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Surgeons
Frederick
H. Armbrust, MD
R.
Joseph Crow, Jr., MD
John
H. Schmidt, III, MD
Matthew
P. Walker, MD |
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Physician Assistants
Larry
Young, PA
Patrick
Anderson, PA-C
Tasha
Elswick, PA-C
Sabrina
Turley, PA-C
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Areas of Expertise
Brain
Diseases & Disorders
Disorders
of the Cervical Spine
Disorders
of the Lumbar Spine
Disorders
of the Spinal Cord
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New
Patient Forms
Registration
Forms
Staff
Request
for Release
of Medical Records
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Disorders of the Lumbar Spine
Low Back Pain
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Low Back Pain Conditions
Herniated Disc (Slipped Disc)
A herniated or slipped disc is a frequent cause of mild or
moderate low back or leg pain. Soft flexible discs separate the
bones in the spine. The discs, which have a rigid outside rim
and a soft, gel-like center, act as shock absorbers and protect
the spinal cord. Activity, stress, or a mechanical problem in
the spine can cause a disc to bulge and become misshapen. The
damaged or bulging disc may pinch or irritate a nerve root,
causing pain.
Disc degeneration (osteoarthritis in the spine)
Another common disorder of the lower spine is disc degeneration,
or osteoarthritis in the spine. As the body ages, the discs in
the spine dehydrate or dry out, and lose their ability to act as
shock absorbers. The bones and ligaments that make up the spine
also become less flexible and thicken. Degeneration in the discs
is normal and is not in itself a problem. But pain occurs when
these discs or bone spurs begin to pinch and put pressure on the
nearby nerve roots or spinal cord.
Sciatica The sciatic nerve, composed of several lumbar
nerve roots, is one of the nerves most likely to become
irritated, usually by a herniated disc. Each of the major
branches of sciatic nerve travels through the pelvis and deep in
the buttocks, then down the hip and along the back of the thigh
to the foot. The pain of sciatica ranges from a mild tingling to
a sharp ache severe enough to cause immobility.
Lumbar spinal stenosis
Degeneration of the spine also can result in lumbar spinal
stenosis (LSS). This disease involves a narrowing of the canal
that houses the spinal cord and nerve roots. A narrowed spinal
canal may compress nerve roots in the lower back, resulting in
pain and weakness in the legs and a dull pain in the lower back.
Patients often find relief by sitting or standing in a hunched
over position, as if leaning on a shopping cart. Symptoms of LSS
usually do not occur until after the age of 50.
Spondylolisthesis
Degeneration in the spine also can lead to spondylolistheses, a
condition characterized by the slippage of a vertebra in the
spine. One vertebra slips forward over another, stretching or
pinching the sciatic nerve and causing pain. |
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Lumbar Disc Disease
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The bones (vertebrae) that form the spine in your back are
cushioned by small discs. These discs are round and flat, with a
tough, outer layer (annulus) that surrounds a jellylike material
called the nucleus. Located between each of your vertebra in the
spinal column, discs act as shock absorbers for the spinal
bones. Thick ligaments attached to the vertebrae hold the pulpy
disc material in place. A herniated (also called a slipped or
ruptured) disc is a fragment of the disc nucleus which is pushed
out of the annulus, into the spinal canal through a tear or
rupture. Discs that become herniated are usually in an early
stage of degeneration. The spinal canal has limited space which
is inadequate for the spinal nerve and the displaced herniated
disc fragment. Due to this displacement, the disc presses on
spinal nerves, often producing pain, which may be severe.
Herniated discs can occur in any part of the spine. Herniated
discs are more common in the lower back (lumbar spine), but also
occur in the neck (cervical spine). The area in which you
experience pain depends on what part of the spine is affected.
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Herniated Disc Symptoms Symptoms vary
greatly depending on the position of the
herniated disc and the size of the herniation.
If the herniated disc is not pressing on a
nerve, you may experience a low backache or no
pain at all. If it is pressing on a nerve, there
may be pain, numbness, or weakness in the area
of the body to which the nerve travels.
Typically, a herniated disc is preceded by an
episode of low back pain or a long history of
intermittent episodes of low back pain.
Lumbar spine (lower back): Sciatica
frequently results from a herniated disc in the
lower back. Pressure on one or several nerves
that contribute to the sciatic nerve can cause
pain, burning, tingling, and numbness that
radiates from the buttock into the leg and
sometimes into the foot. Usually one side (left
or right) is affected. This pain often is
described as sharp and electric shock-like. It
may be more severe with standing, walking or
sitting. Along with leg pain, you may experience
low back pain. |
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Surgery Your doctor may recommend
surgery if conservative treatment options, such
as physical therapy and medications do not
reduce or end the pain altogether. He or she
will talk to you about the types of spinal
surgery available, and depending on your
specific case, will help to determine what
procedure might be an appropriate treatment for
you. As with any surgery, a patient’s age,
overall health, and other issues are taken into
consideration when surgery is considered.
The benefits of surgery should always be
weighed carefully against its risks. Although a
large percentage of patients with herniated
discs report significant pain relief after
surgery, there is no guarantee that surgery will
help every individual.
You may be considered a candidate for spinal
surgery if:
- Back and leg pain limits normal activity
or impairs your quality of life
- You develop progressive neurological
deficits, such as leg weakness and/or
numbness
- You experience loss of normal bowel and
bladder functions
- You have difficulty standing or walking
- Medication and physical therapy are
ineffective
- You are in reasonably good health
Surgical Terms
- Artificial disc surgery –
Surgical replacement of a diseased or
herniated lumbar disc with a manufactured
disc. The CHARITÉ™ artificial disc consists
of a plastic core between two chrome plates
that lock into the spine.
- Discectomy – Surgical removal or
partial removal of an intervertebral disc.
- Laminectomy – Surgical removal of
most of the bony arch, or lamina of a
vertebra.
- Laminotomy – An opening made in a
lamina, to relieve pressure on the nerve
roots.
- Spinal Fusion – A procedure in
which bone is grafted onto the spine,
creating a solid union between two or more
vertebrae; and in which instrumentation such
as screws and rods may be used to provide
additional spinal support.
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Lumbar Stenosis
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The lumbar spine (lower back) consists of five vertebrae in the
lower part of the spine between the ribs and the pelvis. Lumbar
spinal stenosis is a narrowing of the spinal canal which
compresses the nerves traveling through the lower back into the
legs. While it may affect younger patients due to developmental
causes, it is more often a degenerative condition that affects
people age 60 and older. The discs may become less spongy as you
age, resulting in reduced disc height and bulging of the
hardened disc into the spinal canal. Currently, it is estimated
that about 400,000 Americans, most over the age of 60, may be
suffering from the symptoms of lumbar spinal stenosis. There are
as many as 1.2 million Americans with back and leg pain related
to any type of spinal stenosis.
Lumbar spinal stenosis may or may not produce symptoms,
depending on the severity of your case. The narrowing of the
spinal canal itself does not produce these symptoms. It is the
inflammation of the nerves due to increased pressure that may
cause noticeable symptoms to occur. When present, symptoms may
include:
- Pain, weakness, or numbness in the legs, calves,
or buttocks
- Pain radiating into one or both thighs and legs,
similar to sciatica
- In rare cases, loss of motor functioning of the
legs
- In rare cases, loss of normal bowel or bladder
function
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Pain may decrease when you bend forward, sit or lie down. Pain
may get worse when you walk short distances.
Degenerative spondylolisthesis and degenerative scoliosis are
two conditions associated with lumbar spinal stenosis.
Degenerative spondylolisthesis (slippage of one vertebra over
another) is caused by osteoarthritis of the facet joints. Most
commonly, it involves the L4 slipping over the L5 vertebra. It
is usually treated with the same conservative and surgical
methods as lumbar spinal stenosis.
Degenerative scoliosis (curvature of the spine) occurs most
frequently in the lower back and more commonly affects people
age 65 and older. Back pain associated with degenerative
scoliosis usually begins gradually, and is linked with activity.
The curvature of the spine in this form of scoliosis is often
relatively minor, so surgery is required when conservative
methods fail to alleviate pain associated with the condition.
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Surgical treatment
The most common surgery in the lumbar spine is called
decompressive laminectomy in which the laminae (roof) of the
vertebrae are removed to create more space for the nerves. A
neurosurgeon may perform a laminectomy with or without fusing
vertebrae or removing part of a disc. A spinal fusion with or
without spinal instrumentation may be recommended when
spondylolisthesis or scoliosis occurs with spinal stenosis.
Various devices (like screws or rods) may be used to enhance
fusion and support unstable areas of the spine.
Other types of surgery, including several methods of spinal
fusion to treat lumbar spinal stenosis and associated
conditions:
- Anterior Lumbar Interbody Fusion (ALIF): Removal
of the degenerative disc by going through the lower abdomen.
Bone graft material or a metal device filled with bone is
then placed into the disc space.
- Foraminotomy: Surgical opening or enlargement of
the bony opening traversed by a nerve root as it leaves the
spinal canal, to help increase space over a nerve canal.
This surgery can be done alone or together with a laminotomy.
- Laminotomy: An opening made in a lamina, to
relieve pressure on the nerve roots.
- Laparascopic Spinal Fusion: A minimally invasive
procedure involving small incisions in the abdomen, through
which a graft is placed into the disc space.
- Medial Facetectomy: Surgical procedure to remove
part of the facet (a bony structure in the spinal canal), to
increase the space.
- Posterior Lumbar Interbody Fusion (PLIF): Removal
of the posterior bone of the spinal canal, retraction of the
nerves, and removal of the disc material from within the
disc space, followed by insertion of bone graft and
sometimes hardware in order to fuse the bones. This
procedure is called an "interbody fusion" because it is
performed between the “bodies” of the vertebral bones and
across the diseased disc space. This procedure is typically
performed on both sides of the spine.
- Posterolateral fusion: Placing bone on the back
and side of the spine to achieve a fusion.
- Transforaminal Lumbar Interbody Fusion (TLIF):
Removal of the posterior bone of the spinal canal,
retraction of the nerves, and removal of the disc material
from within the disc space, followed by insertion of bone
graft and sometimes hardware in order to fuse the bones.
Similar to a PLIF, but frequently performed from only one
side.
The benefits of surgery should always be weighed carefully
against its risks. Although a large percentage of lumbar spinal
stenosis patients report significant pain relief after surgery,
there is no guarantee that surgery will help every individual. |
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