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Treatments and Conditions

Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis (AIS) is a curvature of the spine that can occur in children aged 10 to maturity. The spine may curve to the left or right. Sometimes AIS may start at puberty or during an adolescent growth spurt.

Idiopathic means the curve develops for unknown reasons. We now know that there is undoubtedly a genetic pre-disposition for some adolescents to develop AIS. Scoliosis is actually quite common – in fact, 3-5% of adolescents will be found to have some form of scoliosis. Most of these children are girls.

Dr. Hershman at Florida Spine Specialists is an expert in treating scoliosis. Having been trained by several of the world’s foremost experts in scoliosis, he is able to diagnose and treat all types of scoliosis using the latest techniques in the field. Each child’s case is different, and the treatment plan is tailored to each individual’s specific problems and needs.

Symptoms
Symptoms of scoliosis can include back pain, legs that aren’t equal in length, or an abnormal gait. Patients with AIS may have one shoulder that is higher than the other, a shoulder blade that sticks out, or a rib cage that is more prominent when bending forward. Often, there is also a visible curving of the spine to one side. Many times, the first indication of AIS is when an adolescent or parent notices that clothes no longer fit correctly (for example, the legs of pants may seem uneven).

It is important to seek treatment for AIS because if left untreated, a progressive scoliosis can result in significant deformity. The deformity can cause marked psychological distress and physical disability, especially among adolescent patients. Additionally, the deformity can have serious physical consequences.

As the spinal bones (vertebrae) rotate, the rib cage “twists” around it, which in turn can cause heart and lung compromise. When progressive scoliosis affects the lumbar spine, the pain can be debilitating.

Non-Surgical Treatment

Fortunately, the vast majority of cases of AIS can be treated non-surgically. Small curves (less than 15-20 degrees) are watched over time for progression. At this stage, no specific treatment is needed. Larger curves (between 20-40 degrees) require bracing to prevent further progression of the curve.

Some adolescents find wearing the brace 16 hours every day difficult. Braces can be uncomfortable, can make a child self-conscious (even though they’re usually well disguised under clothing), and can get very hot, especially here in South Florida. However, wearing a brace can often prevent a curve from getting bad enough to require surgery. Unfortunately, even in the most compliant patients, there are some curves that do not respond to bracing.

Surgical Treatment
Surgery may be recommended for curves that are greater than 40 degrees. Surgery for scoliosis involves special surgical implants such as rods and screws, and sometimes hooks and wires as well. The goal is to straighten and balance the spine and secure it in place (fusion) so that the curve doesn’t get any worse as the child grows. Surgery does not cure scoliosis; it is simply a way to help straighten the curve and manage the progression of the disease to avoid greater deformity.

Adult Degenerative Scoliosis

Scoliosis is a curvature of the spine. Many people think it only occurs in children, but adults can have scoliosis as well. Adult scoliosis is defined as an abnormal curvature of the spine in someone over the age of 18. Sometimes, this is the result of a childhood curvature that was left untreated but has since progressed. Other times, scoliosis can develop as a result of age and normal “wear and tear” on the spine.

Symptoms

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As we get older, many changes occur to our bodies – this is especially true in the spine. As parts of the spine deteriorate, many people begin to experience back or neck pain. This can lead to a number of common degenerative spinal conditions, such as:

  • Spinal stenosis
  • Degenerative disc disease
  • Vertebral compression fractures
  • Kyphosis
  • Sagital imbalance

Any of these conditions can cause the spine to curve to the left or the right, or cause a person to “hunch forward.” Curvature can also cause other problems such as:

  • Trunk imbalance (making the patient appear as though they’re leaning to one side)
  • Spinal instability
  • Rib prominence
  • Humpback
  • Pain
  • Nerve compression causing weakness in the legs or feet
  • Heart and lung problems (only in severe cases)

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Diagnosis
The first step in treating adult degenerative scoliosis, is making an accurate diagnosis. This involves getting a detailed history of your symptoms, past treatments including surgeries, and performing a thorough exam. Additionally, a number of special X-rays are ordered as well as an MRI and/or CT scan.
Treatment

Most cases of adult degenerative scoliosis are treated non-surgically. Some treatment options include:

  • Physical therapy
  • Pain and anti-inflamatory medications
  • Steroid injections

Surgical correction of adult degenerative scoliosis is not common. However, it may be necessary if non-operative treatments fail, and pain persists. If surgery is necessary, it usually includes a fusion of some of the vertebrae using spinal instrumentation (commonly rods and screws) to stabilize the spine. Keep in mind, many cases of adult degenerative scoliosis need no treatment at all. Unfortunately, there is nothing that will guarantee that an adult degenerative scoliosis won’t progress and ultimately need surgery, but the best thing patients can do is maintain a healthy lifestyle, exercise regularly, eat a balanced diet, and avoid nicotine. These good habits can help prevent many spine problems from getting worse, and causing more symptoms.

Cervical Disc Herniation

Cervical-DiscThe neck, or cervical spine is made up of 7 bones, or vertebrae. These bones are separated from each other by a specialized cartilage cushion called an intervertebral disc. As we age, the tough outer ring of the discs can become weaker allowing the soft jelly like center to “squirt out”, or herniate. Herniated discs can put pressure on the spinal cord or nerve roots that pass close by. Herniated discs are also referred to as slipped discs, ruptured discs, protruding discs, or bulging discs.

In the cervical spine, a herniated disk can irritate the spinal cord or nearby nerve roots and result in neck, arm, or shoulder pain, numbness, or weakness in the arm or hand. Occasionally, large disc herniations can even cause some strange symptoms like problems with balance, difficulty controlling one’s bowels or bladder, and changes in dexterity of the hand (this can cause changes in handwriting, problems buttoning one’s shirt, or difficutly finding one’s keys in a pocket or purse.

Treatment
Fortunately, most people with herniated discs experience no symptoms whatsoever. When people do have symptoms, the vast majority of their symptoms will improve with time, and do not require surgery. However, despite adequate time, rest, and treatment, some people have pain or symptoms that persist. When this occurs, more aggressive treatment is usually sought and may include medication, epidural spinal injections, and in some cases, surgery. If surgery is required, the vast majority of herniated discs can be treated with minimally invasive surgery.

The physicians and surgeons at Florida Spine Specialists are experts in treating herniated discs in the neck. We believe in a conservative approach, utilizing all the tools and treatments currently available to help resolve our patients’ symptoms. Our priority is providing the best care for our patients, and treatment plans are tailored to each individual’s specific problems and needs.

Cervical Stenosis

The neck, or cervical spine, is made up of 7 bones (vertebrae). These bones are separated from each other by a specialized cartilage cushion called an intervertebral disc. As we age, the discs begin to “wear out”, causing them to flatten out like a pancake. When this occurs, the space available for the nerve roots is narrowed, and can cause neck, arm, or shoulder pain, and numbness or weakness in the arm or hand (radiculopathy). Occasionally, the narrowing is so significant that the spinal cord is compressed – this is called myelopathy.

Cervical stenosis is not uncommon. Fortunately, many times the symptoms are tolerable, and sometimes, it doesn’t cause pain at all. Additionally, cervical stenosis is often effectively treated with nonsurgical modalities. However, if surgery is indicated, the vast majority of patients obtain good or excellent outcomes.

The physicians and surgeons at Florida Spine Specialists are experts in treating cervical stenosis. Our priority is providing the best care for our patients, and treatment plans are tailored to each individual’s specific problems and needs.

Cervical stenosis is not uncommon. Fortunately, many times the symptoms are tolerable, and sometimes, it doesn’t cause pain at all. Additionally, cervical stenosis is often effectively treated with nonsurgical modalities. However, if surgery is indicated, the vast majority of patients obtain good or excellent outcomes.

The physicians and surgeons at Florida Spine Specialists are experts in treating cervical stenosis. Our priority is providing the best care for our patients, and treatment plans are tailored to each individual’s specific problems and needs.

Symptoms
Patients with myelopathy can have an array of “strange” symptoms such as problems with balance, difficulty controlling one’s bowels or bladder, and changes in dexterity of the hand (this can manifest as changes in handwriting, problems buttoning one’s shirt, or difficutly finding one’s keys in a pocket or purse). Treatment for cervical stenosis is based on the severity of the patient’s symptoms, as well as the degree and extent of spinal narrowing.
Non-Operative Treatment
For most patients, pain and numbness are the major complaints. Patients may be referred for physical therapy, given prescriptions for medication, or be referred for an epidural steroid injection.
Operative Treatment

If patients fail to improve after a thorough course of non-operative management, a decompression procedure is performed. Depending on how severe the stenosis is, and how many levels are involved, your surgeon may choose to perform the surgery from the front of the neck, back of the neck, or sometimes both. Some common surgeries performed for cervical stenosis are:

  • Anterior Cervical Discectomy and
  • Fusion (ACDF)
  • Cervical Disc Replacement
  • Laminoplasty
  • Foraminotomy
  • Laminectomy and fusion

Compression Fracture

A vertebral compression fracture refers to a break of the vertebral body of the Thoracic spine (upper back) or Lumbar spine (lower back), and is most commonly caused by weakened bone due to osteoporosis. Most compression fractures result in a loss of more than 20% of the height of the vertebra.

Compression fractures can occur in the course of normal physical activities, without significant accident or injury. When the fracture occurs there is usually a sudden onset of severe back pain.

Compression fractures increases the risk of future vertebral compression fractures at adjacent levels, which can cause significant height loss, spinal deformity (kyphosis, or hunchback).

Treatments
A vertebral compression fracture refers to a break of the vertebral body of the Thoracic spine (upper back) or Lumbar spine (lower back), and is most commonly caused by weakened bone due to osteoporosis. Most compression fractures result in a loss of more than 20% of the height of the vertebra.

Compression fractures can occur in the course of normal physical activities, without significant accident or injury. When the fracture occurs there is usually a sudden onset of severe back pain.

Compression fractures increases the risk of future vertebral compression fractures at adjacent levels, which can cause significant height loss, spinal deformity (kyphosis, or hunchback).

Non-Surgical Care
Non-surgical care is another option and includes wearing a brace for 6-8 weeks until the fracture heals, pain medications and relative rest until slow return to mobility and activity is possible.

Lumbar Disc Herniation

The lower back, or lumbar spine is made up of 5 bones, or vertebrae. These bones are separated from each other by a specialized cartilage cushion called an intervertebral disc. As we age, the tough outer ring of the discs can become weaker allowing the soft jelly like center to “squirt out”, or herniate. Herniated discs can put pressure on the spinal nerves that pass close by. Herniated discs are often called slipped discs, ruptured discs, protruding discs, or bulging discs.

In the lumbar spine, a herniated disk can irritate nearby nerves and result in pain, numbness, or even weakness in the leg or foot. On the other hand, most people with herniated discs experience no symptoms whatsoever. When people do have symptoms, the vast majority of their symptoms will improve with time, and do not require surgery.

Treatment
When pain or other symptoms persist more aggressive treatment is usually sought and may include medication, epidural spinal injections, and in some cases, surgery. If surgery is required, the vast majority of herniated discs can be treated with minimally invasive surgery, allowing them to leave the hospital the same day as surgery, with only a small bandage.

The physicians and surgeons at Florida Spine Specialists are experts in treating herniated discs. We believe in a conservative approach, utilizing all the tools currently available to help resolve our patients’ symptoms. Our priority is providing the best care for our patients, and treatment plans are tailored to each individual’s specific problems and needs.

Spondylolisthesis

Spondylolisthesis is a condition of the spine in which one vertebral body has slipped forwards or backwards on the vertebral body below. There are several different types of spondylolisthesis. Sometimes the slip is caused by abnormalities of the bone – this type of slip often causes problems during childhood or young adulthood. More commonly, the slip is a result of a degenerative process that occurs as we age.

Often, the slip doesn’t cause problems until there is a narrowing of the space available for the nerve roots, resulting in a condition known as spinal stenosis. Spinal stenosis causes back pain and/or leg pain, and limits the ability to walk. Treatment for spondylolisthesis is based on the severity of the patient’s symptoms, as well as the degree and extent of slippage.

Non-Operative Treatment
For the child or young adult with spondylolisthesis associated back pain, activity modification is recommended. If pain does not subside with activity modification, a brace may be recommended and should be worn full-time for at least 3-6 months.

For the adult patient, pain is generally the major complaint, and may limit the ability of the individual to walk distances. Patients may be referred for physical therapy, prescribed medication, or be referred for an epidural steroid injection.

Operative Treatment
For the pediatric patient with spondylolisthesis that has failed to respond to nonsurgical approaches, either a repair of the bone or a fusion procedure is recommended. Most patients experience pain relief and are able to return to most activity following these procedures.

In the adult patient presenting with degenerative spondylolisthesis in which spinal stenosis is present, a decompression procedure, or laminectomy, is done. This is combined with a spinal fusion procedure to prevent recurrence of symptoms due to the unstable spinal segment.

Spondylolisthesis is a relatively common problem and is often effectively treated with nonsurgical approaches. When surgery is indicated, it is addressed to the specific nature of the disorder and most patients obtain good to excellent outcomes. The physicians and surgeons at Florida Spine Specialists are experts in treating spondylolisthesis and spinal stenosis. Our priority is providing the best care for our patients and treatment plans are tailored to each individual’s specific problems and needs.

Minimally Invasive Spine Surgery

Traditionally, spinal surgery has involved large incisions down the middle of the back and the spreading (retracting) of the back muscles to gain access to the spine. This is referred to as “open” spine surgery. Open techniques provide the surgeon with easy access to the spinal anatomy. The downside of “open” spine surgery is that the muscle retraction damages the spinal muscles and can cause significant post-operative pain. In addition, “open” surgery can result in increased blood loss, larger scars and relatively long recovery times.

In many situations “open” techniques are still preferred, but recently, more and more conditions are being surgically treated using new techniques called minimally invasive spine surgery.

Minimally invasive spine surgery allows the surgeon to make smaller incisions in the skin and avoid large muscle retraction. The surgeon uses a microscope, small instruments, and tubular retractors to perform the surgical procedure.

Advantages of Minimally Invasive Techniques

Minimally invasive spine surgery results in the same surgical outcome as with more traditional, open techniques. However, there are a number of advantages to minimally invasive techniques, including:

  • Reduced operative times
  • Less soft tissue damage
  • Smaller incisions
  • Reduced blood loss
  • Faster recovery with less post-operative pain
  • Shorter, and sometimes no hospital stay

Conditions that can be treated with Minimally Invasive Spine Surgery

  • Herniated discs in the back and neck
  • Cervical stenosis
  • Lumbar stenosis
  • Degenerative disc disease
  • Spondylolisthesis

At Florida Spine Specialists, our priority is providing the best care for our patients; we don’t practice a “one size fits all” approach. For this reason, we offer a variety of minimally invasive techniques that have been scientifically proven, but we avoid others that remain unproven. In addition, we realize that minimally invasive surgery is not right for every patient’s situation, and we customize our approach to each individual’s needs. The minimally invasive techniques we offer include:

  • Microdiscectomy
  • Anterior Lumbar Interbody Fusion (ALIF)
  • Transforaminal Lumbar Interbody
  • Fusion (TLIF)
  • Interspinous Lumbar Fusion (ILIF)
  • Percutaneous Pedicle screws
  • Vertebroplasty and Kyphoplasty
  • Anterior Cervical Discectomy and
  • Fusion (ACDF)
  • Laminoplasty
  • Foraminotomy