Spine care

Our specialists apply their expertise and the latest tools to accurately diagnose your spinal condition. One of these diagnostic tools is advanced orthopedic imaging.

Using advanced imaging technology, we can visualize the spine to determine the location and severity of the issue. Our imaging system creates full-body 2D and 3D images using low-dose radiation. This technology can scan your entire body to assess the alignment of your spine. It also limits your exposure to radiation.

We believe in taking an approach that focuses on your overall well-being. Our pain management program incorporates a large selection of spine-related therapies and holistic solutions designed to help you work toward pain relief and better mobility. We offer:

• Combination of multiple techniques to improve your chances of relieving your pain and improving your function
• Continuity of care between referring providers, physicians, caregivers and patients
• Integrative treatments, including acupuncture and trigger point practices, to help support traditional treatments
• Single-visit consultations, acute pain management and chronic pain management

Our spine specialists will try nonsurgical treatments before moving to surgical procedures. Nonsurgical care options include:

• Anti-inflammatory drugs
• Arthroscopy
• Physical rehabilitation services
• Steroid injections

When other forms of treatment like medication, pain management and physical therapy are not effective, surgery might be necessary.

The surgical procedures our doctors perform include:

• Discectomy — removing a herniated disc
• Decompression — reducing pressure on the affected nerves
• Spinal fusion — fusing of two or more vertebrae
• Kyphoplasty — injecting bone cement to repair fractures
• Neurosurgical treatment — performing surgery on the nervous system to address a condition affecting some part of it

Neuromodulation

Neuromodulation is used to treat pain that can accompany nervous system malfunctions. Surgical neurostimulation procedures involve altering the nervous system. This is done by using technology or medication to change the way the body sends pain signals, with the goal of reducing pain and improving function. In this way, our doctors attempt to correct abnormal electrical signals.

Minimally invasive surgery

When possible, we perform minimally invasive surgery on the nervous system – known as neurosurgical treatment. These procedures use small incisions in your skin. The surgeon operates while looking at the surgical site through a small endoscope or metal tube inserted for this purpose.

The potential benefits of minimally invasive surgery include faster recovery, less impact on your body and less visible scarring.

The minimally invasive surgeries we perform include:

• Anterior lumbar inter-body fusion (ALIF) — removing unstable vertebrae and replacing them with a spacer made of bone, plastic or metal to encourage bone healing and fusion
• Direct lateral inter-body fusion (DLIF) — removing damaged disc and bone from between two vertebrae and inserting bone graft to promote bone growth, which eventually fuses the two vertebrae together
• Minimally invasive disc removal — removing a bulging disc that is putting pressure on a spinal nerve
• Motion-sparing cervical arthroplasty — replacing a disc that has degenerated with an artificial one
• Muscle-sparing lumbar decompression — removing part of a herniated disc that is putting pressure on a spinal nerve
• Percutaneous pedicle screws for fusion — implanting metal rods and screws to stabilize your spine

Surgery for complex spinal deformities and degenerative spine

Some spine conditions require a more intensive approach than minimally invasive surgery can accomplish. Our highly skilled surgeons perform these procedures with great care and attention to detail.

Charcot spine

After a spinal cord injury, you're more susceptible to developing spinal instability below the area where the injury occurred. Significant bony loss of vertebrae along with the destruction of the disc spaces is possible if you get this condition, which is known as Charcot spine.

This instability can lead to symptoms like:

• Back pain
• Worsening neuropathic pain
• Spasticity
• Autonomic dysreflexia
• Neurologic and functional loss

Surgery to correct these issues involves decompression of the deteriorated vertebral bodies and disc spaces. In addition, our doctors stabilize the affected vertebrae by implanting man-made devices in the area.

Scoliosis

Your spine can start curving if you get a spinal cord injury. This condition is called scoliosis. If the curve in your spine becomes pronounced enough, scoliosis can cause the same issues often seen if you have Charcot spine. If surgery is necessary, we realign your spine and implant metallic or non-metallic devices in it. Doing this procedure stabilizes your spine.

Spinal stenosis and ruptured disc

In some cases, a spinal cord injury can cause your spine to degenerate progressively and your spinal canal to narrow. This is called spinal stenosis. A spinal cord injury might also cause a ruptured intervertebral disc.

Both of these developments can put pressure on your spinal cord and nerve roots and can lead to:

• Autonomic dysreflexia — a sudden onset of excessively high blood pressure caused by a nervous system disorder
• Hyperhidrosis — abnormal sweating
• Loss of neurologic function — abnormal neurological function in an area of your body
• Neuropathic pain — pain caused by a lesion or disease that affects your nervous system
• Worsening spasticity — uncontrolled, repetitive and involuntary contractions of skeletal muscles

Surgical correction of these issues involves taking pressure off the spinal cord and nerve roots by removing bones, ligaments and discs as necessary. Sometimes a bony fusion is required.

Surgery for post-traumatic spasticity

After a spinal cord injury, you can have involuntary contractions of your leg, arm and trunk muscles. These contractions are often made worse by a “noxious” stimulus to your body. Examples of this occurrence include a full bladder, bowel stimulation, skin sores and a urinary tract infection.

Spasticity is most commonly treated with oral medications. If your spasticity becomes severe and poorly controlled with medications, surgical options are available to treat it.

Intrathecal baclofen pump

We place a pump containing baclofen, an antispasticity medication, in the fatty tissues of your abdomen. The pump sends the medication to the space where spinal fluid surrounds your spinal cord. A small catheter we thread through the lumbar region of your spine delivers the baclofen.

Selective sensory micro-rootlet section

If the baclofen pump isn't effective, or you prefer not to get a medical device like this implanted, a selective sensory micro-rootlet section is an option.

In this surgery, we address the parts of the sensory nerve rootlets entering the spinal cord that are associated with the muscles that are having spasms.

Spinal cord untethering

If your spasticity resists medication and you develop other symptoms of posttraumatic spinal cord tethering or syringomyelia, you might need surgery aimed at treating this condition.

Syringomyelia occurs when a fluid-filled cyst develops in your spinal cord. Also called a syrinx, the cyst can grow larger over time. This can damage your spinal cord and cause stiffness, weakness and pain.

The goal of syringomyelia surgery is relieving the pressure the cyst places on your spinal cord and restoring the regular flow of cerebrospinal fluid. This fluid, which exists in the tissue surrounding your spinal cord, protects and lubricates this tissue.

Depending on your situation, syringomyelia surgery is performed in several different ways, including:

• Correcting the spinal irregularity if one is slowing down or blocking the flow of cerebrospinal fluid
• Inserting a shunt, which is a flexible tube, to drain the cyst
• Removing a small section of bone at the back of your skull
• Removing the obstruction if one is interfering with the flow of cerebrospinal fluid

A tethered spinal cord is a condition where your spinal cord attaches to the wall of your spinal canal. Your spinal cord should move freely inside of your spinal canal — not become attached to it. The resulting tension on your spinal cord can make it stretch, damage it or restrict blood floor to your spinal nerves. It can also limit your ability to move.

Other possible symptoms include:

• New or worsening blood pressure regulation (high or low) and sweating known as autonomic dysreflexia
• New or worsening pain in parts of your body where the sensation is absent or abnormal
• New or worsening spasticity in your arms legs, or trunk
• Progressive loss of sensation and strength in your arms, legs or torso
• Worsening bowel, bladder or sexual function
• Worsening respiratory function

Surgery is the most commonly used treatment for a tethered spinal cord. Our surgeons will begin by making an incision in your lower back. From there, we remove scar tissue and detach your spinal cord from your spinal canal with the proper tools.

Surgery for spinal cord injury-related neuropathic pain

After sustaining a spinal cord injury, you might experience pain in parts of your body that have little to no sensation in response to normal stimuli like touch or a sharp pin. The pain is often described as sharp, stabbing, burning or tight and accompanied by a feeling of pressure or pins and needles. Surgeries to address this pain include the previously mentioned spinal cord untethering and dorsal root entry zone microcoagulation.

A spinal cord injury can lead to spontaneous electrical firing of neurons (that is, nerve cells) within sensory regions of your spinal cord known as the dorsal root entry zone. These regions receive painful stimuli given to your body, causing neuropathic pain.

The surgery performed to address this issue is only considered if you have a complete spinal cord injury and if you have brachial plexus avulsion. The latter condition occurs when communication from your spinal cord and your arm, wrist or hand is partly or fully cut off. If we determine that surgery is the best option for you, our surgeons will apply radiofrequency heat to the places where electrical hyperactivity is happening in these spinal cord neurons.