It is important to understand not all patients with degenerative disc disease will have significant symptoms, or require surgical intervention. Degenerative disc disease is classified into four stages, each identified by symptoms and pathology. Having knowledge of these four stages, underlying causes, risk factors, and early warning signs will help you with prevention and management. As you explore these aspects, you will gain valuable knowledge on how to effectively address the potential challenges posed by degenerative disc disease.

What is Degenerative Disc Disease (DDD)?

Understanding Degenerative Disc Disease

Degenerative Disc Disease (DDD) is a condition that affects the spine, characterized by the gradual deterioration of one or more intervertebral discs. These discs act as cushions between the vertebrae, providing flexibility and absorbing shock. Over time, due to wear and tear, these discs can lose their ability to function effectively, leading to a range of symptoms from mild discomfort to severe debilitating pain.

Symptoms and Diagnosis

Symptoms of DDD can vary widely. Some individuals may experience persistent back or neck pain, while others might have periods of severe pain followed by stretches of relief. Additional symptoms might include tingling or numbness in the extremities if a degenerated disc results in compression of a nerve root or your spinal cord. 

A diagnosis often involves a physical examination and imaging tests such as X-rays, MRIs, or CT scans to assess the degree of degeneration and rule out other conditions.

Importance of Early Detection

Recognizing the early warning signs of degenerative disc disease is crucial for effective management. Early intervention can prevent the condition from progressing to severe stages, where more invasive treatments may become necessary. If you notice consistent back or neck pain, or any of the aforementioned symptoms, consulting a healthcare professional such as a neurosurgeon can lead to an early diagnosis, improving your chances of managing the condition effectively.

What Are the Four Stages of Degenerative Disc Disease?

Stage 1: Dysfunction-Initial Disc Degeneration

In the initial stage of degenerative disc disease, the intervertebral discs, which act as cushions between the vertebrae, begin to change from a normal or healthy disc.  These discs start to become less effective at absorbing shock. This initial degeneration can cause discomfort or mild pain. Although this stage may not present significant symptoms, it is important to recognize early warning signs like intermittent back pain or stiffness. Early intervention may help slow the progression of the disease.

Stage 2: Dehydration-Effectiveness of Disc is Diminished

As degeneration progresses, the second stage, known as dehydration occurs. This is when your spinal discs begin to dry out, loosing height and flexibility. Often times the outer layer of the disc, called the annulus fibrosus, begins to also weaken, allowing the inner gel-like core, the nucleus pulposus, to slightly bulge out. At this stage, you might experience more pronounced pain, especially during activities that put pressure on the spine. It’s important to address these symptoms promptly through conservative treatments like physical therapy or lifestyle modifications to prevent potential damage to your nerves or spinal cord.

Stage 3: Stabilization-Your Body Responding 

The third stage is stabilization, this is where your spine and body try to compensate for the changes in your discs, often resulting in other conditions such as stenosis and bone spurs. Muscle spams and myofascial pain also become more prominent as the body attempts to stabilize itself. Often times disc herniations occur. When a disc herniates the inner core of the disc actually breaks through the weakened outer layer. This can cause severe pain and discomfort as the herniated disc may press on nearby nerves. Symptoms experienced during this stage often include radiating pain, numbness, or tingling sensations in the limbs. Medical intervention becomes more important at this stage, with potential treatments ranging from medications and physical therapy to minimally invasive procedures.

Stage 4: Collapse-Severe Degeneration

The fourth and final stage is collapse. This stage is characterized by your spinal discs continuing to shrink and the vertebrae of your spine begin to rub together. Severe disc degeneration is where the spine exhibits structural changes due to significant loss of disc space. This stage often leads to chronic pain, may severely impact mobility, and your quality of life. In cases where conservative treatments fail, surgical options, such as spinal fusion, lumbar decompression, or microdiscectomy might be considered to alleviate pain and restore function. Recognizing the progression through these stages can guide effective management and treatment of degenerative disc disease.

What Are the Causes of Degenerative Disc Disease?

Genetic Predisposition

One significant factor in the development of degenerative disc disease (DDD) is genetics. Individuals with a family history of spine problems may be more susceptible to DDD due to inherited traits. Genetic predisposition can influence the rate of disc degeneration, affecting the structural integrity and resilience of intervertebral discs. This genetic link underscores the importance of understanding your family medical history when assessing risk factors for degenerative disc disease.

Aging and Natural Wear

As the human body ages, the intervertebral discs naturally begin to wear down. These discs, composed of a tough outer layer and a gel-like inner core, lose hydration over time, reducing their ability to act as effective cushions between the vertebrae. This process of natural wear and tear can lead to disc degeneration, a common occurrence in individuals as they grow older. Although aging is inevitable, awareness of its impact on spinal health can help guide proactive measures. 

Physical Activity and Lifestyle Choices

The role of lifestyle choices in the progression of DDD cannot be overstated. Engaging in high-impact sports or occupations that involve repetitive heavy lifting can accelerate disc degeneration. Conversely, a sedentary lifestyle contributes to poor spinal health by weakening the muscles that support the spine, thus increasing the likelihood of developing degenerative disc disease. Adopting a balanced lifestyle that includes regular exercise, proper ergonomics, and maintaining a healthy weight is crucial in mitigating risk factors of degenerative disc disease.

Smoking and Nutrition

Smoking is another lifestyle factor that negatively impacts disc health. Nicotine restricts blood flow to the discs, impairing their ability to receive essential nutrients. Moreover, poor nutrition can exacerbate this effect, as a diet lacking in key nutrients such as calcium and vitamin D weakens the overall structure of the spine. Prioritizing a healthy diet and avoiding smoking can play a pivotal role in preventing or delaying the onset of degenerative disc disease.

What Are Early Warning Signs of DDD? 

Recognizing Initial Symptoms

Degenerative disc disease can be challenging to identify in its early stages, as symptoms often develop gradually and may initially be dismissed as minor discomfort. However, being aware of the early warning signs can lead to timely intervention and better management of the condition. One of the most common indicators is persistent back or neck pain, which may be exacerbated by physical activities such as bending or lifting. This pain often fluctuates and can vary in its intensity and duration.

Pain Patterns and Sensations

It’s important to pay attention to the pattern of pain. Individuals with DDD might experience radiculopathy, or pain that radiates to the arms or legs, indicating that a nerve root is being affected. Such referred pain can be accompanied by tingling, numbness, or a “pins and needles” sensation in the extremities. These symptoms suggest that the degenerative process is advancing and affecting the spinal nerves.

Stiffness and Reduced Flexibility

Another early sign of degenerative disc disease is stiffness in the spine, particularly after periods of inactivity, such as in the morning or after sitting for extended periods. This stiffness can limit your range of motion and make everyday activities more challenging. Over time, you might notice a reduction in flexibility, which can interfere with both personal and professional life.

Impact on Daily Life

The impact on daily activities is a significant early warning sign. If you find that pain or discomfort is affecting your ability to perform routine tasks it may be time to consult a healthcare professional. Activities previously done with ease, such as walking or standing for extended periods, may now be met with discomfort or pain.

Recognizing these symptoms early and seeking professional advice can often help manage the condition before it progresses to more severe stages. Early intervention may include a combination of lifestyle changes, physical therapy, and pain management techniques, aimed at improving quality of life and slowing the progression of degenerative disc disease.

Risk Factors of Degenerative Disc Disease: Who is Most at Risk?

Age and Genetics

Degenerative disc disease (DDD) is a condition that tends to develop with age. As you grow older, the likelihood of experiencing DDD increases due to the natural wear and tear on your spinal discs. This is particularly evident in individuals over 40, as the disc’s ability to absorb shock reduces, leading to degeneration. However, genetics also play a crucial role in determining who might be more susceptible. If your family has a history of spinal issues, especially DDD, there is a higher chance that you could develop the condition as well. Hence, understanding your family medical history can be insightful in assessing your risk.

Lifestyle and Physical Activity

Your lifestyle choices can significantly impact the health of your spinal discs. A sedentary lifestyle, characterized by prolonged sitting or low physical activity, can contribute to the development of degenerative disc disease. On the contrary, while regular exercise is beneficial, excessive or improper physical activity, especially activities that place repeated stress on the spine, can accelerate degeneration. It’s important to find a balance in your physical activities, ensuring you maintain a healthy weight and engage in spine-friendly exercises.

Smoking and Obesity

Certain lifestyle factors such as smoking and obesity are well-documented risk factors for degenerative disc disease. Smoking reduces blood flow to the spinal discs, depriving them of essential nutrients and leading to quicker deterioration. Meanwhile, carrying excess body weight adds stress to the spine, exacerbating disc degeneration. By quitting smoking and managing your weight through a balanced diet and regular exercise, you can lessen the risk of developing DDD.

Occupational Hazards

Occupations that involve heavy lifting, repetitive movements, or long periods of sitting can increase the risk of degenerative disc disease. Jobs requiring manual labor can place undue stress on the spine, leading to faster disc wear. Conversely, sitting for long durations without proper ergonomic support can also contribute to spinal problems. Implementing workplace ergonomics and taking regular breaks can help mitigate these risks.

By understanding these risk factors, you can take proactive steps towards minimizing your chances of developing degenerative disc disease. 

What Are Conservative Treatments for Degenerative Disc Disease? 

Lifestyle Modifications

Conservative treatments for degenerative disc disease often begin with lifestyle changes, aiming to reduce pain and improve function. These modifications may include regular exercise and weight management. Engaging in low-impact activities such as swimming, walking, or cycling can help maintain spinal health and reduce stress on the discs. Additionally, maintaining a healthy weight alleviates pressure on the spine, potentially slowing the progression of the disease. It is advisable to incorporate core strengthening exercises to support the spine and enhance overall stability.

Physical Therapy and Exercise

Physical therapy is a cornerstone of non-surgical management for degenerative disc disease. A physical therapist can tailor a specific exercise program to enhance flexibility, strengthen the muscles supporting the spine, and improve posture. These exercises aim to alleviate pain and prevent further degeneration. Stretching and strengthening exercises help maintain spinal integrity, while postural training can promote proper alignment, reducing undue stress on the affected discs. Consistent participation in physical therapy can lead to significant improvements in pain management and mobility.

Medication and Pain Management

Pain management is crucial for those suffering from degenerative disc disease. Over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended to reduce inflammation and relieve discomfort. In some cases, you may be prescribed medications, such as muscle relaxants or corticosteroids, to manage severe pain. Pain management physicians may also become involved in your care at the direction and recommendation from your neurosurgeon. Pain management physicians perform interventional spine procedures such as epidural steroid injections (ESI) or facet injections to reduce inflammation and other diagnostic procedures to block or identify sources of pain. 

Surgical Options for DDD: When Should You Consider Surgery?

Understanding Surgical Intervention

When conservative treatments for degenerative disc disease fail to provide relief, surgical intervention may become a necessary consideration. Surgery is often reserved for individuals who experience persistent pain or neurological deficits that significantly impair daily activities. Understanding when to pursue surgical options involves weighing several factors, including the severity of symptoms, the degree of disc degeneration, and the impact on your quality of life.

Types of Surgical Procedures

There are several surgical procedures available for treating DDD, each tailored to specific conditions and patient needs. Spinal fusion, a common method, involves joining two or more vertebrae to stabilize the spine, thereby reducing pain. Alternatively, discectomy involves the removal of damaged disc material that is compressing nearby nerves. A lumbar laminectomy is typically performed to treat conditions that cause nerve compression in the lower back. In some cases of neck pains, patients may benefit from a artificial cervical disc replacement, which can maintain greater spine mobility than fusion.

Evaluating the Need for Surgery

The decision to undergo surgery typically involves an extensive evaluation process. Key considerations include:

• Severity and Duration of Symptoms: If you have been experiencing severe pain for an extended period of time (six months plus) and it significantly restricts your mobility or daily activities, surgery might be a viable option.

• Effectiveness of Non-Surgical Treatments: Patients who have not found relief from lifestyle modifications, physical therapy, medications, injections, or other conservative approaches may consider surgical options.

• Medical Evaluation: A thorough assessment by a neurosurgeon, often involving imaging tests like MRI or CT scans, is crucial to determine the most appropriate surgical approach.

Can Lifestyle Choices Impact Degenerative Disc Disease?

Prioritize Regular Exercise

Engaging in consistent physical activity is crucial for maintaining spinal health and managing degenerative disc disease (DDD). Regular exercise helps strengthen the muscles surrounding the spine, providing better support and reducing overall strain. Focus on low-impact activities such as walking, swimming, or using an elliptical machine. Incorporating flexibility exercises like yoga or pilates can enhance core stability and improve overall posture. Remember, consult with a healthcare professional before starting any new exercise program to ensure it aligns with your specific needs.

Maintain a Healthy Diet

A balanced diet serves as a foundation for spinal health and can play a significant role in preventing and managing DDD. Consuming a variety of nutrient-rich foods helps support bone health and provides essential vitamins and minerals that can help mitigate degenerative processes. Additionally, maintaining a healthy weight reduces the burden on your spine, potentially slowing the progression of degenerative disc disease.

Adopt Ergonomic Practices

Ergonomic adjustments in your daily routine can greatly impact spinal health over time. Whether at home or work, ensure that your seating and workspace promote good posture, keeping your back properly aligned. Position your computer screen at eye level and use chairs that support the natural curve of your spine. In addition, when lifting heavy objects, use your legs rather than your back to prevent unnecessary strain. Small changes in your environment can collectively enhance your spine’s resilience against DDD.

Avoid Smoking and Limit Alcohol Consumption

Lifestyle choices such as smoking and excessive alcohol consumption have been linked to the exacerbation of degenerative disc disease. Smoking impairs blood flow to the spine, accelerating disc degeneration, while excessive alcohol intake can interfere with nutrient absorption critical for bone health. By avoiding these habits, you can improve your overall health and potentially slow the progression of DDD. Prioritizing these lifestyle modifications can contribute to a reduction in risk factors for degenerative disc disease.

Conclusion

When navigating degenerative disc disease, it is important to recognize early warning signs and risk factors. This will enable timely intervention, potentially slowing the progression of this condition. While conservative treatments often provide relief, surgical options may be considered when these measures no longer suffice. By consulting with a healthcare professional such as a neurosurgeon, you can make informed decisions about your spine and treatment options. Ultimately, a proactive approach can improve your quality of life, emphasizing the importance of personalized care in managing degenerative disc disease.

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery for the treatment of degenerative disc disease. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2024. If you have unanswered questions about your degenerative disc disease, need a second opinion, or to obtain the neurosurgical treatment you need contact Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website. 

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Peripheral nerve entrapment syndrome occurs when nerves become compressed or squeezed at specific points along their path, leading to various uncomfortable and sometimes debilitating symptoms. Understanding what peripheral nerve entrapment is, and recognizing its early warning signs can make a significant difference in treatment outcomes. This comprehensive guide explores the causes, symptoms, diagnosis methods, and effective treatment options available for those affected by nerve compression conditions.

Understanding Nerve Entrapment

Nerve entrapment occurs specifically at points where nerves travel through narrow, tunnel-like structures in your body.  Understanding this condition starts with recognizing how these communication pathways can become compressed between surrounding tissues, such as bones, cartilage, muscles, or tendons.

What Exactly is Nerve Entrapment?

A nerve entrapment develops consequently when too much pressure affects a nerve’s ability to function properly. This pressure disrupts the nerve’s capacity to send and receive messages from your brain, leading to varying symptoms. Furthermore, this compression can cause several changes in the nerve, including reduced blood flow, swelling, and potential damage to the nerve’s protective covering. 

Common Types of Nerve Compression

The most prevalent types of nerve compression include:

• Carpal tunnel syndrome (affecting the median nerve in the wrist) 
• Cubital tunnel syndrome (impacting the ulnar nerve at the elbow) 
• Sciatica (involving the sciatic nerve in the lower back) 
• Thoracic outlet syndrome (affecting nerves in the lower neck and upper chest) 

How Nerves Become Entrapped

The process of nerve entrapment typically begins with pressure changes that affect the nerve’s function. Specifically, with minimal pressure, blood flow to the nerve starts decreasing, with mild pressure, the nerve’s ability to transport signals becomes impaired.  Moreover, complete blood flow disruption occurs with significant pressure, resulting in a total block. 

Several factors can initiate this compression process:

• Anatomical abnormalities
• Repetitive motions or overuse of joints
• Medical conditions like arthritis or diabetes
• Injury or trauma to surrounding tissues
• Pregnancy-related changes 

The severity of nerve entrapment can range from mild compression, where the nerve experiences temporary reduced blood flow, to severe cases involving complete destruction of the nerve. Additionally, the location of the entrapment significantly influences the symptoms you might experience, as nerves in different areas control specific muscle groups and sensory regions throughout your body.

Recognizing the Warning Signs

Identifying nerve entrapment symptoms early can make a significant difference in treatment outcomes. Understanding how these symptoms develop and knowing when to seek medical attention is crucial for preventing long-term nerve damage.

Early Symptoms to Watch For

The initial signs of nerve entrapment generally develop gradually and may come and go. You may notice:

• Tingling or “pins and needles” sensations
• Burning sensations in affected areas
• Occasional muscle weakness
• A dull, aching pain near joints like wrists, elbows, or ankles
• A feeling that your hand or foot has “fallen asleep”

Progressive Symptom Development

As nerve compression continues, symptoms typically become more noticeable and consistent. Particularly during activities that put pressure on the affected nerve, you may experience worsening symptoms. The progression often follows a pattern where mild discomfort evolves into more significant symptoms. 

These may result in changes to your daily activities. Tasks that were once simple, like gripping objects or maintaining balance, become increasingly difficult. In some cases, the symptoms may intensify during sleep or specific movements.

When Symptoms Require Immediate Attention

Specific warning signs often indicate the need for immediate medical care. Seek emergency treatment if you experience:

• Significant loss of coordination 
• Loss of bowel or bladder control 
• Intense pain that prevents standing or using a limb 
• Unrelenting burning or shooting pain 
• Severe numbness between the legs and inner thighs 

It may be time to schedule an appointment with a neurosurgeon if your symptoms persist for several days without improvement, despite self-care measures. This is especially important since chronic untreated compression can lead to permanent nerve damage. 

The severity and duration of symptoms can vary significantly among individuals. Some might experience temporary discomfort lasting a few days, whereas others could face symptoms persisting for 4-6 weeks or longer. The location of nerve entrapment and underlying cause often determine how quickly symptoms develop and resolve.

The Diagnosis Process Explained

Obtaining an accurate diagnosis for peripheral nerve entrapment syndrome begins with a comprehensive medical evaluation. Initially, your physician will conduct a thorough assessment to pinpoint the exact location and nature of your symptoms.

Physical Examination Methods

The diagnostic process starts with a detailed review of your medical history and symptoms. Your physician will ask about when symptoms began, severity, and factors that make your symptoms better or worse. Subsequently, they will perform specific physical tests to evaluate:

• Range of motion in nearby joints
• Areas of numbness or tingling
• Muscle strength and sensation in affected areas
• Nerve sensitivity through percussion tests

Diagnostic Tests and Imaging

After the physical examination, your physician may recommend several specialized tests to confirm the diagnosis:

Electrodiagnostic Studies:

• • Nerve conduction studies (NCV) to measure signal speed
  • Electromyography (EMG) to assess muscle response

Imaging Tests:

• • Ultrasound: Shows nerve thickness and compression points with sensitivity
  • MRI: Creates detailed images of nerves and surrounding tissues
  • X-rays: Used to check for bone-related causes

Understanding Your Diagnosis

The interpretation of your test results helps determine both the location and severity of nerve compression. Altogether, these findings guide treatment decisions based on several factors:

1. Nerve Function Assessment: EMG studies can help determine if your nerve will recover on its own, with changes becoming visible around 3 months after injury. 

2. Severity Levels: Your condition may be classified as:

• • Mild: Temporary nerve compression
  • Moderate: Partial nerve damage
  • Severe: Complete nerve disruption

Rather than relying on a single test, your physician will consider all diagnostic results together. This comprehensive approach ensures a more accurate diagnosis and helps develop an effective treatment strategy. After diagnosis, your physician can begin planning the most appropriate treatment approach for your specific situation.

Treatment Options and Approaches

Relief from nerve entrapment symptoms begins with selecting the most appropriate treatment approach. Treatment choices primarily depend on the severity of your condition and how long you have experienced symptoms.

Conservative Treatment Methods

Most cases of nerve entrapment respond well to non-surgical treatments. The first line of conservative modalities typically includes:

• Physical therapy and specific exercises
• Postural and bio-mechanical corrections
• Bracing or splinting devices
• Ice and heat therapy
• Activity modifications

Notably, splinting shows higher improvement rates compared to other conservative approaches. In fact, a recent study indicated that 89% of patients improved using splint devices over an average period of 18.7 months. 

For patients seeking additional relief, several medical interventions offer promising results. Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce swelling around the nerve. Essentially, these medications work alongside other treatments to manage pain and inflammation. Alternative treatment options include regenerative medicine and TENS treatment. 

Surgical Options When Necessary

If conservative treatments do not provide adequate relief, surgical intervention may be necessary. Surgery becomes a considerable option when:

1. Symptoms persist after 6-8 weeks of conservative treatment
2. Muscle weakness continues to worsen
3. Diagnostic tests show severe nerve compression
4. Quality of life is significantly affected

Based on your specific condition, the preferred surgical approach may vary. For instance, nerve entrapment surgery often involves opening the nerve tunnel or removing pressure points. These procedures typically show positive outcomes, with quick recovery times allowing you to return to regular activities. 

Post-surgical rehabilitation remains essential for optimal results. Physical therapy can help maintain range of motion and prevent stiffness. Your physician will create a personalized recovery plan based on the type of surgery performed and your individual needs.

Long-term Management Strategies

Managing peripheral nerve entrapment syndrome often times requires a long-term commitment to maintaining nerve health after initial treatment. Understanding how to prevent future complications becomes crucial for lasting relief.

Preventing Recurrence

Successful recovery from nerve entrapment depends on consistent monitoring and care. Studies show that with mild nerve damage, recovery typically occurs within 2-8 weeks.  However, more severe cases require longer healing periods, with nerves slightly regenerating each day.

To minimize the risk of recurrence, consider these essential steps:

• Proper ergonomic setup at work and home
• Maintaining correct posture throughout daily activities
• Taking frequent breaks during repetitive tasks

Lifestyle Modifications

A comprehensive approach to managing nerve entrapment symptoms involves several key fundamental lifestyle adjustments:

1. Diet and Nutrition
   • Incorporate anti-inflammatory foods
   • Maintain stable blood sugar levels
   • Include foods rich in antioxidants 

2. Physical Activity

• • Aim for 30 minutes of walking five days weekly 
  • Engage in low-impact activities like swimming or cycling
  • Practice gentle stretching exercises

3. Stress Management

1. • Practice mindfulness techniques
   • Implement relaxation strategies
   • Maintain consistent sleep patterns 

Monitoring Your Condition

Understanding the healing timeline helps set realistic expectations. Although mild nerve damage typically shows rapid improvement, more severe cases require careful monitoring. Your physician may recommend:

1. Regular Assessment Schedule:

• • Follow ups every 1-2 weeks during initial recovery
  • Monthly follow-ups for 3-6 months 
  • Annual evaluations for maintenance

2. Self-Monitoring Guidelines:

• • Track symptom changes
  • Document activities that trigger discomfort
  • Keep a journal regarding your recovery

For optimal results, surgical patients should note that complete return to normal function occurs in 80-90% of cases with early intervention. Research indicates that conservative management should be tried for a minimum of six weeks before considering other treatments.

Remember, healing patterns vary among individuals. Some patients might experience temporary tingling or numbness during recovery exercises. Maintaining open communication with your physician becomes essential for adjusting your management plan as needed.

Conclusion

Understanding nerve entrapment symptoms marks the first step toward effective treatment and lasting relief. These conditions can significantly affect daily activities, however most patients achieve successful outcomes through proper diagnosis and targeted treatment approaches.Studies have shown that early intervention leads to better results, whether through conservative methods or surgical procedures. Patients who combine appropriate medical care with lifestyle modifications generally experience favorable outcomes.

Success rates remain particularly encouraging, especially when patients maintain consistent communication with their physician and follow recommended management strategies. Nerve entrapment typically is not an insurmountable diagnosis, but a manageable condition that responds well to proper care and attention. The path to recovery requires patience and compliance, yet the right combination of treatment, lifestyle changes, and preventive measures can help most people return to their normal activities. Obtaining knowledge about symptoms, treatment options, and management strategies, you can take control of your nerve health and work toward lasting relief.

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, minimally invasive spine surgery, and nerve entrapment syndromes. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physician colleagues from 2017-2024. If you have unanswered questions about your nerve entrapment symptoms, want a second opinion, or to obtain the neurosurgical treatment you need contact Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.  

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What is Spinal Stenosis? 

Spinal stenosis is a condition characterized by the narrowing of spaces within your spine, which can put pressure on the nerves that travel through it. This narrowing most commonly occurs in your lower back (lumbar spinal stenosis) and your neck (cervical spinal stenosis). According to the Cleveland Clinic, degenerative spinal changes affect up to ninety-five (95%) of people over fifty years old (50) making it a significant concern for aging populations. Spinal stenosis is one of these degenerative changes. 

Understanding the Anatomy

Your spine consists of a series of vertebrae or small bones that are stacked or aligned on top of each other. Your spinal canal runs through these vertebrae, housing the spinal cord and nerve roots. These thirty-three (33) bones protect the delicate structures of your spinal cord and nerves. In spinal stenosis, this canal narrows, potentially irritating or compressing these vital neural structures. 

Causes and Risk Factors

Several factors can contribute to the development of spinal stenosis:

• • Age-Related Changes: As you age, your spine naturally undergoes wear and tear.

• • Bone Overgrowth: Osteoarthritis can lead to bone spurs, which can grow into your spinal canal.

• • Herniated Discs:Soft cushions between your vertebrae can bulge and compress nerves.

• • Thickened Ligaments:  Ligaments that hold the spine together can become stiff and thickened over time.

• • Spinal Injuries: Trauma from accidents or sports injuries can damage your spine and lead to stenosis.

If severe spinal stenosis is left untreated, it can potentially lead to permanent numbness or even paralysis. This emphasizes the importance of an early diagnosis and treatment by a spinal stenosis specialist like neurosurgeon, Ricky Kalra, M.D.  

Symptoms and Diagnosis

The symptoms of spinal stenosis can vary depending on the location and severity of the narrowing. Common signs include: 

• • Back pain or neck pain
  • Numbness or tingling in your extremities
  • Weakness in legs or arms
  • Balance problems 

If you are experiencing these symptoms, especially if are over fifty (50) years old or have a history of back problems, it is crucial to consult with a spinal stenosis specialist like Dr. Kalra. Your spine surgeon will perform a thorough examination, including imaging tests such as MRIs or CT scans to diagnose spinal stenosis and recommend appropriate treatment options. 

Causes of Spinal Stenosis 

Age-Related Changes

Spinal stenosis is often a result of the natural aging process. As we grow older, wear and tear damage in the spine related to arthritis becomes more common. This can lead to the formation of bone spurs that push into the spinal canal, reducing the available space. Additionally, the ligaments that stabilize the spine may thicken over time, further narrowing your spinal canal. 

Herniated Discs and Other Conditions 

Herniated discs can also contribute to spinal stenosis. When the soft inner material of a disk leaks out, it can press on the spinal cord or nerves, causing compression. In rare cases, tumors forming inside the spinal canal can also lead to stenosis.

Congenital Factors and Injuries

Some individuals are born with a naturally smaller spinal canal, increasing their risk of developing spinal stenosis later in life. Spinal injuries from an accident or trauma can also lead to stenosis by causing bones to fracture or move out of place, or by creating swelling that puts pressure on the spinal cord or nerves. These factors illustrate the importance of early diagnosis and intervention in spinal stenosis symptoms. 

Other Contributing Factors

Certain medical conditions can also increase the risk of developing spinal stenosis. Paget’s disease of bone, which causes abnormal bone growth, can alter spaces in the spinal canal. Ossification of the posterior longitudinal ligament, is where calcium deposits turn the ligament into a bone like structure. This process may result in narrowing of the spinal canal or nerve root compression. Understanding these diverse causes can help manage back pain and develop effective treatment strategies for spinal stenosis symptoms. 

Diagnosing Spinal Stenosis: Tests and Procedures 

When diagnosing spinal stenosis, a comprehensive approach is essential for an accurate evaluation and effective treatment planning. Spine surgeons will employ a combination of physical examinations, medical history reviews, and various diagnostic tests to confirm the presence of spinal stenosis. 

Physical Examination and Medical History

The diagnostic process typically begins with a thorough physical examination. During this assessment doctors look for telltale sings of spinal stenosis, such as:

• • Loss of sensation
  • Muscle weakness
  • Abnormal reflexes

Imaging Tests

To obtain an image of your spine’s structure, spine surgeons often recommend imaging tests. A few of the most commonly utilized imaging studies utilize in diagnosing spinal stenosis are: 

1. X-rays: These can reveal bone changes that may be narrowing the spinal canal. 

2. Magnetic Resonance Imaging (MRI): This advanced imaging technique provides detailed views of soft tissues, including discs, and ligaments. 

3. Computerized Tomography (CT): When an MRI is not possible, or a detailed picture of the bones is needed a CT scan can be utilized.

These tests help spine surgeons visualize any narrowing of the spinal canal, bone spurs, or other abnormalities that may be causing your symptoms. 

Additional Diagnostic Procedures

In some cases, further testing may be necessary to confirm the diagnosis or rule out other conditions. Additional procedures that may be recommended are:

• • Bone scans
  • CT myelograms (CT scans with injected dye)
  • Nerve conduction studies/electromyography (EMG) 

These tests can provide valuable information about nerve function and help pinpoint the exact location and severity of spinal stenosis. Remember, a diagnosis of spinal stenosis is not solely based on imaging results. A spine surgeon should consider your symptoms, what is generating your pain,  and your overall health when determining the best course of action for your back or neck pain. 

Common Symptoms of Spinal Stenosis 

Spinal stenosis, a condition that can significantly impact your quality of life, and manifests itself through various telltale signs. Understanding these symptoms is crucial for early detection and proper management. As a patient, recognizing these signs can help you seek timely medical attention from a spine specialist such as Dr. Kalra. 

Pain and Discomfort

The hallmark symptom of spinal stenosis is often pain, which can vary in intensity and location. You may experience:

• • Back or neck pain that radiates to your buttocks and legs
  • Burning sensations or numbness in your arms or legs
  • Weakness in your arms and hands, buttocks, legs, and or feet

These symptoms typically worsen with prolonged activities such as standing or walking and may alleviate when you sit or bend forward or rest. 

Neurological Symptoms

As spinal stenosis progresses it can affect your nervous system, leading to more severe symptoms listed below. In some cases, you might experience a loss of sexual ability, or in severe instances, issues with bowl or bladder control. 

• • Tingling or pins and needles sensations in your extremities 
  • Loss of sensation in your feet or hands
  • Foot drop, a condition where weakness causes your foot to slap down when walking

Impact on Daily Activities

Spinal stenosis can significantly affect your daily life. You may find yourself avoiding certain activities or experiencing difficulty with:

• • Walking long distances
  • Standing for extended periods
  • Climbing stairs
  • Balance
  • Fine motor skills

Understand these symptoms is the first step in managing spinal stenosis. If you are experiencing these signs, it is essential to consult with a spinal stenosis specialist to discuss potential treatment options, which may range from non-surgical conservative approaches to more advanced neurosurgical techniques for more severe cases. 

Risk Factors for Developing Spinal Stenosis 

Understanding the risk factors of spinal stenosis can help you take proactive steps to maintain your spinal health. While some factors are out of our control, others can be managed to reduce the likelihood of developing this condition. 

Age Related Changes

The most common cause of spinal stenosis is the natural aging process. As we grow older the ligaments in our spine may thicken and calcify, leading to a narrowing of your spinal canal. This gradual wear and tear on the joints, often associates with osteoarthritis, becomes more prevalent after the age of fifty (50). 

Genetic and Congenital Factors

Some individuals are born with a naturally narrower spinal canal, predisposing them to spinal stenosis. Conditions like congenital stenosis, scoliosis, and achondroplasia can increase the risk. If you have a family history of these conditions, it is essential to discuss this your spine surgeon. 

Medical Conditions

Certain medical conditions can contribute to the development of spinal stenosis. These conditions can cause inflammation, bone growth, or misalignment that narrows the spinal canal.

• Rheumatoid arthritis 
• Paget’s diseases of bone
• Spinal tumors
• Ossification of the posterior longitudinal ligament

Lifestyle Factors

Your daily habits can also impact your risk of developing spinal stenosis. Being overweight puts additional stress on your spine, while smoking can accelerate disc degeneration. Maintaining a healthy weight, exercising regularly, and practicing good posture can help reduce your risk. 

Previous Spine Injuries or Surgeries

A history of spinal injuries or previous spine surgeries can increase your chances of developing spinal stenosis. If you experienced trauma to your spine, or had a previous spinal procedure, it is essential to follow up with your healthcare provider regularly. Understanding these factors and working with your doctor to develop a personalized plan for potentially preventing or delaying the onset of spinal stenosis may help decrease your long term pain or suffering. 

Treatment of Spinal Stenosis

Non-Surgical Treatments for Spinal Stenosis

When it comes to managing spinal stenosis, there are several non-surgical options available to alleviate symptoms and improve quality of life. These treatments can be particularly beneficial for patients with mild to moderate cases of spinal stenosis, or for those patients who are not candidates for surgery. Some potential non-surgical treatment options include:

• • Medication management
  • Physical therapy and exercise
  • Epidural or facet steroid injections
  • Lifestyle modifications 
  • Alternative therapies 

Surgical Treatments for Spinal Stenosis 

When conservative treatments fail to provide relief, surgical intervention may be necessary for patients with severe spinal stenosis. The goal of a surgical procedure to treat spinal stenosis is to alleviate pressure on the spinal cord and nerves, potentially improving pain, numbness, and mobility. Decompression surgeries are the most common surgical approach for spinal stenosis as they aim to create more space within the spinal canal by removing bone or soft tissue. The most common decompression spine surgery options are: 

• • Laminectomy: Removal of the lamina (back part of the vertebrae).  

• • Laminotomy: Partial removal of the lamina. 

• • Foraminotomy: Widening of the neural foramen (where nerves exit spine). 

Decompression procedures may be performed individually or in combination. In cases where spinal instability contributes to stenosis, spinal fusion may be recommended in addition to a decompression. In a spinal fusion two vertebrae are connected or linked together to reinforce your spine’s stability, and to prevent movement between them. 

Understanding spinal stenosis is essential for effective treatment and management. While this condition can be challenging, numerous treatment options exist to alleviate symptoms and improve your quality of life. From conservative modalities to surgical inventions, there are various paths to explore with your spine surgeon. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physician colleagues from 2017-2023. If you have unanswered questions about your spinal stenosis, need a second opinion, or to obtain the neurosurgical treatment you need contact Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.   

The post A Comprehensive Guide to Understanding Spinal Stenosis appeared first on Kalra Brain & Spine.

What are Lumbar Disc Herniations? 

Lumbar disc herniations occur when the soft, gel like center of an intervertebral disc in the lower back push through the annulus fibrosus, or the thick outer ring of a vertebral disc. This condition is a common cause of back and leg pain as this process creates pressure on your neural structures (nerve roots and/or spinal cord). Lumbar disc herniations are one of the most common causes of lower back pain, affecting roughly two percent (2%) of the population annually, with the most common age demographic being thirty (30) to fifty (50) year old males. 

Anatomy and Mechanics

The lumbar spine consists of five (5) vertebrae that start just below T12 at L1 and continue down your spine to the last lumbar vertebrae at L5 (L1-L5). Each of these lumbar vertebrae are separated by discs that act as shock absorbers to provide cushioning. There are also five (5) pairs of lumbar nerves that exit at each level, with one member of the pair exiting on the right side, and the other on the left.  When these discs degenerate due to age, repetitive stress, or injury they can bulge or rupture, leading to a lumbar disc herniation. This disc herniation then compresses or pinches one of your five pair of lumbar nerves that exit at each level. Herniations at each level will result in specific pain patterns, however the symptoms you experience may vary. 

Symptoms and Impact

The most common sign of a lumbar disc herniation is a shooting pain that travels along the path of the sciatic nerve and spreads down your buttock to the back of one thigh or from your buttock down to the bottom of your foot.  This compression leads to a distinct type of nerve pain that can vary from tolerable to severe. Some patients will describe their symptoms as a dull ache, while others will experience a sharp, burning sensation, numbness and tingling, or even weakness. Others may have a lumbar disc herniation and experience no symptoms. The severity of your symptoms often depends on the location and the size of herniation and its proximity to nearby nerves. 

Symptoms of Lumbar Disc Herniations: Low Back Pain and Leg Pain 

Why is Low Back Pain the Primary Symptom?

Lumbar disc herniations often initially present as persistent low back pain. This symptomatic discomfort arises when the disc herniation irritates nearby nerve roots that exit your spine. This pain often intensifies with movement or prolonged sitting, or standing significantly impacting your daily activities and sleep. 

Radiating Leg Pain

Another common symptom of lumbar disc herniations is radiating leg pain or sciatica.  Sciatica is a condition that can cause significant pain and discomfort. It occurs when your sciatic nerve, the largest and longest nerve in your body becomes injured, irritated, or compressed. Your sciatic nerve is actually not one (1) nerve, it is a bundle of five (5) nerves that branch off from your spinal cord. Your sciatic nerve extends from your low back, through an opening (sciatic notch) deep in your buttock, crosses behind muscles located deep in your hip joint, descends down the back portion of the upper thigh, to the back of your knee. Here the nerve divides into two branches. One brach continues down the back of your calf to your heel and sole of your foot. The other branch runs along the outer part of the knee to the lower leg and foot. Your sciatic nerve has both sensory and motor fibers. These fibers provide sensation, and function to your lower limbs. 

This discomfort or nerve pain typically follows the path of the affected nerve, creating a distinct pain pattern known as a dermatome. Sciatica specifically involves pain that radiates from your low back, down the back of your thigh or from your low back to the bottom of your foot. This is often described as numbness or tingling with a heightened sensitivity to touch. 

Additional Symptoms

Lumbar disc herniations can also lead to more severe symptoms. In addition to low back pain and radiating leg pain you may also experience:

• • Muscle weakness or difficulty moving certain body parts
  • Change in your reflexes
  • Changes in your bladder or bowel function. 

Changes in your bladder or bowel function often are indicative of a more serious disc herniation that requires immediate medical attention. 

Causes and Risk Factors for Lumbar Disc Herniations

• • Aging

• • Being overweight

• • Poor posture

• • Improper lifting techniques

• • Repetitive motions

• • Smoking

• • A family history of degenerative bone conditions

Diagnosing Lumbar Disc Herniations

Physical Examination & History 

Lumbar disc herniations are typically diagnosed by reviewing your medical history and a thorough physical exam. Your physician may ask various questions about the location of your pain and symptoms. Your physician will assess your pain levels, reflexes, muscle strength, and sensations in your legs and feet.. Finally you may be asked to perform specific movements to evaluate your range of motion, and to help identify the location and severity of your herniation.

Imaging Studies

If your physician suspects a lumbar disc herniation they may order imaging studies to confirm your diagnosis. Depending on your specific diagnosis x-rays, MRIs, or CT scans are commonly utilized to visualize your spine, detect abnormalities, and confirm your diagnosis. These studies can reveal the exact location of your herniated disc and the extent of your nerve compression. This information combined with the results of your physical examination will be crucial for developing an effective treatment plan. 

If your lumbar disc herniation is caused by a significant lumbar disc herniation, spinal stenosis, degenerative disc disease, or spondylolisthesis your physician may recommend a surgical procedure.

Nerve Conduction Tests

Your physician may recommend nerve conduction studies or electromyography (EMG) to access the function of your nerve. EMGs can help identify specific nerves that are affected by the lumbar disc herniation and measure the degree of damage to the nerve. This test provides value information in diagnosing lumbar disc herniations, and distinguishing from other causes of low back pain and leg pain. 

Treatment Options for Lumbar Disc Herniations

If you have been diagnosed with a lumbar disc herniation and are experiencing symptoms conservative treatment modalities are typically exhausted as an initial treatment recommendation. Symptoms from lumbar disc herniations may heal on their own with time and conservative treatment. If your symptoms do note resolve your physician may recommend interventional pain procedures, medications, and physical therapy. The procedures work to reduce inflammation around the nerve root, often times resulting in significant pain relief. If your symptoms still persist, and significantly impact your daily activities your physician may recommend a surgical procedure.  To help relieve pain often associated with lumbar disc herniation, treatments may includes: 

• • Heat or cold therapy
  • NSAIDs
  • Physical therapy
  • Massage 
  • Epidural steroid injections
  • Nerve blocks
  • Microdiscectomy
  • Laminectomy 
  • Spinal fusion

Potential Long Term Effects of Ignoring Lumbar Disc Herniations

Nerve Damage and Neurological Complications

Prolonged untreated nerve compression from lumbar disc herniations can lead to permanent nerve damage. This may result in muscle weakness, loss of sensation, or even paralysis. Significant lumbar disc herniations can compress the bundle of nerves at the lower end of your lumbosacral spine call the cauda equina. This nerve sends and receives message to and from legs, feet, and pelvic organs. Cauda equina syndrome is the symptomatic compression of this nerve, and often results in emergent surgery.  

Spinal Instability and Increased Risk of Surgery 

Untreated lumbar disc herniations can contribute to progressive spinal degeneration and instability, they may progress to additional complications such as spinal stenosis or spondylolthesis. As the condition worsens over time, more complex and invasive surgical procedures may be necessary to address and alleviate your specific condition and symptoms. 

Why Choose Kalra Brain & Spine to Help Manage Low Back Pain & Leg Pain? 

“My decision to fly from Montana to Texas for the surgery that was necessary, was the RIGHT thing to do! The hospital where surgery was performed was excellent as well. Tiny little place with excellent nursing staff. I was given a clean bill of health today and released to do as I please now. My lumbar fusion was a total success ! I could never find the level of care in my home town as I have found with Dr. Kalra in Texas ! If you have spine issues, Dr. Ricky Kalra is an amazing surgeon. Best decision I have ever made regarding my medical care. ‍”

Yvonne M.

“A huge thank you to Dr Kalra and his team for successfully healing my back!  I was not a believer in undergoing surgery, I felt certain I could overcome my injury with other forms of therapy but the MRI said otherwise.  Dr. Kalra performed a Lumbar Fusion (L2/L3) and I woke up after the surgery, pain free. I was careful to follow his plan for post-op, starting with PT and then moving into more exercise such as swimming, cycling and light weight lifting and now after 12 months, I have been cleared for all normal activity.  My husband and I are looking forward to hiking at Zion National Park in September.  He’s given me my active lifestyle back and I am so happy!”

Julia M. 

“One year ago to the exact date,  I was on an operating table undergoing a 360 L4-5 back surgery and today I’m back to playing pickleball thanks to the expertise and follow up care of Dr. Kalra and his medical team. If you’re experiencing back pain, you will not be disappointed seeking out a consult or second opinion from Dr. Kalra. He uses a conservative, least restrictive multi modal approach. Surgery is often a last resort. His office is run very personably and efficiently. I experienced very little wait time, yet he and his wonderful PA’s gave me all the one on one time I needed, during the actual visit, answering all my questions without rushing.  The office staff quickly responded to my phone calls and any prescription changes or refills were called in promptly. It’s a top notch run “operation” in all ways!

Carol S. 

“I recently took my father to see Dr. Kalra since he was having very bad low back pain. I was very pleased with the way Dr. Kalra sat and explained in detail what could be causing it and laid out all of our options on what he can do to help my father. He actually listens to his patients needs and thoroughly explains what needs to be done, My father was nervous at first but when we met Dr. Kalra and his staff they put my fathers mind at ease. Hands down the best at what he does and would highly recommend him.”

Jaime S. 

“Wow! Where do we even begin with Dr. Kalra and his office. My mother had a bad disc fragment impinging on a nerve root in her back giving her excruciating pain down her leg for quite some time.  She had seen back doctors before, however her experience with Dr. Kalra was nothing like she’d had before. We were very impressed with Dr. Kalra’s level of professionalism, efficiency, and overall treatment approach.  He gave my mom every possible chance to avoid surgery, however in the end, it just wasn’t in the cards for her.  He showed compassion and empathy in all aspects of patient care. He was very patient, and took time to explain all options during hospitalization. He rounded on my mother in person, as well as his PA, and both displayed wonderful bedside manner.  After surgery, my mother’s pain was immediately gone, able to walk unassisted, and was able to return home the very next day.  He kept myself and my family fully updated the entire time she was in the hospital.  Nobody takes on a personal touch like Dr. Kalra, and because of that, I highly recommend Dr. Kalra and his staff to anyone in need of a spine surgeon in the metroplex and beyond. I am so grateful we traveled the distance for his exceptional care! He and his team deserve 10 stars!

Mindy C. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. If you have unanswered questions about your back pain, need a second opinion, or to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.   

The post Lumbar Disc Herniations: Causes, Symptoms, and Management appeared first on Kalra Brain & Spine.

Understanding Your Spinal Anatomy

Understanding the anatomy of your spine’s structure will help to better comprehend radiculopathy and sciatica. Your spine works to support your body, allows you to be flexible and move, as well as protects your spinal cord and nerves. A healthy spine will have an S-shaped curve. Your neck and low back have soft forward curves, while your mid back and sacral spine have small backwards curves. These natural curves aid in movement and shock absorption. These curves and your spinal discs aid in distributing weight and forces evenly through your spine. If your spine was straight instead of an S-shape it would take tremendous wear and tear creating significant spinal disorders. These S-shapes allows a portion of the weight and forces to be distributed to your spinal discs, and not solely to the vertebrae below much like a spring. Overtime, this wear and tear with the aging process result in degeneration of these discs. 

What Structures Make Up Your Spine?

The structure of your spine consists of over one-hundred twenty (120) muscles, two-hundred twenty (220) ligaments, one-hundred joints (100), thirty-three (33) vertebrae. Your spine consists of many complex structures:

• Vertebrae are the small bones that are stacked or aligned to created your spinal canal. These thirty-three (33) bones protect the delicate structures of your spinal cord and nerves

• Intervertebral discs are the flat round cushions that sit between each vertebrae and act as shock absorbers. Each vertebral disc has a soft gel like center with a tougher but flexible outer ring. Under pressure or intense forces this inter gel like center can squeeze out through the outer ring of the disc causing a herniation. This disc material can thencompress your nerves or spinal cord resulting in sciatica or radiculopathy.  

• Spinal cord and nerves make up your spinal canal and run under the vertebrae from the base of your skull to your low back. Thirty-one (31) pairs of nerves branch off from your canal through small openings in the vertebrae. These nerves carry messages between your brain to your muscles. When disc material compress these nerve roots  you often end up with nerve pain referred to as radiculopathy. 

• Facet joints are the connections between each spine level. These are located on the posterior (backside) of the vertebral body and provide structural stability to the spine.   They also limit and guide the motion of each spinal level. These joints can be a significant source of pathology including arthropathy, infection, inflammation, tumors, and trauma. 

• Soft tissues are the non-bony and non-disc aspects of the spine that are primarily muscles, ligaments, and tendons. These muscles and ligaments provide stability, strength, and facilitate spinal movement. Injuries to soft tissues of the spine may be tears or sprains/strains such as whiplash. 

What Are the Different Segments of the Spine? 

The thirty-three (33) vertebrae and thirty-one (31) pairs of spinal nerves that comprise your spine are divided into five segments: 

• Cervical vertebrae are the first seven (7) vertebrae of your spine in your neck. These levels are identified as C1 being the first and highest neck bone through C-7 being the last (C1-C7). There are eight pairs of cervical nerve roots, with one member of the pair exiting on the right side your vertebrae, and the other on the left side. 

• Thoracic vertebrae are the vertebrae located in your upper-mid back. These twelve (12) vertebrae or levels start just below the last cervical vertebrae at T1, and continue down the spine to T12 (T1-T12). There are twelve (12) pairs of thoracic nerve roots that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Lumbar vertebrae are the vertebra located in your low back. These five (5) vertebrae start just below T12 at L1 and continue down your spine to the last lumbar vertebrae at L5 (L1-L5). There are also five (5) pairs of lumbar nerves that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Sacral vertebrae are the vertebrae that are located in your pelvis. These five (5) vertebrae start below L5 at S1 and continue down your spine to the last sacral vertebrae at S5 (S1-S5). There are also five (5) pairs of sacral nerves that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Coccyx vertebrae are four (4) small vertebra that are fused together to form your tailbone. There is only one (1) pair of coccygeal (Co1) nerves that meet in the area of the tailbone. 

What is Radiculopathy? 

Radiculopathy is a medical condition characterized by compression, irritation, or inflammation  of spinal nerve roots, this leads to pain, numbness, tingling, or weakness along the path of the affected nerve. This condition can occur in the cervical, thoracic, or lumbar regions. Radiculopathy most commonly occurs in the cervical and lumbar areas of the spine.

Common Causes

• Spinal stenosis

• Degenerative disc disease

• Bone spurs

• Spinal injury or trauma

• Herniated discs 

Symptoms and Presentation

Symptoms of radiculopathy vary depending on the location of the affected nerve root.

• Decreased sensation in the skin

• Numbness of tingling sensations

• Sharp burning pain that radiates along the nerve path

• Muscle weakness or loss of reflexes

Diagnosis and Treatment

To properly diagnose radiculopathy your physician will typically review your medical history, conduct a physical examination, and order imaging studies such as a x-ray, MRI, or possible nerve test called EMG. Fortunately, the majority of patients can obtain relief of their symptoms with conservative treatment modalities and time. Initial conservative modalities may include anti-inflammatories, physical therapy, and activity modifications such as avoiding activities that cause strain to the back or neck. If you do not respond to the initial course of conservative treatment a referral to pain management may be recommended to obtain an epidural steroid injection or nerve block. For most patients, this will help reduce inflammation and nerve irritation to lessen the symptoms of radiculopathy. You may need additional repeat injections if you did not achieve relief of your symptoms, or if the relief of your symptoms was not lasting. 

Unfortanently, some patients will exhaust conservative treatment modalities and not achieve symptom relief. In this situation your chronic nerve pain may be affecting or limiting your daily activities. This persistent discomfort can make routine tasks feel like monumental challenges. At this point surgical intervention such as a microdiscectomy or laminectomy may be appropriate to consider. A microdiscectomy is a minimally invasive surgery to remove the portion of herniated disc material. A laminectomy is performed by removing a portion or all of the lamina (vertebral bone). This helps create space to relieve pressure on your spinal cord or nerves. A proper diagnosis and early intervention can significantly improve your outcomes, hopefully allowing you to avoid a surgical procedure. 

Understanding Sciatica

Sciatica is a common condition that can cause significant pain and discomfort. It occurs when your sciatic nerve, the largest and longest nerve in your body becomes injured, irritated, or compressed. Your sciatic nerve is actually not one (1) nerve, it is a bundle of five (5) nerves that branch off from your spinal cord. Your sciatic nerve extends from your low back, through an opening (sciatic notch) deep in your buttock, crosses behind muscles located deep in your hip joint, descends down the back portion of the upper thigh, to the back of your knee. Here the nerve divides into two branches. One brach continues down the back of your calf to your heel and sole of your foot. The other branch runs along the outer part of the knee to the lower leg and foot. Your sciatic nerve has both sensory and motor fibers. These fibers provide not only sensation, but function to your lower limbs. 

Common Symptoms

The primary attribute of sciatica is a shooting pain that travels along the above path of the sciatic nerve and spreads down your buttock to the back of one thigh or from your buttock down to the bottom of your foot.  This compression leads to a distinct type of nerve pain that can vary from tolerable to severe. Some patients will describe their symptoms as a dull ache, while others will experience a sharp, burning sensation, numbness and tingling, or even weakness. 

Common Causes

Numerous factors can contribute to the development of sciatic:

• • Herniated discs occur when the soft inner portion of a spinal disc protrudes through the tougher outer shell, often times pressing on the nerve roots that exit the spine.

• • Spinal stenosis is a condition where the spinal canal narrows, which can also put pressure on surrounding nerves. 

• • Spondylolisthesis is when a vertebra moves or slips out of place compared to the subsequent adjacent vertebrae. 

• • Compression fractures occur when there is a fracture in a vertebra causing it to collapse.

• • Osteoarthritis or spinal arthritis occurs from wear and tear or degenerative changes in the spine.

• • Scoliosis is an abnormal sideways curvature of the spine. 

Risk Factors

Risk factors for developing radiculopathy include:

• • Aging

• • Being overweight

• • Poor posture

• • Improper lifting techniques

• • Repetitive motions

• • A family history of degenerative bone conditions

• • Smoking

Diagnosis and Treatment

Sciatica is typically diagnosed by reviewing your medical history and a physical exam. Your physician may ask various questions about the location of your pain and symptoms. Additional diagnostic studies such as x-rays, magnetic resonance imaging (MRIs), or elcectomygraphy (EMG), may be recommended.  Sciatica will usually heal on its own with time and conservative treatment. Sciatica often results from a spinal issue that puts pressure on the sciatic nerve. If your sciatica is caused by a lumbar disc herniation, spinal stenosis, degenerative disc disease, or spondylolisthesis your physician may recommend a surgical procedure. To help relive the pain, treatment often includes:

• • Heat or cold therapy

• • NSAIDs

• • Physical therapy

• • Epidural steroid injections

• • Nerve blocks 

• • Massage 

• • Microdiscectomy

• • Laminectomy 

Common Symptoms of Radiculopathy and Sciatica 

Pain Sensations and Pattern

The classic symptom of both radiculopathy and sciatica is radiating pain. This discomfort or nerve pain typically follows the path of the affected nerve, creating a distinct pain pattern known as a dermatome. With radiculopathy you may experience sharp, burning, or electric like pain that travels from your spine to your extremities. Sciatica specifically involves pain that radiates from your low back, down the back of your thigh or from your low back to the bottom of your foot. With this pain you may also be experiencing:

• • Muscle weakness or difficulty moving certain body parts

• • Numbness or tingling sensations in the affected area

• • Heightened sensitivity to touch

Location Specific Symptoms

The location of your symptoms provide valuable clues about which spinal nerves are being affected. When a spinal nerve is compressed, irritated, or injured it may be on the left, right, or both sides of your spine. All three locations will produce varying symptoms. 

• • Cervical radiculopathy involves pain, numbness, or weakness in your neck, shoulder, arm, or hand.

• • Thoracic radiculopathy involves discomfort in your upper abdomen or chest wall.

• • Lumbar radiculopathy (including sciatica) involves pain in lower back, buttock, leg, or foot. 

While radiculopathy and sciatica are often used interchangeably, radiculopathy and sciatica are not the same. Sciatica refers to symptoms caused by compression or irritation of the sciatic nerve, and is actually a type of lumbar radiculopathy. Remember all cases of sciatica are radiculopathy, but not all radiculopathy is sciatica. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. If you have unanswered questions about your arm or leg pain, need a second opinion, or to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.   

The post Radiculopathy and Sciatica: Arm and Leg Pain Explained appeared first on Kalra Brain & Spine.

When Should I Consider Spine Surgery for Neck or Back Pain?

You Have Exhausted Non-Surgical Treatments

If you have had ongoing, debilitating pain for months despite trying multiple non-operative treatments, you may be a candidate for spine surgery. Imaging studies like MRIs can identify pathology such as herniated discs, spinal stenosis, or degenerative disc diseases that may be the source of your pain. If your daily activities and ability to work or enjoy life are limited, spine surgery may be an option for relief.

After You Have Given Your Injury or Condition Time 

A significant portion of back and neck pain will resolve on its own over a few weeks to few months time frame with conservative treatment. Spine surgery is typically only considered if non-surgical options like lifestyle modifications, physical therapy, medications, and injections, fail to provide adequate relief. Being patient is often difficult when you are in pain, but it is often needed to fully heal from many spinal conditions and injuries. Surgery can be considered for persistent, severe pain or disability that significantly impacts your quality of life. Only you know how bad your pain is, and the decision to proceed with surgery should be yours. There are times when spine surgery is absolutely essential to prevent further injury or permanent damage, however most spine surgery is elective. 

You Have a Potential Surgical Diagnosis 

You have exhausted non-surgical treatments and given adequate time for healing. You have not achieved relief and have a diagnosis that may benefit from surgical intervention. The most common spinal pathologies that can potentially benefit from surgery include: 

• • Herniated, bulging, or ruptured discs pressing on nerves or your spinal cord
  • Spinal stenosis (narrowing of the space for nerves or spinal cord) 
  • Degenerative disc disease
  • Spondylolisthesis (vertebral slipping)
  • Spinal instability 
  • Scoliosis
  • Vertebral factures
  • Spinal tumors

The type of surgical procedure that is recommended depends on your specific condition and symptoms. Surgical spine procedures aim to decompress pinched nerves, stabilize the spine or both.

Am I a Candidate for Spine Surgery?  

Symptoms Persist Despite Conservative Treatments

Spine surgery is typically only recommended after non-surgical treatments have been exhausted without providing adequate relief. Conservative approaches like physical therapy, medications, lifestyle modifications, and epidural steroid injections, and or facet injections are usually attempted first for a minimum of six to twelve weeks. If your symptoms persist or worsen despite these efforts, then you may be a candidate for spine surgery. Common indications include chronic neck or back pain, radiating arm or leg pain, numbness, weakness, or loss of function that severely impacts your daily activities and quality of life. 

Diagnostic Imaging Confirms Need for Surgery

Imaging studies such as an MRI, or CT are essential for diagnosing the underlying spinal condition or pathology causing your symptoms. Conditions that may warrant surgery may include spinal stenosis, herniated discs, degenerative disc disease, spondylolisthesis, spinal instability, bone spurs, or spinal deformities. Dr. Kalra will review images, your symptoms and neurological examination to determine what is generating your pains. Dr. Kalra will then present his opinion and your potential treatment options. Together you will decide if and when to proceed with surgery. 

You Have Realistic Expectations and Are Motivated

Spine surgery outcomes are optimized when patients have a clear understanding of the risks, benefits, recovery process, and realistic goals. You may be a good candidate if you are motivated to improve your situation, can comply with post operative restrictions, and have the ability and support system for rehabilitation. Dr. Kalra will ensure you understand the procedure, have reasonable expectations about reducing pain and symptoms, and are mentally prepared for the road ahead. A positive mindset greatly improves outcomes. 

What Spinal Conditions May Require Surgery? 

Herniated Discs

One of the most common reasons patients consider spine surgery is a herniated disc. Your spinal discs act as cushions between the vertebrae, but injury or degeneration can cause them to bulge out and press on nerves or your spinal cord. This compression leads to pain, numbness, tingling, and weakness in the affected areas. Surgery aims to remove or repair the damaged material to relieve pressure on the nerves and spinal cord. A microdiscectomy is a minimally invasive procedure to access and remove the the portion of herniated disc.   

Spinal Stenosis

Spinal stenosis refers to the narrowing of spaces in the spine that put pressure on the spinal cord and nerve roots. It can occur in the neck (cervical stenosis) or lower back (lumbar stenosis). Causes include overgrowth of bone causing bone spurs, herniated discs, or thickened ligaments. Symptoms like numbness, weakness, and cramping pain in the legs or arms may not respond well to conservative treatments. Surgical options aim to decompress the area by removing bone, disc material, overgrowth of bone, herniated discs, or thickened ligaments. Surgical options to relieve spinal stenosis may include laminectomies, foraminoties, or facetectomies. 

Degenerative Disc Disease 

The discs between your vertebrae can degenerate and break down overtime due to injury and age related changes. As your discs lose hydration and height, it can lead to instability, compression, and irritation of the nearby nerves. Along with pain, it can cause numbness, tingling, and muscle weakness. Surgical options like spinal fusion are considered to treat degenerative disc disease when conservative treatments fail to provide relief. During the fusion the damaged discus is removed and the adjacent vertebra are fused together with bone grafts or implants. This eliminates motion and prevents nerve compression at that level. 

Spondylolisthesis 

Sondylolisthesis occurs when one vertebra slips forward over the one below it. It can be caused by a defect present at birth or degeneration and arthritis over time. The displaced bone can pinch nerves, causing lower back pain that radiates down the legs. Laminectomies and spinal fusions are common surgical treatments to stabilize the slipped vertebra and decompress the pinched nerves. More severe slips may require more complex reconstructive surgery. Determining if spine surgery is appropriate depends on various factors like symptom severity, condition progression, and failure of conservative care. Careful evaluation by an experienced spine surgeon is essential to understand all treatment options. 

What Are The Most Common Types of Spine Surgery? 

Microdiscectomy, Discectomy

One of the most commonly performed spinal procedures is a microdiscectomy or discectomy. This surgery aims to relieve pressure on the nerve roots caused by a herniated disc in your spinal column. During the minimally invasive microdiscectomy, a small portion of the damaged disc is removed through a small incision to decompress the nerves. 

Laminectomy, Laminotomy 

If you suffer from spinal stenosis, a narrowing of the spinal canal that compresses nerves, your surgeon may recommend a laminectomy or laminotomy. These procedures create more space for the spinal cord by removing portions of the lamina, the bony arch protecting the spinal canal. A laminotomy is less invasive, only removing a small part. 

Foraminotomy, Facetectomy

Procedures like foraminotomies and facetectomies enlarge the opening of the foramen where nerve roots exit the spinal column. This alleviates compression caused by bones spurs, arthritis, or herniated discs that are pinching nerves. During a foraminotomy, your surgeon will remove bone of soft tissue that is obstructing the foramen. A facetectomy involves removing part of the facet joint. 

Spinal Fusion  

For more severe spinal conditions or instability, spinal fusion surgery may be recommended to permanently connect two or more vertebrae. This immobilizes the fused section to prevent painful movement and further degeneration. Metal implants are used to hold the vertebra together as the bone grafts fuse over time. 

Disc Replacement 

An artificial disc replacement surgery removes a damaged spinal disc and replaces it with a artificial disc implant. This preserves flexibility and movement at that level compared to a fusion. Disc replacements are most commonly performed in the neck (cervical) and currently indicated for up to two levels or discs. 

How Do I Find the Right Spine Surgeon? 

When considering spine surgery it is critical to choose an experienced, reputable spine surgeon you feel comfortable with. The right surgeon will throughly answers all your questions and educates you on what to expect before, during, and after surgery. Here are a few other items to consider when selecting the right surgeon for you:

• • Experience and specialty training
  • Patient satisfaction ratings and outcomes
  • Perspective on non-surgical versus surgical treatments
  • Communication style explaining procedures and recovery

Should I See a Neurosurgeon or Orthopedic Surgeon For Spine Surgery? What is the Difference Between Each Surgeon? 

Neurosurgeons and orthopedics surgeons both perform many types of spine surgery. Spine surgery is often associated with orthopedic surgeons due to the bony spinal column. Neurosurgeons perform brain, spine, and peripheral nerve surgeries. They regularly operate on the spine and in and around the delicate structures that your spinal column protect, such as your spinal cord and nerve roots. Although both are qualified to perform spine surgery, each surgeon’s training is different:

Orthopedic surgeons are trained on the bone, muscles, and ligaments. Their medical training typically consists of all aspects of orthopedic surgery including: sports medicine, joint replacement, fractures, and spine. Their medical training consists of: 

• • Four (4) years of medical school
  • Five (5) years of residency
  • One (1) year in spine fellowship to become orthopedic spine surgeon

Neurosurgeons are trained on the brain, spinal cord, and nervous system. Their training consists of brain, spine, peripheral nerve pathology and surgical treatment. Roughly fifty (50%) of a neurosurgeon’s surgical training is spent on spine surgery, so some neurosurgeons do not pursue a fellowship. Neurosurgeons medical training consists of:

• • Four (4) years of medical school
  • Five to seven (5-7) years of residency
  • One to two (1-2) year fellowship in spine or brain surgery, typically focusing on advanced, complex, or specific surgical skill sets 

Which Type of Spine Surgeon is Right For Me? 

Surgeon training is a component of determining which spine surgeon is right for you. Some additional questions to consider when selecting your spine surgeon are: 

• • Are they board certified?
  • Did they complete a fellowship? 
  • How many spine surgeries have they done? 
  • How many spine surgeries have they done for your specific condition?
  • How much of their practice is dedicated to your specific condition? 
  • Do they educate and assist with your decision making on treatment?
  • Are they open to you seeking a second opinion?
  • Have they offered and exhausted conservative treatments? 
  • Do they put you at ease with their thoroughness and confidence? 
  • Do they have good bedside manner?
  • Has their staff been helpful and their follow up timely?

How Should I Prepare for My Upcoming Spine Surgery? 

If you have decided spine surgery is your best treatment option you most likely are experiencing mixed emotions, excited for relief but also nervous. These are completely normal emotions when preparing for spine surgery. But there are things you can do to get your body optimally ready for the surgery and set yourself up for the best recovery. The months or weeks leading up to your surgery are crucial preparation time. From specific exercises to quitting smoking, the steps you take now can make a huge difference in healing and preventing potential complications down the road. Refer to our previous blog article “Preoperative Optimization: Preparing for Spine Surgery” for detailed information to help you prepare for your upcoming spine surgery. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board-certified spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physician colleagues from 2017-2023. If you have unanswered questions about a recommended spine surgery, need a second opinion, or would like to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.

The post Considering Spine Surgery: What You Need to Know appeared first on Kalra Brain & Spine.

Why is Preoperative Optimization Crucial? 

Over the years patients presenting for spine surgery have changed. Advances in techniques, technology, pharmacology, and increased life span have allowed patients with extremes of age, comorbidites, and medications to undergo spine surgery. These factors have lead to an increased focus on preoperative screening and optimization. Before your spine surgery Dr. Kalra will request you optimize your health to assist in reducing potential risks. This will include making important lifestyle changes and managing any chronic conditions:

• • Eat a balanced diet, work towards a healthy weight. Focus on proteins, fruits, vegetables, and healthy fats. Staying well-nourished will help your body to heal. Losing excess pounds will make surgery safer and improve your recovery. Work on a nutrition and exercise plan to reach your goal weight before the procedure.

• • Stop smoking and drinking alcohol. Smoking reduces blood flow, slows healing, and increases other health risks including post-operative infection. Quitting for at least a month, but ideally longer, can significantly improve your outcomes. Alcohol causes dehydration, thins your blood, and stresses your liver.  

• • Control blood pressure and blood sugar. Unmanaged high blood pressure or diabetes can lead to poor wound healing and other complications. Exercise, diet, and medications can help get these chronic conditions under control. These conditions need to be within a normal or safe range at least a few weeks prior to spine surgery. 

• • Pre-rehabilitation. Optimizing your physical functionality through physical exercise prior to surgery can improve your post-operative outcomes, function, and rehabilitation. The more strength and stamina you can build prior to surgery the more you will be able to do after surgery.  

• • Improve sleep & reduce stress. Improved sleep and reduced stress often go hand and hand. Working on specific strategies like sleep hygiene, meditation, bedtime routines can help you prepare physically and mentally for spine surgery. 

Preoperative optimization gives you the best chance of a successful and timely recovery. Making these lifestyle changes in the months or weeks before your procedure can have significant benefits, getting you ready for improved spine health and mobility.

Improve Your Nutrition and Weight Loss

Good nutrition is key to preparing for spine surgery and recovery. In the months or weeks leading up to your surgery, focus on eating a balanced diet high in nutrients like protein, iron, vitamin C which promote healing. Reducing portion size, limit high sodium, and high sugar foods. Losing excess weight will make your spine surgery safer and recovery easier. Everyone knows there is countless advice and approaches on how to lose weight. The traditional advice of consuming less calories and being more active is a great starting point. Below are some tips to get started, however you should consult your primary care physician, cardiologist, or a medical weight loss specialist before significantly altering your diet, especially if you have comorbidities or take medications. 

• • Cut down on calories. Figure out how many calories you need per day to lose a few pounds per week. You can use an app or track what you eat to make sure you stay under your desired caloric intake. A free body weight planner from the National Institutes of Health (NIH) will allow you to make personalized calorie and physical activity plans to reach a goal weight within a specific time period. Enter your personalized information and potential or actual surgery date to start on the framework for your preoperative weight loss plan. 

• • Choose healthier cooking methods. Instead of eating fried and ultra processed foods, try grilling, broiling, steaming, or baking your foods. Eating food with natural ingredients or when possible organic foods are best. Instead of vegetable oils or margarine use olive or avocado oil to cook foods. Reduce or eliminate heavy sauces, season your food with spices or lime/lemon juice. 

• • Stay hydrated. Drink plenty of water and unsweetened beverages to stay hydrated. These can also help you feel fuller without taking in extra calories. You may be surprised to learn that our brain is made up of 74% water, our bones are 22% water, and our blood is 83% water. This means it is important to stay hydrated so our organs and body function optimally. The National Academy of Medicine suggests an adequate intake of daily fluids to be thirteen cups for men, and nine cups for women with one cup equaling eight ounces. Higher amounts may be necessary for those with high physical activity levels or for those exposed to warm climates like our summers in Texas. 

• • Get moving. Exercise is key for both weight loss and preparing your body for surgery. Walking, swimming, yoga, Pilates, and light strength training are all good options. Push for at least 20-30 minutes of moderate exercise most days. Be sure to speak with your primary care physician, cardiologist, and/or a personal trainer before starting a new exercise plan. Stay focused on your goals, ask others to join you for their support. If you have not worked out for some time or are struggling with increased exercise, remember each time you exercise you will build endurance and stamina. Although making exercise and increased physical activity a component of your everyday life is optimal, you may need to look at this preoperative time period only, setting a more short-term goal of exercising a certain number of times each week leading up to your spine surgery.

Stop Smoking and Drinking Alcohol

Now is the time to pause and hopefully kick these habits. You should stop smoking and consuming alcohol as soon as you decide on spine surgery. Although the length of time you have prior to your surgery may vary, you should stop smoking and drinking alcohol at least two weeks before spine surgery. 

• • Tobacco. Smoking reduces blood flow, slows wound healing, and increases the risks of surgical complications such as infection and blood clots. The nicotine in tobacco products causes blood vessels to constrict, limiting oxygen supply to your tissues, bones, and organs. If your spine surgery involves a fusion, nicotine limits bone growth and often impedes a successful fusion. Quitting smoking, even just temporarily, will boost your circulation and help your body prepare for the demands of spine surgery. 

• • Alcohol. Alcohol dehydrates your body and thins your blood, making increased bleeding more likely during your surgery. Alcohol also stresses your liver, which helps metabolize medications and nutrients needed for your recovery. Giving up alcohol, even temporarily, leading up to your spine surgery will allow you to rehydrate, your blood to normalize, and your liver function to improve. 

Controlling Underlying Medical Conditions

Before surgery it is critical to get any underlying health issues under control. Unmanaged conditions such as diabetes, high blood pressure, or heart disease can complicate surgery and slow your recovery. Dr. Kalra may refer you to or request you schedule an appointment with your Endocrinologist or Cardiologist to manage these issues and determine when it is safe for you to proceed with spine surgery. 

• • Diabetes Management. If you have diabetes closely monitor your blood sugar levels and take all medicine as prescribed in the month before surgery. It is critical that you work with your doctor to achieve strong control of your diabetes, as high blood sugar can negatively impact wound healing and increase risk of infection. Be especially diligent about checking your blood sugar in the days leading up to surgery, the day of your surgery, and during the post-operative period. 

• • Blood Pressure Control. High blood pressure that is not treated properly can lead to excessive bleeding during surgery. Meet with your doctor to review blood pressure medications and make any needed changes to keep your blood pressure readings within a healthy range. Your doctor may decide to switch or increase your medications prior to surgery to optimize your blood pressure. On the day of your spine surgery, your anesthesiologist will also monitor your blood pressure and may provide temporary medications to keep your blood pressure stable. 

• • Heart Health Optimization. If you have a heart condition like coronary artery disease, heart arrythmias or heart failure, you will need to be cleared by your cardiologist before spine surgery. Your cardiologist may order tests like an EKG or stress test and may adjust or change your cardiac medications to improve your heart health prior to spine surgery. Be sure to bring a list of medications that includes the dosages, to your preoperative appointments so your surgical team and anesthesiologist have a complete understanding of your health. 

Build Up Strength and Endurance, Prehabilitation 

Similar to rehabilitation after surgery, prehabilitation before spine surgery is important to build your strength and endurance. Your body will go through a lot during surgery and recovery, so preparing ahead of time will help you heal faster. You can start an exercise routine focusing on core and back strengthening, cardio, and light weight training. If your insurance will cover prehabilitation at a formal physical therapy clinic, or if you can pay cash, a physical therapist will know targeted exercises to help build your strength and endurance for your specific spine surgery. 

• • Core and Back Exercises. Exercises that target your core muscles, this includes your abdominals, hip flexors, glutes, and back muscles, will help prepare you for spine surgery.  Build up on sets and repetitions slowly to avoid injury. These exercises may help increase flexibility and range of motion in your back. 

• • Cardiovascular Exercise. Strive to get your heart pumping with thirty minutes of cardio at least three times a week. Walking, jogging, biking, swimming are all great options for cardiovascular exercise. Cardio helps strengthen your lungs and increase stamina. Start slow and build up your endurance over weeks. Strong lungs and stamina will help you recover faster from surgery. If you are taking medications, have a heart condition, or are seeing a cardiologist you should consult them before starting a new exercise routine. 

• • Light Weight Training. In addition to cardio, add light weight training with dumbbells or resistance bands. Working your legs, glutes, chest, and arms. For example doing squats, lunges, shoulder press, bicep curls, or triceps extensions. Start with a few pounds or minimal weight and build up gradually. Weight training improves muscle strength which aids in daily activities and mobility during your recovery. 

Practice Good Sleep Hygiene 

Getting quality sleep should be a top priority in the weeks leading up to your spine surgery. Your goal should be seven to eight hours of sleep per night to allow your body to rest and recover. Going into a surgery well rested will help you heal faster and potentially reduce complications. To improve your sleep hygiene, start by establishing a relaxing bedtime routine. One helpful way to prioritize and utilize good sleep practices is the 10, 3, 2, 1, 0 sleep rule. This sleep rule states:

• • Eliminate caffeine ten hours before sleep
  • Stop alcohol three hours before bed
  • Stop working two hours before bed
  • Stop screen time one hour before bed
  • Hit snooze zero times in the morning 

These techniques help to eliminate variables that could delay the start of sleep. Another technique to optimize sleep is working towards a consistent sleep schedule. Try going to bed and waking up at the same or similar times each day. Try to avoid napping during the day as this can interfere with nighttime sleep. 

Relieve Stress

You experience a form of stress when changes occur that result in physical, mental, or emotional responses. This process is normal, as it is a result of hormones being released that cause many different feelings: a racing heart, nausea, sweating, shortness of breath, excitement, or motivation. How you react to stress is what determines if it is a good or bad stress. You may be experiencing stress, anxiety or even fear in the days leading up to your spine surgery. Remember these are common and normal emotions however controlling how you respond to them is important as anxiety increases your blood pressure, heart rate, decreases your pain tolerance, and unsettles your nervous system. Studies have illustrated the importance of being an informed patient and the role it plays in stress and anxiety reduction. This is where having a surgeon like Dr. Kalra and his team will put you at ease with your decision to proceed with spine surgery: 

“Amazing Experience. I have had quite a few surgeries, so I am not new to needing intervention. Dr. Kalra did everything in his power to make sure I understood everything that would or could happen before, during and after surgery. Before surgery we tried PT, injections and medication first because he didn’t want to run straight to surgery (huge plus in a doctor). He also took his time to explain my MRI’s to both my husband and I which is important to me because he included my husband in all decisions and important moves. The day of surgery during pre-op he came and spoke to me about exactly what would happen from the moment I went under to the moment I would wake up. After surgery his office called me at home to make sure I was taken care of and made sure I did not need anything. All follow ups have been quick, simple and purposeful.” Ashley F. 

“I’ve had 20 years of pain stemming from my L5-S1. I am now on the road to recovery and can say that I am able to live a much better life after my surgery. My experience was very easy, but the surgery was difficult, none of the difficulty was created by Dr Kalra or his staff. Any time I needed to talk to someone, make an appointment, or get questions answered, I was always able to reach someone, and I got what I needed. I truly believed this process would be impossible. I was sure something would go wrong, and that I would suffer forever, but it did not go this way. Dr. Kalra is skilled. He knows his craft, and is way ahead of the curve when it comes to being a comforting presence.” Patrick G. 

“I could not have hoped for a better experience. Dr. Kalra is essentially everything you could hope for in a doctor. He spends time with his patients, listening to their concerns, and explaining them in a way that is consumable for you to understand. He gives you all of your potential options, and always reminds you that the decision is yours to make, and he is here to support you. Finally the results have been amazing. My back feels the best it has in 10 years. He has made it possible again to get on the ground and play with my children, when it felt like it would never happen again.” Aaron M. 

“Excellent neurosurgeon and practice. I can not say enough good things about my experience with Dr. Kalra and his team! He is extremely caring, personable, professional, accessible, and I truly sense he cares about his patients and helping them achieve their treatment goals. Dr. Kalra performed a 360 spinal fusion on me a year ago, and I was able to achieve complete pain relief in my lower back after 20 years of debilitating pain. Thank you again for helping me gain my life back, Dr. Kalra and your whole team!  Rebecca S. 

With spine surgery or any situation in life, experience and knowledge can make all the difference. Dr. Kalra and his team work tirelessly to ensure you are educated and know what to expect before, the day of, and after your spine surgery. After determining if spine surgery is your best treatment option rest assured as Dr. Kalra and his team strive to treat every patient as if they were a neighbor, friend, or family.  

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board-certified spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physician colleagues from 2017-2023. If you have unanswered questions about a recommended spine surgery, need a second opinion, or would like to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or  request an appointment on our website.

The post Preoperative Optimization: Preparing for Spine Surgery appeared first on Kalra Brain & Spine.

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative treatment, minimally invasive spine surgery, and complex spinal deformity. During Dr. Kalra’s fellowship training he completed an additional six months of training in Germany to learn advanced spine procedures and new technologies coming out of Europe. Dr. Kalra also has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. 

Does Dr. Kalra See Patients for Second Opinions?

Yes, Dr. Kalra sees patients for second opinions and also encourages his patients to seek a second opinion. Dr. Kalra wants to ensure you make an informed decision that is best for you, your health, and your recovery, regardless if it is with him or another surgeon. Remember, statistics show that roughly 80% of Americans will experience some form of spine pain in their lifetime, however only 10% of spine pain truly requires surgery. If you have been told you need spine surgery a second opinion may also help you find treatment options you were unaware of, or never considered. Two of Dr. Kalra’s patients share their experience on how a second opinion made all the difference:

“Life Changing!! I have had a great experience with Dr. Kalra! He was my second opinion and gave me options that I did not realize I had. He really cares for his patients and will spend as much time with you as you need to answer all your questions. His team worked extremely hard with my difficult insurance to get the surgery approved that was best for me. I am a young mom who could no longer spend time with or take care of my kids due to pain. Now I am pain free and can do all the fun things with my kids again! I have my quality of life back!!” Bailey W.

“With little time remaining before my scheduled cervical fusion surgery I set out to find alternatives and discovered the Mobi-C. I found that Mobi-C patients generally have better outcomes, are less likely to need follow up surgery, are sent home the same day, do not need a neck brace, and most patients report returning back to work in one week. This sounded a lot different then my conversation with my first surgeon regarding a cervical fusion. We researched for a surgeon with advanced training on the Mobi-C and are so grateful to have found Dr. Kalra! With my surgery so close my expectations were low but Dr. Kalra and his staff went out of their way to be flexible and provide a thorough second opinion on my two level ACDF that was set to take place in less than a week. After meeting Dr. Kalra I cancelled the scheduled fusion and proceeded with his recommended C6-7 Mobi-C disc replacement. This was by far the best decision and outcome I could have hoped for. If you are looking for a neck or back surgeon, consider Dr. Kalra. He is genuinely interested in providing the best outcome and his staff is very friendly and helpful!” Jocelyn H.

What Diagnosis or Procedure Does Dr. Kalra See Most Frequently for Second Opinions? 

Patients often seek out Dr. Kalra’s experience and expertise in managing a wide variety of spinal conditions. One of the most common diagnosis Dr. Kalra sees second opinions for is patients who have cervical or neck pathology and have been recommended an anterior cervical discectomy and fusion (ACDF). ACDF has been considered the gold standard for many years in treating neck pathology however cervical disc replacement may be a superior  treatment option for certain patients. Many of these patients who see Dr. Kalra were unaware they had this option to avoid a fusion.

When Should I Seek a Second Opinion? 

You should seek a second opinion for spine surgery when:

• • You want to obtain additional information and knowledge on your diagnosis. 
  • No alternatives or options to a single procedure are presented.
  • Your surgeon recommends a second or confirming opinion.
  • You had previous spine surgery and require a revision surgery.
  • You are not completely comfortable or confident with your surgeon.
  • You experience difficulty in contacting or scheduling with your surgeon’s office.
  • Your surgeon refuses to perform your surgery in a hospital.
  • Your surgeon does not fully answer or address your questions regarding a recommended surgery.
  • You want to ensure you were not misdiagnosed.
  • If you feel pushed or rushed to make a decision on surgery right away.

What Should I Do After I Seek a Second Opinion? 

If you have done your due diligence and sought out a second opinion, what happens next depends on the information and recommendations you were given. If you consulted two surgeons with both confirming your pathology and surgical procedure you should have piece of mind in the recommendations. At this point you need to make the decision to proceed with surgery or continue managing your pain through physical therapy, lifestyle modifications, pain management, or medications. If you determine surgery is your preferred choice, go with your instincts and pick the surgeon who you had the best experience with. Which surgeon answered all your questions, had the best bedside manner, had the better or more helpful staff, and really put you at ease with their thoroughness and confidence. 

If you receive a second opinion that differs from your first opinion and you are not comfortable with either, it may make sense to seek a third opinion. If you find yourself in this situation make sure you do your research and know exact details of both previous surgical recommendations. You should think through each one logically, weigh pro and cons, and address your concerns or doubts with the previous recommendations. 

If you have been told you need a neck or back surgery Dr. Kalra advises you and his patients to seek a second opinion. There are many new ideas, techniques, and technologies that may help you avoid a complex spine surgery or unnecessary pain. Remember, less than ten percent of people that experience neck or back pain need spine surgery. If you are considering spine surgery and need a second opinion, call Kalra Brain & Spine at (972) 905-9226 or schedule an appointment on our website.   

The post Why Your Spine Deserves a Second Opinion appeared first on Kalra Brain & Spine.

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive cervical spine surgery. Following Dr. Kalra’s fellowship training he completed an additional six months of training in Germany to learn advanced spine procedures and new technologies coming out of Europe. He also received advanced training and has achieved superior outcomes utilizing cervical disc replacement technology for his patients. Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. 

What Are The Most Common Causes of Neck Pain? 

The most common cause of neck pain is muscle strain that typically resolves in days but can last up to six weeks for more significant strains. Musculoskeletal strain describes injury to the muscle, ligaments, tendons, or bones. This occurs when one of these structures are stretched too far and tears. Most neck pain will subside on its own or with over the counter treatment such as rest, ice, and medications. Sleeping with your neck in an awkward position or being hunched over your computer for hours can both result in neck pain. Other common causes of neck pain include: 

• Degenerative conditions (osteoarthritis)
• Nerve or spinal cord compression (herniated discs) 
• Injuries or trauma (motor vehicle accidents)
• Diseases (rheumatoid arthritis)

When Should I Be Concerned About My Neck Pain? 

Neck pain can result in significant discomfort and pain. Most neck pain can be managed or controlled with conservative non-invasive treatments. You should be concerned about neck pain and seek immediate medical attention if it is so severe you can not manage it or if you have any of the following symptoms that accompany severe neck pain:

• Significant pain and numbness, tingling, or weakness in one or both hands or arms 
• Fever and headache
• Chest pain
• Chronic swollen glands
• Extreme instability of head or neck

If you experience the above symptoms neck surgery may be necessary. Neck surgery or cervical spine surgery is most commonly performed for three main reasons. The first reason is a pinched nerve or impingement on the spinal cord that may require decompression surgery. The second reason for cervical spine surgery is when a tumor or mass develops at the base of the skull or in the cervical spine that requires removal. The third reason cervical surgery may be performed, is when a patient is experiencing spinal instability and fusion surgery is recommended. With improved minimally invasive surgical techniques, pain control, and technological advancements cervical fusion is no longer a must for cervical spine surgery patients.

How is Cervical Disc Replacement Different From A Cervical Fusion? 

 The surgical procedure for an Anterior Cervical Discectomy and Fusion (ACDF) involves an incision on the front of the neck and removal of the diseased disc. The cervical disc is then replaced with a surgical cage.  A metal plate is secured to the vertebral body above and below the where the cervical cage was placed.  The metal plate will provide stability of the vertebral bodies while a boney fusion is formed. Over the course of six months to one year a solid fusion mass  will form providing stability of the vertebral bodies. Anterior cervical disc replacement (ACDR) surgery requires an incision to  be made on the front of the neck and the diseased disc is removed. Instead of then fusing these bones together Dr. Kalra inserts an artificial disc that allows this space to remain open creating a more natural anatomic structure that functions like your natural disc. Although the two surgeries have similarities, the main difference is post operative cervical range of motion or neck mobility and the recovery time of a cervical disc replacement is much less than the cervical fusion.  

What Are The Benefits of Anterior Cervical Disc Replacement Compared to Anterior Cervical Disc Fusion? 

While there are potential benefits to a cervical disc replacement not all patients are candidates for this procedure. Some potential benefits include:

• Quicker recovery
• Reduced risk of adjacent segment disease
• Reduced risk of future surgery
• Greater range of cervical motion 

If you have struggled with neck or back pain and you have tried lifestyle modifications, physical therapy, medications, pain management and it is not improving it may be time to see a neurosurgeon. If you have been told you need a neck or back surgery Dr. Kalra advises you and his patients to seek a second opinion. There are many new ideas, techniques, and technologies that may help you avoid a complex spine surgery or unnecessary pain. Remember, less than ten percent of people that experience neck or back pain need spine surgery. If you are interested in learning more about cervical disc replacement, need a second opinion, or to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or schedule an appointment on our website.   

The post Neck Surgery: Can It Be Done Minimally Invasive Without A Fusion? appeared first on Kalra Brain & Spine.

At Kalra Brain & Spine, we believe it’s especially important to talk about nagging pain in the neck and back as we are spending more and more time with our heads bent low over computers and smartphones. This unnatural position can place a great deal of strain on the muscles, ligaments, joints and intervertebral discs in the neck. The result? Nagging pain.

What’s Causing My Nagging Neck Pain?

Some causes of neck pain are beyond our control, such as sports injuries or car accidents. And physically demanding jobs, with repetitive lifting, pulling, pushing, bending sideways and twisting, can also come with a greater risk of neck and back problems.
But there are some chronic conditions that can also cause neck, back and even arm pain. These include radiculopathy, herniated discs, degenerative disc disease and even scoliosis. Let’s take a closer look at each.

Radiculopathy. Commonly known as a pinched nerve, radiculopathy occurs when the nerve root in the neck or back becomes compressed. The result is inflammation of the nerve root. Symptoms of radiculopathy include numbness, weakness, tingling and pain.

Learn more about radiculopathy

Herniated Disc. A herniated disc occurs when the soft inner portion of the disc (the rubbery cushion between the vertebrae in your spine) is pushed out through the exterior border. A herniated disc can occur in the neck or the back and often is the result of trauma or excessive strain.

Learn more about herniated discs

Degenerative Disc Disease. This is a condition in which a damaged disc causes pain. A wide range of symptoms and severity is associated with degenerative disc disease. Unlike other tissues of the body, the disc has very low blood supply. Once a disc is injured, it cannot repair itself, and a spiral of degeneration can set in.

Learn more about degenerative disc disease

Scoliosis. Scoliosis is a curvature of the spine often noted to create the shape of a “c” or an “s” due to the spine twisting. Scoliosis occurs in both adults and children, although it manifests most often just before the growth spurt of puberty. Symptoms can vary but often include pain and muscle spasms.

Learn more about scoliosis

Kalra Brain & Spine: Your Trusted Resource for Nagging Pain

At Kalra Brain & Spine, it is our daily honor to provide the most advanced, evidence-based care to our patients. Treatment plans vary depending on the condition, and are often multidisciplinary and always directed toward non-operative management, including physical therapy, injections and lifestyle modifications whenever possible.

In cases where surgery is the best option to offer the pain relief an individual needs, the treatment is customized to each patient, and Dr. Kalra uses the latest technology and techniques to provide the most minimally invasive procedure possible.

North Texas’ Trusted Neurosurgeon

When world-class training meets hometown values deeply rooted in family and community, the result is the kind of medical care you’ve always hoped for. And that’s just what you’ll experience with Dr. Ricky Kalra. Dr. Kalra is the founder and chief surgeon at Kalra Brain & Spine and serves as Chief of Surgery at Presbyterian Hospital and Director of Neurosurgery at Medical City Frisco.

Locally awarded and recognized many times over, Dr. Kalra is as respected by his peers as he is loved by his patients. Dr. Kalra is honored to have been recognized as a Best Doctor in Dallas in D Magazine every year since 2017. He has also been featured in Living Magazine’s Top Healthcare 2019, Local Profile, Dallas Morning News and “Good Morning Texas”.

You may have also seen his name in a number of recent articles about a recent patient’s story or weighing in on Simon Cowell’s surgery recovery.

At Kalra Brain & Spine, the most important thing to know is you’re in good hands. Dr. Kalra has helped countless people get out of pain and regain their lives. Check out Baine’s story about how Dr. Kalra helped him finally find relief from years of nagging pain.

If you have unexplained pain (even if you’ve seen other doctors and still have not found relief), we’d love to meet with you to see if we can help. Schedule an appointment today.

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