What causes neck pain?
The most common causes of neck pain are: degenerative disk disease, arthritis of the spine, scoliosis, muscle spasms, strain or sprain, annular tears, bulging disc, herniated disc, pinched nerve, extruded disc, spinal stenosis, infection, tumor and fractured (broken) bones.
What causes back pain?
The most common causes of back pain are: degenerative disk disease, pinched nerves, herniated disks, extruded disks, arthritis, infection, tumors, fractured or broken bones, bulging disks, annular tears, muscle spasms, strains or sprains.
What is a spinal fusion?
A spinal fusion is fusing together two vertebral bodies of the spine with metal and bone. It can be very effective for the treatment of spinal pain. Only a fellowship-trained spinal surgeon can assess your need for a spinal fusion.
What is scoliosis?
Scoliosis is a curvature of the spine that occurs most commonly in females. It is nine times more common in young girls than boys. It can affect the cervical (neck), thoracic (mid back) or lumbar (low back) spine. During childhood it is known as “idiopathic scoliosis”, meaning the causes is largely unknown. The onset during adulthood, known as “degenerative” scoliosis, is caused by the degeneration of the spine as we age.
Childhood scoliosis is generally treated with a brace. Early diagnosis and bracing is the key to halting the progression of scoliosis during adolescence. Children with larger curves may not respond to bracing and require surgery. Genetic testing is available to predict the progression of childhood scoliosis in some children.
Bracing is not effective for the treatment of scoliosis in adults. Physical therapy and injections are supportive treatments. Surgery may be an option if non-operative measures fail. Patients with a diagnosis of scoliosis require an evaluation by a spine specialist.
What is spinal stenosis?
Spinal stenosis is a narrowing of the spinal canal by the bones, ligaments and disks of the spine. This causes compression of the spinal cord and nerves. The most common symptom is the inability to walk long distances.
Spinal stenosis may occur anywhere in the spine, but is most common in the lumbar (low back) and cervical (neck) regions of the spine. Spinal stenosis occurs when the discs lose water content and become less “spongy” as we age. This results in a bulging or hardening of the discs. At the same time, arthritis can cause bones and ligaments of the spine to thicken and enlarge. All this creates compression of the nerves.
Spinal stenosis does not always cause symptoms. Patients with lumbar or low back stenosis usually experience no symptoms when sitting. The problem is walking more than two or three blocks or standing up straight for an extended period of time. Many patients with spinal stenosis can walk longer distances if they lean forward, such as when holding onto a shopping cart. This is known as a “shopping cart sign.” Spinal stenosis symptoms are made worse by leaning backward.
Cervical stenosis occurs in the neck region. This is a more serious condition and generally requires surgery. Cervical stenosis can cause changes within the substance of the spinal cord resulting in difficulty with balance and walking. Cervical stenosis may cause incoordination of your hands and feet. Patients typically drop objects frequently and having difficulty manipulating small objects.
You should have a complete evaluation by a spinal specialist if you develop any symptoms of spinal stenosis.
What is a pinched nerve?
A “pinched nerve” is caused by a number of conditions. The most common are disc bulge, disc herniation, arthritis of the spine, or spinal stenosis. Pinched nerves can occur in the cervical (neck), thoracic (mid back), or lumbar (low back) regions.
What is a disk? (Also Spelled Disc)
A disk is the soft, gel-like substance between the bones of the spine. It is the cushioning that prevents the spinal bones from rubbing together. These disks are made of a tough outer substance called the annulus fibrosus and a soft, gel-like inner substance called the nucleus pulposus.
Aging causes the disks to lose water content thereby reducing the “shock-absorbing” capacity of the discs. The disks subsequently deteriorate causing pain. The outer layer can also tear. This is called an annular tear which creates intense pain. Over time, the nucleus pulposus can then bulge or herniate through the outer covering of the disk and press on a nerve. This causes “sciatica.” You can have a herniated disk anywhere throughout your spine, be it your neck (cervical), mid back (thoracic), or low back (lumbar) spinal regions.
What is the difference between a herniated disc, a bulging disc, an extruded disc and a disc fragment?
Many times these terms are used interchangeably to describe a herniated disk. Each of these conditions has a slightly different treatment regimen. All can cause sciatica.
A bulging disc is generally a bulge of the outer covering of the disc by the inner material of the disc that results in pressure on a nerve. It is not a rupture of the outer covering or annulus fibrosis. Think of a bubble in a tire. This may cause sciatica.
A herniated disc occurs when the gel-like inner portion of the disc ruptures or breaks through the outer covering of the disc and presses on a nerve. This may cause sciatica.
An extruded disc occurs when the entire inner portion of the disc completely ruptures through the outer covering of the disc and moves freely within the spinal canal. This may cause sciatica.
A disk fragment is a piece of disk not connected to the original intervertebral disk.
How is a herniated disc diagnosed?
A spinal specialist will perform a thorough clinical evaluation. Careful assessment for any weakness, loss of sensation, or abnormal reflexes will be done at the time of your exam.
An MRI confirms the diagnosis of a herniated disc but is only indicated after a full course of non-operative therapy for approximately six weeks after the onset of symptoms. An MRI is the preferred diagnostic study for diagnosing a herniated disc. However, some patients cannot undergo an MRI, such as those patients with a pacemaker, and a CT scan can be utilized.
In addition, electrical nerve studies called EMG’s may be performed to look for signs of nerve damage.
What is an EMG?
EMG stands for Electromyography. An EMG is a nerve test done on the arms or legs. It can help determine injury to a specific nerve. It does not always need to be performed and is used at the discretion of your physician.
If I have weakness in my arm or leg is it irreversible?
Not necessarily. Weakness is reversible if it is treated appropriately. Both surgery and non-operative treatment can reverse weakness. Generally, if you have weakness it is more serious. If you are experiencing weakness you should seek the advice of a spinal professional.
What is the surgical treatment for a herniated lumbar disk?
Surgical treatment for a herniated disk is a discectomy.
Is surgery always indicated for a herniated disk?
No. Ninety percent of all herniated disks are treated non-operatively with rest, anti-inflammatory medication, physical therapy and epidural injections.
Is a disk replacement indicated for a herniated lumbar disk?
No. Disk replacement is never indicated for a herniated lumbar disk.
What is a total disk replacement?
A total disk replacement is placed between to bones of the spine and maintains movement between these bones. It can be done in place of a fusion but has very specific indications.
When is a Lumbar Disk Replacement indicated?
A lumbar disk replacement is indicated for degenerative disk disease without any signs of stenosis or arthritis.
When is a cervical Disk Replacement indicated?
A cervical disk replacement is indicated for a herniated or degenerative disk in the neck.
What is a bone spur?
A bone spur is an outgrowth of the facet joint or vertebral body. Facet joints are small joints within the spinal column that may become arthritic creating a bone spur. These spurs may cause a pinched nerve or spinal stenosis. Bone spurs can only be removed surgically. Spinal injections may provide temporary relief.
What is degenerative disc disease?
Degenerative Disc Disease (DDD) is a breakdown of the intervertebral disc. The disc acts as a cushion between the bones of the spine. As we age our discs lose their water content and they degenerate. The bones begin to rub together and cause pain. The mainstay of treatment for degenerative disc disease is physical therapy and injections. Sometimes surgery may be required.
What is Spondylolisthesis?
Spondylolisthesis is a slippage of one spinal bone on another. This most commonly occurs in the lumbar (low back) spine but can occur in others areas. Spondylolisthesis causes spinal stenosis and sciatica. Patients with spondylolisthesis complain of leg pain, back pain and difficulty walking long distances. It is treated with physical therapy, injections and surgery. Surgery has proven to be the most effective treatment for this disease.
How is spine pain treated?
The treatment of neck or back pain is generally nonoperative; however, there are instances when surgery is necessary. Neck or back pain lasting more than six weeks needs to be evaluated by a spinal specialist.
What are treatment options for spinal stenosis?
Cervical (neck) stenosis is usually treated with surgery. Lumbar spinal stenosis may be treated nonoperatively, such as with physical therapy and/or epidural steroid injections; however, recent studies in the New England Journal of Medicine indicate that surgery for lumbar stenosis is more successful than non-operative treatment.
What are the surgical options for patients with spinal stenosis?
Surgical treatment options for lumbar spinal stenosis include a laminectomy or a laminectomy combined with a fusion. Generally, the more severe the stenosis the more likely you will require a spinal fusion.
Cervical stenosis is generally treated by a fusion procedure. This can be performed either through the front of the neck (anterior approach) or the back of the neck (posterior approach). Ninety percent of patients with cervical stenosis can be treated via the anterior approach. This procedure is called an anterior cervical discectomy and fusion.
Can spinal stenosis be treated with lasers?
No. Lasers are not approved for use in the treatment of ANY spinal disorder. Furthermore, lasers cannot eliminate spinal stenosis. Only a laminectomy is effective treatment for spinal stenosis.
Can disc bulges or disc herniation’s be treated with lasers?
No. There is no data to support that lasers provide any benefit in the treatment of disc bulges or disc herniations. Most centers using lasers also perform a standard non-laser discectomy for the bulk of their treatment.
Can cervical stenosis be treated with lasers?
No. Cervical stenosis cannot be treated with lasers. At this time, laser surgery is not an accepted method of treatment for any spinal disorder It is not the standard of care.
What is the treatment for a herniated disc?
Physical therapy, epidural steroid injections or surgery is the standard treatment of a herniated disk. Your spine specialist will explain these three treatment options. Conservative care is always appropriate for the first six weeks, unless there are warning signs noted by your spinal professional.
What are the nonsurgical treatments available for herniated discs?
Nonsurgical treatments for a herniated disk include a short period of rest followed by anti-inflammatory medications, physical therapy and/or epidural steroid injections. The goal of nonsurgical treatment is to reduce the irritation of the nerve root from the disc herniation and to allow your body to slowly resorb the disc fragment.
Narcotic medications may be used for a very short-term basis to help with the pain that is associated with disc herniations. However, they are NEVER indicated on a long-term basis. Muscle relaxants and over-the-counter, nonsteroid anti-inflammatories (NSAID’s) may also be used.
What are epidural steroid injections?
Epidural steroid injections help to decrease the pain and inflammation that is caused by a herniated disc. These injections are performed by one of our pain management specialists in a surgery center or hospital.
Will I be awake and feel the needle when I have my epidural injection?
No. Twilight anesthesia is given for the injection similar to the anesthesia received during a colonoscopy or tooth extraction. You will be sedated for the procedure and most likely will have no memory of it.
Should I stop any of my medications prior to an epidural injection or surgery?
Yes. Any type of blood thinner needs to be stopped five to seven days prior to an epidural steroid injection or surgery. You must obtain permission from your primary care physician or cardiologist to stop these medications.
When may I restart my blood thinners after an injection or surgery?
After an injection, you may restart you blood the day after the injection. Surgery is different. Restarting your blood thinners must be discussed with your spinal surgeon.
Will Keystone Spine and Pain Management refill my narcotic prescription?
No. The physicians at Keystone Spine and Pain Management will not prescribe long-term narcotic medication, as we feel this is not appropriate treatment for spinal pain. If you are interested in long-term narcotic therapy, we will not be able to comply with this request.
I need surgery for my disc herniation. Are you going to remove the whole disc or just part of the disc?
For a lumbar disc herniation, we only remove about 10-15% of the disc. It is our goal to leave as much of the disc remaining as possible, as you need this for shock absorption between the vertebral bodies.
How long will I be in the hospital?
Discectomies and laminectomies are usually done on an outpatient basis. Fusions generally require a two- to three-day stay at one of the local hospitals.
Will I be able to bend after my spine surgery?
Yes. You are not restricted from bending. However, it will be painful for the first few days. If you have surgery with other doctors, please discuss post-operative restrictions with them.
When can I go back to work after surgery?
Generally, you may return to work three to six weeks after a laminectomy and discectomy and six weeks after a fusion. If you have surgery with other doctors, please discuss post-operative restrictions with them.
If I have neck surgery, will I need to wear a collar 24/7?
No. A cervical collar is used for comfort only. We recommend that you use the collar when you are out of your house or in a car. You do not need to wear the collar while sleeping, eating or showing. If you have surgery with other doctors, please discuss collar requirements with them.
When may I drive after neck surgery?
Approximately 3 weeks, however you must be released to drive by your physician at your first post-operative visit. You will not be allowed to drive if you are taking any narcotics.
When may I drive after back surgery?
You will NOT be allowed to drive if you are taking narcotic medications. Generally, you may resume driving between 7-10 days after surgery. If you have surgery with other doctors, please discuss driving requirements with them.
Will I be on disability after surgery?
No. It is the policy of Keystone Spine and Pain Management that all patients are returned to work after surgery. We believe that all patients can contribute at some level, and permanent disability/Social Security Disability is not an option.
What are my restrictions after lumbar spine surgery?
There are NO walking restrictions after surgery. Patients should be walking 1 mile per day 3 weeks after surgery. There are no restrictions on walking stairs.
For the first 3 weeks after surgery, you are not permitted to lift over 10 lbs. From 3-6 weeks after surgery, you are not permitted to lift over 30 lbs. At six weeks after surgery, you generally have no lifting restrictions. You may NOT take a tub bath, swim in a pool, or soak in a hot tub until given permission to do so by your physician. You may shower 24 hours after your drain is removed. If you have surgery with other doctors, please discuss post-operative restrictions with them.
What are my restrictions after cervical spine surgery?
You cannot drive until you are released by your physician to do so, usually three weeks after surgery. You have no walking restrictions. We encourage you to walk and climb stairs immediately after surgery.
For the first 3 weeks after surgery, you are not permitted to lift over 10 lbs. From 3-6 weeks after surgery, you are not permitted to lift over 30 lbs. At six weeks after surgery, you generally have no lifting restrictions. You may NOT take a tub bath, swim in a pool, or soak in a hot tub until given permission to do so by your physician. You may shower 24 hours after your drain is removed. If you have surgery with other doctors, please discuss post-operative restrictions with them.
May I take anti-inflammatories after my surgery?
Only after a discectomy or laminectomy. Anti-inflammatory medications are restricted for three months after a cervical or lumbar fusion.
What should I put on my incision after surgery?
Nothing. Do not put any salves or ointments on your incision.
When is my bandage removed?
When instructed by your physician. Usually 48 hours after surgery.
When do I remove the Steri-Strips after my surgery?
Seven days after both lumbar (low back) and cervical (neck) surgery