Conditions Treated

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a type of arthritis that affects the spine. "Ankylosing" means stiff or rigid, "spondyl" means spine, and "itis" refers to inflammation. The disease causes inflammation of the spine and large joints, resulting in stiffness and pain. The disease may result in erosion at the joint between the spine and the hip bone (the sacroiliac joint), and the formation of bony bridges between vertebrae in the spine, fusing those bones. In addition, bones in the chest may fuse. The cause of AS is unknown, although researchers suspect genetics play a role.

Who is affected by ankylosing spondylitis?

AS is more common among young people, ages 16 to 30. The disease affects more than 500,000 Americans.

What are the symptoms of ankylosing spondylitis?

Symptoms of AS tend to occur and disappear over periods of time. The following are the most common symptoms of AS. However each individual may experience symptoms differently. Symptoms may include:

• back pain, usually most severe at night during rest
• early morning stiffness
• stooped posture in response to back pain (bending forward tends to relieve the pain)
• straight and stiff spine
• inability to take a deep breath, if the joints between the ribs and spine are affected
• appetite loss
• weight loss
• fatigue
• fever
• anemia
• joint pain
• mild eye inflammation
• organ damage, such as the heart, lungs, and eyes

The symptoms of ankylosing spondylitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is ankylosing spondylitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for ankylosing spondylitis may include the following:

x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
erythrocyte sedimentation rate (Also called ESR or "sed rate") a measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation; persons with AS often have an elevated ESR.
genetic testing - performed to determine if a person carries a copy of an altered gene for a particular disease; the specific gene (HLA-B27) is found to be present in 90 percent of people with AS.

Treatment for ankylosing spondylitis:

Specific treatment for ankylosing spondylitis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, and therapies
• expectation for the course of the disease
• your opinion or preference

There is no cure for ankylosing spondylitis. However, if symptoms are treated quickly and vigorously, long-term disability can be greatly reduced or prevented.

The goal of treatment for AS is to reduce pain and stiffness, prevent deformities, and maintain as normal and active a lifestyle as possible. Treatment may include:

• nonsteroidal anti-inflammatory medications (to reduce pain and inflammation)
• short-term use of corticosteroids (to reduce inflammation)
• short-term use of muscle relaxants and pain relievers (to relieve severe pain and muscle spasms)
• surgery (to replace a joint; to place rods in the spine; to remove parts of the thickened and hardened bone)
• maintain proper posture
• regular exercise, including exercises that strengthen back muscles

What is cervical radiculopathy/myelopathy?

Cervical radiculopathy (ra-dick-you-lop’-a-thee) is the result of injury to or compression of the root of a nerve in the neck which can result in pain at the end of the nerve where sensation is felt. On the other hand, cervical myelopathy (my-lop’-a-thee) affects the spinal cord in the neck rather than the nerve root.

What causes cervical radiculopathy/myelopathy?

There can be many causes of cervical radiculopathy/myelopathy which include degenerative changes in the neck, congenital narrowing of the spinal canal, herniated discs, tumor, trauma, or can be a combination of the any of the above.

What are the symptoms?

Symptoms of cervical radiculopathy may include pain, numbness, or weakness in the shoulder, arm, wrist or hand. Cervical myelopathy can result in weakness, problems manipulating small objects, and difficulty with normal gait.

How is cervical radiculopathy/myelopathy diagnosed?

In addition to a complete history and physical examination, diagnostic procedures for cervical radiculopathy/myelopathy may include the following:

• x-ray - a diagnostic test which uses invisible energy beams to produce images of bones onto film.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in an intervertebral disc, vertebral body, spinal cord, nerve roots, ligaments, and muscle.
• selective anesthetic injection – a needle is introduced through the skin into a specific anatomic area usually to inject a combination of local anesthetic and corticosteroid under radiographic guidance.
• electromyogram/nerve conduction studies (EMG/NCS) - a test to evaluate nerve and muscle function in the arms.

Treatment

Specific treatment for sciatica will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

To help relieve the symptoms, treatment may include:

• nonsteroidal anti-inflammatory medications
• physical therapy
• if symptoms persist or worsen, surgery to relief the pressure on the nerves/spinal cord and possible fusion of the parts of the neck may be suggested by your surgeon

What is flat-back / fixed sagittal imbalance?

“Flat-back” or fixed sagittal imbalance is a type of deformity where loss of the normal lordosis, or “sway-back”, of the lumbar spine causes the torso and head to pitch forward relative to the hips and pelvis.

What causes flat-back / fixed sagittal imbalance?

Most commonly, flat-back/fixed sagittal imbalance is related to previous surgery on the spine. Historically, Harrington-rod instrumentation was used to treat scoliosis and sometimes resulted in loss of lumbar lordosis. Occasionally, procedures which remove bone from the back of the spine to relieve pressure on nerves can result in instability and a forward-pitched position of the spine. Severe spondylolisthesis can also result in a fixed sagittal imbalance.

What are the symptoms?

The primary symptom of flat-back/fixed sagittal imbalance is the feeling of the upper-body and head being pitched forward on the pelvis, and this can be accentuated during walking. Back pain and pain radiating down the legs can also be associated with flat-back/fixed sagittal imbalance.

How is flat-back / fixed sagittal imbalance diagnosed?

In addition to a complete history and physical examination, diagnostic procedures for cervical radiculopathy/myelopathy may include the following:

• x-ray - a diagnostic test which uses invisible energy beams to produce images of bones onto film.
• computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in an intervertebral disc, vertebral body, spinal cord, nerve roots, ligaments, and muscle.

Treatment for flat-back / fixed sagittal imbalance

Specific treatment for sciatica will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

To help relieve the symptoms, treatment may include:

• nonsteroidal anti-inflammatory medications
• physical therapy
• bracing
• if symptoms persist or worsen, surgery to fuse the spine in a more balanced position may be suggested by your surgeon.

What is a herniated disc?

Discs are the soft, rubbery pads which act to provide motion and cushioning between the bones of the spinal column. They consist of an inner gel-like substance (nucleus pulposus) and an outer tough-fibrous ring (annulus fibrosus), not unlike a jelly donut.

A herniated disc, otherwise called “ruptured” or “slipped” disc, describes when the inner jelly pushes out on the outer ring and can put pressure on spinal nerves.

What causes a disc herniation?

Although disc herniations can occur with nearly any type of movement, conditions which increase the risk for a disc herniation include:

• Improper lifting
• Smoking
• Excessive body weight that places added stress on the discs (in the lower back)
• Sudden pressure (which may be slight)
• Repetitive strenuous activities

What are the symptoms of a disc herniation?

Symptoms can include:

• Arm, buttock, or leg pain
• Neck or back pain
• Tingling, numbness, or weakness in an arm, buttocks, or leg
• Loss of bladder or bowel control

How is a disc herniation diagnosed?

The physician makes the diagnosis of a disc herniation with a complete medical history, physical examination, and diagnostic tests. Diagnostic procedures may include the following:

• x-ray - a diagnostic test which uses invisible energy beams to produce images of bones onto film.
• computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in an intervertebral disc, vertebral body, spinal cord, nerve roots, ligaments, and muscle.

Treatment of disc herniations

Specific treatment for kyphosis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, and therapies
• expectation for the course of the disease
• your opinion or preference

Conservative treatment is effective in treating symptoms of herniated discs in more than 90% of patients. Most neck or back pain will resolve gradually with simple measures such as short bed rest, slow and controlled physical activity, and over-the-counter pain relievers. Once the acute symptoms resolve, exercises and physical therapy may help avoid future episodes of pain.

Epidural injections of a cortisone-like drug may also lessen nerve irritation and allow better participation in physical therapy. These shots are given on an outpatient basis over a period of weeks.

Surgery may be required if a disc fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the lower back include microdiscectomy or laminectomy depending on the size and position of the disc herniation.

In the neck, an anterior cervical discectomy and fusion may be recommended. This involves removing the entire disk to take the pressure off the spinal cord and nerve roots. Bone is placed in the disc space and a metal plate may be used to stabilize the spine. On occasion, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together.

What is kyphosis?

A normal spine, when viewed from behind appears straight. A spine affected by kyphosis, however, shows evidence of a forward curvature of the back bones (vertebrae) in the upper back area, giving a "humpback" appearance.

The Scoliosis Research Society defines kyphosis as a curvature of the spine measuring 45 degrees or greater on an x-ray. The normal spine typically has 20 to 45 degrees of forward curvature in the upper back area. Kyphosis is a type of spinal deformity and should not be confused with poor posture.

What causes kyphosis?

Most commonly, kyphosis is postural and represents an exaggerated but flexible curve. Usually postural kyphosis is noted during adolescence and is more common in girls than boys. It rarely causes pain, but exercises to strengthen the abdominal muscles and stretch the hamstrings may improve associated discomfort. Postural kyphosis rarely causes problems into adult life.

Other types of kyphosis can be congenital (present at birth), or due to acquired conditions that may include the following:

• metabolic problems
• neuromuscular conditions
• osteogenesis imperfecta - also called "brittle bone disease." A condition that causes bones to fracture with minimal force.
• spina bifida
• Scheuermann's disease - a condition that causes the vertebrae to curve forward in the upper back area. The cause of Scheuermann's disease is unknown and is commonly seen in males.

What are the symptoms?

The following are the most common symptoms of kyphosis. However, each individual may experience symptoms differently. Symptoms may include:

• difference in shoulder height
• the head bends forward compared to the rest of the body
• difference in shoulder blade height or position
• when bending forward, the height of the upper back appears higher than normal
• tight hamstrings (back thigh) muscles

Back pain, pain down the legs, and changes in bowel and bladder habits are not commonly associated with kyphosis. A person experiencing these types of symptoms requires further medical evaluation by a physician.

The symptoms of kyphosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your physician for a diagnosis.

How is kyphosis diagnosed?

The physician makes the diagnosis of kyphosis with a complete medical history, physical examination, and diagnostic tests. If the patient is a child, the physician obtains a complete prenatal and birth history of him/her and asks if other family members are known to have kyphosis.

The physician also will ask about developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation.

Diagnostic procedures may include the following:

• x-ray - a diagnostic test which uses invisible energy beams to produce images of bones onto film.
• computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in an intervertebral disc, vertebral body, spinal cord, nerve roots, ligaments, and muscle.
• radionuclide bone scan - a nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient's bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
• blood tests

Early detection of kyphosis is important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that kyphosis may be present.

Treatment of kyphosis

Specific treatment for kyphosis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, and therapies
• expectation for the course of the disease
• your opinion or preference

The goal of treatment is to stop the progression of the curve and prevent deformity. According to the Scoliosis Research Society, treatment may include:

• Observation and repeated examinations for curves that measure less than 60 degrees on an x-ray. Progression of the curve depends upon the amount of skeletal growth, or how skeletally mature, the child is. Curve progression slows down or stops after the child reaches puberty.
• Bracing may be used when the curve measures between 60 to 80 degrees on an x-ray, but skeletal growth remains. The type of brace and the amount of time spent in the brace will be determined by your physician.
• In rare instances, surgery is recommended when the curve measures 80 degrees or more on x-ray and bracing is not successful in slowing down the progression of the curve.

What is low back pain?

Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning.

Low back pain is one of the most significant health problems. Consider these statistics from the National Institutes of Health (NIH): Seventy to 85 percent of all people have back pain at some time in their life. Back pain is the most frequent cause of activity limitation in people younger than 45 years old.

What causes low back pain?

Even with today's technology, the exact cause of low back pain can be found in very few cases. In most cases, back pain may be a symptom of many different causes, including any/several of the following:

• overuse, strenuous activity, or improper use (i.e., repetitive or heavy lifting, exposure to vibration for prolonged periods of time)
• trauma/injury/fracture
• degeneration of vertebrae (often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging)
• infection
• abnormal growth (tumor)
• obesity (often caused by increased weight on the spine and pressure on the discs)
• poor muscle tone in the back
• muscle tension or spasm
• sprain or strain
• ligament or muscle tears
• joint problems
• smoking
• protruding or herniated (slipped) disk
• disease (i.e., osteoarthritis, spondylitis, compression fractures)

Can low back pain be prevented?

The following may help to prevent low back pain:

• practicing correct lifting techniques
• maintaining correct posture while sitting, standing, and sleeping
• exercising regularly (with proper stretching before participation)
• avoiding smoking
• maintaining a healthy weight
• reducing emotional stress which may cause muscle tension

How is low back pain diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for low back pain may include the following. However, during many initial assessments and examinations, specialized tests are not necessary.

• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• computed tomography scan (Also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• radionuclide bone scan - a nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient's bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
• electromyogram (EMG) - a test to evaluate nerve and muscle function.

Treatment for low back pain

Specific treatment for low back pain will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include:

• activity modification
• medication
• physical rehabilitation and/or therapy
• occupational therapy
• weight loss (if overweight)
• no smoking
• following a prevention program (as directed by your physician)
• surgery
• assistive devices (i.e., mechanical back supports)

What is neck pain?

The neck is located between the head and the shoulders. Because of its location and range-of-motion, it is often left unprotected and subject to injury.

What causes neck pain?

Neck pain can result from many different causes - from injury to inflammatory disease. Causes of neck pain and problems may include the following:

• injury (damage to the muscles, tendons, and/or ligaments)
• herniated cervical disc
• arthritis (i.e., osteoarthritis, rheumatoid arthritis)
• congenital (present at birth) abnormalities of the vertebrae and bones
• tumors

How is neck pain diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for neck pain may include the following:

• blood tests
• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in a surrounding ligament or muscle.
• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• myelogram - a procedure that uses dye injected into the spinal canal to make the structure clearly visible on x-rays.
• electromyogram (EMG) - a test to evaluate nerve and muscle function.

Treatment for neck pain

Specific treatment for neck pain will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include:

• medication (to reduce inflammation)
• medication (to control pain)
• rest
• physical therapy
• neck brace or immobilization
• exercise
• surgery

What is sciatica?

Sciatica, also known as lumbar radiculopathy, is a pain that was originally described as originating along the sciatic nerve, which extends from the back of the pelvis down the back of the thigh. The sciatic nerve is the primary nerve of the leg and is also the largest nerve in the entire body. Lumbar radiculopathy can involve any nerve which supplies the legs.

What causes sciatica?

Usually, sciatica is caused by a herniated disc in the spine that presses on a spinal nerve. Other causes that may put pressure on spinal nerves may include the following:

• tumor
• abscess
• blood clot
• awkward sitting position
• certain nerve disorders

Sometimes, a cause for the sciatica cannot be identified.

What are the symptoms of sciatica?

The following are the most common symptoms of sciatica. However, each individual may experience symptoms differently. Symptoms may include:

• lower back pain that radiates down the buttock and/or back of one thigh
• pain that extends from back down one leg
• numbness (in severe cases)
• weakness (in severe cases)

The symptoms of sciatica may resemble other conditions or medical problems. Always consult a physician for a diagnosis.

How is sciatica diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for sciatica may include the following:

• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for sciatica

Specific treatment for sciatica will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

To help relieve the pain of sciatica, treatment may include:

• nonsteroidal anti-inflammatory medications
• heat or cold applications to the sore muscles
• keep your body in motion (to minimize inflammation)
• selective injections
• surgery to take pressure off of the affected spinal nerve

What is scoliosis?

A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or sideways, curvature, and sometimes a rotation of the back bones (vertebrae). Scoliosis is defined as a curvature of the spine measuring 10 degrees or greater on x-ray and can occur in any part of the spine.

Scoliosis is a type of spinal deformity and should not be confused with poor posture. There are many types of scoliosis and they can involve any age group.

What causes scoliosis?

Causes in children

• Most cases of scoliosis in children is unknown (idiopathic). It usually develops in middle or late childhood, before puberty, and is seen more often in girls than boys.
• Although scoliosis can occur in children with neuromuscular disorders such as cerebral palsy, muscular dystrophy, spinal bifida and other miscellaneous conditions, most scoliosis is found in otherwise healthy youngsters.
• Rarely, some children are born with scoliosis.

Causes in adults

• Scoliosis usually develops during childhood, but it also can occur in adults. Adult scoliosis may represent the progression of a condition that actually began in childhood, and was not diagnosed or treated while the person was still growing.
• Adult scoliosis may also develop spontaneously during the aging process. Other spinal deformities such as kyphosis or round back, are associated with the common problem of osteoporosis (bone softening) involving the elderly.
• As more and more people reach old age in the U.S., the incidence of scoliosis and kyphosis is expected to increase. If allowed to progress, in severe cases adult scoliosis can lead to chronic severe back pain, deformity, and difficulty breathing.

What are the symptoms of scoliosis?

The following are the most common symptoms of scoliosis. However, each individual may experience symptoms differently. Symptoms may include:

• difference in shoulder height
• the head is not centered with the rest of the body
• difference in hip height or position
• difference in shoulder blade height or position
• when standing straight, difference in the way the arms hang beside the body
• when bending forward, the sides of the back appear different in height

Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated with idiopathic scoliosis. Breathing difficulty does not typically occur until curves reach more than 90 degrees. A person experiencing these types of symptoms requires further medical evaluation by a physician.

The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your physician for a diagnosis.

How is scoliosis diagnosed?

In addition to a complete medical history and physical examination, x-rays (a diagnostic test which uses invisible electromagnetic energy beams to produce images of bones onto film) are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician measures the degree of spinal curvature on the x-ray.

The following other diagnostic procedures may be performed for non-idiopathic curvatures, atypical curve patterns, congenital scoliosis, or adult scoliosis:

• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• computed tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones. CT scans are more detailed than general x-rays.

Early detection of scoliosis is most important for successful treatment.

Treatment of scoliosis

Specific treatment of scoliosis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

The goal of treatment is to stop the progression of the curve, not necessarily to completely correct the curve.

Treatment may include:

• Observation and repeated examinations may be necessary to determine if the spine is continuing to curve.
• Bracing may be used in children when the curve measures between 25 to 40 degrees on an x-ray, but skeletal growth remains. The type of brace and the amount of time spent in the brace will depend on the severity of the condition.
• Surgery may be recommended for children when the curve measures 50 degrees or more on an x-ray and bracing is not successful in slowing down the progression of the curve. For adults, recommendation for surgery depends not only on the size of the curve, but more on overall spinal balance, specific symptoms, and health status.

According to the Scoliosis Research Society, there is no scientific evidence to show that other methods for treating scoliosis (i.e., manipulation, electrical stimulation, and corrective exercise) prevent the progression of the disease.

What are spinal fractures?

Fractures are breaks in the bones of the spinal column. There can be involvement of ligaments and/or joints of the spine as well. Spinal fractures can be stable or unstable.

What causes spinal fractures?

People with osteoporosis, tumors or other underlying conditions that weaken bone can get a spinal fracture with minimal trauma or normal activities of daily living.

Other fractures may be the result high-energy trauma like a car crash, fall, sports accident or act of violence (e.g. gunshot wound).

Males experience high-energy injuries four times more often than females do. The spinal cord may be injured depending on the severity of the fracture.

What are the symptoms?

Symptoms include:

• Moderate to severe neck/back pain made worse by movement.
• In some cases when the spinal cord is also involved, numbness, tingling, weakness or bowel/bladder dysfunction.

How are spinal fractures diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for spinal fractures may include the following:

• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for spinal fractures

Specific treatment for spinal fractures will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

To help relieve the symptoms of spinal fractures and facilitate healing of the injury, treatment may include:

• nonsteroidal anti-inflammatory medications
• neck collar or back brace
• halo vest immobilization
• surgery may involve vertebroplasty/kyphoplasty where bone cement is injected into the fracture or fusion procedures to stabilize the area of injury

What is spinal stenosis?

Stenosis means narrowing. In spinal stenosis, the spinal canal, which contains and protects the spinal cord and nerve roots, narrows and pinches the spinal cord and nerves. This can occur in the neck or back. Stenosis may pinch the nerves that control muscle power and sensation in the arms or legs.

What causes spinal stenosis?

There are many potential causes for spinal stenosis, including: Aging. As you get older, the ligaments (tough connective tissues between the bones in the spine) can thicken. Spurs (small growths) may develop on the bones and into the spinal canal. The cushioning disks between the vertebrae may begin to deteriorate. The facet joints (flat surfaces on each vertebra that form the spinal column) also may begin to break down.

Heredity. If the spinal canal is too small at birth, symptoms may show up in a relatively young person.

What are the symptoms?

• In the neck, symptoms may include arm pain and difficulty manipulating small objects
• In the back, symptoms may include leg pain and difficulty walking aggravated by activity
• Numbness, tingling, hot or cold feelings, weakness or a heavy and tired feeling in the arms or legs
• Clumsiness, frequent falling, or a foot-slapping gait

How is spinal stenosis diagnosed?

These symptoms also can be caused by many other conditions, which makes spinal stenosis difficult to diagnose. There is usually no history of neck or back problems or any recent injury. Often, unusual arm or leg symptoms are a clue to the presence of spinal stenosis.

In addition to a complete medical history and physical examination, diagnostic procedures for sciatica may include the following:

• x-ray - a diagnostic test which uses invisible energy beams to produce images of bones onto film.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• computed tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for spinal stenosis

Specific treatment for sciatica will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

To help relieve the symptoms of spinal stenosis, treatment may include:

• Medications. Sometimes the pressure on the nerves is caused by inflammatory swelling. Nonsteroidal anti-inflammatory medication such as aspirin or ibuprofen may help relieve symptoms.
• Rest, followed by a gradual resumption of activity, also can help. Aerobic activity such as bicycling is often recommended.
• Losing weight can also relieve some of the load on the spine.

In such cases where conservative treatment does not relieve the symptoms, surgery may be suggested by your physician to relieve the pressure on the affected nerves.

What is spondylolysis / spondylolisthesis?

Spondylolysis is a defect or fracture of part of the vertebral bones called the pars interarticularis. It usually occurs in the fifth lumbar vertebra and, less commonly, in the fourth lumbar vertebra. Spondylolisthesis is a slippage of one vertebral body on top of another.

What causes spondylolysis / spondylolisthesis?

Spondylolysis can be attributed to a number of factors, including genetics, overuse activities (particularly those with hyperextension involvement such as football and gymnastics), and previous surgery.

Spondylolisthesis occurs when there is weakening of the restraining structures of the spine. This can be due to spondylolysis, congenital factors, degeneration of the spine, trauma, or cancer.

What are the symptoms of spondylolysis / spondylolisthesis?

Most people with spondylolysis / spondylolisthesis are asymptomatic and are unaware they have the condition. When symptoms are present, however, they may include:

• Low back pain
• Feeling of “hamstring tightness”
• Pain radiating down the legs
• Difficulty with upright posture and gait

How is spondylolysis / spondylolisthesis diagnosed?

In addition to a complete history and physical examination, diagnostic procedures for spondylolysis/spondylolisthesis may include the following:

• x-ray - a diagnostic test which uses invisible energy beams to produce images of bones onto film.
• computed tomography scan (also called a CT or CAT scan) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in an intervertebral disc, vertebral body, spinal cord, nerve roots, ligaments, and muscle.
• radionuclide bone scan - a nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient's bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
• selective anesthetic injection - a needle is introduced through the skin into a specific anatomic area usually to inject a combination of local anesthetic and corticosteroid under radiographic guidance.

Treatment for spondylolysis / spondylolisthesis

Specific treatment for spondylolysis / spondylolisthesis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Spondylolysis / spondylolisthesis symptoms usually improve with rest and time. To help relieve the pain, treatment may include:

• nonsteroidal anti-inflammatory medications
• bracing
• physical therapy
• if symptoms persist or the slippage continues, surgery to fix the bony defect or fuse the spine may be suggested by your surgeon