SPINE

The Washington Sports Medicine Institute provides a central location for patients in the Tysons, McLean and Arlington, Virgini  region with treatment for orthopedic spine conditions and surgical procedures. Our fellowship-trained orthopedic spine surgeons provide a combined total of 40+ years of experience. We provide trusted, quality patient care along with cutting-edge techniques and state-of-the-art technology to find and treat arthritis and other causes of pain including issues in bones, joints, and muscles.

CONDITIONS WE TREAT

LOW BACK PAIN

Understanding your spine and how it works can help you understand why you have low back pain. Your spine is made up of small bones, called vertebrae, which are stacked on top of one another. Muscles, ligaments, nerves, and intervertebral discs are all parts that make up your spine. The vertebrae connect to create a canal that protects the spinal cord. The spinal column is made up of three sections that create three natural curves in your back: the curves of the neck area (cervical), chest area (thoracic), and lower back (lumbar). The lower section of your spine (sacrum and coccyx) is made up of vertebrae that are fused together. Five lumbar vertebrae connect the upper spine to the pelvis.

Back pain is different from one person to the next. The pain can have a slow onset or come on suddenly. The pain may be intermittent or constant. In most cases, back pain resolves on its own within a few weeks

Causes of low back pain

• Low Back Pain due to Over-activity
• Disc Injury
• Disc Degeneration
• Degenerative Spondylolisthesis
• Inactive lifestyle and Obesity
• Spinal Stenosis
• Scoliosis

TREATMENT OPTIONS

In general, treatment for low back pain falls into one of three categories: medications, physical medicine, and surgery. Nonsurgical Treatment includes:

• Aspirin or acetaminophen
• Non-steroidal anti-inflammatory medicines
• Narcotic pain medications
• Steroids
• Physical Therapy

SURGERY

Most types of surgeries should only be considered when nonsurgical treatment options have been tried and have failed. It is best to try nonsurgical options for 6 months to a year before considering surgery. In addition, surgery should only be considered if your doctor can pinpoint the source of your pain. Surgery is not always a last resort treatment option “when all else fails.” Some patients are not candidates for surgery, even though they have significant pain and other treatments have not worked. Some types of chronic low back pain simply can not be treated with surgery.

Spinal Fusion. This is essentially a “welding” process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone. Spinal fusion eliminates motion between vertebral segments. It is an option when motion is the source of pain. For example, your doctor may recommend spinal fusion if you have spinal instability, a bad curvature (scoliosis), or severe degeneration of one or more of your discs. The theory is if the painful spine segments do not move, they should not hurt. The fusion of the vertebrae in the lower back has been performed for decades. A variety of surgical techniques have evolved. In most cases, a bone graft is used to fuse the vertebrae. Screws, rods, or a “cage” are used to keep your spine stable while the bone graft heals.

The surgery can be done through your abdomen, your side, your back, or a combination of these. There is even a procedure that is done through a small opening next to your tailbone. No one procedure has been proven better than another. The results of spinal fusion for low back pain vary. It can be very effective at eliminating pain, not work at all, and everything in between. Full recovery can take more than a year.

Disc Replacement. This procedure involves removing the disc and replacing it with artificial parts, similar to replacements of the hip or knee. The goal of disc replacement is to allow the spinal segment to keep some flexibility and maintain more normal motion. The surgery is done through your abdomen, usually on the lower two discs of the spine.

HERNIATED DISC

When people say they have a “slipped” or “ruptured” disc in their neck or lower back, what they are actually describing is a herniated disc (sometimes also spelled disk) which is a common source of pain in the neck, lower back, arms, or legs. A disc herniates or ruptures when part of the center nucleus pushes through the outer edge of the disc and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs. Conditions that can weaken the disc include:

• Arthritis
• Knee ligament injuries
• Torn meniscus
• Patellar tendonitis
• Chondromalacia patellae
• Dislocated kneecap
• Baker’s cyst
• Knee bursitis
• Plica syndrome
• Osgood-Schlatter disease
• Osteochondritis dissecans
• Gout

TREATMENT OPTIONS

Nonsurgical treatment is effective in treating the symptoms of herniated discs in more than 90% of patients. Most neck or back pain will resolve gradually with simple measures.

SURGERY

Surgery may be required if a disc fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the lower back include microdiscectomy or laminectomy, depending on the size and position of the disc herniation. In the neck, an anterior cervical discectomy and fusion are usually recommended. This involves removing the entire disc to take the pressure off the spinal cord and nerve roots. Bone is placed in the disc space and a metal plate may be used to stabilize the spine. For some patients, a less invasive surgery may be performed on the back of the neck that does not require fusing the bones together. Each of these surgical procedures is performed with the patient under general anesthesia. They may be performed on an outpatient basis or require an overnight hospital stay. You should be able to return to work in 2 to 6 weeks after surgery.

NECK PAIN

The neck (cervical spine) is composed of vertebrae that begin in the upper torso and end at the base of the skull. The bony vertebrae along with the ligaments (which are comparable to thick rubber bands) provide stability to the spine. The muscles allow for support and motion. The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion. For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms.

TREATMENT OPTIONS

If severe neck pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately. If there has not been an injury, you should seek medical care when neck pain is.

• continuous and persistent
• severe
• accompanied by pain that radiates down the arms or legs
• accompanied by headaches, numbness, tingling, or weakness

SURGERY

Knee arthroscopy is the commonly recommended surgical procedure for meniscal tears. The surgical treatment options include meniscus removal (meniscectomy), meniscus repair, and meniscus replacement. Surgery can be performed using arthroscopy where a tiny camera will be inserted through a tiny incision which enables the surgeon to view inside of your knee on a large screen and through other tiny incisions, surgery will be performed. During meniscectomy, small instruments called shavers or scissors may be used to remove the torn meniscus. In arthroscopic meniscus repair, the torn meniscus will be pinned or sutured depending on the extent of tear.

SCIATICA

If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may have a protruding (herniated) disc in your spinal column that is pressing on the roots of the sciatic nerve. This condition is known as sciatica. Sciatica may feel like a bad leg cramp that lasts for weeks before it goes away. You may have pain, especially when you sit, sneeze, or cough. You may also have weakness, “pins and needles” numbness, or a burning or tingling sensation down your leg.

You are most likely to get sciatica between the ages of 30 and 50 years. It may happen as a result of the general wear and tear of aging, plus any sudden pressure on the discs that cushion the bones (vertebrae) of your lower spine. The gel-like center (nucleus) of a disc may protrude into or through the disc’s outer lining. This herniated disc may press directly on the nerve roots that become the sciatic nerve. Nerve roots may also get inflamed and irritated by chemicals from the disc’s nucleus.

TREATMENT OPTIONS

The condition usually heals itself, given sufficient time and rest. Approximately 80% to 90% of patients with sciatica get better over time without surgery. Nonsurgical treatment is aimed at helping you manage your pain without long-term use of medications. First, you’ll probably need at least a few days of bed rest while the inflammation goes away. Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants may also help. In addition, you may find it soothing to put gentle heat or cold on your painful muscles.

SURGERY

You might need surgery if you still have disabling leg pain after 3 months or more of nonsurgical treatment. A part of the herniated disc may be removed to stop it from pressing on your nerve. The surgery (laminotomy with discectomy) may be done under local, spinal, or general anesthesia. You have a 90% chance of successful surgery if most of the pain is in your leg.

SPONDYLOLYSIS AND SPONDYLOLISTHESIS

The most common cause of low back pain in adolescent athletes that can be seen on X-ray is a stress fracture in one of the bones (vertebrae) that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects the fifth lumbar vertebra in the lower back and, much less commonly, the fourth lumbar vertebra.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis). If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition.

TREATMENT OPTIONS

Initial treatment for spondylolysis is always nonsurgical. The individual should take a break from the activities until symptoms go away, as they often do. Anti-inflammatory medications, such as ibuprofen, may help reduce back pain. Occasionally, a back brace and physical therapy may be recommended. In most cases, activities can be resumed gradually and there will be few complications or recurrences. Stretching and strengthening exercises for the back and abdominal muscles can help prevent future recurrences of pain. Periodic X-rays will show whether the vertebra is changing position.

SURGERY

Surgery may be needed if slippage progressively worsens or if back pain does not respond to nonsurgical treatment and begins to interfere with activities of daily living. A spinal fusion is performed between the lumbar vertebra and the sacrum. Sometimes, an internal brace of screws and rods is used to hold together the vertebra as the fusion heals.