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HERNIATED DISC
What is it?
A “herniated disc” is a problem with one of the rubbery, gel-like cushions between the vertebrae of the spine. When the interior “jelly” of the disc pushes through the tougher exterior and irritates nearby nerves, resulting in pain that ranges from mild to severe.
If a disc is herniated, it may bulge and the jelly-like interior could leak out through a tear, or the bulge may press against or pinch a nerve.
Symptoms
Symptoms caused by a herniated disc in the lumbar spine include:
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Pain in the leg, especially in the buttocks, thigh, and calf
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Numbness or tingling in your leg
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Weakness of your leg
Pain is caused by inflammatory chemicals that are released around the injured area, and the injured disc can also put pressure on the nerve roots as they travel through the adjoining tunnel to and from the spinal cord. This can cause pain, pins and needles and numbness into your leg and also lead to significant muscular weakness.
Treatment
If symptoms don’t respond to conservative measures or time then Dr. Adler may recommend surgery, particularly if there is persistent pain or weakness in your legs. If surgery is needed, it is aimed at reducing the pressure from the herniated disc on surrounding tissues or relieving any pressure on the nerve roots as they exit from the spinal cord. This should relieve any pain or unpleasant sensation traveling down into your legs.
Degenerative
Disc Disease
What is it?
Degenerative disc disease is a common condition among aging adults that refers to the process of degenerative changes that occur in the discs – the soft, gel-like pads located between the vertebrae of your spine. Wear and tear on your spine over time cause the discs to gradually lose their ability to cushion the vertebrae.
At the same time, the outer layer of the spine can develop cracks, which gradually worsen. The discs may also develop herniated areas, which is where the central portion of the disc protrudes through the outer layer.
Symptoms
A lumbar disc herniation in the lower back may result in:
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Shooting pain into the buttocks or down the leg
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Local severe back pain or “burning” in the back
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Weakness in one or both legs
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Changes in bowel or bladder activity
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Lack of sensation or pins-and-needles tingling in one or both legs
Pain is caused by inflammatory chemicals that are released around the injured area, and the injured disc can also put pressure on the nerve roots as they travel through the adjoining tunnel to and from the spinal cord. This can cause pain, pins and needles and numbness into your leg and also lead to significant muscular weakness.
Treatment
There is a wide range of surgical techniques that may be used for this condition, depending on the extent and exact nature of the damage to the disc and spine. Dr. Adler will discuss with you fully the type of surgery he recommends for you and will work with you to develop a treatment plan.
Spondylolisthesis
What is it?
Spondylolisthesis is a common condition in which one vertebrae slips out of place and onto the vertebra below it and typically affects the vertebra of the lower back. If the vertebra slips too far, it may press on a nerve, which can cause pain and limitation.
The most common forms of the condition are:
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Degenerative Spondylolisthesis is the most common form and happens with aging as the discs that cushion the vertebrae become less spongy.
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Congenital Spondylolisthesis occurs when an abnormal bone formation is present at birth.
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Isthmic Spondylolisthesis leads to small stress fractures in the vertebrae.
Less common are:
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Traumatic Spondylolisthesis occurs when an injury causes a spinal fracture.
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Pathological Spondylolisthesis occurs when a disease like osteoporosis, a tumor, or an infection weakens the spine.
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Post-Surgical Spondylolisthesis sometimes happens after spine surgery.
Symptoms
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Pain in the lower back, often worse after walking or exercise, or extending the back (straightening or leaning back)
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Stiffness in the lower back
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Increased tightness of the hamstrings
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Pain, numbness, or tingling in your legs if nerves are being compressed
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Loss of control of bladder or bowel function (in severe cases)
Treatment
Dr. Adler will first carry out a thorough assessment to determine the severity of your condition. Spondylolisthesis will usually be evident on plain x-rays but further scans such as an MRI or CT scan may be ordered to see if there is pressure on other structures, such as nerves or the spinal cord.
In less severe cases, physical therapy may be helpful. This treatment may consist of manual therapy, stretches to address the tightness of hamstrings and other structures, and strengthening exercises for your core muscles to help support your back. Your doctor may also prescribe medication to help manage your pain and reduce inflammation. A back brace is sometimes used to stabilize the area.
For a number of people with more severe forms of spondylolisthesis, surgery is recommended, especially if the slippage is severe or if there is pressure on the spinal cord or nerves. The goal of surgery is to provide more space for the spinal cord and nerve roots while stabilizing the spine. In some cases, it can also be effective at reducing pain. Dr. Adler will discuss with you the most appropriate surgical technique for your condition.
