Degenerative Disc Disease of the Spine
This encompasses changes of the discs with loss of disc height, loss of water, and instability, which frequently results in chronic and progressive neck and back pain. Therapies for this include muscle stabilization, electro-surgical procedures and, where appropriate, surgical fusion and stabilization procedures to reduce pain. Individuals that are affected are usually middle-aged, however, depending upon trauma and predisposition, we have seen individuals from their early 20's into their late 80's with problems relating to degenerative disc disease.

Scoliosis
Individuals with scoliosis have a curvature of the spine in a rotational and saggital translation. Options for treatment include conservative therapy with bracing, physical therapy, and where needed, surgery for progressive scoliosis will be considered. Individuals need to be followed by a doctor to determine whether the curve is progressive. If the curve is progressive and not able to be controlled with conservative measures (including exercise and bracing), then surgery becomes the treatment of choice. Surgery can be done posteriorly or anteriorly through the thoracic and lumbar cavities with care taken to minimize the amount of vertbrae fused. Additionally, proper balance is very important so that the individual has a good cosmetic result.

Spinal Stenosis
Spinal Stenosis frequently happens in an aging population where the aging joints and disks deteriorate and encroach upon the exiting nerve roots. This condition was diagnosed approximately 30 years ago with the advent of modern imaging technologies. We now appreciate this clinical problem more often, since our population is living to an older age and we are demanding more activities of this aging population. Frequently individuals will state that they are not able to walk as much as they once were able. Where they could walk a mile one year ago, they can now only walk several blocks before an aching tiredness in the legs is apparent. These individuals note a deterioration in their activities of daily living, their ability to stand and walk, do marketing and feel that they are not able to keep up with their peer group. Procedures that can be performed for spinal stenosis are numerous, ranging from conservative all the way to operative intervention. Frequently individuals are assessed and injection therapies are offered. If this fails, a decompressive laminectomy needs to be considered to keep the individual as active and ambulatory as possible.

Disc Herniation Syndrome
Disc herniations are protrusions of disks in the cervical, thoracic and lumbar spines. These are most frequently seen in the lower lumbar spince and mid and lower cervical spines. Herniations frequently cause neck and axial skeletal pain, as well as leg and arm pain. Conservative treatment is the rule, inlcuding rest, anit-inflammatory medications, injection therapies including nerve root blocks and epidural steroid injections. If this fails and the individual still has leg and/or arm pain, then frequently a micro diskecotomy approach will relieve the pain. These syndromes are seen more frequently in individuals that have to do heavy lifting and bending and also individuals that are addicted to tobacco.

In the cervical spine, the preferred approach is conservative therapy where we achieve good results in upwards of 90% of patients and thereby avoiding surgery. However, when surgery is necessary, the anterior cervical diskectomy and fusion is the preferred treatment of choice, giving the best long-term results.

In the lumbar spine, a disk herniation can be managed sucessfully without surgery in up to 90% of individuals. However, those who remain painful after three months of conservative therapy should be considered for a microdiskectomy.

At times a disk herniation will trigger a degenerative painful disk condition and may require fusion surgery.

Osteoporosis of the Spine
Osteoporosis of the spine is very common and is an age-related process. Individuals frequently develop thoracic and lumbar kyphosis. (They lose vertebral heights and have compression fractures). Until recently, the only help that was offered to individuals suffering from compression fractures was a brace support, and to boost the amount of calcium delivered to the spine. Now there are advances with vertebroplasty techniques used to correct the compressed fracture where an injection of bone cement has reversed the kyphosis (so-called Dowager's Hump) as well as restore height and significantly reduce pain. Individuals that are candidates for vertebroplasty have had compression fractures or a painful fracture that is approximately 4 to 6 weeks old, which continues to cause significant pain. The best way to treat osteoporosis of the spine is to avoid the condition altogether, with the use of pre- and post-menopausal medications that can restore calcium for bone support.

Tumors of the Spine
Tumors of the spine range from benign, non-aggressive tumors to highly aggressive, destructive lesions. Frequently surgery is required and can range from biopsies, with subsequent radiation and/or chemotherapy, to en-bloc resections for removal of the entire tumor and instrumentation with hardware and bone. Concerns for individuals with spinal tumors are removal of the tumor while maintaining the structural integrity of the axial spine to permit standing and walking. Accurate diagnosis with imaging technologies is necessary for proper evaluation and the decision making process regarding these complex problems.