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Spine Abnormalities

Patients need neurosurgeons for other types of spine-related conditions that are not of the more-acute variety and instead are congenital or progressive.   These abnormalities, or a predisposition to them, are present from birth and are primarily anatomical problems.

Some of these conditions are deformities or developed abnormalities than can cause spinal cord disruption, resulting in pain and functional problems.   Care of these conditions is a dedicated focus of the Lourdes/DNI neurosurgical team, which maintains subspecialty expertise in this field.

  • spine abnormalitiesScoliosis is a common, sideways curve to the spine when viewed from the back or front. It is seen in about two percent of the population, usually becomes evident during the growth spurt of early adolescence and is more common in girls. Bracing may be used during the growing years.  In some patients, physical therapy, massage and exercises, including yoga, can reduce back pain and can strengthen muscles in the back.   Only if the angle of the curve becomes great enough is the condition considered in need of treatment.   Only a tiny fraction of those with scoliosis have it severely enough to be considered for surgery, and ideally this can be delayed until after growth is completed.  Implants and bone grafts are used to reduce the curvature and fuse some of the vertebrae, thus straightening the spine.   The operation can be performed by accessing the spine from the patient’s front or back.
  • Kyphosis causes a forward bend in the upper (thoracic) spine that creates a hunchback-like posture in which patients walk in a forward-flexed position. Kyphosis can be congenital, hereditary or due to poor use or condition of muscles employed for standing straight. Treatment can include instruction in improved postural habits and core conditioning, as well as bracing and physical therapy.   Kyphosis can also result from osteoporosis-related vertebral fracture in the upper back.   Direct intervention is used in cases of collapsed vertebrae, typically with nonsurgical kyphoplasty, or to correct the curvature itself in severe cases through use of screws, plates or rods to fuse the vertebrae and hold them straight.
  • Spinal stenosis is a narrowing of the space through which the spinal cord passes in one or more vertebrae. When this spinal canal becomes reduced, the pressure on the cord can cause pain and functional problems. Most cases occur in the lower back (lumbar spine).   One of the most common symptoms is sciatica——pain, weakness or numbness that radiates from the lower back across the buttocks and to the legs. Spinal stenosis can also occur in the neck (cervical spine).   It can cause similar symptoms in other extremities, as well as cramping during standing and even bladder and bowel control problems. The condition is often gradual, increasing with age, primarily because it can be caused by wear-and-tear arthritic changes in the back, such as bone spurs, bulging or herniated discs and thickened ligaments in the spine.   Almost all people over 50 have this process to some extent.   Treatment can include exercise, physical therapy, steroid injections into the spinal canal and medications to reduce pain and inflammation.   For cases where surgery is necessary, the goal is to remove bone and other tissue within the spinal canal to decompress the spinal cord.   The most common surgery is called decompressive laminectomy: removal of the lamina (roof of the canal) of one or more vertebrae to create more space for the nerves.  If the condition includes spinal instability, verterbral fusion may be incorporated in the operation.  When the problem is due to disc changes, newer approaches such as minimally invasive decompression and placement of spine spacers may be effective.

 

 

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