Lumbar Spine Health

Lumbar Spine Health

The lumbar spine, also known as the lower back, is a critical part of the human body. It provides structural support, enables movement, and protects the delicate spinal cord and nerves that run through it. As a result, maintaining the health of the lumbar spine is essential for overall well-being, and any issues in this region can have a significant impact on a person’s quality of life. This is particularly important for patients who require neurological surgery, as the lumbar spine can be a common site of nerve compression, herniated discs, and other conditions that may require surgical intervention.

At the Dr. Ilyas Munshi, M.D. neurological surgery clinic, ensuring the health of the lumbar spine is a top priority. Patients who seek out these clinics may be experiencing a wide range of issues related to the nervous system, and many of these conditions can be linked back to problems with the lumbar spine. By emphasizing the importance of lumbar spine health, our clinic can help patients take proactive steps to maintain their spinal health, identify potential issues early on, and receive the appropriate treatment when necessary. By doing so, patients can experience better outcomes from their surgeries and improve their overall quality of life.

Cauda Equina Syndrome

Overview

Cauda Equina Syndrome is caused by compression of lower spinal cord and nerve roots. This is a medical emergency that can cause irreversible damage if not treated immediately.

Anatomy

The spinal cord begins to taper and end between the first and second lumbar vertebrae. Following the end of the spinal cord is a collection of nerve roots called the cauda equina. These nerve roots resemble a “horse-tail,” hence, the name cauda equina (latin for horse tail.)  These nerve roots provide motor and sensory function to many areas, including the legs, bladder, anus, and perineum.  In Cauda Equina Syndrome, the cauda equina nerves become compressed.

Causes

• Large herniated disc
• Trauma
• Tumor
• Hemorrhage

Symptoms

• Sudden lower back pain
• Loss of bladder or bowel function
• Saddle paresthesias (rectal and/or genital numbness)
• Extreme leg weakness

Diagnosis

Cauda Equina Syndrome may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause including: x-rays, CT, or MRI imaging.

Treatment

Cauda Equina Syndrome is a medical emergency and must be treated promptly to prevent irreversible damage. Depending on the cause, a discectomy or a spinal decompression surgery may be necessary.

 

Lumbar Radiculopathy

Overview

Lumbar radiculopathy is a problem that results when a nerve in the lower back  is irritated as it leaves the spinal canal.

Anatomy

The lumbar spine is made up of five vertebrae which span from the base of the thoracic spine to the sacrum. The vertebrae are separated by discs which help with shock absorption. The vertebrae and discs are located in front of the spinal canal where the spinal cord is located. Spinal nerves run from the spinal canal to the body through openings on both sides of the vertebrae called neural foramen. The spinal nerves are responsible for providing sensation and motor function to the areas they innervate.

In the case of cervical radiculopathy, the spinal nerve will become irritated secondary to herniated disc, osteoarthritis, or another interfering structure.

Symptoms

• Back pain that radiates into the buttock, hip, or lower leg
• Lower extremity numbness
• Lower extremity weakness

Diagnosis

Lumbar radiculopathy may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause including: x-rays, CT, or MRI imaging.

Treatment

Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include medications, heat/ice, physical therapy, and epidural injections. In some cases, surgery may be necessary.

 

Lumbar Spondylolysis & Spondylolisthesis

Overview

Spondylolysis and spondylolisthesis are conditions that affect the facet joints. Spondylolysis is a weakness or fracture of the facet joint. Over time, the weakness can lead the bones to slip out of their normal position, called spondylolisthesis.

Anatomy

The spine is made out of 24 vertebral bones. The vertebrae are separated by intervertebral discs which provide a cushion and keep the bones from rubbing together. Additionally, the vertebrae are connected to each other by a facet joint.

Each vertebrae has a superior facet and an inferior facet, separated the pars interarticularis. The inferior facet of one vertebrae connects to the superior facet of the underlying vertebrae, overlapping like shingles on a roof. These joints are found throughout the spine– beginning at the base of the skull and ending at the sacrum, or tailbone.

In the setting of spondylolysis, the pars interarticularis begins to break down or is fractured. If spondylolysis is present, then you are at risk to develop spondylolisthesis.

Spondylolisthesis is when the vertebrae slips forward out of its normal position. This slippage can cause pinched nerves and pain.

Causes

• Genetic
• Repeated stress
• Trauma

Symptoms

• Many patients may be asymptomatic
• Lower back pain
• Lower back stiffness
• Sciatica

Diagnosis

Spondylolysis and spondylolisthesis may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause including: x-rays, CT, or MRI imaging.

Treatment

Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include medications, heat/ice, physical therapy, and epidural injections. In some cases, surgery may be necessary.

 

Lumbar Disc Herniation

Overview

A lumbar disc herniation occurs when an intervertebral disc tears or ruptures. The protruding disc material will cause compression and irritation to the spinal cord or nerve root.

Anatomy

The lumbar spine is made up of five vertebrae which span from the base of the thoracic spine to the sacrum. The vertebrae are separated by discs which help with shock absorption. The disc is made up of an inner gel-like substance which is surrounded by a fibrous cartilage. When the outer layer tears or ruptures, the gel substance can protrude, or herinate.

The vertebrae and discs are located in front of the spinal canal where the spinal cord is located. Spinal nerves run from the spinal canal to the body through openings on both sides of the vertebrae called neural foramen. The spinal nerves are responsible for providing sensation and motor function to the areas they innervate.

When the disc herniates, it can push against the spinal cord or nerve roots and cause lumbar radiculopathy.

Causes

• Age
• Trauma
• Heavy lifting or strains

Symptoms

• Lower back pain
• Radiating pain in buttocks or lower extremities
• Numbness or tingling in lower extremities
• Lower extremity weakness

Diagnosis

A herniated disc may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause including: x-rays, CT, CT myelogram, or MRI imaging.

Treatment

Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include medications, physical therapy, and epidural injections. In some cases, surgery may be necessary.

 

Lumbar Degenerative Disc Disease

Overview

Degenerative disc disease is a form of arthritis which causes the discs in the spine to degenerate typically secondary to aging.

Anatomy

The lumbar spine is made up of five vertebrae which span from the thoracic spine to the sacrum. The vertebrae are separated by discs which help with shock absorption.

The disc is made up of an inner gel-like substance which is surrounded by a fibrous cartilage. With age, typically the disc will begin to dry out and shrink. This causes the vertebrae to become closer together which may lead to the development of bone spurs.

The vertebrae and discs are located in front of the spinal canal where the spinal cord is located. Spinal nerves run from the spinal canal to the body through openings on both sides of the vertebrae called neural foramen. The spinal nerves are responsible for providing sensation and motor function to the areas they innervate.

Causes

• Age
• Excessive straining
• Obesity

Symptoms

• Back pain
• Lower extremity pain
• Lower extremity numbness or tingling

Diagnosis

Degenerative disc disease may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause including: x-rays, CT, or MRI imaging.

Treatment

Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include medications, physical therapy, and epidural injections. In some cases, surgery may be necessary.

 

Sciatica

Overview

Sciatica is caused by pressure on the sciatic nerve in the lower back. This is typically caused by herniated discs, bone spurs, or muscle strain.

Anatomy

The sciatic nerve is formed from L3 and L4 spinal nerves.The sciatic nerve runs through the pelvis and down the back of each leg. The large nerve divides into two smaller nerves (peroneal and tibial nerve) around the knee. The nerves provide motor and sensation to the legs and feet.

One might experience sciatica if the sciatic nerve becomes compressed, inflamed, or damaged.

Causes

• Piriformis syndrome (tightening of piriformis muscle)
• Herniated disc
• Spondylolisthesis 
• Trauma
• Osteoarthritis

Symptoms

• Lower back pain that radiates to the buttock
• Pain radiating down the leg
• Numbness in leg or foot

Diagnosis

Sciatica may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause including: x-rays, CT, or MRI imaging.

Treatment

Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include medications, activity modification, and physical therapy. In some cases, surgery may be necessary.

 

Lumbar Microdiscectomy

Overview

A lumbar microdiscectomy is a minimally invasive surgery to remove a herniated or damaged disc in the lower back.

Who is a Candidate?

This surgery may be performed for individuals with herniated or degenerative discs with significant lower back pain, sciatic pain, or weakness that did not improve with physical therapy, medications, and/ or epidural injections.

What Happens During Surgery?

1. Using specialized x-ray imaging, called fluoroscopy, the correct vertebral and disc levels are identified.
2. Once the surgeon has identified the correct spinal level, a small incision is made on the affected side of the lower back.
3. Next, a series of progressive dilators are used to gradually create a tunnel leading to the vertebrae overlying the nerve root and disc.
4. A microscope is then appropriately placed and adjusted to visualize within the dilators.
5. Then, a small opening in the bone is made to uncover the spinal nerve. This is known as a laminotomy and exposes the compressed spinal nerve root.
6. After the surgeon has visualized the spinal nerve, it is gently retracted to visualize the herniated or damaged disc on the other side.
7. Then, the damaged disc fragments, as well as, excess bone growth, or bone spurs, are removed to decompress the nerve root.
8. The muscle and skin is then closed with sutures and a gauze dressing is placed on the skin.

Recovery

• Most patients go home the same day as surgery. Others may be kept overnight for monitoring.
• You may begin gentle movements following surgery including: sitting in a chair, standing, and walking.
• Immediately following surgery, the patient will be unable to lift anything over 5 pounds, bend over completely, twist, or drive until they follow-up in clinic, approximately 2-3 weeks after surgery
• Most patients recover and return to most everyday activities 4-6 weeks following surgery

Potential Complications

• Inadequate symptom relief
• Nerve root damage
• No surgery is risk free, other complications include, but are not limited to, bleeding, infection, injury, or even death.

 

Laminectomy

Overview

A laminectomy is a surgery which opens the bony, spinal canal, which holds the spinal cord and spinal nerve roots. The purpose of the surgery is to decompress the spinal cord and/or nerve roots.

Who is a Candidate?

This surgery may be performed for individuals with spinal canal stenosis with significant pain, difficulty walking, or weakness that did not improve with physical therapy, medications, and/ or epidural injections. Oftentimes, this procedure can be scheduled electively, however, there are cases of having a laminectomy as an emergency surgery, such as cauda equina syndrome.

What Happens During Surgery?

1. An incision is made down the midline of your back over the appropriate vertebrae. The size of the incision depends on the number of levels affected by stenosis.
2. Specialized x-ray imaging, called fluoroscopy, is used during the procedure to identify the correct vertebral levels.
3. Once the surgeon has identified the correct spinal level(s), the spinous processes are removed along with the lamina of the vertebrae. This is done with bone-biting tools and a small drill.
4. Along with the bony pieces of the vertebrae, thick ligaments that cover the spinal cord and connect the lamina are also removed to decompress the spinal cord.
5. The surgeon then may remove a part of the facet joint which lies directly over the spinal nerve roots, this is known as a facetectomy. Additionally, a foraminotomy may be performed to open the neural foramen and further decompress the spinal nerve.
6. Then, if there is spine instability or multiple laminectomies a fusion may be performed.
7. The muscle and skin is then closed with sutures and a gauze dressing is placed on the skin.

Recovery

• Most patient typically stay 1-2 nights in the hospital following the surgery
• You may begin gentle movements following surgery including: sitting in a chair, standing, and walking.
• Immediately following surgery, the patient will be unable to lift anything over 5 pounds, bend over completely, twist, or drive until they follow-up in clinic, approximately 2-3 weeks after surgery
• Depending on the levels decompressed and/or if a fusion was performed, recovery time may vary.

Potential Complications

• Inadequate symptom relief
• Nerve root damage
• No surgery is risk free, other complications include, but are not limited to, bleeding, infection, injury, or even death.

Disclaimer: This information is strictly informational and not intended for medical advice. If you have any questions about surgical procedures, symptoms, or restrictions following surgery please contact your physician.

 

Anterior Lumbar Interbody and Fusion

Overview

An Anterior Lumbar Interbody Fusion (ALIF) is a type of fusion surgery, in which the surgeon repairs the lumbar spine from the front (anterior) of the patient’s body through a lower abdominal incision. A fusion surgery “locks” together two or more vertebrae to stop painful motion and correct their alignment.

Who is a Candidate?

This surgery may be performed for individuals with herniated discs, degenerative discs, or spinal instability with significant lower back pain or weakness that did not improve with physical therapy, medications, and/ or epidural injections.

What Happens During Surgery?

1. A vascular surgeon will begin the surgery by making a 2- to 3-inch incision on the lower abdomen at the specific disc level.
2. Specialized x-ray imaging, called fluoroscopy, is used during the procedure to identify the correct vertebral levels.
3. Once the correct vertebrae is identified, the vascular surgeon will gently clear a path through the abdominal cavity. The intestines are protected in the peritoneal sac, which will be temporarily moved to the right side of the abdominal cavity. Additionally, the large veins and arteries overlying the vertebrae will be gently moved to the side.
4. Next, the neurosurgeon will remove the damaged disc, or discs, depending on how many spine levels are affected.
5. Once the disc is removed, the disc space is measured and a trial spacer is slid into the empty disc space. X-ray imaging is used again during this step to ensure that the spacer is well-aligned and placed properly.
6. Once the correct size spacer is determined, the trial spacer is removed and the permanent spacer is placed into the empty disc space. In some cases, the spacer is held in place with screws or a plate.
7. The abdomen is then closed with sutures and a gauze dressing is placed on the skin.
8. In some cases, the patient may then be turned over so that screws and rods can be inserted from the back as well. This provides additional stability. If this is done, the muscle of the back and skin will be closed with sutures and a gauze dressing is placed on the skin following correct placement.

Recovery

• Most patient typically stay 1-2 nights in the hospital following the surgery
• You may begin gentle movements following surgery including: sitting in a chair, standing, and walking.
• Immediately following surgery, the patient will be unable to lift anything over 5 pounds, bend over completely, twist, or drive until they follow-up in clinic, approximately 2-3 weeks after surgery
• Depending on the levels decompressed and/or if a fusion was performed, recovery time may vary. Recovery time to return to daily activities usually take up to 6 to 12 weeks.

Potential Complications

• Injury to abdominal organs or large blood vessels
• Failure of fusion
• Hardware fracture
• Nerve damage or persistent pain
• No surgery is risk free, other complications include, but are not limited to, bleeding, infection, injury, or even death.

Disclaimer: This information is strictly informational and not intended for medical advice. If you have any questions about surgical procedures, symptoms, or restrictions following surgery please contact your physician.

 

Transforaminal Interbody and Fusion

Overview

A Transforaminal Lumbar Interbody Fusion (TLIF) is a minimally invasive type of fusion surgery, used to treat disc problems. A fusion surgery “locks” together two or more vertebrae to stop painful motion and correct their alignment.

Who is a Candidate?

This surgery may be performed for individuals with degenerative disc disease, spondylolisthesis, or scoliosis with significant lower back pain or weakness that did not improve with physical therapy, medications, and/ or epidural injections.

What Happens During Surgery?

1. Using specialized x-ray imaging, called fluoroscopy, the correct vertebral and disc levels are identified.
2. Once the surgeon has identified the correct spinal level, a small incision is made on the affected side of the lower back.
3. Next, a series of progressive dilators are used to gradually create a tunnel leading to the vertebrae overlying the nerve root and disc.
4. The surgeon removes a portion of the lamina and facet joint, also known as a facetectomy. This will reveal the underlying spinal cord. Additionally, bone spurs and ligaments interfering with the spinal cord and/or nerve roots may be removed during this time.
5. The nerve is then gently retracted to reveal the intervertebral disc, which may be causing additional pressure on the spinal canal and nerve roots.
6. Once the disc is removed, the disc space is measured by placing a trial spacer. Following identifying the correct size, the permanent cage is placed. X-ray imaging is used during this step to ensure correct placement, size, and alignment of the trial and permanent cage.
7. Then, pedicle screws are placed in the vertebrae above and below the disc space that was operated on. To further stabilize the spine, a rod will be placed to connect the two screws.
8. The muscle and skin is then closed with sutures and a gauze dressing is placed on the skin.

Recovery

• Most patient typically stay 1-2 nights in the hospital following the surgery
• You may begin gentle movements following surgery including: sitting in a chair, standing, and walking.
• Immediately following surgery, the patient will be unable to lift anything over 5 pounds, bend over completely, twist, or drive until they follow-up in clinic, approximately 2-3 weeks after surgery
• Depending on the levels decompressed and/or if a fusion was performed, recovery time may vary. Recovery time to return to daily activities usually take up to 6 to 12 weeks.

Potential Complications

• Failure of fusion
• Hardware fracture
• Nerve damage or persistent pain
• No surgery is risk free, other complications include, but are not limited to, bleeding, infection, injury, or even death.

Disclaimer: This information is strictly informational and not intended for medical advice. If you have any questions about surgical procedures, symptoms, or restrictions following surgery please contact your physician.

 

Sacroiliac Joint Fusion

Overview

A Sacroiliac Joint Fusion is a minimally invasive surgery used to stabilize the sacroiliac joint, promote bone growth, and relieve pain.

Who is a Candidate?

This surgery may be performed for individuals with pelvic instability, SI joint pain, or with significant lower back, hip, or groin pain that did not improve with physical therapy, medications, and/ or epidural injections.

What Happens During Surgery?

1. Using specialized x-ray imaging, called fluoroscopy, the surgeon will identify the pelvic bone and sacrum.
2. Once the surgeon has identified the correct area, a small incision is made on the affected buttock and the gluteal muscles will be dissected to reach the pelvic bone, or ilium.
3. Using a guide pin, a small hole is created in the ilium. Then, a drill extends the small hole to create a tunnel through the pelvic bone into the sacrum.
4. Then, an implant is inserted into the hole and will fuse the ilium and sacrum together. Additionally, a bone graft may, or may not, be used to promote bone growth and healing.
5. Once the implant is placed correctly, screws and pins may be used to hold it in place.
6. The muscle and skin is then closed with sutures and a gauze dressing is placed on the skin.

Recovery

• Most patients go home the same day as surgery. Others may be kept overnight for monitoring.
• You may begin gentle movements following surgery including: sitting in a chair, standing, and walking.
• Immediately following surgery, the patient will be unable to lift anything over 5 pounds, bend over completely, twist, or drive until they follow-up in clinic, approximately 2-3 weeks after surgery
• Most patients recover and return to most everyday activities 4-6 weeks following surgery

Potential Complications

• Failure of fusion
• Hardware fracture
• Nerve damage or persistent pain
• No surgery is risk free, other complications include, but are not limited to, bleeding, infection, injury, or even death.

Disclaimer: This information is strictly informational and not intended for medical advice. If you have any questions about surgical procedures, symptoms, or restrictions following surgery please contact your physician.

 

Kyphoplasty

Overview

A kyphoplasty is a minimally invasive procedure used to treat vertebral compression fractures of the spine. Compression fractures are most commonly caused by injury to the spine, however, they can also chronically occur with certain diseases such as osteoporosis and multiple myeloma.

Depending on the severity of injury to the spinal cord and nerves, compression fractures may initially be treated conservatively with pain control, activity modification, and bracing. Patients who continue to have pain or worsening symptoms may benefit from a kyphoplasty procedure.

Procedure

Prior to undergoing the kyphoplasty, the patient will be sedated under general anesthesia. Specialized x-ray imaging, known as fluoroscopy, will be used to determine the correct level of the compression fracture. After determining the correct level, a small incision will be made over the fractured bone. Following, 1-2 large needles will be inserted into the compressed bone. The surgeon then will insert inflatable balloons through the needles to inflate and restore normal bone height. Once adequate height is restored, bone cement will be inserted into the vertebrae. The needles are then removed prior to the cement hardening and the overlying skin is closed with sutures.

Results

• Most patients go home the same day as surgery. Others may be kept overnight for monitoring.
• You may begin gentle movements following surgery including: sitting in a chair, standing, and walking.
• Immediately following surgery, the patient will be unable to lift anything over 5 pounds, bend over completely, twist, or drive until they follow-up in clinic, approximately 2-3 weeks after surgery.