NECK AND SPINE SURGERY

Low-back pain is a common problem, most commonly due to spraining injuries, disk herniations, and facet joint arthritis. There are many other less-common causes of back pain, including tumor, infection, stress fractures, compression fractures, and spondylitis.

Disk herniations oftentimes produce sciatic pain radiating down the thighs and legs. The majority of disk herniations respond to conservative treatment. An MRI study is reserved for those patients who do not improve within a reasonable interval of time. Microscopic diskectomy is the standard treatment for disk herniations that do not respond to conservative management.

Spondylolisthesis is a condition where there is instability of the lumbar vertebrae, allowing one vertebra to displace forward upon another. The condition can be caused by a stress fracture of the pars interarticularis or can be related to degenerative facet arthritis with instability. Spondylolisthesis, secondary to stress fractures, is oftentimes asymptomatic. Spondylolisthesis from facet joint disease usually occurs in older individuals, beyond the age of 50.

Spinal stenosis is a condition where there is narrowing of the spinal canal, where the nerves are compressed, oftentimes causing hip and thigh pain. This is usually aggravated by walking, relieved by sitting and also relieved by bending forward. Vascular insufficiency can also cause lower-extremity claudication symptoms, but usually involves the legs rather than the thighs. Surgery is often necessary for spondylolisthesis that does not respond to conservative treatment and usually requires a decompression of the stenotic canal accompanied by a fusion of the unstable vertebrae, oftentimes with the use of instrumentation for stabilization and better healing of the fusion.

Scoliosis is a lateral curvature of the spine. Eight-five percent of the cause of scoliosis in adolescents is unknown and is termed "idiopathic." Scoliosis is often progressive during adolescence and spinal growth. Bracing is a standard treatment for scoliosis that is progressing greater than 25 degrees and in an adolescent who still has at least one more year of active spinal skeletal growth before maturity. Bracing after growth has been completed is not effective. Surgery for scoliosis is often performed for those curves that are progressive over 45 degrees to 50 degrees. Scoliosis usually does not cause pain in young individuals but can be painful in later adulthood when accompanied by degenerative arthritis of the scoliosis.

Spinal fractures commonly occur from falls from ladders or rooftops. Fractures which have instability and are productive of deformity usually require surgical stabilization and fusion. Common compression fractures that are not associated with instability usually heal satisfactorily with a limited interval of bracing.