Education Center |

Spinal Conditions

Adult Scoliosis

Scoliosis is a musculoskeletal disorder that adversely affects the spine. Normally, when the spine is viewed from behind, spinal vertebrae run down the back in a straight line. Patients with scoliosis have a “side-to-side” curvature of the spine, presenting in the shape of a letter “C” or “S’”. This condition generally develops in children, but can also occur in adults. Treatment varies depending on the patient’s age and growth stage.

While adolescents with scoliosis rarely experience pain, adult patients often have a variety of symptoms, including pain in the back, gradual loss of function, and decrease in the ability to complete daily activities. It may be time to see a physician for advice if your spine curves to one side, you are experiencing low back pain, pain in your legs, muscle fatigue, a hump on the back, or uneven hips and/or shoulders. Adult scoliosis is usually diagnosed when the spine curves more than 10 degrees.

Treatment options for adult scoliosis are focused on specific symptoms and age of the patient. These options include pain relievers, anti-inflammatory injections, physical therapy, water therapy, back adjustments, or if conservative methods fail, a surgical decompression. If the spine curves more than 30 degrees, a fusion procedure will most likely be recommended along with decompression surgery. The ultimate goal of surgery is to remove pressure on the nerves and to keep the scoliosis from progressing further.

Degenerative Disc Disease

Degenerative Disc Disease (DDD) describes the normal wear and tear on spinal disks as the body ages. The vertebrae that make up the spine are separated by the soft disks. These disks act as the spine’s shock absorbers. When disks weaken, DDD occurs. Despite the name, DDD is not actually a disease. However, the pain it causes can be debilitating.

As the disks age, they will lose fluid, making them less flexible and reducing ability to absorb shock from the body. The outer layers of the disks may get damaged or cracked, forcing the nucleus, or jelly-like material inside the disk, to flow out of the cracks. Sudden injuries, smoking, heavy physical work, and obesity can also start the disk degeneration process early.

Symptoms of DDD include hip and lower back pain, thigh and buttock pain, tingling and weakness through the back, legs, and knees, and pain in the upper spine which radiates to the shoulders, arms, or hands.

To diagnose the condition, your neurosurgeon will begin with a review of your medical history and a physical examination. During the exam, your surgeon will look for tenderness and nerve changes such as numbness or tingling. If DDD is expected, an X-ray, MRI, or CT scan may be ordered. Usually, DDD can be successfully treated with conservative options like chiropractic manipulative therapy (CMT), physical therapy, and anti-inflammatory medications. However, if non-surgical treatments fail to provide relief within a few months, or if activity is greatly restricted, surgery may be recommended.

Lumbar Herniated Discs

It’s no secret that our bodies become more vulnerable to stress and trauma as we age. Our spines in particular can be affected, often leading to herniated discs. This condition involves the tearing or ripping of the intervertebral disc, which leaves the nucleus of the disc exposed to the spinal column. Herniated discs most commonly occur in the bottom two discs of the lumbar spine, causing pressure against the surrounding nerve roots or spinal cord area.

As a result, patients can feel heightened pain and immense discomfort. In addition to pain, patients suffering from lumbar herniated discs can also experience symptoms such as numbness in corresponding areas of the body, weakness resulting from nerve compression, and a tingling sensation in the hands or feet.

Treatment for lumbar herniated discs include both surgical and nonsurgical options. Nonsurgical methods of treatment are less invasive and typically involve a short period of rest, anti-inflammatory medications to help minimize swelling, and physical therapy. A common surgical procedure used to alleviate the pain associated with lumbar herniated discs is a discectomy. The goal for this type of surgery is to remove the herniated disc material that is pressing on a nerve root or spinal cord.

Most patients are usually released within 24 hours after surgery, and some even go home later the same day. During the first month of home recovery, certain tasks such as driving, sitting for prolonged periods of time, and heavy lifting should be avoided. In some instances, patients may also benefit from post-surgery physical therapy sessions to help strengthen their back and prevent relapses in the future.

Lumbar Spinal Stenosis

As we get older, our spines age too, often leading to a degeneration of the vertebrae, discs, ligaments, and muscles that make up the spinal column. These changes can lead to a condition called spinal stenosis.

“Stenosis” comes from the Greek word meaning “choking”. When the spinal nerves in the lower back become stifled, lumbar spinal stenosis occurs and often leads to leg pain and other symptoms.

The most common symptom is increased pain in the legs while walking. This can noticeably decrease one’s activity level. Patients with lumbar spinal stenosis are typically comfortable at rest, but cannot walk distances without developing leg pain. Pain relief is achieved, sometimes almost immediately, when they sit down again.

For many, the symptoms of lumbar stenosis will fluctuate, with some periods of more severe symptoms and others with fewer symptoms or none at all. Symptoms are not always progressive over time. For each person, the severity and duration of lumbar stenosis symptoms is different and often dictates whether conservative (non-surgical) treatment or surgery is more suitable.

When a patient presents with the typical symptoms of lumbar spinal stenosis, a conclusive diagnosis is made using imaging from an MRI or CT scan. Physical examination alone cannot be used for a conclusive lumbar spinal stenosis diagnosis.

Non-surgical treatment options for lumbar spinal stenosis include exercise and physical therapy, activity modification, non-steroid anti-inflammatory drugs, and epidural injections. Surgery for lumbar spinal stenosis should only be considered if a patient’s ability to participate in everyday activities is reduced to an unacceptable level and after conservative treatments have been tried to no avail.

Sciatica

A common type of pain which affects the sciatic nerve, and extends from the lower back down the back of each leg, is known as Sciatica. It usually affects just one side of the lower body, but can sometimes spread to the foot or toes as well. Sciatica occurs when the discs in our lumbar spine wear down over time, causing them to bulge out and become herniated. As a result, the nerve root gets compressed and irritated, leading to inflammation, pain, and even numbness in the affected leg.

Other possible causes of Sciatica include lumbar spinal stenosis, degenerative disc disease, spondylolisthesis, and pregnancy. Sciatica can affect different age groups, including both younger and older people. Patients suffering from this condition often experience pain in the rear or leg that tends to get worse when sitting. Other common symptoms associated with sciatica include weakness/numbness, difficulty moving the leg or foot, and a shooting pain that hinders the ability to stand up.

Certain things that can further intensify one’s pain include being overweight, engaging in little to no physical activity, wearing high heels, or sleeping on  too soft of a mattress. Depending on the severity of the patient’s sciatica, it’s possible to experience improvement without resorting to surgical intervention through methods like physical therapy and muscle relaxants.

However, other extreme instances of sciatica may call for surgery. This is particularly evident when severe leg pain persists for 6 weeks or longer, causing patients to have limited mobility. Another situation that makes surgery necessary is when pain relief is not achieved after nonsurgical treatments have been administered. Two common surgical procedures that sciatica patients should consider include a microdiscectomy, which is a small open surgery, and a lumbar laminectomy or an open decompression.

Cranial Conditions

Acoustic neuroma - Vestibular Schwannoma

An acoustic neuroma, also known as a vestibular schwannoma, is a benign, or non-cancerous tumor that grows on the vestibular cochlear nerve. This nerve is located behind the ear and under the brain, and is responsible for balance and hearing.

Acoustic neuromas are slow-growing tumors that do not spread to other parts of the body. Although they do not encroach on the brain, pressure on the brain from the acoustic neuroma can cause complications.

Although genetic defects, exposure to loud noise, and prior exposure of the neck and/or head to radiation are all possible suspects in causing or contributing to these types of tumors, the causes are not fully understood.

Symptoms are often not noticeable in the beginning, but as the tumor grows in size, common symptoms may include ringing in the ear (tinnitus), hearing loss, or abnormal sensation of movement. Other possible symptoms are headaches, facial numbness, loss of coordination and balance, drowsiness, ear pain, and cognitive difficulties.

If an acoustic neuroma is suspected, the diagnosis process starts with an audiogram, a test to evaluate hearing ability in each ear. Speech may also be evaluated. Afterward, imaging such as an MRI or CT scan can be used to help highlight and detect presence of a tumor.

An auditory brainstem response, or ABR test, may also be performed by your neurosurgeon. Although an abnormal result of the ABR test may imply possible diagnosis of acoustic neuroma, an abnormal result should be validated by an imaging test.

Options for treatment depend on the size and location of the tumor; radiation therapy, surgery, or a combination of both may be recommended.

Arteriovenous Malformation

An arteriovenous malformation, or brain AVM, is a defective tangle, or knot of abnormal blood vessels that connect the arteries and veins in the brain.

Although the cause is still unclear, it is suspected that most people are born with brain AVMs, with only a small portion of AVMs forming later in life. They can develop anywhere in the body, but occur mostly in the brain and spine.

The arteries, which are responsible for carrying oxygenated blood from the heart to the brain, and veins, which take oxygen-depleted blood to the lungs and heart, are disrupted when brain AVMs occur. Potential for bleeding make AVMs dangerous.

Symptoms, which may present at any time, include headaches, and even seizures, although not one particular headache or seizure has been identified. Seizures can be partial or total, and headaches can vary greatly in intensity. Sometimes, a migraine-type headache on one side of the head can be indicative of brain AVM. Other symptoms may occur, such as weakness or paralysis on one side of the body, a loss of coordination, visual disturbances, and/or memory deficits.

Brain AVMs are rare and affect about 300,000 Americans, or less than 1 percent of the US population.

Tests such as a Cerebral Angiography, an MRI, MRA, or CT scan may be used to help diagnose and determine the best treatment options.

Treatment options may include embolization, non-reactive liquid glue used to block off the AVM, or radiation therapy. Radiation therapy is a non-surgical treatment where X-rays are used to reduce the size of the AVM and close it off over a set period of time. Another option is surgical excision, in which the AVM is surgically removed. An arteriovenous malformation will not grow back after surgical excision.

Chiari Malformation

When a Chiari Malformation occurs, the part of the skull containing the cerebellum is either deformed or too small, which puts pressure on the brain and brainstem, forcing it past the opening of the spinal canal. This pressure can cause neurological issues, and can disrupt the flow of cerebrospinal fluid, which protects the brain and spinal cord.

The cause of Chiari malformation is not currently known, but experts suspect it may occur as a result of faulty fetal development, or is possibly genetically-derived. There are four distinct forms of Chiari malformation, Type I being the most common of the four.

Symptoms of Chiari malformation Type I include headaches made worse by coughing, sneezing, or otherwise straining the upper body. Neck pain accompanied with gait and balance problems may also occur. Patients with Chiari malformation Type I may also experience numbness and tingling of the feet and hands, motor issues, slurred speech, vision problems, and difficulty swallowing. Type II may also include symptoms related to spina bifida. Types II, II and IV may be noticed when the patient is born, but Type I may not present itself until adolescence or adulthood. With older patients, a family history questionnaire, along with a physical exam and diagnostic imaging tests can help confirm diagnosis.

If symptoms are not severe or present at all, your neurosurgeon may prescribe observation and medication. However, to treat a case of severe Chiari malformation, surgery is required. More than one surgery may be needed to treat Chiari Malformation.

Craniopharyngiomas

Craniopharyngiomas are benign, slow-growing tumors that develop near the pituitary gland, a small endocrine gland at the base of the brain. These tumors commonly affect children 5-10 years of age, although adults may be affected. Both boys and girls are equally likely to develop the condition. The causes of craniopharyngiomas are not yet fully known or understood; however, doctors believe these tumors are formed at birth.

Craniopharyngioma cause increased pressure on the brain, which in turn disrupts the function of the pituitary gland and damages the optic nerve. Increased intracranial pressure can cause headaches, nausea, vomiting, and coordination difficulties. In addition, pressure on the pituitary gland can cause delayed puberty, stunted growth, loss of sexual desire, excessive thirst, cold sensitivity, constipation, excessive urination, nausea, depression, behavioral and learning problems, obesity, dry skin, and increased sleepiness.

Again, although these tumors are not malignant, they may invade and become adherent to the pituitary gland, optic nerves, intracranial arteries, and the brain. A CT scan or MRI can be used to diagnose and evaluate these tumors. A blood test may also be performed to aid diagnosis.

While surgery is the traditional treatment option for craniopharyngiomas, as the goal is to remove the tumor cells, radiation treatment may be the better option for some patients. In these cases, radiation can be used instead of surgery, or along with a smaller surgery, depending on the exact location of the tumor.

 

Ependymoma

An ependymoma is a type of brain tumor that arises from from ependymal cells that line the brain and spinal cord. Ependymomas are classified into four major types, found in different regions of the brain and spinal column and with different growth rates. Ependymomas can affect both adults and children.

Symptoms may vary depending on the size and location of the tumor. Some symptoms that may suggest the development of ependymomas include headaches, nausea, fatigue, mobility issues, fatigue, nausea, body weakness, or issues with coordination.

Diagnosis of an ependymoma starts with a review of medical history and a physical and neurological exam. Then, imaging studies like an MRI or CT scan, or a biopsy, can be used to confirm diagnosis and determine the best course of treatment.

Treatment options depend on the location and grade of ependymoma, as well as the age and health of the patient. Treatment may include one or a combination of options, including surgery, chemotherapy, or radiotherapy.

Gliomas

Gliomas are brain tumors that arise from neuroglial cells, the supportive cells of the brain. The risk of developing a glioma increases with age, with the greatest risk between 75 and 84 years, although versions of gliomas can occur in children.

Causes are not fully known. Genetic disorders are suspected as culprits, and exposure of the brain to radiation is the only other significantly-known risk factor.

Symptoms of gliomas vary depending on the location of the tumor. Some of the common symptoms include persistent headaches, impaired vision, vomiting (not associated with migraine), loss of appetite, lack of muscle control, memory loss, changes in personality, mood, cognitive changes, new seizures, and speech difficulties.

If your neurosurgeon suspects the presence of a glioma, several high-tech options are utilized for diagnosis. Options include a CT scan, MRI, or PET scan. Magnetic resonance spectroscopy (MRS) may also be used to examine the tumor’s chemical profile.

Treatment options depend on the grade, or severity of the tumor, as well as its location in the brain. Programs for treating gliomas may include surgery, radiation, and chemotherapy, or a combination.

If surgery is needed, it is scheduled soon after initial diagnosis. During surgery, affected cells are removed. Afterward, radiation and/or chemotherapy are often used to remove the remaining affected cells. Gliomas bear tentacles that may spread throughout the brain. Radiation tries to shrink the cells, using energy beams to slow or stop the growth. With successful radiation, the cancerous cells are unable to reproduce. This mode of treatment is typically used for about 6 weeks, and is started approximately 2 to 4 weeks after surgery. Chemotherapy drugs are given during radiation to help kill cells, and their usage is continued after radiation as maintenance treatment of the glioma.

Meningioma

A meningioma is a tumor that arises from the meninges, or the membranes of the brain and spinal cord. Most meningiomas are non-cancerous, or benign. Sometimes, however, this type of tumor may be cancerous (malignant), or in-between. This brain tumor develops and stays in the brain, and is classified into three grades, or types, depending on growth rate and location.

Meningiomas occur most often in older women, but they can occur in males or people of any age, including children.

Since meningiomas grow slowly, and may not have to be treated at the onset. However, if left untreated, they can interfere with the brain’s normal functioning. In certain areas of the brain, they can be severely disabling and even fatal if they become large enough.

Although some environmental factors are suspected of contributing to the development of tumors like meningiomas, doctors do not know the exact cause.

The symptoms of meningiomas become noticeable when the tumor has grown quite large. Some people with a meningioma may never experience symptoms. If experienced, common symptoms include headaches, seizures, changes in behavior, confusion, nausea, vomiting, and vision problems. Symptoms will vary depending on the size and location of the tumor.

If a meningioma is suspected, a neurological exam will be performed. The exam often involves checking the function of the eyes, ears, nose, and muscles. Sensation, balance, coordination, mental state, and memory are assessed, and an MRI, MRA, or CT scan may be ordered. Results from imaging studies can help determine the size, location, and type of meningioma.

Surgery is generally the standard treatment option for meningiomas because they are a benign tumor with defined boundaries. But surgery may not be the only treatment option available. Radiation therapy may be ordered if complete removal of affected cells is impossible or if the tumor returns.

Normal pressure hydrocephalus

Normal pressure hydrocephalus, or NPH, is a condition that occurs in the brain’s ventricles or cavities when an abnormal buildup of cerebrospinal fluid (CSF) is present. NPH causes a disruption in the normal flow of CSF throughout the brain and spinal cord area, thus creating a blockage. Although it is most commonly diagnosed in the elderly, NPH can be found in people of any age. The development of NPH among patients may stem from other known conditions, including a subarachnoid hemorrhage, head trauma, infection, tumor, or surgery related complications. However, others may also develop the disorder regardless of these underlying factors.

Normal pressure hydrocephalus usually presents itself with symptoms of forgetfulness, poor balance, trouble walking, falling, mood changes, depression, and trouble with bladder or bowel control. The symptoms associated with NPH are similar to those of other conditions, such as Parkinson’s, Dementia or Alzheimer’s. For this reason, the disorder is often misdiagnosed, or in some cases, is overlooked by family members who may believe the signs are typical of “old age” ailments. There are several tools and tests used by doctors to correctly diagnose NPH, while ruling out other conditions. These include brain scans such as CT or MRI, spinal tap or lumbar catheter, intracranial pressure monitoring, as well as other types of neuropsychological tests.

Once a patient is diagnosed with NPH, a lumbar puncture to remove the spinal fluid is usually recommended as a treatment option, followed by surgery. During the surgery, a ventriculoperitoneal shunt or tube is placed in the brain with the use of a catheter to drain fluid from the head into the abdomen. Although this procedure isn’t effective for everyone with NPH, some patients do show significant improvement. Timely diagnosis and treatment are key to increase your chances of a successful outcome.

Pituitary Tumors

Our pituitary gland is one of the most important glands in the human body. Attached to the brain’s base, it controls the secretion of hormones and is often called the “master gland”. The pituitary gland is indeed important, affecting growth, metabolism, sex drive, and stress function.

Pituitary tumors grow abnormally within the pituitary gland. When these types of tumors are benign, they grow at extremely slow speeds and do not spread to surrounding areas. Invasive types of pituitary tumors can be benign or malignant (cancerous) in nature. While invasive pituitary adenomas are benign, they can spread to affect the bones of the skull and/or the sinus cavities, causing further complications.

Pituitary carcinomas are invasive, cancerous tumors that may grow and affect the brain, spinal cord, and the areas just outside the central nervous system (CNS). These tumors can also affect the pituitary gland’s functions, making it secrete too many or too few hormones. Consequentially, abnormal hormone levels can arise and cause problems in other parts of the body.

Radiation exposure and genetic disorders have been linked with tumor growth, although the cause of pituitary tumors is not yet fully known. Symptoms depend on if the tumor is affecting hormone production. A variety of symptoms are possible, depending upon the type of hormone affected. If the tumor is non-functioning, or does not affect hormones, symptoms will be directly related to the tumor’s size and may include headaches, nausea, vomiting, and vision problems. Other symptoms may include production of breast milk, even when not pregnant or nursing, loss of male sex drive, or lower sperm count, weight changes, increased bruising, aching joints, and muscle weakness.

If your neurosurgeon suspects that you have a pituitary tumor, a neurological exam is completed. The function of eyes, ears, nose, and muscles is checked, as well as muscle coordination, sensation, mental state, and memory. Levels of hormones in the blood are examined. Diagnostic imaging tests such as a CT scan or MRI may be ordered to learn more about the tumor’s size and location. Diagnosis may also be confirmed by examining a tissue sample taken from the tumor by way of a biopsy.

Treatment options may vary; some pituitary tumors may be treated with medication, but observation of the tumor with periodic diagnostic imaging scans should be performed. Patients may be referred to an endocrinologist if hormone changes occur or if prescribed hormone-blocking medication is utilized a form of treatment.

If the tumor is too large, and is putting pressure on crucial nearby structures like the optic nerve, surgery may be necessary, and radiation therapy may be used to complement surgery.

Subarachnoid Hemorrhage

When a subarachnoid hemorrhage occurs, bleeding is present within the subarachnoid cavity, the area of the skull between the brain and the thin tissues that cover the brain. A subarachnoid hemorrhage may occur as a result of arteriovenous malformation, cerebral aneurysms, head injury, or even bleeding disorders or use of blood thinners.

A sudden and severe headache is the most common symptom of subarachnoid hemorrhage. Patients typically describe the headache as the worst headache of their lives. Other symptoms that may indicate presence of a subarachnoid hemorrhage include dizziness, fainting, personality and mood changes, confusion, seizures, neck pain and stiffness, vision problems, nausea, and vomiting.

Diagnosis involves a physical, neural, and eye examination. Diagnostic imaging tests such as a CT scan, MRI, MRA, or Transcranial Doppler Ultrasound may also be used. If a CT scan shows no abnromal results, your neurosurgeon may recommend a lumbar puncture, or spinal tap, to be sure.

A subarachnoid hemorrhage can be life threatening. Treatment may include repairing causes of bleeding, relieving symptoms, and preventing possible complications such as stroke. Surgery is performed to remove pockets of blood in the subarachnoid space and to relieve pressure on the brain.

Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. When trigeminal neuralgia is present, even mild stimulation of the face, such as brushing your teeth or putting on makeup—can cause excruciating pain.

Initially, mild attacks are common. However, trigeminal neuralgia can progress and cause longer, more painful episodes. Trigeminal neuralgia affects women more often than men and is more likely to occur in adults over 50. Symptoms include one or more of the following patterns: shooting or jabbing pain that feels like an electric shock, spontaneous pain attacks, pain caused by activities such as brushing teeth, chewing, speaking, and touching the face, bouts of pain lasting a few seconds to several minutes, episodes of attacks lasting days, weeks, or even longer, constant aching and burning, and attacks that become more frequent over time.

Thankfully, there are a variety of treatment options available for trigeminal neuralgia. These include medications, injections, and surgery. Your doctor will make a diagnosis based on the characterization of your pain, including the type, location, and triggers of the pain. A neurological examination or MRI may be ordered to aid in diagnosis.

Medications such as anticonvulsants, antispasmodic agents, and Botox injections may help. If surgery is indicated, there are several surgery options ranging from balloon compression to Gamma Knife radiosurgery. You can talk with your doctor to see what’s best for you.

If you experience facial pain, especially if it’s prolonged or recurring or doesn’t go away with over the counter pain relievers, visit your doctor for advice.

The information provided in the Education Center is for educational purposes only. Please follow up with a medical professional for advice. If you are experiencing a medical emergency, please call 911.

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