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.

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.

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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.   

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