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.   

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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 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.   

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