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Ask The Expert Archive

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Spine Archive Questions

Below are Dr. Gelb’s answers to Spine questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 91.

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Q : 1

What is a two-level decompression laminectomy of the cervical spine?

Laminectomy is a procedure where the posterior bony arch of the vertebra is removed in order to make more room for the spinal cord and nerve roots. A 2 level decompression laminectomy would perform this procedure at 2 consecutive vertebra in the neck.

Q : 2

What is c4 c5 syrinix t8 hemangioma secondary to diffuse bulge mild degeration t10 -t11 l4l5 bulge l5 s1 right central bulge?

Each of these things is different: a syrinx is a cyst in the central spinal cord. An hemangioma is an abnormal collection of blood vessels in the bone of the vertebra. A disk bulge is a sign of degeneration in the disk - part of the process of normal aging.

Q : 3

Will SI joint injuries typically heal on their own without medication or therapy? If so, how long does it typically take? I injured mine seven weeks ago and still have fairly sharp pain upon rotation to the opposite side - is this typical? Thanks!

Most episodes of acute low back pain, from whatever cause, will resolve in about 6 or 10 weeks. It is impossible to know whether you have injured your sacroiliac joint or simply strained a low back muscle. In any case, you will probably get better on your own. Relative rest and use of over the counter pain medications and local modalities such as heat or ice generally will help resolve the problem.

Q : 4

I've had a herniated disc (left paracentral sub ligamentous disc protrusion c6-c7) for 6 weeks. The pain resolved a couple weeks ago, but had left arm weakness (triceps) for about 4 weeks. The weakness doesn't seem to be getting worse. Do I run a high risk of permanent nerve damage if I were to wait a couple more weeks before considering surgery?

As long as your symptoms are not getting worse, I think you can certainly wait. The main reason for surgery is to treat pain. Numbness and weakness will generally resolve if the pain has as well. However, it can take three months or more for strength to recover. Some of the decision regarding surgery revolves around the severity of the weakness. The more profound the loss of motor strength, and the larger the disc herniation, the less likely that it will resolve without surgical intervention.

Q : 5

I've been diagnosed with an unusual condition called diffuse idiopathic skeletal hyperostosis (DISH). Is there a surgical treatment available?

DISH syndrome causes spontaneous spinal fusion. That cannot be reversed. As the fusion process occurs, nerve root or spinal cord compression may occur, causing pain, weakness or loss of sensation. This compression can be treated surgically to relieve the compression and improve symptoms.

Q : 6

My Dad has severe back pain and has difficulty walking. His doctor recommended a low back operation. Is it safe for a 76-year-old? What can we do for the time being to relieve his pain? Pain killers are no longer working.

Surgery can be done safely in patients in their 70s (and even 80s). We often use epidural injections to control pain prior to surgery.

Q : 7

For two years I had osteomyelitis in my lower spine without any treatment. Antibotic was eventually given for 8wks. I have read that these type of infections have the possibility of becoming active again. Is this tue?

Osteomyelitis can be difficult to eradicate. Bone infection in other areas almost always requires surgery. However, the spine has such excellent blood supply that frequently it can be treated with only IV antibiotics and surgery is not required. Generally, spontaneous fusion of the affected segment occurs. Once this happens it is extremely rare for the infection to reactivate. Many people believe that bacteria can remain dormant within the bone permanently and then if the area is disturbed (usually by surgery) infection can become active again.

Q : 8

I had an X-ray which showed curving of the spine what can I do on my own to help the pain. The medicine does help.

Physical fitness consisting of aerobic conditioning, flexibility exercises and core strengthening are generally helpful to deal with spinal pain.

Q : 9

My mother fractured her 9th vertebra and is experiencing severe pain. Would she need surgery?

Most vertebral compression fractures heal without surgery. Usually bracing is sufficient.

Q : 10

Are there surgeons on staff that have performed endoscopic spine surgery for spinal stenosis?

We do not perform endoscopic spine surgery. We use other minimally invasive techniques and the operating microscope.

Q : 11

Does your department deal with adult Chiari I Malformations in adults with scoliosis?

Yes, we can deal with adult scoliosis in the context of a Chiari malformation. Just call (410) 448-6400 for an appointment.

Q : 12

How long is the recovery time for anterior and posterior spinal fusion for kyphosis? Also, does an anterior approach involve opening the chest?

Generally, recovery time is a function of how many levels were fused and the age of the patient. Around 8 to 10 weeks is the average recovery time from the surgery, although it can be several months until things are fully healed. Anterior surgery usually involves a thoracotomy (opening the chest) but fewer and fewer patients require that type of surgery with modern techniques.

Q : 13

My 18 year old daughter has just been diagnosed with Scheuermann's disease (Kyphosis). It presented as a result of a fender bender she was involved in, however; after hours of research I realize that it was missed at least three times by the medical community. I also had this disorder as a child, along with the side-to-side curvature. I have had every pediatrician her entire life check for scoliosis and none found it because there is no side-to-side curve on her, just the front to back. She absolutely inherited this disorder from me, and all the abnormalities in my own spine as a child (more than just curvatures). I went on disability at the age of 34 when I could no longer work because of my back. I felt I paid the price as a child for this ailment; it isn't easy going to school in a back brace in 5th grade. Please help save my daughter from a similar fate. It appears you are the top doctor on this subject. And I am running into far too many people in the medical community that have never heard of this disorder. I know it is rare, rarer still because she is female. Nonetheless, I am beginning to panic because I can't find anyone knowledgeable on the subject. Please help my daughter as well as myself. Thank you.

There is no reason to panic. Since your daughter has finished growth it is unlikely that her curvature will progress significantly rapidly. Most patients with moderate kyphosis tolerated quite well with no significant disability. Without seeing her and her x-rays it's difficult for me to give you more information. However, since you are relatively close, why don't you make an appointment to come see me in the office sometime soon. You can call 410-448-6400 for an appointment. I look forward to seeing you.

Q : 14

Can inflammation in the colon be caused by a degenerative disk in my spine? I just had a colonoscopy, and it was normal except for inflammation. I'm getting pain in and around my colon mostly in the back area.

Intra-abdominal processes such as pancreatitis or intestinal inflammation can definitely be a cause of low back pain. In addition, certain types of colitis can be associated with the development of low back arthritis similar to ankylosing spondylitis. A good rheumatologist should be able to do the appropriate tests to determine if this is the case.

Q : 15

Several years ago, I had an MRI that revealed a severe case of a slipped disc. I've had two shots, but I've had numerous incidents since, some acute low back and pain that radiates down to my calf. Why does everyone steer clear of the shot? Will I always have to deal with this?

At best, most spinal injections offer temporary relief. At worst, they can be painful and offer no relief. They are extremely useful when used correctly. Whether any given patient wants to undergo an injection is a personal decision.

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