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Spinal Conditions: Back Pain Treatment in Portland

Degenerative Disc Disease: Portland, OR Spine SurgeryDegenerative Disc Disease

Degenerative disc disease is less a disease than a description of aging in the discs of the spine. X-rays and MRI studies can describe the degree of degeneration present. Disc degeneration is a normal course of aging but can lead to neck and back pain, arthritis in the spine, and instability (spondylolisthesis or scoliosis) or nerve impingement (stenosis). Degenerative disc disease without instability or stenosis is generally successfully treated with physical therapy and medications.
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Low Back Pain

Back pain can originate from many locations but frequently resolves with rest and medicines. Doing exercises as guided by a licensed physical therapist is important to help minimize pain and prevent future flare-ups. Strengthening one's core, or abdominal and back muscles, can take pressure off the discs and joints of the spine and lead to relief of pain. If preliminary treatments such as rest, medicines, and physical therapy do not relieve back pain then further investigation is warranted. Identification of a correctable problem is important for successful surgery on the back.
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Spinal Stenosis

Stenosis in the spine represents a narrowing of the canal, or space, for the nerves traveling within the spine. Stenosis can have many causes including disc bulging, arthritis of the facet joints, spondylolisthesis (slipped bones in the spine), tumor, and fatty tissue in the spinal column. Lumbar spinal stenosis typically presents with buttock and/or leg pain especially when standing in one place or walking. Frequently people must lean forward or sit down to get relief. Sometimes patients feel heaviness in the legs or say "they just don't work." At times lumbar spinal stenosis presents primarily as back pain but generally hip or leg involvement is present. Frequently patients are evaluated for hip pain when spinal stenosis is the underlying cause of deep pain in the hips. Spinal stenosis can be seen well on a MRI and frequently symptoms can be relieved by an epidural injection in the area of greatest narrowing. Surgery is generally highly successful at relieving leg pain and heaviness and usually involves a laminectomy, removal of bone, to make more room for the nerves. Stenosis in the neck or mid-back can lead to myelopathy, or spinal cord compression. Myelopathy is a serious condition best treated by surgery.
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Spondylolisthesis: Slipped Disc CorrecetionSpondylolisthesis

Spondylolisthesis is a Greek term meaning slipped spine. It is most commonly found at the fourth and fifth lumbar levels (L4-5) and is more common in women. Overall, 5% of women have this condition, likely related to the forces placed on the spine due to women's pelvic anatomy . Most cases of spondylolisthesis produce no symptoms and people are unaware of the condition. However, spondylolisthesis can produce back, buttock or leg pain due to stenosis that results from the slipped vertebrae. Most cases of spondylolisthesis respond well to anti-inflammatory medicines, physical therapy, or epidural injections. Over 80% of patients whose symptoms do not disappear with non-operative treatments have an excellent result from surgical intervention. Generally spinal fusion is necessary to correct the slip and prevent further slippage.
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Scoliosis

Scoliosis, or curvature of the spine, frequently presents either in the teenage years or much later in adult life (typically after age 50). Scoliosis is not necessarily painful although large curves (above 50 degrees) can lead to back pain, poor balance, or stenosis. During adolescence bracing of scoliosis can be effective; however, once people are adults bracing no longer has a significant effect. Therapy can help with instability or balance problems resulting from scoliosis and injections are frequently helpful if patients develop leg pain from the scoliosis. Surgery is generally quite large and should be used as a very last resort.
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Sciatica

Sciatica, or radiating nerve pain going down a leg, occurs in up to 40% of the population at some time during their life. The pain can range from mild throbbing to severe ache that leads to difficulty walking. 50% of cases improve within one month and nearly 90% of cases of sciatica will spontaneously resolve within 3 months. Medications and epidural injections can be quite helpful. In cases of progressive weakness or severe pain a small surgery, a microdiscectomy, can be done. Patients can leave the same day or after an overnight stay. Over 80% of patients see significant immediate improvement in symptoms immediately after the surgery.
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Compression Fractures

Compression fractures are fractures of the vertebral body which is the front of the spine. They typically occur in the low thoracic or lumbar spine.
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Neck Pain TreatmentNeck Pain

Neck pain can have a large number of causes including disc degeneration, arthritis, muscle imbalance, or pinching of nerves. Most people experience neck pain at some point in their lives but it generally resolves with a combination of rest, anti-inflammatory medications, and physical therapy. If these treatments are not successful over weeks to months further evaluation is indicated and may include x-rays or MRIs in addition to a good physical exam. Successful surgical treatment for neck pain depends largely on being able to clearly identify a correctable cause of that pain.
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Cervical Disc Herniation

There are many causes for arm pain but only a small percentage of arm pain originates from pinched nerves in the neck. Nonetheless, the pain resulting from a cervical disc herniation or stenosis can be severe. Frequently, arm pain starts at the base of the neck or near the scapula (shoulder blade). The pain commonly is constant and little can relieve it. At times, placing the hand on top of the head can help as that decreases the stretch occurring on the pinched nerve. Most cases of radiating arm pain resolve spontaneously, but medications and epidural injections can be quite helpful in decreasing pain while the body heals itself. If non-operative treatments fail there are multiple surgical options including a foraminotomy (enlarging the space for the nerve), fusion, and disc replacement. Progressive weakness in an arm is concerning and frequently an indication for surgery.
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Myelopathy

Myelopathy is a neurologic condition created by pressure on the spinal cord. It can lead to a large number of symptoms including neck or back pain, poor balance, numbness, weakness, trouble using the hands, and loss of bladder or bowel control. Myelopathy is usually diagnosed on physical exam in combination with MRI. It is a serious condition that is almost always progressive; it is generally best treated with surgery.
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