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Back & Spine

Conquering Back and Spinal Conditions at Aria

No two backs are the same.  And even the strongest, most seemingly resilient back can suffer wear and tear or sudden injury.  

For these reasons, most adults experience back pain at some time in their lives.  Such discomfort needs medical attention and intervention if it persists or, of course, is the result of significant trauma or other event.  Knowledgeable orthopedists at Aria take advantage of years of training and experience to sort out the causes and defects involved in individual back problems.

Practiced use of imaging and collaboration with radiologists helps to reveal the locations where problems occur and where interventions can bring solutions and relief to both acute and chronic back pain.  Large nerves that emanate from the spine can get squeezed when they exit past compromised vertebrae and discs, causing pain to radiate to the extremities.  Aria’s back specialists look at the complete patient and his or her history, physical activities, and life and work situation in seeking to solve these conditions.
The goal always is to try to safely avoid short- and long-term debilitation, when possible.
The Aria staff is adept at managing most back problems without surgery, using various strategies involving:
•    medications;
•    heat & cold;
•    rest;
•    work modification;
•    bracing;
•    exercise; stretching;
•    manipulation;
•    physical and occupational therapy;
•    integrative- and alternative-medicine;
•    psychological counseling;
•    and other techniques.  

When these approaches are insufficient, and an operation is necessary for treatment, Aria orthopedic surgeons also provide the most skilled surgical interventions available.

Disc problems

The gel-like pads that provide spacing and cushioning between the vertebrae bones often become compressed, causing pressure on nerve roots and sometimes resulting in bulged, herniated, or ruptured discs that can even further impose on nerves exiting the back at these sites.  This is most common in the lower part of the back called the lumbar spine (where pressure on nerves that innervate the lower extremeities can result in pain, numbness, and even weakness in the pelvis and legs), though it also frequently occurs in the neck or other parts of the spine.  Deformed discs that compromise nerve roots can be one of the most painful medical conditions and can result in loss of feeling, movement, and other function.

Aria’s team works to help patients recognize the symptoms of compressed discs and take steps to relieve pressure on the back before the condition becomes worse.  Physical therapy in particular can help to prevent or treat bulging and herniated discs, as can medications (steroids and painkillers) and referral for steroid injection to reduce inflammation.

If noninvasive solutions don’t prove adequate, the staff provides surgery with confidence and exacting technique.

For the smaller group of patients for whom time and conservative care does not solve significant disc-related symptoms, the orthopedic team can take advantage of disc surgery.  Many factors come into play in deeming such surgery necessary and appropriate, including type and degree of remaining symptoms and their impact on the patient’s life.

Patients may chose to undergo a discectomy to remove herniated disc material that presses on a nerve root or on the spinal cord.  Back surgeons may perform these procedures through a standard open incision or sometimes through a smaller (percutaneous) skin puncture.

Vertebrae problems
Each of the closely linked vertebra bones of the back help to protect the spinal cord and give the back its shape, structure, and strength.  These pieces of bone, like the soft tissue around them suffer pressures and strains of weight support and tortional movements.  They absorb countless impacts, and often incur the weakening effects of acute injury, repetitive stress, or diseases such as osteoporosis.  They can fracture, decay, or shift out of proper position to impose upon the nerves, connective tissues, and muscle immediately around them.

Not surprisingly, defects in the vertebrae cause the same types of pain and dysfunction that disc problems do, and two are closely associated and often present together.  When conservative means can’t relieve the nerve pressure causing vertebral symptoms, the orthopedic team has a number of interventions to offer patients, including:

•    vertrebroplasty.  The surgeon can repair fractures and compressed areas in a vertebra nonsurgically by injecting high-strength bone cement into the fracture.  

•    kyphoplasty.  In this form of verterbroplasty, the surgeon first introduces a balloon, at the end of a needle-like device, into the abnormal area of the vertebra and inflates the balloon to reposition the bone before reinforcing it with injected cement.

•    laminectomy.   In this operation, back surgeons use an open incision to remove the bone overlying the spinal canal (lamina) of a vertebra to relieve pressure on the spine.

•    fusion.  This more serious and invasive form of back surgery, once performed mostly for spinal deformity, has seen broader use for lower back pain if other options are exhausted.  The team uses pieces of bone, and sometimes plates, screws, or other hardware, to fuse one or more vertebrae rigidly together to correct compression, deformity, breaks, narrowed spinal canal, or misalignment that impinges on nerves.  The procedure strengthens and realigns the treated vertebrae, and removes unwanted movement within the section treated.  Patients who undergo spinal fusion require a substantial amount of time for recovery and rehabilitation, but the operation can return stability and mobility, and relieve pain.
Arthroscopic spinal procedures allow the surgical team to access a variety of spinal conditions with tiny instruments and minimal invasiveness.  Patients recover faster and can sometimes receive treatment as outpatients.

Other back problems

Aria’s orthopedists also offer care for a host of other back conditions, including ankylosing spondylitis, arachnoiditis, facet arthropathy, ligament injury, muscle spasms or strains, scoliosis, sciatica, and other conditions.  They also collaborate with Aria’s Cancer Center for tumors involving the back.

For spinal cord injury, the orthopedic service at Aria refers to the Regional Spinal Cord Injury Center of the Delaware Valley, located at Thomas Jefferson University Hospital.  In affiliation with Magee Rehabilitation Hospital, the center has treated thousands of patients since its designation in 1978, and it is one of the nation’s 14 Model Spinal Cord Injury Centers.

The back staff works with rheumatologists, rehabilitation medicine specialists, neurologists, neurosurgeons, and pain-medicine specialists in providing care to the patient and recommendations to the referring doctor.  They may also refer patients to Aria’s Wellness Program for such complementary therapies as yoga, weight loss, and physical conditioning.

Whether back problems come from life-long degenerative conditions, congenital problems, accident, or on-the-job injury, Aria’s orthodedists can get to the cause and can deliver and manage the right care.  They can offer the best in surgery, when direct interventions are needed.

 

See also Aria’s:

•    Work Health program
•    hand and wrist services
•    podiatry services