Your situation is unique. This is our starting point.

Embarking upon a health procedure, whether simple or involved, can be an anxiety-producing experience for most patients. The critical thing to remember is that SPINE-PEDS ORTHO team of professionals will handle complicated spinal problems, possibly much like your own, on a frequent basis. And knowledge helps a great deal. Higher volume leads to better expertise and outcomes.

One step in allaying concern is to try and become more familiar with your condition and treatment options. Our team believes in educating our patients about their conditions. Your physician will determine the best treatment for your particular condition.

Disc Herniation

Intervertebral discs are rubbery cushions between the segmental bones of the spine (vertebrae) that act as shock absorbers and provide the normal flexibility of the spinal column. Each disc’s normal location is directly adjacent to the spinal nerves. When the discs deteriorate with age or are otherwise affected by injury, they become prone to herniation (bulging/rupture), which can cause a piece of the disc to move out of place and squeeze a spinal nerve.

Although herniation can occur in any section of the spine, lumbar (low back) and cervical (neck) disc herniations are the most common. Symptoms may include low back or neck pain along with pain radiating into the leg (sciatica) or arm, along with weakness and/or numbness.

Cervical radiculopathy refers to a pinching or inflammation of a cervical nerve from its exit point in the spine, called the neural foramen. The symptoms of cervical radiculopathy may include pain, numbness, or weakness in different areas of the arm or hand. Different common conditions associated with cervical radiculopathy include cervical disc herniation and cervical spondylosis.

Non-operative treatment of Radiculopathy

The logic of using non-operative treatment is reinforced by a variety of evidence from scientific studies. Some studies have shown that cervical radiculopathy usually improves with time without the need for surgery. The nature of some of these non-operative treatment modalities are noted below.

Relative rest and collar immobilization
It may be important to refrain from repetitive movements of the neck and forceful or heavy lifting movements during the acute phase. A soft cervical collar is often helpful to limit neck motion and provide splinting or rest in a position of comfort.

Whenever possible, your physician may prescribe anti-inflammatory medication, particularly at the outset of the problem. Some radiculopathies will respond to non-steroidal anti-inflammatory medication alone, but a short course of oral corticosteroid medication is often prescribed as well.

Physical therapy
The physical therapist can administer intermittent neck traction to help relieve pain. If traction is particularly effective, a patient can purchase a traction unit and self-administer traction at home on a regular basis. When pain is reduced, range of motion and strengthening exercises can help to gradually restore areas in the neck and shoulder that have been weakened by disuse and pain.

Epidural steroid injection treatment

In many cases, the initial therapies for cervical radiculopathy are ineffective. Epidural steroid injection may benefit patients who would otherwise suffer with the kind of lasting pain that would sometimes necessitate surgical treatment. The procedure can be performed in an outpatient setting using fluoroscopy (x-ray guidance).
The membrane covering the spine and nerve roots is called the dura. The space surrounding the dura is the epidural space. An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, reducing pain and hopefully aiding the healing process. It may provide permanent relief or pain relief for several months while the injury/cause is healing.

Improvement may occur immediately or within two weeks. Some patients will respond with one injection, but some may require up to three, interspersed over the course of a recovery period of one to three months. Most patients will benefit from a gradual exercise performed simultaneously with the supervision of a physical therapist.

Surgical Management

Lumbar Spine

Microdiscectomy – Percutaneous disc removal (PDR)

A herniated lumbar disc can push on spinal nerves and cause severe, shooting leg pain, numbness and/or weakness. A percutaneous disc removal (PDR) can remove a portion of the herniated disc that is compressing spinal nerves through a small incision in the skin. This minimally invasive approach uses a much smaller incision than traditional open spinal surgeries and avoids damage to the low back muscles.

Cervical Spine

Instrumented Anterior Cervical Discectomy, Fusion (ACDF)

ACDF is the procedure in which a section of the a ruptured disc is removed in patients with spinal stenosis to remove pressure on nerves from disc herniations. A bone graft is usually inserted with instrumentation to keep the disc space at a normal height and fuse the vertebrae above and below the removed disc.