Orthopedic Services
Back/Spine Topics
Anatomy
Symptoms
Diagnosis
Tests and Exams
Technology
Treatment Options
Scientific Glossary
Herniated Disc (Laminotomy/ Microdiscectomy)
Osteoporosis
ScoliosisSpinal Topic Website Links
www.back.com
www.knowyourback.org
www.necksurgery.com
www.iscoliosis.com
www.pwhs.org/pdfs/PWHP_Winter2003.pdf
www.potomachospital.com/documents/HealthConnection_WI06.pdf
Herniated Disc (Laminotomy/Microdiscectomy)
To alleviate the pain of a ruptured or herniated intervetebral disc, a Laminotomy/Microdiscectomy may be performed.
This surgical procedure is carried out in two steps beginning with the laminotomy. Lamina is the Latin name given to the bone protecting the spinal canal, and otomy means opening or hole. The laminotomy simply opens up the spinal canal in order to visualize the pinched nerve root.
Once this is accomplished, the second procedure, the microdiscectomy, is performed. A high powered stereoscopic microscope is used to provide illumination and magnification to allow the nerve and surrounding structures to be visualized clearly through an incision less than one inch long. The nerve root is carefully protected with a specialized retractor, and protruding disc fragments, along with any remaining loose or degenerated disc material, are then removed with a small grasping device.
The small hole left in the annulus will regenerate in 4 to 6 weeks and fill in with new disc material.
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There has been much recognition of osteoporosis as a women's health problem, but five million American men are also affected. Even teenagers are not immune, particularly girls. Osteoporosis causes the bones to weaken and fracture under the slightest stress. If detected early, it can be prevented and treated before significant bone loss occurs. Bone tissue can be affected by age, heredity, unhealthy habits, diet, sex hormones, physical inactivity and certain medications.
Osteoporosis can be a complication of any chronic disease involving the lungs, liver, kidneys, GI tract, hormones, and rheumatoid arthritis. Bone loss can occur as a result of long term use of steroids, thyroid hormone, some anti-convulsant drugs and chemo-therapies.
Low levels of sex hormones are the major cause of osteoporosis. Men with low testosterone levels can be treated with replacement therapy.
Detecting Osteoporosis with Bone Mineral Density Testing
Women who complete menopause or suffer loss of menstrual periods should investigate the possibility of bone loss with a BMD test. The BMD test is quick, painless, similar to x-ray, and can predict fracture risk.
Unhealthy habits such as smoking and excessive alcohol intake are known risk factors.
A regular regimen of improved physical activity, especially weight-bearing exercise or the use of resistance machines, can prevent or slow the loss of bone with aging.
It is important to tell your doctor if you detect any loss of height, have sudden back pain or suffer a fracture with little trauma. A medical workup would include a complete medical history, x-rays and blood and urine test. Your doctor can order a bone mineral density (BMD) test to detect low bone density.
Men and women who have risk factors should take calcium and, in some instances, Vitamin D, as a preventative measure. Additional treatments for osteoporosis now include calcitonin, which comes in a nasal spray, and bisphosphonate alendronate (Fosamax). Estrogen is the first line of defense against osteoporosis and the decision whether or not to take estrogen should be carefully considered with your doctor, who can recommend a specific program of treatment.
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Everyone's spine has curves. These curves produce the normal rounding of the shoulder and the sway of the lower back.
A spine with scoliosis has abnormal curves with a rotational deformity. This means that the spine turns on its axis like a corkscrew. Compare the more subtle curve of the normal spine to the severe curvature of the scoliotic spine.
Scoliosis is a curvature of the spine which may have its onset in infancy but is most frequently seen in adolescence. It is more common in females by a 2:1 ratio. However, when curves in excess of 30 degrees are evaluated, females are more frequently affected by a ration of approximately 8-10:1.
The cause of the most common form of scoliosis -- idiopathic scoliosis -- is unknown, but there are certainly hereditary factors that are present.
Scoliosis causes shoulder, trunk and waistline asymmetry. In mild forms, the condition may be barely noticed; whereas in severe forms there is significant disfigurement, back pain and postural fatigue, and it may be associated with heart failure. Fortunately the majority of scoliosis cases need only close follow-up to watch for worsening of the curve. Some cases require more aggressive treatment which could include surgery (see below).
Orthopedic surgeons are best qualified to evaluate and treat deforming spinal conditions like scoliosis. However, a good resource for further information is:
The National Scoliosis Foundation
5 Cabot Place
Stoughton, MA 02072
Phone: (617) 341-6333
Fax: (617) 341-8333
www.scoliosis.org/Non-Operative Treatment
The non-operative treatment of scoliosis involves observing the deformity with examinations and repeated x-rays. Under certain circumstances, when spinal growth remains, a brace may be used in combination with follow-up x-rays. Physical therapy exercises have not been shown to be effective treatment for scoliosis.
Why Surgery?
Surgical treatment of scoliosis may be indicated for any of the following reasons:
To prevent further progression of the curve.
To control the curve when brace treatment has failed.
To improve an undesired cosmetic appearance.
For reasons of discomfort or postural fatigue.
The most common surgical treatment for scoliosis is a spine fusion using special stainless steel rods, hooks, and a bone graft.
The rods are attached to the spine with hooks and the curved portion of the spine is carefully straightened.
Then, small strips of bone graft are placed over the spine to fuse it in a straight position.
As the bone graft heals over the next several months, the spine becomes solid and will not curve again. But the part of the spine that has not been fused will still be flexible, and allow nearly normal overall movement.
