Get answers to your Spine related questions.
Below are University of Maryland Spine Program surgeon Dan Gelb's answers to commonly asked questions about spine-related disorders and surgical treatments.
This information 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.
Click on a question below for an answer to a specific question, or scroll down to view the complete list of questions.
Question: I've have had 2 chiropractors tell me that I have spinal stenosis but the last neurologist told me nothing was wrong. In the meantime I'm in extreme pain. Can you help?
Answer: The diagnosis of spinal stenosis is generally fairly straightforward. Either an MRI scan or myelogram will show the narrowing of the spinal canal. Many people have radiographic stenosis, which is asymptomatic. Only in cases where there is symptomatic leg pain that is related to standing and walking with a sense of leg heaviness or fatigue deserve treatment. Back pain alone is generally related to arthritis in the back and not the stenosis per se.
Question: I was initially diagnosed with spinal stenosis after having an MRI. My main symptoms are low back pain and an inability to stand up straight and walk (I am now walking somewhat bent over with a cane). I went to another doctor, who said the stenosis wasn't bad enough to cause my problems -- he said it was muscle weakness combined with scoliosis. I've had physical therapy for about three weeks and, while I feel stronger, I'm not walking any better. It seems to me my symptoms are characteristic of spinal stenosis. Any thoughts?
Answer: Certainly it may take 3 to 6 months of consistent exercise to see much effect. But if there is structural spinal deformity (scoliosis), no amount of exercise will correct that. Spinal stenosis generally gives leg pain and a feeling of leg heaviness, not just backache and hunched posture.
Answer: I think standard laminectomy or laminectomy using a microscope is easier and more likely to be complete than endoscopic techniques. I think standard laminectomy has a proven track record that endoscopic surgery does not.
Question: I've been diagnosed with lumbar spinal stenosis and a degenerative disc. I'm a 56-year old male with an active lifestyle. My doctor says a laminectomy is a possibility but fusion is more probable. I'm exploring all options, so if you could comment on the following I'd appreciate it:
Question: I am a 46-year-old female who has had 3 previous back surgeries. I am still in pain. Do you know of any doctors who are experienced in removing BAK cages and doing revision surgery?
Also, how would you know if indeed the BAK cages are causing the pain? Shortly after surgery over 5 years ago, I developed pain in one particular area, right where the left cage is. It has always remained, even after each subsequent surgery to 1) add rods and screws posteriorly and then a few years later to remove the rod and screw on that same side only. Thus, I feel the left cage has something to do with the pain. Have you removed them in a person who has had them over 5 years? What else could be causing the pain? Who's to say something wasn't pushed behind it when it was installed?
Answer: My partner, Dr. [Steven] Ludwig, and I certainly have experience with revision of BAK cages. The cages rarely need to be removed but both he and I have done it before when necessary. Successful revision surgery is generally a complex analysis of the causes of continued pain. There is not always an easy solution such as simple instrumentation removal. Revision anterior surgery can be complex and dangerous.
Regarding your second question, I think there are three basic issues here:
I think this is the only way to determine with any certainty what the problem is and I would not recommend any further surgery until the cause of the pain was specifically determined. Another thing that might be useful would be a selective nerve root block of the exiting nerve root at the level of the cages on that side to see how much pain relief it affords.
This is how I would approach this problem if such a patient were to see me in the office.
Question: I underwent a discectomy in 1988 and a discectomy with fusion in 1991. About four years ago I started experiencing back pain in my lower right side, upper buttock, and hip. The pain was only occasional and something I could control, but the pain has become constant and significantly worse. An orthopedic surgeon I visited wasn't interested because I didn't have pain down my leg symptomatic of a spinal problem. He suggested I might be experiencing arthritis as a result of the surgeries, and that I should learn to live with it. At 47 years old I am discouraged at the prospect of facing a long life of pain and degeneration. What source of diagnosis and treatment can you recommend pursuing?
Answer: Advanced degeneration of the segments next to a previous fusion certainly is a well-recognized phenomenon that can cause pain many years following a spinal fusion, especially with instrumentation. Often symptoms from this type of arthritis can be controlled non-surgically with medication and exercise. Occasionally, the pain becomes so severe that extension of the fusion is necessary in order to control pain. This is especially true when spinal stenosis with nerve root compression develops.
The diagnosis is relatively straightforward with plain X-rays and either an MRI scan or a myelogram. If you have already gone through a conservative management program consisting of nonsteroidal anti-inflammatory pain medications and physical therapy, then I think you need to see another spine surgeon for a second opinion.