Neurosurgery and Spinal Surgery
Spine Conditions & Spinal Surgery
The human vertebral column known as the backbone or spine, consists of twenty-four articulating vertebrae (bones), and nine fused vertebrae in the sacrum (a triangular-shaped bone at the bottom of the spine), and the coccyx (tailbone). The vertebral column protects the delicate spinal cord. There are seven vertebrae in the cervical spine, 12 in the thoracic spine, five in the lumbar spine, five in the sacrum, and four in the coccyx. The vertebrae are separated from each other by intervertebral discs, which cushion the bones.
Neurosurgeons treat a full spectrum of spine conditions, surgically and non-surgically. These include minor to severe injuries, as well as age-related conditions that cause chronic symptoms. Our surgical team is also equipped to treat tumours that are either primary to the spine or metastatic, meaning they have spread to the spine from other cancers, such as the breast or lung.
The medical term for bone spurs is osteophytes, which are a common sign of spinal degeneration associated with aging, especially in people age 60 and older. In most cases, bone spurs are treated non-surgically with anti-inflammatory medications and cortisone epidural injections. A surgical procedure called laminectomy can relieve pain and neurological symptoms by removing the bone spurs and thickened ligaments that are responsible for painful nerve compression.
Degenerative disc disease
This condition occurs over a period of time as a part of the normal aging process. Deterioration affects the intervertebral discs, the cushions between the vertebrae in the spine. These discs act as shock absorbers and enable complex motions such as twisting. Disc degeneration can affect any part of the spine, but is most common in the cervical or lumbar spine. Nonsurgical treatment includes physiotherapy, anti-inflammatory medication, and cortisone epidural injections. If nonsurgical treatment proves ineffective, there are a number of surgical procedures that can be performed. These include discectomy, laminectomy, spinal fusion, or foraminotomy.
Discs are gel-like cushions between the vertebrae of the spine. A herniated disc can occur anywhere in the spine, but is most common in the cervical and lumbar spine. When some of the softer material pushes out through a crack of the more durable outside, a bulge or rupture can occur, putting pressure on the spinal nerve roots. While some people do not experience symptoms, this condition can be very painful. This most commonly results from aging, which leads to a gradual loss of water content in the discs, but injury can also lead to herniation. If a bulging or ruptured disc presses on the sciatic nerve, pain may run from the buttock down one leg, leading to sciatica. Nonsurgical treatment is the first course of treatment for most patients with a herniated disc. If a patient has progressive major weakness in the arms or legs due to pinching of the nerve root, surgery may be advised sooner, because if left untreated, there is a risk of permanent nerve damage.
Low back and upper back pain
Back pain is very common, affecting as many as 85% of people at some point in their lives. Pain in the lumbar spine (low back) is more prevalent than in the thoracic spine (upper/middle back). There are many causes, and although most are fairly benign, sometimes there may be a serious underlying medical problem. Pain that lasts more than three months is considered chronic. Low back pain can be quite debilitating and painful, but in about 90% of cases, the pain improves without surgery. Serious symptoms that need immediate treatment include new or sudden bowel or bladder problems; pain or throbbing in the abdomen or a fever; pain related to a fall, blow to the back, or other injury; or pain associated with coughing or urination. Nonsurgical treatment includes anti-inflammatory medication, bed rest, reduced physical activity, physiotherapy, and cortisone epidural injections. Imaging studies will be ordered if conservative treatment methods are ineffective. There are several types of surgery depending on the underlying cause, including lumbar decompression with or without spinal fusion, laminectomy, foraminotomy, lumbar microdiscectomy, and minimally invasive options.
There are many causes including disc degeneration, narrowing of the spinal canal, arthritis, and injury. Pain can be temporary or chronic, limited to the neck area or radiating down the arm. When pain radiates, the symptoms generally develop slowly, typically resulting from a cervical herniated disc or degenerative changes in the joints. These conditions can pinch nerves and cause pressure on the cervical spine and spinal cord. Nonsurgical treatment includes anti-inflammatory medication, bed rest, reduced physical activity, physiotherapy, and cortisone epidural injections. There are several different surgical procedures that can be utilized, including minimally invasive options, based on the severity of the underlying pathology. In a small percentage of patients, spinal instability requires spinal fusion.
A fracture or dislocation of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Most spinal fractures occur from injuries sustained in car accidents, falls, or sports. Injuries can range from fractures and dislocations of the bony vertebrae, to debilitating spinal cord damage, which can result in paralysis. A different type of spinal fracture called vertebral compression fracture (VCF) is caused by osteoporosis or spinal tumours and is most common in older adults. A VCF occurs when the bony block or vertebral body in the spine collapses, which can lead to severe pain, deformity and loss of height. These fractures more commonly affect the lower part of the thoracic spine. Treatment of spinal fractures depends on the severity of the injury, but includes pain management, bracing and orthotics to provide immobilization and stability, and instrumentation and fusion procedures. Vertebroplasty and kyphoplasty are minimally invasive procedures reserved for the treatment of compression fractures.
This is a narrowing of spaces in the spine, most often in the cervical and lumbar areas. It is most prevalent in people age 60 and older and associated with aging or arthritic degeneration in the spine. The narrowing puts pressure on the spinal cord and the spinal nerve roots, and may result in pain, numbness, or weakness in the legs. Nonsurgical treatment includes anti-inflammatory medication, physiotherapy, and cortisone epidural injections. Two types of surgery for spinal stenosis are spinal fusion and laminectomy, with minimally invasive options.
These are abnormal growths of tissue within or surrounding the spinal cord and/or spinal column. Spinal tumours can be benign (non-cancerous) or malignant (cancerous). Primary tumours originate in the spine, while metastatic tumours are primary tumours located in another part of the body, such as the breast, that spread to the spine. Intradural-extramedullary tumours are the most common, developing in the nerve roots that extend out from the spinal cord or at the spinal cord base. Intramedullary tumours develop inside the spinal cord, most frequently in the cervical region. Nonsurgical treatment options include observation, chemotherapy, and radiation therapy. Primary spinal tumours can be resected completely, giving the patient an excellent prognosis. In patients with metastatic tumours, treatment is usually palliative, with the goal of restoring or preserving neurological function, stabilizing the spine, and alleviating pain.
This occurs when one of the vertebra in the spine slips forward and out of place, most commonly affecting the lumbar spine. Degenerative spondylolisthesis is associated with aging or arthritic degeneration in the spine. This slippage can cause spinal stenosis, which puts pressure on the spinal cord and the spinal nerve roots, sometimes resulting in low back and leg pain. Spondylolytic spondylolisthesis is most often caused by a broken bone in the back and results in slippage. This usually occurs during adolescence with symptoms not manifesting until adulthood, when degenerative changes associated with aging compound the problem. Nonsurgical treatment includes anti-inflammatory medication, physiotherapy, and cortisone epidural injections. Two types of surgery for spinal stenosis are spinal fusion and laminectomy, with minimally invasive options.
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