Spine Disorders
Disk herniation
Disk herniation is one of the most common conditions of the spine. Other terms used to describe herniation include fragment, protrusion, bulge, and/or sequestration. Herniation can occur in any segment of the spine, although is most common in the lumbar spine followed by the cervical then the thoracic spine. Symptoms of a disk herniation include numbness/tingling, weakness, and pain. The term radiculopathy refers to the pain in a band-like distribution down the extremity. This pain is due to the compression of one or more nerve roots by the herniated disk.
Disk herniations are very common in the population. In fact, many patients who have herniations often do not have symptoms (are asymptomatic). Therefore, the most important decision-making step in treatment is to determine the exact symptoms that the herniation is causing. Surgeons can often predict which herniations are symptomatic because each nerve root that is being compressed causes a specific distribution of pain. Your doctor must match the distribution of the pain and any weakness with the nerve root being compressed on the MRI. For instance, a L5/S1 disk herniation typically compresses the S1 nerve root and can lead to pain in the buttock, back of the thigh and calf, and bottom of the foot. In addition, patients may have weakness in foot plantar flexion (ability to stand on the toes). If a disk herniation is determined to be symptomatic, then multiple treatment options are available. Surgery is one of many treatment options.
Spine Surgery Microdiskectomy
Stenosis
Stenosis refers to narrowing of the spinal canal. Areas of the spinal canal that can have stenosis include the foramen, central canal, or lateral recess. Symptoms typically include radiculopathy (especially with foraminal stenosis) and/or neurogenic claudication (stenosis of the central canal ) or myelopathy (central canal stenosis of the cervical spine). Stenosis can be graded as mild, moderate, or severe, but such a grading scheme is subjective. The symptoms from the stenosis, rather than the degree of stenosis, are most important in deciding between treatment options.
Spine Surgery Laminotomy/foraminotomy
Spine Surgery Laminectomy
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Myelopathy
Central canal stenosis of the cervical spine can cause compression of the spinal cord and result in myelopathy. Symptoms of myelopathy include numbness, weakness, and pain in the hands. With severe myelopathy, patients can develop bladder and bowel incontinence as well as weakness in the legs.
Spine Surgery Cervical Laminectomy
Radiculopathy
Radiculopathy refers to pain in the extremities (either arms or legs) as a result of compression of a single or multiple nerve roots. Symptoms include pain, numbness, tingling, or weakness in the extremities. Common causes of radiculopathy include disk herniations and bone spurs. Radiculopathy is commonly referred to as sciatica when the nerve root being compressed is the sciatic nerve.
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Facet arthrosis (degeneration)
Facet joints undergo degeneration and can cause back or neck pain. Pain is often increased with extension of the neck (or back), standing or activity.
Degenerative disk disease (DDD)
DDD refers to dehydration and degeneration of the disk spaces. On MRI imaging, disks become dark, decrease in height, and can develop Modic changes (inflammation surrounding the disks). Symptoms, including back (or neck) pain, are often associated with sitting and activity.
Spine Surgery ALIF, PLIF, TLIF, XLIF
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Osteomyelitis/diskitis
Infection of the disk (diskitis) or vertebral body (osteomyelitis) can cause pain, fever, weakness, or neurologic injury with subsequent leg and/or arm weakness. Causes of infection include bacteria, fungus, and tuberculosis.
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Sciatica
See definition for radiculopathy.
See our glossary of terms
Tumor
Metastatic Tumors that originate elsewhere in the body then travel to the spine are called metastatic. Often the tumor seeds the vertebral body and can cause pain, fracture, and spinal cord or nerve compression. Common metastatic tumors to the spine include breast, prostate, lung, and colon cancers.
Primary tumors (originate in the structures of the spine) include schwannomas, neurofibromas, ependymomas, and chordomas. Such tumors can be benign or malignant.
Scoliosis
Scoliosis can occur in kids (adolescent idiopathic scoliosis) or in adults (degenerative). A grading scheme, called the Lenke classification system, is used to categorize the type of curvature. Patients develop deformity (rib humps, curvature of the spine, loss of height, shoulder tilt) or pain (either back pain or radiculopathy). Severe curves can uncommonly cause respiratory problems.
Learn more about Scoliosis & Deformity
Flatback syndrome
Flatback syndrome refers to loss of lumbar lordosis. Normally, the lumbar spine has a gentle backwards sway of approximately 40 degrees. When lordosis is lost, the lumbar spine straightens. Symptoms include back pain and a forward tilt of the upper back and head. Often patients have to bend the hips and knees in order to stand and look upright (see figure). If severe, the normal lordosis of the lumbar spine can be reversed into abnormal kyphosis.
Kyphosis
Kyphosis is normal in the thoracic spine, but abnormal in the cervical and lumbar spine. Kyphosis refers to a forward tilt of the spine. Symptoms include pain and an ability to look or stand upright.
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Ankylosing Spondylitis (AS)
Hyperhidrosis
Excess sweating is referred to as hyperhidrosis. Often symptomatic over-sweating involves the palms, armpits, and plantar feet. The cause is unknown, but is thought to result from an autonomic dysfunction or “overactive sympathetic nerves”. Surgical treatment involves division of the sympathetic chain (sympathectomy) using two small incisions placed in the armpits. This surgery typically takes 45 minutes and is able to completely reverse the patient’s embarrassing or functionally disabling sweating. Click here to download the chapter written by Dr. Perri for further information on treatment options.
Spondylolisthesis
Spondylolisthesis is subluxation (slippage) of one vertebral body on another. Typically the subluxation is due to degenerative (arthritis) changes, but subluxation can also be due to trauma, spondylolysis (pars defect), or uncommonly tumor or infection. The degree of slippage is graded from 1-4. Symptoms include back (or neck) pain and radiculopathy. Treatment is typically a fusion procedure (TLIF, XLIF, or ALIF), but a micro-decompression can sometimes be performed for a patient with predominantly radiculopathy symptoms (arm or leg pain).
Spine Surgery ALIF, PLIF, TLIF, XLIF
See our glossary of terms
