Adjacent segment degeneration is the process of rapid degeneration of the segment next to a spinal fusion. Historically, rates of ASD are 3% per year utilizing tradition open surgical techniques. Minimally invasive techniques may reduce the incidence of ASD by providing less disruption to the supporting tissues.

Ankylosing spondylitis is an autoimmune inflammatory disease that causes auto fusion of spinal vertebrae and loss of flexibility.

Annular tear is a defect in the annulus fibrosis, the hard outer crust of the intervertebral disc. Annular tears can cause nagging lower back pain and usually improve with conservative treatment or an epidural steroid injection.

Lower Back Pain is the leading cause of global disability. Causes of lower back pain include age-related wear and tear, disc degeneration, and arthritis of the facet joints. Usually, lower back pain can be treated with physical therapy and nonsurgical treatment. If nonsurgical treatment fails to provide relief, select patients can benefit from surgical intervention.

Automobile accidents account for 34.5% of spinal cord injuries. If you are involved in an automobile accident and have pain, weakness, or numbness, you should see a spine surgeon.

Cauda Equina Syndrome is a surgical emergency. The nerve roots in the bottom of the spinal nerve root sac resemble a horse’s tail. If these nerve roots become compressed, usually by arthritis, infection, or a large disc herniation they can cause loss of bowel or bladder function, numbness of the saddle region, and leg weakness. This is an emergency and a patient experiencing these symptoms must present to the emergency room immediately. Recovery of function is much greater when surgical decompression is performed within 24-48 hours after onset of symptoms.

Cervical Myelopathy is a dysfunction of the spinal cord. When the spinal cord is compressed in the cervical spine, patients develop gait imbalance (“wobbly gait”), hand dysfunction (difficulty with handwriting and fine motor tasks), as well as other clinical symptoms such as hyperactive reflexes. If you notice that your balance or hand function has been worsening, you may have cervical spinal cord compression. Cervical myelpathy is especially common in patients with lumbar spinal stenosis.

Cervical Radiculopathy refers to cervical nerve root dysfunction, usually due to compression from disc herniation or bone spurs. Due to a phenomenon called referred pain, patients with nerve root compression in their cervical spines will experience pain radiating to their shoulders, arms, and/or hands. They may also experience numbness, tingling, or weakness. If nonsurgical treatment fails to provide relief, Anterior Cervical Discectomy and Fusion (ACDF) or Cervical Artificial Disc Replacement (ADR) are very effective treatments.

Degenerative disc disease (DDD) is extremely common with >50% of asymptomatic patients over age 40 and >95% of asymptomatic patients over age 65 demonstrating signs of DDD on MRI. DDD in itself does not require surgery. However, which DDD leads to collapse of nerve root tunnels, spinal instability, or spinal deformity causing significant disability then surgery can provide significant relief of symptoms.

Disc herniation occurs when the nucleus pulposus or gelatinous inner filling of an intervertebral disc herniates through a defect or crack in the annulus fibrosis or outer crust. Herniated disc material can cause nerve pain by direct mechanical compression and also through chemical inflammation surrounding nerve roots. Most disc herniations can be treated nonsurgically and those that do not improve with conservative treatment can be removed with a minimally invasive, outpatient microdiscectomy.

The facet joints on the back of the spine are lubricated by joint fluid or synovial fluid. In cases of spinal instability or aberrant motion of these facet joints, the synovial fluid may bulge out of the facet joint capsule and create a cyst that causes nerve root pain and irritation by direct compression and also mechanical inflammation. Facet cysts have a tendency to scar onto the dura or nerve root sac, causing severe pain. Facet cysts that do not improve with nonsurgical treatment can be removed surgically.

Failed Back Syndrome refers to any patient who has not obtained acceptable relief of pain or improvement in function after spine surgery. A significant portion of Dr. NaPier’s practice involves the treatment of failed back syndrome including the revision of prior spine surgeries. The most common reasons for failure are the inappropriate restoration of spinal balance and inadequate stabilization of the spine. If you have had prior spine surgery and are experiencing significant pain or disability or if you have been diagnosed with a failed back syndrome, you may benefit from a second opinion from Dr. NaPier.

Flat Back Syndrome or Sagittal Imbalance refers to a patient who has undergone spinal fusion surgery that has not restored the proper amount of lordosis for a given spine. Consequently, the patient often experiences significant disability due to having a severely pitched forward posture. Surgical treatment involves both minimally invasive reconstruction of the anterior column of the spine if the patient has open disc spaces and posterior-based osteotomies if the patient’s spine is fused. If open disc spaces remain then these disc spaces can be utilized to generate the necessary lordosis. If open disc spaces are not available then a wedge must be cut out of the back of the spine in order to restore appropriate spinal balance.

Pseudarthrosis or Nonunion of the spine occurs when a spinal fusion surgery is performed, but the bones that are intended to fuse into a single mass of bone do not fuse and remain separated. Often this results in painful, persistent motion with eventual screw pullout and hardware failure. Most commonly pseudarthrosis occurs due to inadequate mechanical stability or excess motion at the fusion site, inadequate preparation of the fusion bed, or insufficient biological activity for bone growth at the fusion site. Depending on the cause of pseudarthrosis a wide range of revision surgical techniques is available to promote fusion. Dr. NaPier prefers to utilize minimally invasive techniques such as Lateral Interbody fusion (LLIF) or Minimally Invasive Percutaneous Posterior Cervical Fusion (MIS PCF) to treat pseudarthrosis when possible.

Kyphosis is an excessive forward tilt of the spine. This can occur in the cervical, thoracic, or lumbar spine. Treatment involves reduction of kyphosis and restoration of appropriate lordosis.

Lumbar radiculopathy refers to pain that radiates down the hip, thigh, leg, or foot due to nerve root compression in the lumbar spine. This phenomenon is known as referred pain.

A lumbar strain is a pulled muscle or a charley horse of the paraspinal muscles in the lumbar spine. This injury can be very painful since paraspinal muscles are constantly contracting and relaxing to support the functions of everyday life. Typically lumbar strains will improve with anti-inflammatory medications, physical therapy, and chiropractic care.

Neck pain is a common cause of disability. This is usually due to arthritis of the bones in the cervical spine or a strain of the cervical paraspinal muscles. Burning pain that radiates down the arms may be due to cervical nerve root compression and warrants an evaluation by a doctor.

Spondylosis or osteoarthritis of the spine is age related wear and tear of the spine. This is very common and usually improves with physical therapy and anti-inflammatory medications.

Scheuermann’s Kyphosis is caused by anterior wedging of more than 5 degrees across three consecutive thoracic vertebrae. Mild and moderate cases can be treated with physical therapy and bracing. Severe cases show significant improvement with surgical correction.

Sciatica is a term for pain that radiates down the leg. The sciatic nerve is the largest nerve in the body and runs down the buttock area and back of the thigh, but the term sciatica refers to any pain that radiates down the leg and is caused by nerve root compression in the lumbar spine.

Scoliosis is a sideways or “S” shaped curvature of the spine in the frontal view. Most cases of scoliosis are mild and do not require surgical treatment. Severe cases, especially those with nerve root compression, can benefit from surgical reconstruction.

The Sacroiliac Joint connects the spine to the pelvis and is a significant generator of pain, especially in patients who have had prior lumbar fusion surgery. Patients who experience significant relief from a diagnostic sacroiliac joint injection may benefit from outpatient sacroiliac joint fusion surgery.

Spinal cord injury can result from acute trauma to the spinal cord or prolonged compression. There are many different patterns of spinal cord injury. If you are experiencing loss of strength or sensation or burning pain in the arms or legs this may be a symptom of spinal cord injury.

In a balanced spine, the headrests directly over the pelvis, which rests directly over the feet. A patient with a balanced spine is able to remain balanced and stand upright with minimal effort. Unfortunately, as we age discs collapse and tilt resulting in a posture that is pitched forward (sagittal imbalance) and sideways (degenerative scoliosis). These conditions are broadly referred to as adult spinal deformities. Many times adult spinal deformity is the result of age-related degeneration of the spine, but frequently spinal deformities are caused by prior spine surgeries that did not restore balance to the spine.

The more pitched forward a patient’s posture is, the more disabled he or she becomes. Recent studies have demonstrated that Adult Spinal Deformity has a similar impact on the physical function to cancer, diabetes, heart disease, and rheumatoid arthritis. Initially, patients may be able to compensate for spinal imbalance by rotating their buttocks underneath their pelvis, extending their hips, or bending their knees, but ultimately patients will develop fatigue in this inefficient posture. The goal of spinal deformity surgery is to reduce pain and improve function by restoring balance to the spine.

Spinal fractures can occur as the result of trauma or injury or as a result of insufficient bone strength. Many fractures can be treated nonoperatively, but some require surgical stabilization in order to heal appropriately.

Spinal infections typically occur in immunocompromised patients or in healthy patients after spine surgery. If the infection is causing mechanical instability or neurological symptoms surgical intervention may be required.

Spinal stenosis is the most common reason for lumbar spine surgery in a patient greater than 65 years old. Neurogenic claudication refers to a heaviness, cramping, or aching in the thigh or buttocks due to nerve compression. Typically, symptoms improve with leaning forward or sitting down as these positions enlarge the volume of the spinal canal. Patients experience significant relief when leaning forward on a shopping cart and prefer a stationary bike to a treadmill. Most patients with lumbar stenosis at one or two levels can be treated with an outpatient minimally invasive decompression surgery. If you are experiencing these symptoms you should schedule a consultation with Dr. NaPier.

A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal (cauda equina) — often causes permanent changes in strength, sensation and other body functions below the site of the injury. If you've recently injured your spinal cord, it might seem like every aspect of your life has been affected. You might feel the effects of your injury mentally, emotionally and socially.

A spinal tumor is a growth that develops within your spinal canal or within the bones of your spine. A spinal cord tumor, also called an intradural tumor, is a spinal tumor that that begins within the spinal cord or the covering of the spinal cord (dura).

Some of the most common types of spine injuries include broken back, bruises, muscle strains, herniated discs and joint sprains. These ailments may require surgery to repair and can lead to lengthy recovery times and chronic pain that may require significant time off work – or prevent you from returning to work at all.

Spondylolisthesis or slipped vertebrae refers to a slip of one vertebra forward in relation to neighboring vertebrae. This can cause back pain and compression of the spinal canal or the nerve root tunnels. Degenerative spondylolisthesis typically occurs at the L4-5 level due to degeneration and failure of the lumbar facet joints. Isthmic or lytic spondylolisthesis usually occurs at the L5-S1 level due to a defect in the pars interarticularis. Patients with spondylolisthesis should see Dr. NaPier for evaluation.

Spondylolysis refers to a defect in the pars interarticularis that can result in the slippage of one vertebrae on another. This is present in 3-6% of the population and is more common in athletes with repetitive hyperextension such as gymnasts, weightlifters, and football linemen. Compression of the L5 nerve root can result in a foot drop in these patients. These patients can benefit from a consultation with Dr. NaPier.

The sports with the highest risk of catastrophic spinal injuries are football, ice hockey, wrestling, diving, skiing and snowboarding, rugby, cheerleading, and baseball. A common mechanism of injury for all at-risk sports is an axial compression force to the top of the head with the neck slightly flexed.

When a nerve root is compressed in the thoracic spine, the patient may experience pain radiating around the trunk or chest.

Whiplash occurs with forced hyperextension of the lower cervical vertebrae and affects up to 83% of patients involved in automobile collisions. Patients who have persistent burning pain, numbness, or weakness of the shoulder, arms, or hands should see Dr. NaPier for evaluation.

Many common spine injuries such as disc herniation or spine fracture can occur as a result of work-related injuries. It is important to seek medical care in order to determine the extent of these injuries and whether there may be any lasting consequences of the injury.

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