disability
  • Shortness of breath

These additional symptoms signal the possibility of multiple vertebral fractures:

  • Hunched back ("dowager's hump")
  • Bulging abdomen
  • Gastrointestinal problems - crowding of the internal organs can be a serious side effect of multiple compression fractures.
  • Shortness of breath - it's possible for the torso to become so compressed that it's difficult to breathe.
  • Hip pain (hip fracture)

How Are Vertebral Compression Fractures Diagnosed?

If you think you may have a compression fracture, see a doctor. (To find one near you, visit our Physician Locator.) Here are some questions your doctor may ask:

  • How long have you been in pain? Was the onset sudden or gradual?
  • Where is the pain located? What is the intensity?
  • Does the pain radiate to other parts of the body?
  • In what positions is the pain better or worse?
  • Is the pain getting worse or better over time?

Your doctor also may recommend one or more of the following diagnostic tests:

  • A spinal X-ray to determine the presence of a fracture.
  • An MRI to check for the age of the fracture and other abnormalities in the soft tissues, including nerves and ligaments.
  • A nuclear bone scan, another test that can determine the presence and/or age of a fracture.
  • DEXA scan

How Are Vertebral Compression Fractures Treated?

Treatment of compression fractures includes measures to alleviate the pain, stabilize and repair the fracture, and diagnose the underlying cause of the breakage.

Non-Surgical Measures

Non-surgical treatment options your doctor may recommend include:

  • Medications to relieve bone, muscle and nerve pain.
  • A reduction in activity or bed rest
  • A spinal brace to limit motion
  • Medication to stabilize or improve bone density
  • Physical therapy
  • Epidural spinal injection
  • External soft bracing

Surgical Options

If compression fractures fail to heal or if pain persists despite non-surgical measures, your doctor may recommend surgery as the next step toward relief. Surgical procedures for treating vertebral compression fractures are usually minimally invasive.

How Can I Prevent Vertebral Compression Fractures?

The best way to avoid vertebral compression fractures is to begin taking preventive measures toward building a strong back and spine early in life. But, even if you didn't, it's never too late to start! Here are a few tips:

Exercise - Exercise, especially strength/resistance training and/or lifting weights regularly, can help build strong bones. Engaging in some form of cardiovascular exercise and strength training at least three times a week can help combat bone loss, and the earlier you start exercising and strength training the better. Strong muscles also help you maintain balance to avoid falls and other accidents.

For back-strengthening programs at the beginner, intermediate and advanced levels, check out these exercises for the back and spine.

Eat Right – Eat a nutrient-rich, balanced diet, with sufficient intake of calcium, Vitamin D and phosphorus. Avoid smoking and excessive alcohol use; smoking contributes to bone density loss and too much alcohol inhibits bone formation. If possible, maintain a healthy weight – additional pounds place excess strain on the back.

Stay Hydrated – Drink between six and eight cups or water a day to keep the body well hydrated. Water helps reduce stiffness and contributes to overall spine health.  Learn how to maintain bone density for a healthy spine.

Practice Good Posture – Maintaining a "neutral spine" is the foundation of good posture. In a neutral spine, the natural curves of the spine (the concave, or lordotic, curves, and the convex, or kyphotic, curves) are in proper balance. The spine is neither rounded forward nor arched back too much.

Proper posture keeps your bones properly aligned and alleviates excess stress on your musculoskeletal systems, allowing your muscles, joints, and ligaments to work as intended.

Neuropathic Pain Read Description

Neuropathic Pain

Neuropathic pain is usually felt as a burning or throbbing, is typically constant, and sometimes worsens at night time. Neuropathic pain can be a common result of a damaged nerve that was initially affected by a disc or bone spur or other form of trauma.

The treatment of neuropathic pain may include medications and spinal cord stimulation. Spinal cord stimulation is a technique whereby electrodes are placed in the spinal canal alongside the spinal cord. The electrodes deliver electrical stimulation to the region of the spinal cord with the aim of blocking the transmission of pain signals from the back, arms, and legs. Various medications may help to treat neuropathic pain. If the pain does not respond to pain medications, then spinal cord stimulation is a reasonable option.

A spinal cord stimulation trial is first done to determine if the pain is responsive to stimulation. It involves the placement of a lead into the spinal canal and externally connected to a battery. It allows for the patient to experience the degree of pain relief for several days. If there is a significant pain reduction then a permanent spinal cord stimulator is placed.

A spinal cord stimulator consists of an electrical lead that is connected to a wire which is connected to a small generator/battery typically at the level of the hip. The procedure usually takes 1–2 hours and usually will require one night stay in the hospital. The goal of a spinal cord stimulator is to reduce pain and therefore to reduce or eliminate use of pain medications.

SI Joint Dysfunction Read Description

SI Joint Dysfunction

The sacroiliac joint (SI joint) is the joint connecting the sacrum which is the lowest portion of the spine to the ilium which is the hip bone. Pain from the sacroiliac joint localizes to the upper buttock region and can also cause pain into the groin, thigh, calf, and foot.

Trauma is the most common cause of SI joint pain. Pregnancy can also lead to SI joint dysfunction as hormones produced during pregnancy cause a looseness of the ligamentous structures supporting the joint. Furthermore, patients that undergo lumbar fusions are at increased risk for developing SI joint pain due to the greater stress being put on this area.

The diagnosis of SI joint dysfunction relies mainly on the response to injection of steroid and anesthetic directly into the joint. Treatment options for SI joint dysfunction include medications (usually antiinflammatories and muscle relaxants), physical therapy, injections, radiofrequency ablation, and surgery. Surgery is indicated when nonsurgical options have failed to provide long lasting relief of pain.

A new minimally invasive procedure to fixate the SI joint is now available and our practice is the first to utilize this technique in Pennsylvania. The surgery involves a small 3-4 cm incision over the outer buttock area. Then 3–4 triangular titanium rods are placed across the SI joint to help stabilize it.

The procedure generally takes 1–2 hours and usually requires an overnight stay in the hospital. For the first 3–4 weeks after the procedure, patients are not to bear weight on the same side leg as the surgery. Patients may advance to partial weight bearing for the next 3–4 weeks.

Surgical Procedures

  • AxiaLIF® (Axial Lumbar Interbody Fusion)

    Read Description

    In this minimally-invasive procedure, performed under general anesthesia, portions of a diseased or damaged disc in the lumbar spine are removed and a device is implanted to secure one or more vertebrae to the sacrum. It is typically used to treat back pain caused by a degenerative disc between the lowest lumbar vertebra (called L5) and the top of the sacrum (called S1).

  • ILIF: Interlaminar Lumbar Instrumented Fusion

    Read Description

    In this minimally-invasive procedure, the spinal nerve roots are decompressed and a metal device is implanted to stabilize the spine and help relieve back problems from conditions such as spinal stenosis, spondylolisthesis, and degenerative arthritis.

  • Kyphoplasty

    Read Description

    This minimally-invasive procedure treats spine fractures caused by osteoporosis. It is designed to provide rapid back pain relief and help straighten the spine.

  • Lumbar Disc Microsurgery

    Read Description

    This minimally invasive technique is used to remove the herniated portion of a vertebral disc. It is 95% to 98% effective in eliminating leg pain (sciatica) caused by nerve root compression. The procedure is performed through a small incision on the back.

  • Laminectomy

    Read Description

    This procedure is performed through an incision on the lower back. The surgeon removes a section of bone, called the lamina, from one or more vertebrae. This relieves pressure on the nerve roots caused by stenosis (a narrowing of the spinal canal).

  • Percutaneous Disc Nucleoplasty

    Read Description

    This minimally-invasive procedure uses a small needle and advanced radiofrequency technology to reduce a herniated disc, quickly relieving pain in most patients. The procedure may be performed on an outpatient basis using a gentle, relaxing medicine and local anesthetic.

  • Spinal Cord Stimulator Implant

    Read Description

    Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

  • XLIF: Lateral Lumbar Interbody Fusion

    Read Description

    Unlike traditional back surgery, XLIF is performed through the patient's side. By entering this way, major muscles of the back are avoided. This minimally-invasive procedure is generally used to treat leg or back pain caused by degenerative disc disease. It can be performed on an outpatient basis.