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Resources From Our Physicians

  • Information Directly from our Doctors

  • Questions & Answers about Cervical Radiculopathy

    Cervical Radiculopathy

    Definition:
    Cervical radiculopathy is the result of nerve entrapment within the cervical spine of exiting nerve roots that extend into the shoulders and upper extremities.  Nerve root entrapment can occur most commonly on the basis of a cervical disk herniation or the formation of bone spurs as the result of degenerative changes in the cervical spine.

    What are the Symptoms?
    Typically, cervical radiculopathy manifests itself as neck pain that includes radiating pain from the neck through the shoulder area into one or both upper extremities.  It often associated with upper extremity neurologic symptoms such as numbness, tingling, and/or weakness.

    What are the Treatment Options?
    Typically nonoperative measures are pursued initially unless severe neurologic deficits prompt consideration of early surgical intervention; for example, the development of significant weakness of the affected upper extremity.  Nonoperative treatment usually consists of a period of restricted activity, appropriate prescription medications, physical therapy measures directed towards relief of nerve entrapment, often including cervical traction, and often cervical injections.  Should the patient’s pain and/or neurologic symptoms fail to respond to an appropriate period of nonoperative care over a reasonable period of time, surgery can then be considered to remove the offending source of nerve entrapment.

    If Left Untreated:
    By definition, cervical radiculopathy involves neck pain radiating into one or both upper extremities.  Radiating arm pain can also be associated with neurologic symptoms such as numbness, tingling, and weakness.  Even without treatment, the natural history of the disease process is typically one of improvement over a period of time, often with resolution of symptoms within two to three months.  Institution of appropriate nonoperative treatment measures, however, can hasten the patient’s improvement and minimize the risk of recurrent episodes. If significant neurologic deficits are present, however, and left untreated, this can result in potentially irreversible loss of neurologic function in the affected upper extremity; for example, persistent numbness and/or weakness.  Should the patient’s radiating arm pain fail to improve, whether untreated or treated, the patient then faces the prospect of chronic radiating arm pain.

    Rehabilitation:
    Typically nonoperative measures are pursued initially unless severe neurologic deficits prompt consideration of early surgical intervention; for example, the development of significant weakness of the affected upper extremity.  Nonoperative treatment usually consists of a period of restricted activity, appropriate prescription medications, physical therapy measures directed towards relief of nerve entrapment, often including cervical traction, and often cervical injections.  Should the patient’s pain and/or neurologic symptoms fail to response to an appropriate period of nonoperative care over a reasonable period of time, surgery can then be considered to remove the offending source of nerve entrapment.

  • Questions & Answers about Lumbar Myeloradiculopathy

    Lumbar Myeloradiculopathy

    Definition:
    Lumbar myeloradiculopathy refers to nerve entrapment in the lumbar spine on the basis of disk herniations and/or enlargement of joint structures and ligaments resulting in compression of individual nerve roots and/or the entirety of the nerve sac in the lumbar spinal canal.

    What are the Symptoms?
    The common symptoms patients experience are low back pain with radiating pain affecting one or both lower extremities.  Frequently, neurologic symptoms are present as well, including numbness, tingling, weakness or easy fatigability in one or both lower extremities extremity with standing and walking.  Rarely, dysfunction of bowel and/or bladder may be present.

    What are the Treatment Options?
    Typically, nonoperative measures are initially pursued unless there are compelling neurologic deficits that demand consideration of early surgical intervention in order to avoid irreversible neurologic deficits. Non-operative measures usually include restriction of activity, use of adjunctive prescription medications, physical therapy measures directed towards relief of nerve entrapment, some form of low impact cardiovascular conditioning, and often spinal injections.  Should the patient fail to improve with nonoperative measures, surgical intervention can be discussed, tailored specifically towards removal of the offending lesion causing nerve entrapment.  The level of surgery falls along quite a wide spectrum, ranging from the simplest type of intervention in the form removal of a single disc herniation to surgery for relief of nerve entrapment occurring at multiple levels, also requiring spinal stabilization and/or correction of spinal deformity in order to provide a comprehensive solution to the patient’s problems.

    If Left Untreated:
    Entrapment of an individual nerve root in the lumbar spine due to a disk herniation often will improve spontaneously over time even if left untreated, typically within a period of two to three months.  On the other hand, nerve entrapment on the basis of progressive degenerative change resulting in enlargement of joint structures and ligaments that cause narrowing of the spinal canal usually are progressive over time, although symptoms are often intermittent early on.  If no treatment is pursued and the patient’s lower extremity pain persists, the patient faces the prospect of chronic or recurrent pain episodes for the foreseeable future.  If neurologic symptoms are present, this can potentially lead to irreversible loss of neurologic function, particularly important with regard to weakness of the lower extremities.  Any dysfunction of bowel or bladder is an indication for prompt surgical intervention because of the unacceptable nature of loss of neurologic function of this type.

    Rehabilitation:
    Typically, nonoperative measures are initially pursued unless there are compelling neurologic deficits that demand consideration of early surgical intervention in order to avoid irreversible neurologic deficits. Non-operative measures usually include restriction of activity, use of adjunctive prescription medications, physical therapy measures directed towards relief of nerve entrapment, some form of low impact cardiovascular conditioning, and often spinal injections.  Should the patient fail to improve with nonoperative measures, surgical intervention can be discussed, tailored specifically towards removal of the offending lesion causing nerve entrapment.  The level of surgery falls along quite a wide spectrum, ranging from the simplest type of intervention in the form removal of a single disc herniation to surgery for relief of nerve entrapment occurring at multiple levels, also requiring spinal stabilization and/or correction of spinal deformity in order to provide a comprehensive solution to the patient’s problems.

  • Questions & Answers about Neck and Low Back Pain

    Neck and Low Back Pain

    Definition:
    Spinal pain indicates the development of a pain generator, potentially due to a wide variety of causes, resulting in pain somewhere in the spine including the neck, upper back, and lower back.

    What are the Symptoms?
    Patients typically complain of pain emanating from the neck, upper back, and/or lower back, or some combination of these areas.  The pain symptoms can also include radiating pain into the shoulder girdle regions, buttock and hip areas, as well as into the upper and/or lower extremities.  Radiating pain in the upper extremities can occur on the basis of “referred pain,” or can be due a combined clinical picture of spinal pain with a source of nerve entrapment of exiting nerve roots or the spinal cord itself.

    Patients typically present with spinal pain in the neck, upper back, lower back, or a combination of these areas.  Often the pain can radiate into the shoulder girdle, buttock, or hip regions, as well as is into upper or lower extremities.  Radiating pain from the spine can occur on the basis of “referred pain,” and back pain syndromes often are associated with nerve entrapment syndromes, which can result in radiating upper and lower extremity pain with neurologic symptoms on the basis of both spinal pain and a syndrome of nerve entrapment.  Spinal pain due to inflammation of joint structures, whether disks or facets, usually is aggravated with activity that increases the stress in the spine or posturally induced.  On the other hand, spinal pain due to fractures, infections, and tumors tends to be constant and unrelenting, present at all times, and not particularly aggravated with certain activities or postures.

    What are the Treatment Options?
    The first priority in evaluating a patient with spinal pain is to determine as accurately as possible the patient’s true pain generator.  Given that the list of diagnostic possibilities is quite extensive, at a minimum, x-rays should be obtained, and frequently additional diagnostic imaging, usually in the form of an MRI, is appropriate.  The most common pain generators in the spine are the joints that support body weight and allow for movement within the spine itself.  Disk related spinal pain is probably the most common source, followed by pain in the facet joints or a combination of both.  A small minority of patients can have pain attributable to the sacroiliac joint regions.  Additional diagnostic possibilities include spinal fractures, including compression fractures in the older age groups, and infections and tumors.

    The type of treatment obviously depends of the underlying diagnosis or cause of the patient’s spinal pain.  Joint related pain in the spine typically is responsive to a period of restricted activity with symptomatic measures, adjunctive use of prescription medications, specifically tailored physical therapy interventions, and often spinal injections are helpful both diagnostically and therapeutically.  Occasionally, if a patient has a severe unrelenting pain unresponsive to nonoperative measures, then surgical intervention can be considered.  Surgical procedures for relief of spinal pain alone not combined with nerve entrapment syndromes, however, tends to result less gratifying outcomes than operations performed for relief of nerve entrapment that involves radiating upper or lower extremity pain and neurologic symptoms.  Chronic pain patients, including patients with failed back syndromes, often are best treated in the context of a comprehensive pain management program, and are occasionally candidates for implantation of devices such as a spinal infusion pump or spinal cord stimulator.

    If Left Untreated:
    A first time episode of spinal pain actually carries a quite favorable outlook in that the vast majority of patients will improve over time even if left untreated.  The duration of the pain episode, however, can be significantly impacted through prompt institution of appropriate nonoperative treatment measures as noted above.  Patients with recurrent pain episodes, particularly if increasing in frequency and severity, typically have a progressive course of worsening over time.  The failure of the patient to pursue appropriate activity modification and institute an appropriate program of spinal rehabilitation may cause progressive injuries to their spines if left untreated.  Obviously, if the underlying pain is the result of fracture, infection, or tumor, the consequences of failure to pursue diagnosis and treatment can be life impacting and potentially life threatening.

    Rehabilitation:
    Typically, nonoperative measures are initially pursued unless there are compelling neurologic deficits that demand consideration of early surgical intervention in order to avoid irreversible neurologic deficits. Non-operative measures usually include restriction of activity, use of adjunctive prescription medications, physical therapy measures directed towards relief of nerve entrapment, some form of low impact cardiovascular conditioning, and often spinal injections.  Should the patient fail to improve with nonoperative measures, surgical intervention can be discussed, tailored specifically towards removal of the offending lesion causing nerve entrapment.  The level of surgery falls along quite a wide spectrum, ranging from the simplest type of intervention in the form removal of a single disc herniation to surgery for relief of nerve entrapment occurring at multiple levels, also requiring spinal stabilization and/or correction of spinal deformity in order to provide a comprehensive solution to the patient’s problems.

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