Frequently Asked Questions & Answers About Spine and Neck Pain or Treatment
What are the symptoms of a herniated disc?
Herniated discs are caused by a tearing or weakness of the outer fibers and the softer gel-like material inside of the disc can protrude out towards the spinal sac and the nerves. They can be found in the neck, mid-back, and the lower back. The symptoms can vary from neck or back pain, arm or leg pain, weakness, numbness, tingling or a combination of the above. It can cause an entity known as sciatica (pain starting in the buttock shooting down the leg). In rare instances, it can cause spinal cord compression (Myelopathy/cauda equina syndrome). The symptoms include unsteadiness when walking, balance problems, slow gait, unusual sensations in the chest wall, abdomen, arms, legs, bowel and bladder problems, or weakness.
What is the treatment for a herniated disc?
The treatment for herniated disc is aimed at improving the symptoms associated with this. This may involve physical therapy to try to reduce the symptoms especially if it is back pain. Conservative care is the first line treatment and also may include medications and chiropractic care. If conservative care fails, epidural steroid injections can be used to reduce inflammation from around the nerve. The final option if all treatment fails is surgery which may include decompression of the nerve root and possibly a fusion.
What is degenerative disc disease (DDD)?
Degenerative disc disease (DDD or spondylosis) is a normal part of intervertebral disc aging. There are several well-studied changes that occur in the aging disc that can be observed with common medical imaging. These degenerative processes that probably begin at the disc, lead to changes in adjacent structures of the spine. Together, these lead to changes in the normal function of the spine. In some individuals, this degenerative process can be painful, in others it is not.
What is lumbar instability?
Lumbar instability means that there is abnormal motion in the spine as a result of trauma or degenerative conditions. A spondylolisthesis which is shifting of one vertebra on top of the other is a type of lumbar instability. Usually they can be on found X-rays with the body in flexion and extension.
What is spinal stenosis?
Spinal Stenosis is a condition where there is tightening of the nerves in the spine due to a combination of disc problems, thickening of the ligament, and arthritis of the facet joints. Think of a clogged pipe at the bottom of the sink where the water does not flow freely. Similarly in spinal stenosis, the signals don’t get through to the legs or arms and you can get pain, weakness, numbness, tingling, and Myelopathy symptoms if at the spinal cord level. Lumbar symptoms may also include pain with walking with relief in a hunched over position (using a cart), back pain, numbness, tingling, and weakness.
What is the treatment for spinal stenosis?
The treatment for spinal stenosis varies based on the symptoms that are found. Typically physical therapy is a first line treat for spinal stenosis to try to improve strength of the muscles and decrease the back pain. If this does not work, epidural steroid injections may work to decrease the pain and if all else fails, surgery may be an option.
What is a laminectomy?
A laminectomy is a procedure performed to relieve the pressure around the nerves in cases of spinal stenosis and open up the spinal canal. It is performed by removing the structures in the back of the spine that encase the spinal cord including the spinous process, lamina, and part of the facet joint. This may be performed with or without a fusion depending on the amount of stability that is needed after surgery and other symptoms.
How quickly can I recover from surgery?
It depends on the type of surgery that is required, the length of the symptoms, the amount of nerve damage, the amount of dissection needed for the procedure, and the pre-operative level of function. With a discectomy (removal of the herniated disc), the sharp nerve pain can go away almost immediately but there will be residual pain as the nerve is healing and pain from the surgery. Please discuss this with your doctor.
What is an epidural steroid injection?
An epidural steroid inject, or “ESI” or “Epidural” is a medical procedure where an anti-inflammatory drug called cortisone, which is also considered one of the “steroid” medications, is injected into the area of the spine called the epidural space. In the epidural space are potentially sensitive structures such as nerves, discs, bones and ligaments that can become inflamed and irritated thus causing a painful or uncomfortable sensation. By suppressing this reaction with a locally-applied medication, the healing processes of the injured structures can improve.
What is an EMG? An EMG/NCV
(Nerve Conduction Velocity and Electromyography) is a test used to determine if there is damage to nerves. It is a painless procedure that involves checking the signals along the nerves and checking the activity of the muscle. It can be used to diagnose nerve injuries along the course of the nerve. For example in the neck, it can be used to look for nerve damage from the neck, brachial plexus, elbow, or wrist. Just because a test is normal does not mean that a herniated disc is not causing pain.
What are some of the complications associated with fusion surgery
Complications associated with fusion surgery include failure of fusion (pseudoarthrosis), hardware failure, failure to relieve pain, or hardware malposition. This may involve the need for further surgery, revision of the hardware, or removal of the hardware.
What is a bone graft?
A bone graft is a piece of bone take either from your own bone (hip and local bone graft) or a bone donor. This is used to perform a fusion of the spine.
What are the alternatives to bone graft from the hip? There are alternatives to taking one’s own bone from the hip including using local bone, allograft bone (cadaveric bone), and various bone graft substitutes. This can include a scaffolding device, bone morphogenic protein (an enzyme to stimulate bone production), demineralized bone matrix, and other substances.
What does it mean to take a bone graft from the hip?
Taking bone graft from the hip can be performed from the front if surgery is being performed in the front of the neck or through the abdomen. Bone graft is taken from the back if posterior lumbar surgery is being performed and usually does not require a separate incision. There are complications of taking bone including a longer operative time with more chance of blood loss, infection, persistent pain, fracture, and nerve damage.
What is a cervical herniated disc?
A cervical herniated disc is a condition in the neck where the disc protrudes out of it’s normal position due to weakening of the disc or an injury. The disc that pushes out towards the nerve causing neck pain, upper back pain, arm pain, spinal cord compression, or headaches.
Why is surgery done through the front of the neck?
For a cervical herniated disc this is the most direct approach to the herniated disc. This is a very safe approach to the neck and has a high success rate for relieving pain. There are instances where going through the back of the neck is necessary. Going through the back of the neck would not allow direct access to the herniated disc or spinal stenosis as the spinal cord is in the “way”.
Should I have my own bone, cadaver bone, or other sources of bone?
This is a discussion you need to have with your physician. There are risks and benefits for each type of bone graft. Some people prefer cadaver bone because of the pain of taking bone from the iliac crest (hip) and the extra surgical time involved.
I was told that I needed a series of epidurals. How many is that?
A “series” of epidural steroid injection is commonly prescribed as three injections over a specific period of time. However, there is no scientific rational to perform a “series” of these injections. The original physicians who started using epidural injections began to use three based on the limited responses seen and the limited accuracy of the injections. Today, using image guidance, correlation with advanced diagnostic testing and clinical presentation of the patient, the injection can be placed in a very specific area. There frequently is no need to repeat the injection. If it has to be repeated, there is no evidence that more that three injections is harmful or not useful.
I was told that my teenager has a broken bone in her back, how can that be diagnosed?
The best way to prove that there is a recent fracture (or stress fracture) of the spinal bone called the pars interarticularis is to get a single photon emitted computed tomography (SPECT) scan. Plain x-rays, MRIs and computed tomography (CT) scans will not show if there is recent fracture. These tests can be used later in the workup if needed.
Are x-rays harmful?
Yes. X-rays (and CT scans) use ionizing radiation that is proven to be a carcinogen. Therefore, physicians order as few x-rays as necessary to answer the clinical question. When available, body parts not being imaged should be shielded from the x-rays being used. Modern X-ray techniques have minimized the amount of radiation needed to take a film but should be avoided when possible.
What is a CT Myelogram?
This a combination test where first a myelogram is done, where radiographic contrast is injected into the subdural space, then a CT scan is performed. This test can show abnormalities of the discs, nerve roots, bones and deep ligaments of the spine. It is especially useful for those who cannot get an MRI for medical reasons, who are too uncomfortable in an MRI machine, or who have a disorder such as scoliosis or spondylolisthesis where learning about the bone is more important. This test is helpful in people who have had a previous surgery where bone fusion has been done.