 
Frequently
Asked Questions
Below
is a list of some frequently asked questions, but please feel
free to contact
us if you need additional information.
We
are always
pleased to
answer your questions and assist you.
How do I know
if I need a spine specialist?
In the majority of cases, your
primary doctor will diagnose your problem and make the
appropriate referral to a spine specialist. Some patients,
however, presents directly to a spine specialist.
Commonly occurring problems in
your spine include disc herniations (ruptured disc, herniated
nucleus pulposis [HNP], etc.), degenerative disc disease
(aging discs, dried or desiccated discs), spondylosis
(degeneration of overall spine with aging, degenerative
arthritis), stenosis (narrowing of areas within the spine that
in turn cause neural compression or pinching),
spondylolisthesis (a shifting or slipping of one vertebra in
relation to another) and strains. Less common problems include
trauma, infections and tumors. All of these conditions can
occur in the cervical spine (neck), thoracic spine (trunk) or
lumbar spine (lower back) with symptoms varying depending on
site and location of the problem.
Problems in the cervical spine
can result in symptoms including: headaches, neck pain, neck
stiffness, spasms, shoulder girdle and upper back pain,
numbness and or weakness in the arms. The distribution of
symptoms of pain, numbness and weakness will depend on the
nerve being compressed, i.e. the site of pathology in your
spine.
The more severe cervical
pathology will result in myelopathy or spinal cord changes
resulting from compression. Myelopathic symptoms can include
fine motor dexterity changes (change in handwriting,
difficulty controlling you fingers for picking up tiny objects
or buttoning shirts), gait balance difficulties and walking
with a wide based gait.
Progressive radiculopathy
(worsening weakness or numbness without resolution) is a
relative neurologic emergency that can be caused by the above
conditions. Should you develop this, in general you have a
two-week window in which surgery can reverse a portion or all
of your numbness and weakness. Once numbness and/or weakness
have been present for greater than two weeks, I advise my
patients to not expect significant recovery of sensation or
strength even with surgery. This pertains to constantly
present numbness or weakness. Numbness or weakness that occurs
intermittently, but then resolves again, should respond to
surgery well anytime you choose to have it. This is to say
also, that as long as your numbness and weakness occur only
intermittently, you can choose to live with it without a high
risk for permanent deficits.
Problems in the lumbar spine
can result in symptoms including: back pain, stiffness,
spasms, pain, numbness or weakness radiating into you
buttocks, thighs, calves, ankles and feet. Again, the
distribution of symptoms of pain, numbness and weakness will
depend on the nerve being compressed, i.e. the site of
pathology in your lumbar spine.
The more severe lumbar
pathology will result in urinary retention (inability to void
or urinate), incontinence of stool, saddle anesthesia
(numbness in an area a saddle would touch), progressive
radiculopathy (worsening weakness or numbness without
resolution), a foot drop (inability to completely lift the
foot secondary to weakness). These are all spine emergencies
that require timely evaluation and intervention.
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How do I know
if my shoulder and arm pain is caused by a problem in my neck?
Pain that occurs as a result of
a cervical spine problem usually radiates in a line extending
distally from the neck or shoulder girdle into the arm and
toward the hand/fingers. It usually has a specific
distribution in the arm rather than feeling like "whole
arm" pain. Such radicular pain can also often be
accompanied by numbness or tingling in a similar distribution,
in contrast numbness does not commonly occur as a result of
problems in the extremities, unless it involves a peripheral
nerve entrapment or irritation.
It can be very difficult to
differentiate cervical radiculopathy (radiating pain, numbness
or weakness) from extremity problems, even for the
well-trained physician. Your physician will rely on subtle
aspects of your history and subjective findings, physical exam
findings, x-rays and sometimes more sophisticated imaging. An
injection of local anesthetic and steroids into your shoulder
may be necessary as a final means of differentiating between a
shoulder problem (such as subacromial impingement, rotator
cuff problems or shoulder arthritis) and cervical
radiculopathy.
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What are some
arm problems that can mimic cervical radiculopathy?
Shoulder problems such as
subacromial impingement, rotator cuff problems and arthritis
can mimic cervical radiculopathy in that they can all cause
shoulder girdle pain. All can cause pain to seem to radiate
either from or to the shoulder to the neck and into the upper
arm. Numbness does not usually accompany the shoulder
pathology, but can occur with cervical spine pathology. Other
common complaints with these shoulder ailments that help to
differentiate them from spine pathology include pain that
wakes you up at night when you roll onto the shoulder;
difficulty raising your arm over your head; difficulty with
reaching into your back pocket.
Carpal tunnel syndrome is
caused by compression of your median nerve at the wrist, it
can cause pain in your forearm, wrist and hand. It can cause
numbness in your middle three fingers and weakness in your
hand. It can awaken you with wrist and hand pain, numbness or
tingling at night as a result of compression while you sleep
with your wrists flexed.
Ulnar tunnel syndrome can cause
numbness and tingling in your forearm distal to the elbow.
Tennis elbow or golfer's elbow can cause pain in the elbow and
forearm as a result of tendonitis. Many other less common
problems can also mimic cervical radiculopathy. Your physician
can help you come up with the appropriate diagnosis.
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How do I know
if my buttock, hip or leg pain is caused by a problem in my
back?
Pain that occurs as a result of
a lumbar spine problem usually radiates in a line extending
distally from the back into the buttocks, hip or thigh and
toward the foot and ankle. It usually has a specific
distribution in the leg rather than feeling like "whole
leg" pain. Such radicular pain can also often be
accompanied by numbness or tingling in a similar distribution.
In contrast numbness does not commonly occur as a result of
problems in the extremities, unless it involves a peripheral
nerve entrapment or irritation. These peripheral nerve
entrapments are far less common in the legs than they are in
the arms.
It can be very difficult to
differentiate lumbar radiculopathy (radiating pain, numbness
or weakness, often referred to incorrectly as sciatica) from
extremity problems, even for the well-trained physician. Your
physician will rely on subtle aspects of your history and
subjective findings, physical exam findings, x-rays and
sometimes more sophisticated imaging.
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What are some
hip and leg problems that can mimic lumbar radiculopathy?
Hip problems such as tendonitis
or arthritis can mimic lumbar radiculopathy in that they can
cause hip pain, buttock pain, groin pain, anterior thigh pain
and even knee pain. These can also cause radiation of pain
into the lower back. The presence of pain radiating in a line
past the knee into the calf, ankle or foot would heavily weigh
toward the diagnosis of spine problem. The presence of
radicular numbness or tingling would also implicate your
spine.
Sciatica is the irritation of
your sciatic nerve in your buttock or leg after it has exited
your spine. It can be caused by irritation, compression or
other injury. It is usually a self-limited problem. Again, if
you have persistent symptoms please discuss them with your
doctor. Your physician can help you come up with the
appropriate diagnosis.
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Do I need
surgery?
Most of the time, you are the
only person who can answer that question. If you have
persistent symptoms of pain, numbness, tingling or weakness or
bowel or bladder dysfunction you need to be evaluated by your
doctor. Although there are many spine-related problems that
can be significantly improved with surgery, most are performed
on an elective basis after exhaustion of more conservative
non-surgical measures.
As a spine surgeon it is my job
to evaluate you and diagnose your problem. It is my job to
inform you of the full spectrum of treatments available to you
for your specific problem and to guide your through your
treatment course. As long as you do not have a life
threatening problem or a problem that is going to leave you
permanently impaired, then you can choose to live with your
symptoms and avoid surgery. You can always accept your level
of function, limitations and symptoms as long as you wish to
do so and understand the consequences of waiting.
Some spine related problems will
require surgery and these can include: cancer, fracture,
infection, cauda equina syndrome (urinary retention, inability
to void or urinate), incontinence of stool, saddle anesthesia
(numbness in an area a saddle
would touch) or progressive radiculopathy (worsening weakness
or numbness without resolution). In the absence of such
problems you can choose to live with your pain, intermittently
occurring numbness, tingling or weakness without significant
risk of permanent neurologic injury.
Progressive radiculopathy (worsening weakness or numbness
without resolution) is a relative neurologic emergency that
can be caused by the above conditions. Should you develop
this, in general you have a two-week window in which surgery
can reverse a portion or all of your numbness and weakness.
Once numbness and/or weakness have been present for greater
than two weeks, I advise my patients to not expect significant
recovery of sensation or strength even with surgery. This
pertains to constantly present numbness or weakness. Numbness
or weakness that occurs intermittently, but then resolves
again, should respond to surgery well anytime you choose to
have it. This is to say also, that as long as your numbness
and weakness occur only intermittently, you can choose to live
with it without a high risk for permanent deficits.
Non-operative treatments for
your spine related problem may initially consist of
anti-inflammatory medications (NSAID's including Motrin,
Naprosyn, Ibuprofen, Relafen, Celebrex, Vioxx, Bextra, etc.),
muscle relaxers (Skelaxin, Xanaflex, Flexeril, Robaxin, Soma,
etc.), physical therapy, active traction, chiropractic
treatments, acupuncture, and other measures. These are often
directed by your primary care physician. If you fail to
improve with such measures then you will have the option of
going to the next level of intervention.
The next level of intervention
will depend on your specific problem and may include: epidural
steroid injections, differential nerve blocks, or other
invasive options.
When you have reached a point
where you have failed to improve with all non-surgical
measures then you may be a surgical candidate. You will be
offered surgery once you reach this stage, if you have a
surgical target (i.e. a lesion or problem that can be
addressed or improved with surgery) that can be improved with
surgery. Once you are offered surgery at this stage you have
the option of proceeding with surgery or choosing to live with
your symptoms and level of function.
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