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Spine Pathology

Spine surgery can be a daunting idea to entertain. Most people, if they are contemplating the surgery, are either in significant pain, or they have been dealing with the problem for so long, that they are finally succumbing to the concept. Ultimately, the decision as to whether one needs surgery rests with the group of specialists involved, in conjunction with the patient. Usually the team will involve a Spine Surgeon, a Primary Care Physician, and a Physical Therapist and/or Chiropractor.

The Anatomy of the spine is important to understand.  Essentially, the spine is a column of bones called Vertebrae. The vertebrae are separated by a cushion of sponge-like structures called Discs. These discs allow the vertebrae to slightly angle forward and back, and side to side. The spine is the main structure holding the body upright from the pelvis to the head.  Additionally, the spine houses the all-important spinal cord, which is the neural connection from the brain to the rest of the body.

Pathology of the spine exists on many levels. The most common problem occurs when a disc begins to bulge outward and press or “impinge” upon the spinal cord. When this occurs, multiple symptoms can be seen. The symptoms are usually dictated by the level the impingement is located, as the level determines which nerves are affected.

Bulging Disc into Spinal Cord

 The most common impingement is L5/S1 which is at the lower end of the spine, called the sacrum. The symptoms here are commonly pain into the buttock and down the back of the leg. Additionally one may experience numbness, or weakness. Other levels of impingement which may occur higher up on the spine, for example in the Thoracic or Cervical Spine, will result in symptoms related to these locations. These symptoms may include groin or abdominal pain, or weakness, pain or numbness in the upper extremities.

MRI of Bulging Disc

The most common impingement is L5/S1 which is at the lower end of the spine, called the sacrum. The symptoms here are commonly pain into the buttock and down the back of the leg. Additionally one may experience numbness, or weakness. Other levels of impingement which may occur higher up on the spine, for example in the Thoracic or Cervical Spine, will result in symptoms related to these locations. These symptoms may include groin or abdominal pain, or weakness, pain or numbness in the upper extremities.

Bone on bone Compression

Finally, Spondylolisthesis is another entity which is where the vertebral bodies are not aligned vertically. The disc of one vertebra has shifted in relation to the rest of the column. Usually it has moved forward beyond the column causing, in some cases, pressure on the bones or spinal cord.

Spondylolithesis

When Spine Surgery is Indicated

In most cases, spine surgery can be avoided with proper rest, anti-inflammatory medications, and at times, steroids. A Physical Therapy protocol is usually started after the acute event in order to strengthen the structures in an attempt to prevent further issues.  Surgery may ultimately be required if multiple episodes of the same problem keep occurring, or the compression on the nerve results in a functional loss of the limb (the typical issue being a “foot drop”). The type of surgery required depends upon an algorithm which is specific to the anatomic problem, the patient’s age and health, and the solution that has the least amount of risk. The patient is involved with this decision making process.