Spine Topics

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Anatomy of the spine

The spine is made of 33 individual bony vertebrae stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. Strong bones and muscles, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine.

Back problems

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Back pain

Back pain results when the spine is stressed by injury, disease, wear and tear, or poor body mechanics. Acute low back pain is abrupt, intense pain that subsides after a period of days or weeks. It typically resolves with rest, physical therapy, and other self-care measures. You play an important role in the prevention, treatment, and recovery of back pain. Chronic pain that persists may need further evaluation.

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Leg pain (sciatica)

Sciatica is a shooting pain that begins in the lower back, radiates into the buttock and down the back of one leg. Pain is often caused by pressure on the sciatic nerve from a herniated disc, bone spurs or muscle strain. You play an important role in the prevention, treatment, and recovery of leg pain. It typically improves with rest, physical therapy, and other self-care measures. Chronic pain may be helped with surgery.

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Neck pain

Neck pain results when the spine is stressed by injury, disease, wear and tear, or poor body mechanics. Acute neck pain is abrupt, intense pain that can radiate to the head, shoulders, arms, or hands. It typically subsides with rest, physical therapy, and self-care measures. You play an important role in the prevention, treatment and recovery of neck pain. Chronic pain that persists may need further evaluation.

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Chiari I malformation

Chiari I is a condition in which the bony space enclosing the lower part of the brain is smaller than normal. Crowding pushes the cerebellar tonsils through the skull and down into the spinal canal. The herniated tonsils block the flow of cerebrospinal fluid. Symptoms vary widely; most common are headache, neck pain, dizziness, and tingling in the arms. Treatment includes monitoring of mild symptoms or surgery to expand the space.

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Degenerative disc disease

Degenerative disc disease affects the discs that separate the spine bones. As you age, the spine begins to show signs of wear and tear as the discs dry out and shrink. These age-related changes can lead to arthritis, disc herniation, or stenosis. Pressure on the spinal nerves may cause pain. Physical therapy, self-care, medication, and spinal injections are used to manage symptoms. Surgery may be an option if the pain is chronic.

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Facet arthritis, facet joint syndrome

Facet joint syndrome is an arthritis-like condition of the spine that can be a significant source of back and neck pain. It is caused by degenerative changes to the joints between the spine bones. The cartilage inside the facet joint can break down and become inflamed, triggering pain signals in nearby nerve endings. Medication, physical therapy, joint injections, nerve blocks, and nerve ablations may be used to manage symptoms.

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Herniated cervical disc

A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall. Neck or arm pain, numbness or tingling may result when the disc material compresses a spinal nerve. Treatment with medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be an option.

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Herniated lumbar disc

A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall. Back or leg pain, numbness or tingling may result when the disc material compresses a spinal nerve. Treatment with medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be an option.

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Cauda equina syndrome

Cauda equina syndrome is a rare condition most often caused by a large disc herniation in the lower back that compresses the nerve roots at the end of the spinal cord. Sudden back pain with numbness in the genital area, difficulty urinating, and weakness in the legs is a medical emergency. Prompt surgery to relieve the pressure may prevent permanent damage and restore bladder and bowel function.

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Sacroiliac joint pain

Sacroiliac (SI) pain is felt in the low back and buttocks. The pain is caused by damage to the joint between the spine and hip. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem. Accurate diagnosis is important to determine the source of pain. Physical therapy, stretching exercises, pain medication, and joint injections are used first to manage the symptoms. Surgery can fuse the joint.

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Spinal fractures

A fracture of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Most spinal fractures occur from car accidents, falls, gunshot, or sports. Injuries can range from mild ligament and muscle strains, to fractures and dislocations of the bones, to debilitating spinal cord damage. Many fractures heal with conservative treatment; some may require surgery to realign the bones.

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Spinal deformity, scoliosis

Spinal deformity is an abnormal alignment or curve of the bony vertebral column. Adult scoliosis and kyphosis can be caused by age-related wear and tear on the back or complications from past surgeries. Moderate deformity occurs when the facet joints and discs deteriorate over time and are no longer able to support the spine's normal posture. Pain results from stressed joints and pinched nerves, not the abnormal curve. Treatment can include medications, physical therapy, injections, or surgery.

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Spinal stenosis

Spinal stenosis is the narrowing of the bony canals through which the nerves and spinal cord pass. Arthritis can cause the facet joints and ligaments to enlarge and thicken restricting the space for the nerves. The pinched nerves become inflamed and cause pain, cramping, or weakness in your legs or arms. Medication, physical therapy and spinal injections can help control symptoms. Chronic symptoms may require surgery.

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Spondylolysis and spondylolisthesis

Spondylolysis and spondylolisthesis are conditions affecting the joints that align the vertebrae one on top of the other. Spondylolysis is a weakness or stress fracture in the facet joint area. This weakness can cause the bones to slip forward out of normal position, called spondylolisthesis, and kink the spinal nerves. Treatment options include physical therapy, a back brace, or surgery to realign and fuse the bones.

Prevention & general health

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Balance activities for home

Balance training consists of strengthening core muscles (abdominals, back extensors, and hip muscles) to improve balance and coordination. Balance exercises will improve your posture, prevent falls, and reduce injuries.

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Core exercises to strengthen the spine

Your core muscles support your spine. The muscles in your abdomen and back - which we call the "core" - are central to your everyday spine health. They are at the heart of any fitness plan to strengthen a healthy or ailing back. Just as you protect your heart through cardiovascular exercises, you will benefit from strengthening your back through core exercises.

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Exercises: Back Stretches & Strengthening

Exercise is a vital part of maintaining a normal healthy back. It is important to exercise regularly so you can maintain your fitness level and prevent back pain and injury. A program of strengthening, stretching and aerobic exercises will improve your overall fitness. Research shows that people who are physically fit are more resistant and recover quicker.

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Exercises: Neck Stretches & Strengthening

Exercise is a vital part of treating the spine after injury or surgery. Active therapeutic exercises distribute nutrients into the disc space, joints and soft tissues in the back. A regular exercise routine helps patients improve mobility and strength, minimize recurrence, and reduces the severity and duration of possible future episodes of back pain.

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Posture and Body Mechanics

Good posture involves training your body to stand, walk, sit, and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities. The spine's curves work like a coiled spring to absorb shock, maintain balance, and to facilitate the full range of motion throughout the spinal column.

Non-surgical treatments

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Braces and orthotics

Your doctor may prescribe a neck or back brace for you to wear after a spinal injury or surgery. A brace does three things: immobilizes your spine during healing; stabilizes injured areas; controls pain by restricting movement.

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Chiropractic care

Chiropractic medicine aims to improve health by restoring structure and function to the spine and other joints. Stress, accidents, overexertion, or other injuries may cause minor displacement of the spinal vertebra. When a vertebra is displaced, muscle tension or irritation to spinal nerves can result, causing pain (e.g., neck, back, headache).

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Physical Medicine & Rehabilitation (PM&R)

Physiatry, also called physical medicine and rehabilitation, is a medical specialty that uses physical means to help in diagnosis, healing, and rehabilitation. Physiatrists specialize in the treatment of patients with chronic illness (stroke) or injury (spinal cord, brain), acute and chronic pain, and musculoskeletal injuries. Many physiatrists specialize in the treatment of back pain.

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Physical Therapy

Physical therapy is an important part of a nonsurgical approach to maintain, restore, and improve overall physical health. Pain-free mobility is crucial for physical independence, earning a living, quality of life and well being. Working with a doctor, a physical therapist (PT) can help patients who have suffered an injury, disease, or those recovering from surgery.

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Self care for neck & back pain

Eight out of 10 people will suffer from back or neck pain at some point in their life. Acute pain is abrupt, intense pain that subsides after a period of days or weeks. However, some people continue to suffer from pain that continues despite nonsurgical or surgical treatment methods. This long-term pain is called chronic pain.

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Transcutaneous Electrical Nerve Stimulation (TENS)

Transcutaneous Electrical Nerve Stimulation (TENS) is a noninvasive device placed on the skin that can help control pain. Use of this small, battery-operated device can block pain signals from reaching the brain and potentially reduce pain medication. It is important to remember that TENS does not cure or eliminate the cause of pain and is not effective for every patient.

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Who treats spine problems?

Of the many specialists who treat spine problems, each has specific skills and plays an important role in patient care. Some spine specialists are physicians and some are non-physicians. The right specialist(s) to treat your condition depends on the type and severity of the problem.

Pain procedures

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Carpal tunnel syndrome surgery

Carpal tunnel syndrome causes tingling, numbness, or pain in the hand. The wrist bones and ligament form a tunnel, a passage for the median nerve and finger tendons. Repetitive strain may cause swelling that traps the nerve within the tunnel. Treatments include modifying activities, physical therapy, a wrist brace, or medications. Surgery that re-opens the space and frees the nerve may be an option.

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Epidural steroid injection (ESI)

An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to stenosis, spondylolysis, or disc herniation. Medicines are delivered to the spinal nerve through the epidural space, the area between the protective covering of the spinal nerves and bony vertebrae. Pain relief may last for several days or even years.

Joint Injections

Joint injections

A steroid injection is a minimally invasive procedure that can temporarily relieve pain caused by an inflamed joint. The cause of joint pain (arthritis, injury, degeneration) is not well understood. The procedure has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from the joint. Second, it can be used as a treatment to relieve inflammation and pain caused by various conditions.

Nerve block injection test

Nerve block injection test

A nerve block injection, also called a pain receptor block injection, is a minimally invasive procedure that can temporarily relieve joint or nerve pain. The procedure is used as a diagnostic test to determine if the pain is actually coming from the nerve or joint. The effects of a nerve/pain receptor block tend to be temporary and are rarely long term. If the block is successful, then a radiofrequency ablation may be recommended.

Radiofrequency Ablation

Nerve radiofrequency ablation

A radiofrequency ablation is a minimally invasive procedure that destroys the nerve fibers carrying pain signals to the brain. It can provide lasting relief for people with chronic pain, especially in the lower back, neck and arthritic joints. If you suffer recurrent pain and you’ve experienced good relief with a nerve block injection, you may be a candidate for a radiofrequency ablation.

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Pain management

Acute pain starts suddenly and improves over time with healing. Chronic pain persists and is often present in ongoing conditions such as arthritis or cancer. Pain management is an integrated approach to making pain tolerable by learning coping skills. This may include exercise, physical therapy, medication, holistic therapies, and counseling.

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Pain pump (intrathecal drug pump)

A "pain pump" is a method of giving medication directly to the spinal cord. The system uses a small pump that is surgically placed under the skin of your abdomen. The pump delivers medication through a catheter to the space around your spinal cord. Because the drug is delivered directly to the pain area, symptoms can be controlled with a much smaller dose than is needed with oral medication.

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Spinal cord stimulation

Spinal cord stimulation delivers low voltage current to block the feeling of pain. A small device implanted in the body transmits an electrical current to the spinal cord. When turned on, the stimulation feels like a mild tingling in the area where pain is felt. It helps patients with chronic pain better manage symptoms and potentially decrease use of pain medications.

Surgical treatments

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Anterior cervical discectomy & fusion (ACDF)

Anterior cervical discectomy and fusion is a surgery to remove a herniated or degenerative disc in the neck. An incision is made in the throat area to reach and remove the disc. A graft is inserted to fuse together the bones above and below the disc. ACDF may be an option if physical therapy or medications fail to relieve your neck or arm pain caused by pinched nerves. Patients typically go home the same day.

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Axial lumbar interbody fusion (AxiaLIF)

AxiaLIF is a minimally invasive spinal fusion to treat disc problems in the low back. Fusion stabilizes the spine to stop the painful motion and decompress pinched nerves. Through a small incision at the tailbone, the damaged disc is removed and a rod placed to correct the spacing between the vertebrae. During healing, the bones will fuse together. The back muscles are avoided, so recovery is quicker.

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Chiari decompression surgery

Chiari decompression surgery removes bone at the back of the skull to widen the foramen magnum and create space for the brain. The dura overlying the tonsils is opened and a patch is sewn to expand the space, similar to letting out the waistband on a pair of pants. The goals of surgery are to control the progression of symptoms, relieve compression, and restore the normal flow of cerebrospinal fluid (CSF).

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Lateral lumbar interbody fusion (LLIF)

Lateral interbody fusion is a minimally invasive surgery to treat disc problems in the low back. In spinal fusion, two or more bones of the spine are joined to stop painful motion, decompress pinched nerves, and correct scoliosis. Through a small incision at the side of the waist, the disc is removed and a bone graft is inserted to restore the height and relieve nerve pinching. During healing, the bones will fuse together.

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Minimally invasive spine surgery

Minimally invasive surgery (MIS) uses advanced technology to treat back and neck pain caused by various spinal conditions. As the words suggest, the surgical “invasion” of the body is minimized. Special instruments and viewing systems allow surgeons to work through small incisions, often shorter than an inch. These include tubular retractors, image-guidance systems, and endoscopes.

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Posterior lumbar discectomy

Lumbar discectomy is a surgery to remove a herniated or degenerative disc in the lower spine. The incision is made posterior, through the back muscles, to reach and remove the disc pressing on the nerve. Discectomy may be recommended if physical therapy or medication fail to relieve leg or back pain caused by pinched spinal nerves. The surgery can be performed in an open or minimally invasive technique.

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Preparing for lumbar spinal fusion

Spinal fusion is a surgery that permanently joins together one or more bony vertebrae of the spine. Abnormal movement of the vertebrae rubbing against one another may result in back, leg, or arm pain. Fusing the vertebrae bones together stabilizes and aligns the spine, maintains the normal disc space between the bones, and prevents further damage to the spinal nerves and cord.

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Spinal decompression (laminectomy)

Decompression surgery (laminectomy) removes the bony roof covering the spinal cord and nerves to create more space for them to move freely. Narrowing / stenosis of the spinal canal can cause chronic pain, numbness, and muscle weakness in the arms or legs. Surgery may be recommended if your symptoms have not improved with physical therapy or medications.

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Vertebroplasty & kyphoplasty

Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat vertebral compression fractures of the spine. These painful, wedge-shaped fractures can be caused by osteoporosis or injury. Left untreated, they can lead to a humped spine. By restoring the vertebra height with a balloon and injecting a cement into the fractured bone, patients can recover faster and reduce the risk of future fractures.