Conditions
Once you can put a name to your pain, you've taken your first step toward healing. Let our caring, world-class specialists help start you on your way with our innovative approach to spinal care. Click a specific condition (below) to get a complete description of symptoms, treatments, etc.
 
[Dr. Lonstein] at Sarasota Spine Specialists and is the absolute best surgeon for anyone that has any spine problems anywhere. I have had problems most of my life and he has been a miracle for me. I would recommend him nationwide.
Sincerely,
Penelope R.
March 2012
Herniated Disc Click for more info
The disc has a tough outer layer (annulus) surrounding a jelly-like substance in the center (nucleus). A herniation occurs when the nucleus pushes into or through the outer tissue layer. The discs are in front of the spinal cord and exiting nerves, and the herniated material may compress the nerves.

Full Description

Some of the terms commonly used to describe the condition include herniated disc, prolapsed disc, ruptured disc and the misleading expression "slipped disc". Other terms that are closely related include disc protrusion, bulging disc, pinched nerve, sciatica, disc disease, disc degeneration, degenerative disc disease, and black disc.
Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation. The former is the most common, causing lower back pain (lumbago) and often leg pain as well, in which case it is commonly referred to as sciatica.
Lumbar disc herniation occurs 15 times more often than cervical (neck) disc herniation, and it is one of the most common causes of lower back pain. The cervical discs are affected 8% of the time and the upper-to-mid-back (thoracic) discs only 1 - 2% of the time.

Causes

Disc herniations can occur from general wear and tear, such as jobs that require constant sitting, but especially jobs that require lifting. Traumatic (quick) injury to lumbar discs commonly occurs from lifting while bent at the waist, rather than lifting while using the legs with a straightened back. When the spine is straight, such as standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 17 psi (lying down) to over 300 psi (lifting with a rounded back).
Herniation of the contents of the disc into the spinal canal often occurs when the front side (stomach side) of the disc is compressed while sitting or bending forward, and the contents (nucleus pulposus) get pressed against the tightly stretched and thinned membrane (annulus fibrosis) on the rear (back side) of the disc. The combination of membrane thinning from stretching and increased internal pressure (200 to 300 psi) results in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, thus producing intense and usually disabling pain and other symptoms.

Treatment Options:

Thoracic Disc Herniation:

  • VATS – Video Assisted Thoracic Surgery
  • Discectomy
  • Fusion
  • Spinal Instrumentation

Lumbar Disc Herniation:

  • BAK Fusion Cages
  • ALIF (Anterior Lumbar Interbody Fusion)
  • PLIF (Posterior Lumbar Interbody Fusion)
  • TLIF (Transforamenal Lumbar Interbody Fusion)
  • IDET (Intradiscal Electrothermal Therapy)
  • Laminotomy
  • Laparoscopic Fusion
  • Artificial Disc Replacement

Cervical Disc Herniation

  • Microscopic Posterior Cervical Foraminotomy
  • Anterior Cervical Discectomy and Fusion
  • Cervical Laminaplasty
  • Cervical Instrumentation
Spinal Stenosis Click for more info
The spinal canal is the passageway where the spinal cord and nerve roots reside. Spinal stenosis results when the canal is narrowed. The narrowing may result from disc protrusions or herniations, thickening of the ligaments within the canal, movement of the vertebral bodies or osteophytes (bone spurs) growing into the canal.

Full Description

The spinal canal is the passageway where the spinal cord and nerve roots reside. Spinal stenosis results when the canal is narrowed. The narrowing may result from disc protrusions or herniations, thickening of the ligaments within the canal, movement of the vertebral bodies or osteophytes (bone spurs) growing into the canal. Whether an individual will develop stenosis cannot be predicted. It does not have a predisposition for any sex, race or ethnicity. Spinal stenosis can be congenital, meaning present at birth. Acquired stenosis is more common and generally affects people 60 or more years of age. Spinal stenosis may affect the cervical or lumbar spine. Symptoms include nerve compression leading to persistent pain in the buttocks, limping, lack of feeling in the extremities, or loss of bladder or bowel control. Often, patients have difficulty walking even relatively short distances because of leg symptoms of pain or weakness. This typically resolves with a brief period of rest.

Screening and Diagnosis

Your physician will perform a physical examination. Imaging studies such as an MRI, CT scan or myelogram may also be ordered to help make the diagnosis. If the doctor thinks you have nerve damage, an electromyography (EMG) may be needed. This exam measures the effectiveness of your nerves to conduct signals.

Treatments for Spinal Stenosis

Non-surgical options include medication, physical therapy, aerobic conditioning and epidural injections. Indications for surgery include pain that fails to improve satisfactorily with non-surgical treatment. Surgical treatment generally consists of spinal decompression to enlarge the spinal canal and relieve the pressure on the spinal cord or nerve roots. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.

Treatment Options:

  • Foraminotomy
  • Surgical Decompression
  • Laminectomy
  • Laminotomy
Spondylolisthesis Click for more info
Spondylolisthesis occurs when one vertebral body slides forward relative to the one below it. It can develop in adolescence or adulthood. The disorder may result from the physical stresses to the spine from physical activity, trauma, and general wear and tear.

Full Description

Spondylolisthesis occurs when there is abnormal alignment of the spine when seen from the side (lateral view). The vertebra above slides forward relative to the one below it. This malalignment may result from several causes, including trauma or degeneration. There may be abnormal spinal motion associated with this condition. Spondylolisthesis may result in back or neck pain, but extremities can be involved if the spinal cord or nerve roots are compressed or irritated. Commonly, patients will complain of muscle spasms, thigh and/or buttock pain, as well as tight hamstrings. There are patients who have spondylolisthesis and do not have symptoms. Spondylolisthesis can be congenital (present at birth) or develop in adolescence or adulthood. The disorder may result from the physical stresses to the spine from physical activity, trauma, and general wear and tear.

Screening and Diagnosis

The best initial test for diagnosis of spondylolisthesis is an x-ray taken in the standing position. For further confirmation of spondylolisthesis, a CT scan may be ordered. If the slipped vertebra is suspected to be pressing on nerves, the doctor may order a myelogram. In addition to imaging studies, part of your visit to the doctor will include physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion and physical condition, noting any movement that causes you pain. During the neurological exam, your doctor will test your reflexes and muscle strength. Most commonly with spondylolisthesis, the neurological exam findings are relatively normal.

Treatments for Spondylolisthesis

Treatment varies with severity of the spondylolisthesis. Most patients require only physical therapy combined with activity modification. If pain is arising from nerve root irritation, epidural steroid injection may be considered. For cases with severe pain not responding to therapy, if the slip is severe or there are neurologic changes, the slipping vertebra might be surgically fused to the vertebra below it. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.

Treatment Options:

  • Anterior and Posterior Decompression with Fusion Cages
  • Laminectomy Decompression with Graft
  • Posterolateral Fusion
  • Spinal Instrumentation with Pedicle Screws
Spinal Fracture Click for more info
Many people mistake spinal fractures for backaches, which they assume are just part of getting older. The primary symptom of compression fractures is back pain that is made worse by movement. When the spinal cord is involved, numbness, tingling, weakness, bowel/bladder dysfunction or even paralysis may occur.

Full Description

Spine fractures can occur at any segment of the spinal column. The spinal column is made up of multiple vertebrae. Fractures can involve the vertebral body or the posterior elements of the spine. The posterior elements form the back wall of the spinal canal and provide protection for the spinal cord. Spinal fractures can happen from something as dramatic as a fall or motor vehicle accident, or, in a patient with osteoporosis, from a simple movement like coughing or reaching overhead. Osteoporosis, or loss in bone quality, makes the vertebrae vulnerable to vertebral compression fractures. The pain from an osteoporotic fracture is not always severe – sometimes it is mild. Many people mistake these spinal fractures for backaches, which they assume are just part of getting older. The primary symptom seen in compression fractures is moderate to severe back pain that is made worse by movement. When the spinal cord is involved, numbness, tingling, weakness, bowel/bladder dysfunction or even paralysis may occur.

Screening and Diagnosis

The first step in the evaluation of spinal fractures is to get a detailed history about what caused the injury. The doctor will perform a physical examination. This may include checking for swelling, bruising, tenderness and other signs of injury to the head, abdomen and back as well as evaluating strength, motion and alignment of arms and legs. A neurologic examination may also be done. This may include tests of sensory (temperature, pain and pressure sensitivity), motor (muscle strength) and reflex functions of the nervous system. In addition, x-rays may be necessary to look for fractures or dislocations. Often computed tomography (CT) or magnetic resonance imaging (MRI) scans may be ordered to determine the extent of injury.

Treatments for Spinal Fracture

Treatment goals include protecting nerve function and restoring alignment and strength of the spine. Treatment options are based upon the type of fracture and other factors. Non-surgical treatment options include wearing a brace for sitting and standing activities for 6 to 12 weeks. Patients should walk and do other exercises while healing and may take medications for pain. Depending on the symptoms and the type of fracture, surgery may be an option. For some fractures, metal screws and rods or plates may be used to realign the spine. For osteoporotic fractures, vertebroplasty or Kyphoplasty may be performed. These are minimally invasive procedures in which a bone cement is injected into the fractured vertebrae. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.

Treatment Options: