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Conditions We Treat:

Herniated Disc
Lumbar Spinal Stenosis
Pain
Scoliosis, Lordosis, Kyphosis
Spondylolysis and Spondylolisthesis

Herniated Disc

A herniated (slipped) disk occurs when all or part of a disk is forced through a weakened part of the disk. This may place pressure on nearby nerves or the spinal cord.

Causes:

The bones (vertebrae) of the spinal column protect nerves that come out of the brain and travel down your back to form the spinal cord. Nerve roots are large nerves that branch out from the spinal cord and leave your spinal column between each vertebra.

The spinal bones are separated by disks. These disks cushion the spinal column and put space between your vertebrae. The disks allow movement between the vertebrae, which lets you bend and reach.

With herniated disc:

The disk may move out of place (herniate) or break open (rupture) from injury or strain. When this happens, there may be pressure on one or more spinal nerves. This can lead to pain, numbness, or weakness.
The lower back (lumbar area) of the spine is the most common area affected by a herniated disk. The neck (cervical) disks are the second most commonly affected area. The upper-to-mid-back (thoracic) disks are rarely involved.

Herniated disks occur more often in middle-aged and older men, usually after strenuous activity. Other risk factors may include:

Lifting heavy objects
Being overweight
Repetitive bending or twisting the lower back or neck
Sitting or standing in same position for long hours
Inactive lifestyle
Smoking

Management:

The first treatment for a slipped disk is a short period of rest and taking medicines for the pain. This is usually followed by physical therapy. Most people who follow these treatments recover and return to normal activities. Some people will need to have more treatment. This may include steroid injections or surgery.

If you are overweight, diet and exercise are very important for improving back pain.

Physical therapy is important for nearly everyone with disk disease. Therapists will teach you how to properly lift, dress, walk, and perform other activities. They will teach you how to strengthen muscles that help support the spine. You will also learn how to increase flexibility in your spine and legs.

Take care of your back at home:

Reduce activity for the first few days. Slowly restart your usual activities.
Avoid heavy lifting or twisting your back for the first 6 weeks after the pain starts.
After 2 to 3 weeks, gradually start exercising again.

Scoliosis

Scoliosis is an abnormal curving of the spine. Your spine is your backbone. It runs straight down your back. Everyone's spine naturally curves a bit. But people with scoliosis have a spine that curves too much. The spine might look like the letter C or S.

Causes:

Most of the time, the cause of scoliosis is unknown. This is called idiopathic scoliosis. It is the most common type and is grouped by age, including infantile scoliosis, juvenile scoliosis, and adolescent scoliosis. Scoliosis most often affects girls. Some people are more likely to have curving of the spine. Curving generally gets worse during a growth spurt. Other types of scoliosis are:

Congenital scoliosis: This type of scoliosis is present at birth. It occurs when the baby's ribs or spine bones do not form properly.
Neuromuscular scoliosis: This type is caused by a nervous system problem that affects the muscles. Problems can include cerebral palsy, muscular dystrophy, spina bifida, and polio.

Management:

Most people with idiopathic scoliosis do not need treatment. But you should still be checked by your provider about every 6 months. If you are still growing, your provider might recommend a back brace. A back brace prevents further curving. Back braces work best in people over age 10 with continued growing potential. Braces do not work for those with congenital or neuromuscular scoliosis.

You may need surgery if the spine curve is severe or getting worse very quickly.

Scoliosis treatment may also include:

Emotional support: Some children, especially teens, may be self-conscious when using a back brace.
Physical therapy and other specialists to help explain the treatments and make sure the brace fits correctly.

Lordosis

Lordosis is the inward curve of the lumbar spine (just above the buttocks). A small degree of lordosis is normal. Too much curving is called swayback.

Lordosis tends to make the buttocks appear more prominent. Children with hyperlordosis will have a large space underneath the lower back when lying face up on a hard surface.

Causes:

Spondylolisthesis may cause lordosis. In this condition, a bone (vertebra) in the spine slips out of the proper position onto the bone below it. You may be born with this. It can develop after certain sports activities, such as gymnastics. It may develop along with arthritis in the spine.

Much less common causes in children include:

Achondroplasia, a disorder of bone growth that causes the most common type of dwarfism
Muscular dystrophy
Other genetic conditions

Management:

Most of the time, lordosis is not treated if the back is flexible. It is not likely to progress or cause problems. Contact your health care provider if you notice that your child has an exaggerated posture or a curve in the back. Your provider must check to see if there is a medical problem.

Lumbar Spine Stenosis

Spinal stenosis happens when the spaces in the spine narrow and create pressure on the spinal cord and nerve roots.

Causes:

Several factors can contribute to the narrowing of the spinal canal, leading to spinal stenosis. Normally, the vertebral canal provides enough room for the spinal cord, cauda equina, and the exiting nerves. Common factors that can cause narrowing of the spine include:

Aging and age-related changes in the spine: As people age, the ligaments that keep the vertebrae of the spine in place may thicken and calcify (harden from deposits of calcium salts). Bones and joints may also enlarge. When surfaces of the bone begin to project out from the body, these projections are called osteophytes (bone spurs). For example:
- A herniated (bulging) disk may place pressure on the spinal cord or nerve root. Disks are cushion-like pads that lie between the vertebrae and act like shock absorbers and spacers for the spine. As the disk ages, it can dry out and crack, causing the disk to bulge.
- When a segment of the spine becomes too mobile, the capsules (membranes) of the facet joints at the back of the vertebrae thicken. This effort to try to stabilize the segment can cause bone spurs, which decrease the space around the nerve roots leaving the spinal cord.
- Spondylolisthesis happens when one vertebra slips forward on another vertebra. This creates poor alignment of the spinal column and can place pressure on the spinal cord or nerve roots.
Arthritis:
- Osteoarthritis can lead to disk degeneration and an enlargement or overgrowth of bone that narrows the central and nerve root canals, causing spinal stenosis.
- Rheumatoid arthritis (RA). Although not a common cause of spinal stenosis, damage from RA can cause significant problems with joints in the spine, leading to spinal stenosis.
Tumors of the spine: It causes inflammation or growth of tissue into the spinal canal. This can narrow the space and cause bone changes, leading to spinal stenosis. Some people develop a rare disorder called epidural lipomatosis, which happens when fat builds up on or around the lining of the spine.
Fractures due to trauma (injury) or other medical conditions: This may cause misalignment of the spine and the spinal canal or cause fractures that produce fragments of bone that penetrate the canal.
Paget's disease of bone: It is a chronic disorder that causes bones to grow larger and become weaker than normal. As Paget’s disease progresses, new bone forms at a faster rate than the rate at which old bone is removed. However, the new bone does not form correctly, leading to larger bones that are misshapen, weaker, and softer than normal bone. This can cause problems with blood supply and bone structure, which changes the spaces in the spinal canal, leading to spinal stenosis.
Ossification of the posterior longitudinal ligament: It happens when calcium deposits form on the ligament that runs up and down behind the spine and inside the spinal canal. These deposits turn the fibrous tissue of the ligament into bone and may press on the nerves in the spinal canal.
Inherited conditions:
- Congenital stenosis happens when you are born with a small and narrow spinal canal.
- Scoliosis is a curvature of the spine.
- Achondroplasia is an inherited condition that causes problems with bone formation in the spine and other bones in the body.

Management:

Living with spinal stenosis can be challenging. However, these self-care tips may help.

Get regular exercise. Try to exercise at least three times a week for 30 minutes. Modify or adjust your activity and try to avoid doing things that can make the pain worse. Your health care provider or physical therapist may recommend specific exercises for you to do at home as well. Talk to your doctor before beginning any exercise program.
Make adjustments in your daily routines that might trigger pain. Pace activities so you don’t overdo it.
Use assistive devices to help give you stability when you walk around.
Try changing your posture. Some people may find that flexing the spine can relieve some of their symptoms. Flexing opens the spaces in the spine, which takes pressure off the nerves and can help decrease pain.
Practice healthy habits. For example, maintain a healthy weight and if you smoke, quit.

Low Back Pain

Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight.

Causes:

A single event may not have caused your pain. You may have been doing many activities, such as lifting the wrong way, for a long time. Then suddenly, one simple movement, such as reaching for something or bending from your waist, leads to pain.

Many people with chronic back pain have arthritis. Or they may have extra wear and tear of the spine, which may be due to:

Heavy use from work or sports
Injuries or fractures
Surgery

You may have had a herniated disk, in which part of the spinal disk pushed onto nearby nerves. Normally, the disks provide space and cushion in your spine. If these disks dry out and become thinner and more brittle, you can lose movement in the spine over time.

If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal stenosis. These problems are called degenerative joint or spine disease.

Other possible causes of chronic low back pain include:

Curvature of the spine, such as scoliosis or kyphosis
Medical problems, such as fibromyalgia or rheumatoid arthritis
Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the piriformis muscle

You are at greater risk for low back pain if you:

Are over age 30
Are overweight
Are pregnant
Do not exercise
Feel stressed or depressed
Have a job in which you have to do heavy lifting, bending and twisting, or that involves whole body vibration, such as truck driving or using a sandblaster
Smoke

Management:

A common myth about back pain is that you need to rest and avoid activity for a long time. In fact, health care providers do not recommend bed rest. If you have no sign of a serious cause for your back pain (such as loss of bowel or bladder control, weakness, weight loss, or fever), stay as active as possible.

Here are tips for how to handle back pain and activity:

Stop normal physical activity for only the first few days. This helps calm your symptoms and reduce swelling (inflammation) in the area of the pain.
Apply heat or ice to the painful area. Use ice for the first 48 to 72 hours, and then use heat.
Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
Sleep in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.
Do not do activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins.
Do not exercise in the days right after the pain begins. After 2 to 3 weeks, slowly begin to exercise again. A physical therapist can teach you which exercises are right for you.

These other health care providers may also help:

Massage therapist
Someone who performs acupuncture
Someone who does spinal manipulation (a chiropractor, osteopathic physician, or physical therapist)

Kyphosis

Kyphosis is a curving of the spine that causes a bowing or rounding of the back. This leads to a hunchback or slouching posture.

Causes:

In adults, kyphosis can be caused by:

Degenerative diseases of the spine (such as arthritis or disk degeneration)
Fractures caused by osteoporosis (osteoporotic compression fractures)
Injury (trauma)
Slipping of one vertebra forward on another (spondylolisthesis)
Previous surgeries or fusion on the spine

Other causes of kyphosis include:

Certain hormone (endocrine) diseases
Connective tissue disorders
Infection (such as tuberculosis)
Muscular dystrophy (group of inherited disorders that cause muscle weakness and loss of muscle tissue)
Neurofibromatosis (disorder in which nerve tissue tumors form)
Paget disease (disorder that involves abnormal bone destruction and regrowth)
Polio
Scoliosis (curving of the spine often looks like a C or S when viewed from behind)
Spina bifida (birth defect in which the backbone and spinal canal don't close before birth)
Tumors of the spine or the area nearby

Management:

Treatment depends on the cause of the disorder:

Congenital kyphosis needs corrective surgery at an early age.
Scheuermann disease is treated with a brace and physical therapy. Sometimes surgery is needed for large (greater than 60 degrees), painful curves.
Compression fractures from osteoporosis can be left alone if there are no nervous system problems or pain. But the osteoporosis needs to be treated to help prevent future fractures. For severe deformity or pain from osteoporosis, surgery is an option.
Kyphosis caused by infection or tumor needs prompt treatment, often with surgery and medicines.

Treatment for other types of kyphosis depends on the cause. Surgery is needed if nervous system symptoms or constant pain develop.

Spondylolisthesis

Spondylolisthesis is a condition in which a bone (vertebra) in the spine moves forward, out of its proper position, in relation to the bone below it.

Causes:

In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis) area. It is often due to a birth defect in that area of the spine or sudden injury (acute trauma).

In adults, the most common cause is abnormal wear on the cartilage and bones, such as arthritis. The condition mostly affects people over 50 years old. It is more common in women than in men.

Bone disease and fractures can also cause spondylolisthesis. Certain sports activities, such as gymnastics, weightlifting, and football, greatly stress the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. This can lead to a stress fracture on one or both sides of the vertebra. A stress fracture can cause a spinal bone to become weak and shift out of place.

Management:

Treatment depends on how severely the vertebra has shifted out of place. Most people get better with exercises that stretch and strengthen lower back muscles.

If the shift is not severe, you can play most sports if there is no pain. Most of the time, you can slowly resume activities.

You may be asked to avoid contact sports or to change activities to protect your back from being overextended.

Your provider may also recommend:

A back brace to limit spine movement
Pain medicine (taken by mouth or injected into the back)
Physical therapy

Spondylolysis

Spondylolysis is a weakness or stress fracture in one of the vertebrae, the small bones that make up the spinal column.

Spondylolysis can occur in people of all ages without injury or sports participation.

Often, patients with spondylolysis will also have some degree of spondylolisthesis.

Causes:

In spondylolysis, a crack or stress fracture develops through the pars interarticularis (pars fracture). The pars interarticularis is a small, thin portion of the vertebra that connects the upper and lower facet joints.

Most commonly, this fracture occurs in the fifth vertebra of the lumbar spine, although it sometimes occurs in the fourth lumbar vertebra. Fracture can occur on one side or both sides of the bone.

The pars interarticularis is the weakest portion of the vertebra. For this reason, it is the area most vulnerable to injury from the repetitive stress and overuse that characterize many sports.

Overuse: Spondylolysis is likely to occur in young people who participate in sports that require frequent overstretching (hyperextension) of the lumbar spine — such as gymnastics, football, and weightlifting. Over time, this type of repetitive activity can weaken the pars interarticularis, leading to fracture and/or slippage of a vertebra.

Genetics: The lower lumbar spine has a risk of developing stress weakness at the location of a spondylolysis in all children, adolescents, and adults who walk upright. Doctors believe that some people may be born with vertebral bone that is thinner than normal — and this may make them more vulnerable to fractures.

Management:

For most patients with spondylolysis and low-grade spondylolisthesis, back pain and other symptoms will improve with nonsurgical treatment.

Rest. Avoiding sports and other activities that place excessive stress on the lower back for a period of time can often help improve back pain and other symptoms.
Physical therapy. Specific exercises can help improve flexibility, stretch tight hamstring muscles, and strengthen muscles in the back and abdomen.
Bracing. Some patients may need to wear a back brace for a period of time to limit movement in the spine and allow a recent pars fracture the opportunity to heal. Although athletes wtih sudden or acute onset of pain are candidates for brace treatment, patients with longer-term pain are not. In these patients, the stress fracture will have a low chance of healing, even after several months in a brace.