Spine Problems

Dr. John Stokes specializes in the following spine issues:

 

Back & Neck Pain

Back and neck pain can be caused by a variety of problems. The important thing to understand about spine problems is that pain is NOT a good indicator of when you must see a doctor.

For example, with back or neck problems, numbness or weakness in an arm or hand, or leg or foot, is more of an emergency signal. It implies that a disc may have herniated and is now pressing on a nearby nerve root. Left untreated over several days, and the numbness/weakness could become permanent and lifelong.

Also, any back or neck problem that started with a fall, car accident or other trauma needs to be seen promptly to rule out any fracture of the neck or back which could cause serious spinal cord issues and paralysis.

Conversely, pain that is limited to the neck or low back often can often respond to non-surgical treatment like rest, anti-inflammatories, custom pain-relieving stretches or spinal injections. Your spine specialist may prescribe medication to relieve pain symptoms, and a therapy visit which can relieve pain symptoms and speed return to activity.

Generally speaking, if you still have any back or neck pain after 3 days, you should see a spine physician to make sure nothing more serious is involved.


Bone Spur / Stenosis

A bone spur is an excess growth of bone around a vertebral body. It is not the bone spur itself that is the real problem, but rather pain and inflammation can occur when the bone spur rubs against nerves and bones. If bone spurs grow too much, they can impinge on nerve roots.

Stenosis is another issue that can affect people as they age past 50 years old. The spinal canal can become more narrow with age, causing back pain that worsens as a person arches their back.

Treatment of stenosis can be done with a surgical procedure that re-opens the space in the spinal canal providing immediate relief of symptoms.


Degenerative Disc

Degenerative disc disease can also occur as a person ages or when they lift something too heavy. Over the years, discs become more brittle, less resilient and more prone to herniation. In many cases, the space between vertebrae can shrink and compress, which in turn can impinge upon nearby nerve roots, causing radiating pain into a leg or arm, or worse, numbness and weakness into a leg or arm.

When a disc herniates in the spine, the surgeon can remove a portion of the disc. In other cases, where the disc is more damaged and must be removed, something must be placed into the disc space. Otherwise, the two vertebrae will collapse on top of one another, placing pressure on the nerve roots that branch off from the spinal cord. Treatment may involve artificial disc implantation surgery.

In the event of a fall or heavy strain, these discs can rupture, causing the nucleus to break through the wall of the disc and place pressure on the nerves that branch out from the spinal cord. This results in a herniated disc, accompanied by back or neck pain.

The good news is that in many cases, the pain and inflammation originating from damaged discs can be treated nonsurgically by reducing the inflammation and by strengthening the musculature surrounding the damaged disc to give it more support.


Herniated Disc

The spine is composed of many vertebrae stacked on top of each other. Between these bones are discs, which act as shock absorbers. The shock absorbing discs resemble jelly donuts, each having a jelly-like center. As we age, the discs naturally become less flexible and more brittle.

In the event of a fall or heavy strain, these discs can rupture, causing the nucleus to break through the wall of the disc and place pressure on the nerves that branch out from the spinal cord. This results in a herniated disc, accompanied by back or neck pain.

The good news is that in many cases, the pain and inflammation originating from damaged discs can be treated nonsurgically by reducing the inflammation and by strengthening the musculature surrounding the damaged disc to give it more support.




Spinal Tumors

Spinal cord tumors are abnormal growths of tissue found inside the bony spinal column, which is a primary component of the central nervous system. Benign tumors are noncancerous, while malignant tumors are cancerous. Because the central nervous system is found in rigid, bony quarters (i.e., the spinal column), any abnormal growth, whether benign or malignant, can place pressure on sensitive tissues and impair function.

The most frequent symptom of benign and malignant spinal tumors is back pain. However, this type of back pain doesn’t not start with an injury, stress or physical activity. The type of back pain may worsen with activity or when lying down. The back pain may also worsen over time and spread to the hips and legs, which is a sign that the tumor is pressing on nerve roots. Spinal cord tumor symptoms include back pain, numbness in a leg, muscle weakness, incontinence, loss of bowel and bladder control and muscle spasms. Other symptoms may include changing sensitivity to heat or cold, and difficulty walking.

The goal in the treatment of spinal cord tumors is to minimize nerve damage related to compression of the spinal cord. The three most commonly used treatment options are surgery, radiation and chemotherapy to kill any remaining cancer cells. Steroids may also be used to reduce swelling.

Spine surgeons use an array of diagnostic tests including MRI and CT to visualze the tumor and determine treatment options including surgical removal of the tumor. Lab tests can include an EEG and a spinal tap. A biopsy may also be performed, to remove a piece of the tumor tissue to diagnose the type of tumor. The tumor may be classified as benign or malignant and graded to enable the surgeon or oncologist to develop a prognosis or outcome for the patient.


Spondylolysis / Spondylolisthesis / Spinal Deformity

Spondylolysis relates to instability of specific bones in the low back. It a very common cause of back pain, particularly in young athletes.

Gymnasts who perform routines that bend and arch the back are often victims of spondylolysis or spondylolisthesis.

With spondylolysis there may be a fracture in the vertebra, but the spine has not moved out of position. With spondylolisthesis, the fracture has allowed the spine to shift out of position to become unstable.

When there is a fracture, the vertebral bones can shift our of position, called spondylolisthesis. Surgery may be needed to treat such a fracture and prevent that spinal instability.

Symptoms of spondylolysis or spondylolisthesis can incude:

  • A stiff back
  • Difficulty walking or standing for long period of time
  • Pain when bending over
  • Numbness/weakness in a foot

Spondylolysis or spondylolisthesis can affect about 5% of adults, sometimes without any symptoms. After age 50, such spinal deformity occurs more often, affecting women more than men because of osteoporosis weakening the strength of bones.

Nonsurgical treatment options include:

  • Rest and anti-inflammatories
  • Spinal Injections
  • Physical therapy and exercises to strengthen the stomach and back
  • Bracing to stabilize the back

Surgery may be recommended if the spine has become unstable or pain symptoms are severe. During surgery, a fusion may be performed and space provided to nerve roots which can relieve symptoms.


 

Dr. John Stokes is a fellowship-trained neurological spine surgeon and is co-chief of Texas Spine and Scoliosis, which is a regional spine center of excellence based in Austin that is referred complex back and neck patients, spinal tumor patients and scoliosis patients from across Texas, Oklahoma, Louisiana and Arkansas. The regional spine center is referred international patients from cities across Mexico — including Mexico City, Monterrey, Hermosillo and Merida. Patients come to the spine center for second opinions for minimally invasive spine surgery; spinal tumor and artificial disc replacement. Texas Spine and Scoliosis has offices in Central Austin; Round Rock/Georgetown; Burnet/Marble Falls; and Kyle, Texas, which is just north of San Antonio.

Medical Disclaimer: Medical information within this site is not intended for use in the diagnosis or treatment of any health or physical condition. This website does not provide specific medical advice and does not endorse any medical or professional service or services obtained through information provided on this site or any links to or from this site. This information and advice published or made available through this website is not intended to replace the services of a physician, nor does it constitute a doctor-patient relationship. For the treatment or diagnosis of any medical condition, consultation with a licensed health care professional is strongly recommended.