The Spine Center

Our prestigious Spine program is led by Dr. Karen Avanesov alongside Dr. Vadim Lerman.

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Spine Conditions & Procedures

Performed at The Spine Center at Total Orthopedics

Spinal Conditions

At Total Orthopedics & Sports Medicine, we treat a variety of conditions involving problems with the Spine. Select a condition below to learn more.

Degenerative Disc Disease

Degenerative Disc Disease (DDD) occurs when a patient’s intervertebral disc begins a natural degeneration, meaning there was loss of fluid in a given disc. This process flattens the disc, therefore bringing the vertebra closer together. This makes it harder for it to act as a cushion and less likely to absorb shock. This disease, also called Degenerative Disc Disorder, is one that many will acquire as they get into their 30’s and 40’s. In some cases, a patient will not feel any pain when contracting this disease, but if left untreated it could result in chronic pain.

It is possible for Degenerative Disc Disease to impact any part of the spine but it would be most commonly found in the neck or lower back area.

If a patient has DDD they may have one or more of these conditions:

  • Cervical Disc Herniation
  • Lumbar Disc Herniation
  • Sciatica
  • Nerve Impingement
  • Spinal Stenosis
  • Spondylosis
  • Spinal Stenosis
  • Spondylolisthesis
  • Scoliosis
  • Spondylitis
  • Osteoarthritis
  • Spinal Fracture

Symptoms would include:

  • Pain in neck, thighs or lower back area
  • Feeling the need to switch positions constantly
  • Pain coming “in and out” for different lengths of time
  • Pain while: bending down, sitting down and/or twisting body
  • Anxious to lie down to subside the pain
  • A tingling sensation in all extremities

It is worth noting that some people who have DDD will not show any symptoms.

Causes:

  • Loss of fluid in the disc- A normal, healthy disc would consist of about 85% fluid. As we age it is known to lose a bit from time to time.
  • Miniscule cracks in the outer structure of the disc- It is possible for tears or cracks to form on the outer structure of the disc, which allows the fluid to make its way out quickly. This is in essence, a ruptured disc.

The disease originates from:

  • Natural wear and tear
  • Minor Injuries from the past
  • Undetected or Untreated Injuries
  • Obesity
  • Heavy Smokers
Cervical Disc Herniation

A cervical disc herniation, often referred to as a slipped or ruptured disc, means that a disc between one of the 7 vertebra along the neck has been damaged. The disc being damaged means that it is either bulging or has broken open, resulting in a loss of fluid. This would limit the capability of the disc to act as a cushion, and absorb shock like it is supposed to. It could occur suddenly if the patient has suffered an injury, or gradually over time.

Unfortunately 10-15% of patients who are diagnosed with herniated discs will suffer a reoccurrence in the same disc within 3 months of recovery.

Symptoms would include:

  • Weakness in the upper arm or shoulder area
  • Numbness and/tingling sensation in fingers/wrist
  • Having trouble gripping with hand
  • Difficulty rotating neck
  • The type of pain varies from dull to sharp

Causes:

  • Damage stemming from an injury- A herniated disc resonates from damage done to disc itself, meaning it is bulging or has completely broken open. Both would result in a loss of fluid.
  • Natural wear and tear-The trials and tribulations that the spine goes through daily will probably catch up at some point. Just because of everyday use, the disc will undergo a natural degeneration (See Degenerative Disc Disease). It will lose some of the fluid over time and because of this, the back will lose its flexibility.

This condition originates from:

  • Active use
  • Major or minor injury
  • Obesity
  • Heavy Smoking
Nerve Impingement

Nerve Impingement is a general term for when a misalignment in the spine puts immense pressure on the nerve. It is also referred to as a subluxation. Nerves are basically the control room of the body, which send certain signals to communicate throughout the body. The signals coming through the brain are conflicted by the pressure on the nerve in the back, which could cause some discomfort. It has the potential to occur in any place on the spine.

Symptoms may include pain, numbness or discomfort in the following areas:

  • Upper/Lower Back
  • Neck
  • Hand/Wrist
  • Foot/Ankle
  • Thigh/Buttocks

Mysterious symptoms may be felt in other areas of the body that are controlled by the impinged nerve. One may not associate these symptoms with a spinal condition. Here are a few (among others):

  • Headache
  • Trouble Sleeping
  • Sinus Infection
  • Digestive Problems
  • Feeling Fatigued
  • “Pins and Needles”

These conditions are known to cause nerve impingement in the spine:

  • Herniated disc (Lumbar or Cervical)
  • Degenerative Disc Disease
  • Spinal Fracture
  • Spinal Osteoarthritis

Nerve Impingement may originate from:

  • Obesity
  • Pregnancy/Child Birth
  • Overuse
  • Injury
Lumbar Disc Herniation

A Lumbar disc herniation, often referred to as a slipped or ruptured disc, means that a disc towards the bottom of the spine (normally L5-S1 or L4-L5) has been damaged. The disc being damaged means that it is either bulging or has broken open, resulting in a loss of fluid. This would limit the capability of the disc to act as a cushion, and absorb shock like it is supposed to. It could occur suddenly if the patient has suffered an injury, or gradually over time.

Unfortunately 10-15% of patients who are diagnosed with herniated discs will suffer a reoccurrence in the same disc within 3 months of recovery.

Symptoms would include:

  • Sciatica
  • Numbness or pain in the foot
  • Numbness or pain in ankle
  • Unable to stretch or extend toes
  • Unable to push off with foot
  • Pain radiating up the leg to buttocks/thighs

Causes:

  • Damage stemming from an injury- A herniated disc resonates from damage done to disc itself, meaning it is bulging or has completely broken open. Both would result in a loss of fluid. A given disc is located directly under the nerve root in the spine. A bulging or damaged disc would put immense pressure on this nerve, possibly leading to pain or numbness in the lower extremities.
  • Natural wear and tear-The trials and tribulations that the spine goes through daily will probably catch up at some point. Just because of everyday use, the disc will undergo a natural degeneration (See Degenerative Disc Disease). It will lose some of the fluid over time and because of this, the back will lose its flexibility.

This condition may originate from:

  • Active use
  • Major or minor injury
  • Obesity
  • Heavy Smoking
Spinal Stenosis

There are two types of Spinal Stenosis that can occur. There is Cervical Stenosis, which takes place in the neck area and Lumbar Stenosis, which takes place in the lower back area.

Lumbar Stenosis is the more common diagnosis. This occurs when the spinal nerves in the lower back are compressed and unable to send clear signals to the lower extremities. This can result in pain and numbness in the leg area, otherwise known as Sciatica. It is important to note that Lumbar Stenosis does not always result in pain or any symptoms

Cervical Stenosis is the more serious diagnosis, because of the possible consequences that go with it. The compression of the spinal cord causes the space between the vertebras to shrink. This has the potential to result in weakness of the body and potentially paralysis. This diagnosis is more common with elderly patients.

Symptoms would include:

  • Inability to walk without pain
  • Sitting down often to combat pain
  • Tingling feeling in Lower Extremities
  • Deterioration in motor skills
  • Trouble lifting arms in the air
  • Pains coming “in and out”
  • Clumsiness

Common Causes:

  • Aging- As the body gets older problems may arise along the spinal cord to cause stenosis. Most commonly, discs will flatten over time, causing the space between vertebras to narrow.
  • Spondylolisthesis- One vertebra slipping past another could result in the space between being narrowed.
  • Hereditary- One could have had a compressed spinal cord from birth, but symptoms may not arise until later in life.
  • Injury- An unfortunate accident may result in spinal fracture or a bone spur. Any sort of fracture to the spine has potential to cause damage to a disc and the space between.
Sciatica

Sciatica is basically symptoms of leg pain, stiffness and numbness, originating in the lower back. Usually the root of the problem is a ruptured or degenerative disc, and the pain travels down from there through the large sciatic nerve. It should be known that Sciatica is not an acceptable diagnosis for a patient, it is just a tell-tale sign of a different condition, such as a herniated disc or Degenerative Disc Disease. There is a great deal of pain involved.

Symptoms would include:

  • Constant pain in one leg
  • Jarring pain while seated
  • Difficulty standing and/or walking
  • Numbness in the foot and ankle
  • Numbness thigh area

If a patient suffers from Sciatica, they may have one or more of these conditions:

  • Degenerative Disc Disease- The gradual breakdown of a disc over time, making it unable to absorb shock
  • A Lumbar Disc Herniation- Damage to a disc along the patient’s lower back, forcing the jelly-like fluid out
  • Lumbar Spinal Stenosis- The narrowing of space between vertebra in the lower back, which compresses the nerve
  • Spondylolisthesis- A disorder where one vertebra juts forward in front of another (more common for senior citizens)

Sciatica pains can originate from:

  • Obesity
  • Smoking
  • Pregnancy
  • Sleeping improperly
Scoliosis

Scoliosis of the spine is an unnatural curvature in the spinal cord that is supposed to be completely straight. The spine would round off to one side and curve back towards the middle of the back near the lower back.  Scoliosis is often discovered when a child is in elementary school. It tends to occur once a child hits their “growth spurt”.

Symptoms May Include:

  • Shoulders at different height
  • Head not center
  • Shoulder blades stick out more than normal
  • Ribs higher than normal

Most patients with scoliosis do not have pain. Scoliosis patients with back pain would most likely also suffer from:

  • Degenerative Disc Disease
  • Osteoarthritis
  • A Ruptured Disc
  • Kyphosis

Causes:

  • Spina Bifida
  • Nerve Disorders
  • Unfortunate Injuries or Infections
  • Genetics

An adult patient with a curve in the spine that is under 40 degrees should be able to avoid surgery.

Spondylitis

Spondylitis is a condition when joints in the spine become inflamed. In some cases this will lead to bone growth or for 2 or more vertebra in the spine begin to fuse together. The process of the bone overgrowth is called Ankylosis, which could cause a spinal fracture or loss of movement. This can occur anywhere along the spinal cord but is most common in the lower back and pelvic area. There are many different forms of Spondylitis, but the symptoms are very similar.

Forms of Spondylitis:

  • Pott’s Disease
  • Ankylosing Spondylitis
  • Reiter’s Syndrome
  • Spondyloarthritis
  • Enteropathic Arthritis
  • Psoriatic Arthritis

Symptoms may include:

  • Dull pain in the back
  • Sharp Pains “in and out”
  • Back stiffness
  • Trouble walking/bending over
  • Tingling Sensation

Over 45% of patients with Spondylitis will experience inflammation of the eye, causing redness, itching and puffiness.

This condition may originate from:

  • Natural Wear and Tear
  • Degenerative Disc Disease
  • Genetics
  • An Injury/infection
Spondylosis

The term Spondylosis is most commonly used to describe osteoarthritis or arthritis of the spine, but can be used for any sort of degeneration of the spine. It is important to note however that Spondylosis is a general description of lower back pain not a firm diagnosis. It can occur in the cervical, thoracic or lumbar sections of the back.

If a patient suffers from Spondylosis, they may suffer from one of these conditions as well:

  • Osteoarthritis
  • Spinal Stenosis
  • Degenerative Disc Disease
  • Sacroiliitis

Symptoms may include:

  • Back Spasms
  • Difficulty Walking
  • Loss of motor skills
  • Tingling or weakness in extremities
  • Digestive problems
  • Difficulty turning or moving neck

Causes:

  • Natural Wear and Tear-Over time, the ligaments on ones spine can become brittle and stiffen up. This limits the flexibility in the back. Also over time a disc will naturally lose the jelly-like fluid inside them, which goes along with the next cause.
  • Herniated Disc-A damaged disc can also cause fluid loss. When a disc loses fluid the space between vertebra becomes smaller, causing pain and discomfort.
  • Spinal Fracture or a bone spur- Extra amounts of bone, or a displaced bone can put unnecessary pressure on the nerves in the spinal cord. This pressure can misconstrue signals and cause pain and discomfort.
Sacroiliitis

Sacroiliitis is a condition that comes about when there is inflammation in the sacroiliac joint, which basically connects the lower spine to the hip. This joint does not move much but it does bear a lot of weight. If this joint becomes inflamed it will not be effective as a shock absorber. Women are especially at risk for this condition after giving birth to a child. It is a leading cause of lower back pain.

Symptoms May Include:

  • A dull soreness in the lower back
  • Pain becomes more intense during even the slightest physical activity
  • Difficulty standing up/sitting down
  • Skin becomes inflamed
  • Digestive Problems

Causes:

  • Osteoarthritis
  • Pregnancy
  • Degenerative Disc Disease
  • Infection

Sacroiliitis may originate from:

  • Active lifestyle
  • Improper lifting technique
  • Unfortunate Injury
  • Child Birth
  • Food Poisoning (leads to Infection)
Spondylolisthesis

The condition called Spondylolisthesis describes when a spinal defect causes a vertebra to slip to one side of the body. When this occurs there is a good chance that it will disrupt a nerve, causing pain and discomfort. It is most commonly found in the lower back area.

Symptoms may include:

  • Lower back pain
  • Tight and sore hamstrings
  • Back spasms
  • Walking with a gait or waddle
  • Pain or numbness in foot

3 Different Types:

  • Degenerative- Commonly found in older patients. Occurs when the disc loses fluid over time, and become unable to absorb shock and resist spinal movement.
  • Isthmic- This condition occurs from a fracture in the spinal cord, leading to the bone slipping out of place
  • Congenital- This type would be a result of being born with an abnormal formation, resulting in the disc slipping out of place.

Spondylolisthesis is the leading cause of back pain for people in their teenage years.

Spinal Fracture

A spinal fracture is considered one of the worse injuries one could suffer from. It generally occurs from the lumbar spine on down and would most likely occur from an accident. Senior men are most likely to experience this type of injury.

Symptoms may include:

  • Unable to move without pain
  • Digestive problems
  • Weakness and/or tingling sensation
  • Numbness
  • Loss of consciousness

The different types of Spinal Fracture:

  • Compression- This fracture occurs when the front of the vertebra breaks but the back stays stable. The vertebra should remain stable and in position.
  • Burst-When both the front and back of the vertebra break from too heavy of a force. Can lead to long-term damage and possible loss of motion.
  • Flexion- When a vertebra is literally pulled off of the spinal cord. They will commonly occur in car accidents or severe falls.
  • Transverse- Will occur from lateral movements and bending. Vertebra should remain stable.

While most spinal fractures are the result of severe accidents such as car accidents, severe falls or sports injuries, it is important to note that some fractures can occur genetically or form over time.

Spinal Procedures

At Total Orthopedics & Sports Medicine, we offer a variety of surgical solutions in helping problems with the Spine. Select a procedure below to learn more.

Spinal Trauma

Spinal Trauma is the result of a traumatic impact to the spinal column. This injury can either be to the spinal cord itself or to the spinal column bone and tissue. Spinal trauma can either cause direct injury to these structures, as in the case of a direct blow (car accident, awkward fall) or penetrating injury to the neck or back. It can also cause an indirect spinal injury, which occurs when trauma elsewhere causes unnecessary pressure on the spine. For example, a fall landing on the buttocks may cause pressure that causes injury to the lumbar spine.

Trauma will most commonly be the result of a high impact injury, after which a patient will always be considered to have a spinal injury until proven otherwise. Following stabilization and initial evaluation the spine will be explored through various forms of imaging.  X-rays are taken to demonstrate any obvious spinal fractures or dislocations. CT scans are taken as well to reveal any subtle fractures.

After work-up, if a patient is found to have a spine injury, the treatment will depend entirely on the specific type and location of the injury.

Transforaminal Lumbar Interbody Fusion

Transforaminal Lumbar Interbody Fusion is a minimally invasive procedure, which involves the removal of a herniated disc and fusion of two vertebrae. This procedure is done to correct a disc herniation or degenerative disc disease. The surgeon will begin by making a small 1 inch incision through the back. The degenerated or herniated disc is removed, and a fusion cage is inserted into the newly opened space.

Once this spacer is properly positioned, bone graft material is placed in the back of and along the side of the vertebra. When the bone graft is placed in the spacer area, it begins the process of fusing the vertebra above and below, forming one bone. Rods may be attached to the screws to ensure stabilization if the surgeon sees fit.

This procedure may be performed as an inpatient or outpatient surgery, depending on the surgeon’s discretion. The patient will be able to walk the day of surgery and resume daily activity after a few weeks of rest. Physical therapy will begin 6 weeks after the procedure.

Direct Lateral Interbody Fusion

Direct Lateral Interbody Fusion is a minimally invasive procedure to treat back pain caused by degenerative disc disease. Unlike the traditional approach to spinal surgery, this procedure involves approaching the spine from the side.

The surgeon will make two small incisions in the side of the patient.  Each will not exceed 1 inch in diameter. The surgeon will insert a probe into one incision to stimulate and detect the nerves around the spine. This allows the surgeon to avoid these nerves and leave them undamaged. The second incision is used to guide instruments.

The degenerated or herniated disc is removed, and a fusion cage is inserted into the newly opened space. Once this spacer is properly positioned, bone graft material is placed in the back of and along the side of the vertebra. When the bone graft is placed in the spacer area, it begins the process of fusing the vertebra above and below, forming one bone. Rods may be attached to the screws to ensure stabilization if the surgeon sees fit.

This procedure may be performed as an inpatient or outpatient surgery, depending on the surgeon’s discretion. The patient will be able to walk the day of surgery and resume daily activity after a few weeks of rest. Physical therapy will begin 6 weeks after the procedure.

Oblique Lumbar Interbody Fusion

Oblique lumbar Interbody fusion is a minimally invasive procedure that involves approaching the spine from the oblique area remove all or part of a herniated disc from in between two adjacent vertebrae in the lumbar spine, then fusing the vertebrae on either side of the remaining disc space using bone graft or bone graft substitute.

The patient will be positioned on their right side. The surgeon will then make an incision no larger than an inch on the left side of the abdomen, and split the abdominal wall without disrupting the soft tissue.

The degenerated or herniated disc is removed, and a fusion cage is inserted into the newly opened space. Once this spacer is properly positioned, bone graft material is placed in the back of and along the side of the vertebra. When the bone graft is placed in the spacer area, it begins the process of fusing the vertebra above and below, forming one bone. Rods may be attached to the screws to ensure stabilization if the surgeon sees fit.

This procedure may be performed as an inpatient or outpatient surgery, depending on the surgeon’s discretion. The patient will be able to walk the day of surgery and resume daily activity after a few weeks of rest.  Physical therapy will begin 6 weeks after the procedure.

Treatment for Scoliosis in Pediatrics and Adults

Scoliosis is the curvature of the spine, which often develops during a patient’s childhood. It causes the spine to move laterally in either direction. The spine is known to have curves when looked at from the side, but when viewed from the back it should be straight.

In the case of a child, surgery is performed when a curve greater than 45 degrees is present. The surgeon will approach the spine through the posterior, making an incision that runs the length of the thoracic spine. Once the surgeon gains access to the spinal cord, metal rods and screws are inserted to reduce the amount of curvature. Bone graft is then added to incite a bone fusion, a process that can take up to5 months.

In the case of an adult, the same procedure is recommended only when a curve greater than 60 degrees is present, and their condition has worsened over a period of time.  A patient who has not undergone any previous treatment will undergo a discectomy in addition to a scoliosis procedure. A patient who has been previously treated for the condition will simply have their old instrumentation replaced and realigned. It should be noted that most procedures for an adult with scoliosis are complicated and are only undertaken after every other non-surgical option has been exhausted.

The patient will be in a brace for about 12 weeks and will have to restrict activity for 12-18 weeks until the bone can successfully fuse. After the bone has successfully fused, the surgeon will remove the rod and the spine becomes fully mobile.

Are your or a loved one suffering from a spinal condition? We can help.

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