A to Z about Spondylolisthesis Condition

Studies show that up to 4-6% of the U.S. population suffers from either spondylolisthesis or spondylolysis. This translates to a staggering 12,463,676 – 18,695,515 Americans. Further, recent studies show that up to 90% of isthmic Spondylolisthesis is from grade 1 to 2, while 10% of the slips are high grade from grade 3 and above.

What is Spondylolisthesis?
Spondylolisthesis is a condition whereby one of the spine bones, also referred to as vertebrae, slips forward (anterolisthesis) or backwards (retrolisthesis) onto the vertebra below it.  When this spine bone slips too much, it is likely to compress on a nerve that exits the canal (foraminal stenosis) or narrowing of the canal of nerves (central stenosis) and in turn the subject experiences too much pain. Spondylolisthesis comes from a Greek word spondylos that means the spine. It also means the ‘vertebra’. Listhesis is also a Greek word that means to slide. There are up to three types of Spondylolisthesis.

There is the congenital Spondylolisthesis, whereby congenital stands for ‘present at birth.’ This condition is as a result of an abnormal formation of born. Here, the disorderly arrangement of vertebrae puts the bones at a great risk of sliding into the vertebra. There is also the Isthmic Spondylolisthesis that occurs due to spondylolysis. Spondylolysis is a condition whereby the vertebrae experience breaks or fractures. These fractures are responsible for the bone weakening that in turn makes it slip out of place.  The third type of Spondylolisthesis is called degenerative Spondylolisthesis which is thought to be the most common type of disorder. When a patient ages, their discs, these are cushions that are found between the vertebral bones, lose water and become less spongy and therefore not able to resist the vertebrae movement.

There are also some forms of Spondylolisthesis which are considered to be less common, and these comprise of traumatic Spondylolisthesis, which is essentially an injury that leads to the fracture of the spinal feature or at times a slip. The other less common type of Spondylolisthesis is known as pathological Spondylolisthesis. Here, the spine is often weakened by a disease like osteoporosis or an infection and at times a tumor. Then we have the third type of a less common Spondylolisthesis which is Post-surgical Spondylolisthesis. It is the spillage that occurs after a spinal surgery; at times the spinal surgery may worsen the condition.

Signs of Spondylolisthesis
Before we delve into the symptoms, it’s vital to know the risk factors of Spondylolisthesis. Common risk factors include certain sports that entail hyperextension and rotation, Spinal Bifida Occulta, generalized mobility, Inuit population, facet joint morphology and genetic susceptibility. Females have 2 to 3 times chances of having this condition, and so are men but seldom experience slips. Also, degenerative Spondylolisthesis is likely to affect expectant black women.

Black people are more prevalent to get Spondylolisthesis. This condition is one of a kind, which does not immediately show the symptoms when the slippage occurs. However, a person who has this condition may often present with excruciating low back pain. The pain may extend to the buttocks or often complain of leg pain. You will often have your back aching and have an intense sway back. Also, many people have tight hamstrings, up to 80% of patients presenting with severe tight hamstrings have Spondylolisthesis. Also, the pain may have you limping when walking.

Spondylolisthesis in its severe case may make one to produce neurological signs such as a feeling of numbness or tingling pain. Here, your leg muscles may weaken and experience diminished reflexes. When the spine tries to stabilize the unstable part of the back, facet joints enlarges hence intense pressure on your nerve roots that causes lumbar spinal stenosis and also recess stenosis. When a bone slips forward, there is often a narrowing of the intervertebral foramen this is called foraminal stenosis. Doctors measure the degree of slippage in grade by obtaining and classifying the width of your vertebral body as follows;

  • 1st grade 0-25%
  • 2nd grade 25- 50%
  • 3rd grade 50-75%
  • 4th grade 75-100%
  • 5th grade 100% plus

Since Spondylolisthesis seldom presents symptoms, a trained spine doctor may always observe it through X-rays or CT scans. These are obtained while the patient lays flat. Mostly though, a slip may be detected when the patient bends forward or stands straight. Spinal surgeon and neurosurgeons obtain flexion standing X-rays or extensions and sometimes the CT myelogram.

Treatment of Spondylolisthesis
The symptoms of Spondylolisthesis can be treated several different ways.  One way, is oral steroids to reduce inflammation and irritation. The second is to consider an epidural steroid injection (ESI).  An ESI is a method to deliver a steroid medication directly to the segment of your back that is causing your painful symptoms.  Physical therapy, is another option to assist is some pain relief for patient with minor symptoms.  A physical therapist can assist the patient in hamstrings stretching, lumbar stretching and abdominal strengthening.  Although, physical therapy is not recommended if the patient has moderate to severe radiculopathy, or pain radiating to their legs, because it can make the symptoms worse.  One is recommended to stretch at least twice every day to ease the pain on the lower back. The exercise program should start gradually and increase as time goes by. The last and final form of treatment that a Miami doctor would recommend would be a fusion surgery.  Lumbar fusion could be an option for patients that suffer from back pain radiating to the lower extremities caused by spondylolisthesis.  Fusion surgery immobilizes a painful mobile vertebral segment.  After fusion surgery to correct spondylolisthesis, the expectations are to walk immediately after surgery with no need for physical therapy or back braces.  Patients should go back to their normal life, pain free.

Scoliosis – Symptoms, Causes, and Treatment

Scoliosis is an abnormal curve of the spine. The curve can vary in location and severity. The causes of scoliosis are unknown. While most common in young women ages 9 to 15, presenting as an S-shaped curve of the spine, there are many types of scoliosis that can affect others age groups as well.
+ Scoliosis before birth: Congenital Scoliosis
+ Scoliosis in young children: Early Onset Scoliosis
+ Scoliosis in older children/teenagers: Adolescent/Idiopathic Scoliosis
+ Scoliosis in Adults: Degenerative Scoliosis

There are different types of scoliosis curvatures such as kyphoscoliosis (outward and lateral spine curvature), dextroscoliosis (curvature of the spine to the right), rotoscoliosis (curvature of the vertebral column on the axis), levoconvex (curvature of the spine to the left), and thoracolumbar (curvature in both thoracic and lumbar regions).

Some patients with scoliosis may be asymptomatic (no painful symptoms), and others may have chronic back pain and/or symptoms such as leg pain or numbness due to nerve compression as a result of the scoliosis. These symptoms can affect your activities of daily living.

Treatment depends on the type, severity and location of the curve and can range from observation and/or brace to surgery. Patients with Degenerative Scoliosis in the thoracolumbar region with pain radiating to their legs may be a candidate for lumbar fusion (an operation that results in vertebrae in the lower back to grow together, reducing pressure on nerves). Given the intricacies of the surgery, it may be performed by an orthopedic spine surgeon or a neurosurgeon. While there is no cure for scoliosis, treatment can reduce symptoms and prognosis is good, particularly if diagnosed and treated early.

Interested in learning more or seeking treatment for back pain, a spine doctor at Miami Back and Neck Specialists can support you in taking next steps in protecting your back and minimizing any pain. Contact us at 305-901-1511 or BackDoctorMiami.com today for a free evaluation with a board-certified specialist and develop your individualized plan.

Know the Signs of Spinal Cancer

What is spinal cancer?
Cancer is an uncontrolled overgrowth of cells that can occur anywhere in the body. Spinal cancer occurs when cells in the spine–nerves, bone, fluid, or connective tissue–begin to overgrow in this way. Most back pain isn’t related to spinal cancer, but being informed of the signs can help you get early, effective treatment.

When to seek treatment
Spinal cancer is easy to mistake for other types of back problems, which is why it’s important to make an appointment with a spine doctor right away if you are experiencing persistent back, neck, or shoulder pain that worsens at night and is unrelated to physical activity, especially if it’s accompanied by nausea or vomiting.

What a spinal cancer diagnosis means for you
If your doctor suspects spinal cancer, they will probably order an MRI, CT scan, or biopsy in order to confirm the diagnosis and decide on the best course of treatment. Spinal cancer is treatable, and treatment often focuses on managing pain as well as controlling the growth of cancer.

Best available spinal cancer treatments
Spinal cancer is usually treated with a combination of surgery, radiation, and chemotherapy. Miami Back Specialists can help you receive a diagnosis and achieve your treatment goals for spinal cancer and other back and spine conditions.

The Vast World of Spine Surgery

Are you dealing with any problems that relate to your back? Is a problematic spine making your daily life practically unbearable? If so, it may be the right time to learn all about big changes and improvements that are taking place in the spine surgery world. Spine surgery can do wonders for people who suffer from severe and incessant back pain.

Spine Surgery Advancements
Spine surgery is something that’s constantly evolving. Researchers are always trying to come up with fresh and in-depth solutions to all kinds of spine surgery concerns and needs. Lateral access techniques are a big part of the newest wave of spinal surgery practices. These techniques can do a lot for people who appreciate options that are markedly less invasive. Other big focal points for the spine surgery world are instrumentation and implant materials, image guidance technology, growth tethers, disc regeneration treatment, biologic treatment and bone morphogenic protein. These things all serve different functions and purposes. Bone morphogenic protein can help with spine fusions. It can be suitable for situations that involve extensive comorbidities. Image guidance technology, on the other hand, can be superb for revision purposes of all varieties.

Contact Us Right Now
Are you looking for a great spine doctor? Get in contact with Miami Back Specialists as soon as possible. We specialize in all kinds of treatments for backaches. We want to help you reclaim your happiness and comfort as soon as possible. Our phone number is 305-901-1511

Understanding Spinal Stenosis

Spinal stenosis is a condition that will eventually affect most men and women, although its physical effects may not be the same in every person. The treatment of spinal stenosis is one of the medical services available from Miami Back Specialists.

Understanding the Spinal Cord
The spinal column extends the length of our backs and allows us to stand, walk and generally move about. The column itself is comprised of more than 30 bones, known as vertebra, through which runs the spinal cord. An important element of the central nervous system, the spinal cord carries signals from the brain, making possible the normal functioning of the body.

The Causes and Effects of Spinal Stenosis

The condition can affect anyone and may result from a traumatic injury or the development of a tumor in the spine. It can also occur if the tissue between the bone, known as a disk, becomes herniated. However, it normally begins to develop after the age of 50 and is related to the general effects of “wear and tear” on the body. The narrowing of the spaces in the bone will eventually begin will impose pressure on the spinal column. The effects of this pressure translate into the condition known as spinal stenosis. Some of those with the condition may not have developed obvious symptoms. Others may experience neck or back pain, numbness in the extremities and muscle weakness. Spinal stenosis may occasionally affect the functioning of the bladder and digestive system.

Treating Spinal Stenosis
In addition to recognizing the symptoms, doctors can usually detect spinal stenosis through internal imaging techniques, including MRI scans. The condition can in some cases be treated with medications or through physical therapy. In other cases, surgery may be needed to increase the space in the bones. A spine doctor can help determine the nature of the problem and help the patient decide on the best course of action. Our team of doctors and pain specialists offer a variety of treatment options for spinal stenosis and other back problems. Contact us at 305-901-1511 for a free consultation.

Myths About Spine Surgery

Spine surgery has changed drastically in the past decade and Dr. Brusovanik has been at the forefront of the most innovative techniques in minimally invasive spine surgery. With the use of these new methods, Dr. Brusovanik’s patients are walking the night of their spine surgery and rarely need physical therapy after surgery. His patients’ great outcomes are achieved because Dr. Brusovanik is very selective with who he does surgery on. Patients first try conservative therapies and only after those options have failed does Dr. Brusovanik consider surgery. He also performs diagnostic injections that aid in determining the level in the spine that is causing the pain. With the aid of a detailed history, comprehensive physical exam, studying the patient’s imaging and these diagnostic injections; Dr. Brusovanik is able to perform the most appropriate procedure that will yield the greatest outcome.

Furthermore, the use of the minimally invasive technique results in no muscle injury and the smallest incisions. This leads to a faster recovery and Dr. Brusovanik’s patients are never required to wear a brace or placed on bed rest.

Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. It is occurs when there is inflammation of the thick band of tissue that runs across the bottom of the foot called the plantar fascia. This band of tissue connects the heel bone to the toes.

It is common for patients with spine issue to present with a similar pattern of pain. As the nerves exit the spinal cord, they innervate different muscle groups, each nerve follows a distinct pattern down the extremities. The pathway for the S1 nerve is down the back of the leg to the heel of the foot. Patients may feel this heel pain and it can be confused with plantar fasciitis. It is important to distinguish the two by obtaining a proper history, physical exam and diagnostic imaging.

What to expect with an Anterior Lumbar Interbody Fusion with Percutaneous Posterior Stabilization (ALIF/PSF):

The purpose of an ALIF/PSF is to fuse the segment in the lumbar spine that is causing pain with movement, if those segments are indeed degenerative. The idea behind the fusion is that stopping movement at that segment will no longer cause pain. Prior to surgery, proving that pain is coming from a specific level is usually confirmed with injections.

An ALIF/PSF (CPT code: 22558) is usually done for the last 2 levels in the lumbar spine, L4-5 or L5-S1. A vascular surgeon does the exposure for Dr. Brusovanik and accessing the spine from the front of the abdomen just below the navel. Once the spine is exposed the disc is removed and an interbody with bone graft is placed in the disc space. The incision is then cleaned and closed using a plastic surgery technique. Over the next few months, bone grows in the disc space connecting the two vertebrae causing a fusion.

The patient is then turned onto his/her stomach; small incisions are made in the back where the screws are passed through the muscle planes. This technique prevents muscle injury. Screws are inserted into both sides of each vertebrae (above and below) the disc space being fused. Rods are then placed on each side to connect the screws, stopping any movement at the painful level.

Patients are encouraged to walk the same night of surgery and are kept in the hospital for 1-2 nights. Patients are able to perform their daily activities once they are discharged home. They are able to go back to work within 1-2 weeks. Patients with labor intensive work can return in 3-4 weeks.