Conditions Treated at The Spine Institute

A herniated (or “ruptured”) disc occurs when some of the gel-like substance inside one of the rubbery discs cushioning the vertebrae of the spine pushes through a tear in its exterior. This can irritate or compress nearby nerves, causing pain, tingling, and discomfort – although the herniation on its own may cause no discernible symptoms. While the disc may have been bulging at some point prior, it is only considered ruptured or herniated when it tears.

The most common cause of a herniated disc is wear and tear, or disc degeneration. The second-most common is trauma, as can happen when using back muscles to lift heavy objects, instead of thigh and leg muscles, for example. The lumbar (lower back) and cervical (neck) spine are most often affected by herniated discs.

Imaging tests, such as an MRI or computed tomography (CT scan) may be used to identify bone or soft tissues disorders like a herniated disc. X-rays may be used to rule out other causes of spinal pain like fractures, tumors, or alignment issues.

Your treatment choices will depend on the degree of damage or degeneration of the disc. For the majority of people, conservative treatment options, such as medications, epidural injections, or physical therapy, will relieve the pain and symptoms of nerve compression. Others may require surgery to alleviate the pressure on nerves and resulting pain.

There are various methods of spinal decompression surgery, which is performed to create more space around the affected nerve and relieve pressure:

• Discectomy, or surgery to remove the protruding portion of the spinal disc
• Laminectomy, which removes part of the vertebra to provide more room for the spinal cord
• Foraminotomy, which widens the opening between vertebrae known as the foramen

If the disc is severely damaged, it may need to be replaced with an artificial disc to stabilize the spine.

Stenosis indicates a narrowing of the spinal canal. It occurs most often in the cervical (neck) and lumbar (lower back) areas of the spine, and can be caused by herniated discs, bone spurs, fractures, and tumors, as well as thickening of the ligaments that hold the spinal bones together.

Much like a herniated disc, spinal stenosis can cause pain, numbness, or tingling symptoms when nearby nerves become compressed. Decompression surgery and spinal fusion procedures are common treatment choices.

Scoliosis is an abnormal sideways curvature of the spine, creating an S or C shape in the spine in severe cases.

Most cases of scoliosis become evident during adolescence, with girls and those with a family history of scoliosis at higher risk of developing the condition. Because its cause is unclear, this type of scoliosis is often referred to as idiopathic scoliosis.

Symptoms of scoliosis may be difficult to notice early on, as spinal changes occur slowly over time. Telltale signs are clothing that no longer fits properly – especially at the waist – or uneven pant legs. A person’s head may appear to be off-center, and a hip or shoulder may be noticeably higher than the opposite side.

Less common types and causes of scoliosis include:

• Congenital Scoliosis: Occurs when vertebrae do not properly form during fetal development, so the sideways curve of the spine is present at birth.
• Degenerative Scoliosis: Occurs due to arthritic changes in the spine (spondylosis), and is thus most likely to occur in older adults. The spine may abnormally curve when the soft tissue of the spine weakens over time. It may be accompanied by bone spurs,osteoporosis, spinal fractures, and disc degeneration. Back and leg pain frequently occur with this type of scoliosis, due to arthritic inflammation and nerve compression.
• Functional Scoliosis: Occurs due to other problems in the body, such as muscle spasms in the back or one leg being shorter than the other.
• Spinal Tumors: Tumors of the spine, such as benign osteoid osteoma, can sometimes create scoliosis. This is because patients often lean to one side to reduce painful pressure on the tumor, causing the spine to curve over time. Surgical removal of the tumor usually corrects the curvature.

At The Spine Institute, we treat adult and pediatric patients with scoliosis. Treatment is based on the severity of the spinal curvature. Bracing tends to be used when scoliosis is caught early, but it only works to prevent the curve from getting worse – it doesn’t correct the curvature.

In more severe cases, Dr. Hardacker may recommend surgically correcting the curvature and stabilizing the spine. This typically involves a spinal fusion surgery.

Spinal fractures most commonly occur due to the degenerative spinal weakening of osteoporosis, in which case the break is called a compression fracture. It indicates that a vertebra in the spine has decreased in height due to a break in the bone.

Once the vertebrae have been weakened, all it can take is a fall, severe cough, or lifting of a heavy object to cause a spinal fracture. Trauma – due to sports or work-related injuries or accidents – can also cause spine fractures.

The sudden onset of back pain may indicate a spinal fracture. Pain may worsen while standing or walking and may lessen when lying on your back. A spinal X-ray should be able to determine whether a fracture occurred.

Immobilization of the area with a brace or corset may be required to prevent further injury in the event of a spine fracture.

Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat vertebral compression fractures. Both aim to stabilize a fracture by injecting surgical bone cement into the fractured vertebra.

During a vertebroplasty, the patient is sedated but remains awake while the cement is injected under high pressure with X-ray guidance. The cement simply fills the fracture but does not restore the normal height of the vertebra.

Kyphoplasty – also known as a balloon kyphoplasty – is typically performed under general anesthesia. A balloon catheter is guided into the vertebra and inflated with liquid to create a cavity so that the cement may be injected with little pressure. The inflation of the balloon also helps to restore the natural height of the vertebra, as well as spinal alignment. The balloon is deflated, removed, and the cavity filled with a thicker cement than is used in a vertebroplasty.

Kyphoplasty may be the best option for severe vertebral fractures in which the collapse or wedging of the vertebra causes spinal deformity.

Tumors that develop along the spine, like tumors elsewhere in the body, can be either benign (noncancerous) or malignant (cancerous).

Most spinal tumors are benign and grow slowly; they include meningiomas, neurofibromas, osteoid osteomas, and many more. The most common malignant spinal tumor is osteogenic sarcoma (osteosarcoma).

Depending on the type of tumor, its location, rate of development, and suspected cause, treatment may include biopsy or removal of the tumor itself, and preserving spinal function and stability with spinal decompression and fusion. Controlling pain and treating any underlying cause is also an important part of any plan to treat spine tumors.

Kyphosis is an abnormal curvature of the spine, where the spine is bent forward so that a person appears to have an abnormally rounded upper back. It is commonly referred to as a hunchback. This is different from scoliosis, in which the curvature is lateral – curving sideways into an S or C shape.

Kyphosis occurs due to degeneration of the spine over time. Osteoporosis can contribute to this, as can receiving high doses of corticosteroids for long periods of time.

Nonsurgical treatments – such as pain medications and physical therapy – are typical first-line therapies for milder cases of kyphosis. In severe cases, surgery can correct and stabilize spinal alignment.

Commonly referred to as a “slipped disc,” spondylolisthesis refers to an abnormal alignment of the spine due to the forward or backward slip of a vertebra onto an adjacent vertebra.

When the extent of slippage is significant, the disc can pinch nerves in the spinal cord, causing pain in the back, legs, and buttocks that worsens with standing.

Spondylolisthesis may occur as the result of degenerative conditions that affect the spine, such as osteoporosis, or due to the sudden trauma of an accident or injury.

Treatment will depend on the severity of the condition. Surgical options focus on alleviating pressure on the nerves and stabilizing the spine, such as with a spinal decompression procedure and spinal fusion.

Myelopathy is a nervous system disorder affecting the spine. It can occur in any area of the spine but is most common in the neck (cervical myelopathy). It is caused by compression of the spinal cord, which can occur for a variety of reasons, including disc herniation, degenerative disorders such as stenosis (narrowing of spinal canal), spine tumors, trauma, and infection. Nerve damage that results in inflammation is called myelitis.

When the nerves of the spinal cord do not function as they should, communication signals are not properly transmitted to the brain or other parts of the body. This can result in pain, tingling, or numbness in areas of the body associated with the affected nerves.

For example, nerves damaged in the cervical area of the spine can cause weakness in the neck or arms. Difficulty with motor functioning is a common symptom of myelopathy – such as trouble with walking, bodily coordination, or proprioception (sense of body position).

Imaging tests such as X-rays, computed tomography (CT scans), or a myelography (a type of X-ray used in conjunction with injected contrast dye) may be used to identify a nervous system disorder of the spine.

Treatment for myelopathy includes relieving pressure on the spinal cord, as with any of the surgical procedures treating stenosis. The treatment selected may depend on the cause of the problem. If not treated, myelopathy can lead to permanent nerve damage.

Neuromuscular disorders involve impairment of the muscles of the body, usually by nerve damage, which disrupts nerve signals to the muscles.

A wide range of conditions can affect the nerves of the spine, including:

• Polio – condition in which a virus destroys nerve cells in the spinal cord
• Multiple sclerosis (MS) – autoimmune disease in which the body’s own immune system damages the protective coating of nerves
• Spinal muscular atrophy (SMA) – a genetic disorder that destroys nerves in the spinal cord

At The Spine Institute, Dr. Hardacker can treat polio-associated spinal deformities with complex spinal reconstruction.

Spinal decompression procedures may be indicated for patients with MS or SMA. Spinal fusion surgery may be recommended to treat scoliosis caused by SMA.