Tag Archives: Spine

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #58: SPINAL STENOSIS

Spinal stenosis is a narrowing in the spinal canal. Constriction of the spinal nerves can produce pain that goes down one or both of the arms or legs, depending on the location of the stenosis. Malfunction of the nerves can cause numbness In the arms or legs, or weakness in muscles served by the affected spinal nerves.

Your doctor can confirm the diagnosis with imaging techniques such as MRI or CT scan.

The interesting part of this condition to me is the tremendous advances in surgical techniques that have taken place in the past decade. Many surgeries are now done through an endoscope, which limits the surgical disruption in the area. There is even a needle guided procedure to remove part of the ligament that is causing compression of the nerve.

Depending on the exact problem, small amounts of bone or other tissues can be removed, especially if the exact site of compression has been identified. If the extent of compression is more extensive, increasing amounts of bone is removed from the lamina (bony arches), facets , or nerve outlets (foramina) to give the nerves more room.

If there is slippage of the vertebra, a fusion is sometimes done. My understanding is that fusion is becoming less common. That being said, the Cloward procedure in the neck, with its approach from the front, is still sometimes used with neck pain.

Pain in the neck or back without any associated nerve malfunction is often best treated with physical therapy, steroid injections, or other conservative methods.

In my opinion spinal surgery is best done by trained neurosurgeons, who are familiar with minimally invasive surgery.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #57: SCOLIOSIS

Scoliosis is a curvature of the spine most commonly starting in childhood or adolescence. The cause can be a muscle imbalance from cerebral palsy or other muscle problems, a birth defect,  an injury, or sometimes there is scoliosis that runs in the family and is hereditary. Occasionally it is caused by a difference in the length of the two legs.

The curvature is sometimes accompanied by a rotation of the spine, and will produce an asymmetry of the back. Perhaps one shoulder blade is higher than the other or one shoulder is lower than the other. Differences in the leg length can be seen by differences in height of the pelvis.

The problem can be silent, if mild. However it can affect the way the child walks, or even interfere with breathing if severe. If untreated and progressive, it can cause chronic back pain in adulthood. Treatment is accomplished by braces, or occasionally by screws placed in the side of the vertebra that can be adjusted.

I had a friend that was 70 years old whose back pain eventually forced surgery. Scoliosis should definitely be supervised by a Doctor who will use physical therapy, braces, or some other conservative treatment to avoid later difficulties.

Please refer to the Mayo clinic article for more information.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #49: KYPHOSIS (ROUNDBACK)

Older people are more susceptible to kyphosis. Osteoporosis is a risk factor, so it is no surprise that women are affected more frequently. This rounding tendency of the thoracic spine can be measured on a lateral x-ray of the spine in terms of degrees; 20 to 40°  is considered normal. The angle increases with age, and almost half of older people have an angle more than 40°.

Children can also get kyphosis-Scheuermann’s disease-during the rapidly growing years. Kyphosis occurs when the normally block-like vertebrae become wedge shaped, with the narrow part towards the front.

Causes of kyphosis include fractures, with or without osteoporosis, disc degeneration, cancer and cancer treatment. Tuberculosis of the bone used  to be a common cause of hunchbacks, but this is no longer a problem.

Kyphosis can produce breathing problems by putting pressure on the lungs, increase digestive problems such as GERD, or compress spinal nerves causing pain.

At the age of 89, I have a problem with kyphosis. At the age of 30, one of my thoracic vertebrae sustained a wedge compression fracture, probably from jumping off a wall or something similarly stupid.

I continually have to fight foreword slouching when I walk, and remind myself to stand up straight, and throw my shoulders back. My neck arthritis makes it difficult to look up when I walk.

I also do angle push-ups to strengthen my back muscles. I have a friend who has severe kyphosis, and recently had an orthopedic operation to correct it. I am hopeful that this operation will relieve his sense of shortness of breath and reduce his GERD.

Treatment includes taking vitamin D and calcium, or other medicines for osteoporosis. Smoking should be avoided, and alcohol limited. There are a number of exercises that are recommended, some of which I have mentioned.

Please refer to the following Mayo clinic article for more information.

—Dr. C.

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Technology: Augmented Reality Improves Spine Surgery Outcomes (Video)

Kay suffered from debilitating muscle cramping and lower back pain due to spondylolisthesis, a common condition in the lumbar spine. When nonsurgical treatment options failed, she turned to spine neurosurgeon Timothy Witham for help. He used a new augmented reality technology to accurately place spinal instrumentation in her back. Seven months after surgery, Kay has resumed her daily pursuits without pain and is enjoying life.