A herniated disc occurs when the soft inner gel that cushions the spine’s vertebrae protrudes into the spinal canal. This places pressure on nearby nerves, causing pain, tingling, numbness or weakness in the arms or legs. Herniated discs are very common, and can be caused by injury.
A herniated disc can be managed nonsurgically with medication, physical therapy and pain management. In some cases, surgical intervention is necessary.
Spinal Stenosis occurs either in the neck (cervical spine) or the lower back (lumbar spine). When spinal stenosis occurs in the lumbar spine, the pressure on the nerve roots can cause tingling, numbness, weakness, or pain in the legs when walking. When Spinal Stenosis occurs in the cervical spine, patients often experience tingling, numbness, or pain in the shoulders and arms.
Stenosis is most common in men and women over 50 years of age, and can be caused by arthritis or aging.
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Degenerative disc disease is caused by aging of the spine and pain can be caused by a damaged disc. It often occurs in either the lower back (lumbar spine) or neck (cervical spine).
Discs are soft, compressible cushions that sit between the bones of your spine. They act as shock absorbers for the spine, allowing it to bend and flex. As a person ages, the disc can become injured. As a disc degenerates, a patient can experience back or neck pain that can spread through the extremities.
Spondylolisthesis is a condition in which a bone in the spine (vertebra) slips out of position. At first, the out-of-position disc may be minor without presenting symptoms. However, if the condition is more severe, a nerve could be compressed, causing pain in the back or neck. Degenerative spondylolisthesis, which occurs naturally as your spine ages, is more common in adults aged 50 and older.
Treatment for spondylolisthesis depends on a number of factors. Often patients are successful with non-surgical treatment, but if the slip is severe, surgical intervention may be necessary.
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Trauma to the spinal vertebrae often leads to spinal fractures. Trauma could come from a fall or accident, or any situation that severely stresses the spinal vertebrae.
Spinal compression fractures can be caused by osteoporosis or cancer (see Spinal and Spinal Cord Tumors below). Compression fractures can occur in vertebrae anywhere in the spine, but they tend to occur most commonly in the upper back (thoracic spine) or the upper lumbar sections of the spine. Compression fractures can be treated by a brace or vetebroplasty, but more severe cases may require surgical intervention.
Types of compression fractures include wedge fractures (when the fracture occurs in the front of the vertebra) or crush fractures (when the entire bone breaks). Patients experiencing spinal fractures often have acute back pain, which can lead to chronic pain, deformity, and height loss.
Spinal Infections can occur in the vertebral column, intervertebral discs, the spinal canal, the dural sac or the adjacent soft tissues. Infections can be caused by bacterial or fungal organisms and often occur in patients who recently underwent surgery or who have particular set of risk factors. Symptoms of a spinal infection can include fever, chills, pain, headache, neck stiffness, wound tenderness, and wound drainage. In some cases, patients may notice new weakness, numbness or tingling sensations in the arms or legs.
Spine and spinal cord tumors can cause pain and progressive paralysis. The most common type of spinal tumor is metastatic cancer, when cancer is spread from other sites and causes tumors in the spine. Primary spinal tumors are rare tumors which originate from the spine itself. These tumors can vary in complexity depending on their location and extent of growth.
Proper diagnosis is paramount in selecting the appropriate surgery. Surgery can be a highly effective method of preserving the ability to walk, reducing pain, and decreasing the tumor burden for other treatments to take effect.
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As a cancer progresses, it may spread, or metastasize, from its original site to other areas of the body. The spine is a common site for metastatic cancer. When cancer spreads to the spine, patients may experience back pain or numbness and weakness in the arms and legs, and in some cases, this pain is severe. To treat spinal metastatic disease, neurosurgeons will work with other physicians, including oncologists and radiologists, to develop a comprehensive treatment plan specific for each specific patient.
Spinal cord tumors are tumors arising from the spinal cord or nerves themselves and require delicate handling to prevent injury to normal spinal cord tissue. Surgery is performed under a specialized microscope by neurosurgeons constantly monitoring the function of the spinal cord during surgery.
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Nerve sheath tumors (schwannomas and neurofibromas) are types of tumors that arise from the nerve roots that come off the spinal cord. Typically, these tumors are benign and slow growing. However, they can cause pain, weakness, or numbness depending on the exact location and size of the tumor. In some cases physicians may just closely monitor the tumor, but in other cases, surgical intervention is necessary.
Spinal vascular diseases affect the veins and arteries that carry blood to the spinal cord. Patients are diagnosed with vascular disease of the spine when blood vessels are formed abnormally near the spinal cord. The most common vascular spinal disorders are arteriovenous malformations and arteriovenous fistulae.
Symptoms of vascular disease in the spine may vary depending on location and severity. Symptoms may include pain and numbness in extremities, or in some case, paralysis in one or more extremities. To determine if a patient has a spinal vascular diseases, our surgeons will review MRI or CT imaging to identify any abnormalities.
In some cases, surgical treatment may be necessary. This can include endovascular or open surgical procedures.
The adult spine is structured with a series of natural curves and angles which allow it to carry the weight of the head, arms, shoulders, chest and torso in balance with the pelvis, hips and legs. When these curves and angles bend to abnormal degrees, the spine becomes imbalanced, which can lead to pain and limitation of function.
One type of spinal deformity often first seen in children during a growth spurt is scoliosis. Scoliosis is typically a sideways curvature of the spine. This curvature may be mild, or may continue to get more severe as children grow, resulting in a disabling spinal deformity.
Other spinal deformities can arise from trauma, previous surgery, osteoporosis, spinal cord injury, neuromuscular diseases, congenital causes or degenerative spinal disease. Correcting scoliosis and spinal deformities often require complex surgery.
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Tethered Spinal Cord Syndrome refers to a disorder where the spinal cord is unusually attached to the surrounding tissues, causing an abnormal stretching of the spine. This abnormal spinal attachment may be congenital or a result of a spinal cord injury. Symptoms may appear in birth or childhood, as well as later in adulthood, depending on the severity of the disorder and the variation of the growth of the spinal cord.
A Chiari Malformation is characterized by structural defects in the cerebellum, the part of the brain that controls balance. If a patient has a Chiari Malformation, their cerebellum descends out of the base of the skull and crowds the spinal cord, putting pressure on both the brain and spinal cord.
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The spinal cord is comprised of a bundle of nerves that travels down your back and carries messages from the brain to the rest of the body. An injury to the spinal cord disrupts these signals, and can result in a decreased or absence of movement and sensation below the level of the injury, and/or bowel and bladder function. Spinal cord injury can result from trauma, loss of blood supply or compression from a tumor. There are about 12,000 new cases of spinal cord injury each year.
When diagnosed with a spinal cord injury, patients are seen by a rehabilitation team that can include neurosurgeons, neurologists, physiatrists, rehabilitation specialists, occupational therapists, and more. Neurosurgeons may perform surgery to stabilize the spine, so that a patient can participate in rehab. However, surgery does not necessarily improve deficits that resulted from the spinal cord injury.
Our neurosurgeons also treat sequels from spinal cord injury, including spinal cord tethering, cysts, and more.
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Failed back syndrome is characterized by persistent pain following back surgeries. Our surgeons are here to make sure that treatment for spinal disorders is successful, and patients’ pain is alleviated. As a tertiary center, we welcome patients who have failed treatments elsewhere. Patients are evaluated at the Brigham and Women’s Hospital Department of Neurosurgery Spine Center to see whether further surgical treatments can be performed to solve the problems.
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