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We provide information to help patients and caregivers to understand of anatomy, associated symptoms, and arthroplasty of spine.

The Anatomy

The Spinal Column / Vertebrae

The spine is made up of vertebrae and is divided into 3 main sections:

  • Cervical (7 vertebrae)
  • Thoracic (12 vertebrae)
  • Lumbar (5 vertebrae)

Below the lumbar spine is the sacrum which is comprised of 5 fused vertebrae At the end of the spine is the coccyx or the tailbone.

The vertebrae bear the weight of the upper body and provide points of attachment for muscles and ligaments. It also protects the spinal canal and provides exit points for spinal nerves.

The individual vertebrae are separated by intervertebral discs, which act as cushions or shock absorbers between the vertebral bodies.

Intervertebral Discs

These vertebrae are connected by several joints, which allow you to bend, twist, and carry loads. The main joint between two vertebrae is called an intervertebral disc. The disc is comprised of two parts, a tough and fibrous outer layer (annulus fibrosis) and a soft, gelatinous center (nucleus pulposus). These two parts work in conjunction to allow the spine to move, and also provide shock absorption.

Spinal Ligaments

Ligaments are tough bands of elastic tissue that connect bones together and help to restrain excessive motion at the joints. The spinal ligaments help to stabilize the spinal column during motion.

Spinal Nerves

The shape of the vertebrae allows for the passage of spinal cord from the brain to lower part of the body through the spinal canal. Spinal nerves stem from the spinal cord and exit the spinal column between each vertebra on both sides. After exiting the spinal canal, these spinal nerves then further entwine and extend to send signals between your brain and your organs, muscles, and other tissues.

Disease & Injury

Intervertebral Discs

Degenerative changes in the spine may cause instability and pain in your back Degenerative Disc Disease (DDD) involves the intervertebral disc and is part of the natural aging process.

In the normal spine, your discs act as a shock absorber between vertebrae Over time the discs can lose flexibility, elasticity, and height When this happens, they lose their shock absorbing characteristics and can lead to abnormal motion or alignment of the spine, which may result in pain.

Symptoms may include pain or numbness in the back or legs This pain may increase with activities that involve sitting for extended periods, bending or twisting.


Spondylolisthesis is a condition in which one of the vertebrae slips forward or backward If left untreated, this can lead to deformity of the spine and narrowing of the spinal canal.

Typical symptoms include low back pain, muscle spasms, thigh or leg pain, and weakness Interestingly, some patients are asymptomatic and only learn of the disorder after spinal radiographs, such as x-rays.

Spinal Stenosis s

Spinal stenosis is the narrowing of areas in the spine where nerve roots and the spinal cord must travel It is most commonly caused by age-related spinal degeneration This narrowing can put pressure on the nerves and cause pain.

Symptoms often start gradually over time Pain is likely to be present or worsen when you stand or walk, and lessen or disappear when you sit down or lean forward Typically, people suffering from lumbar spinal stenosis will experience pain, tingling weakness or numbness that radiates from the lower back into the buttocks and legs.

What are the Symptoms?

Symptoms of lumbar spinal stenosis may include:

  • Decreased endurance during physical exercise and activities
  • Weakness and/or loss of balance
  • Numbness and a “prickly” feeling in your legs, calves, or buttocks
  • Aching, dull back pain radiating (spreading) to your legs
  • Symptoms improve when you sit, lean forward, lie on your back, or sit with your feet raised

If you feel that you are experiencing any of these symptoms you should see a physician for an accurate diagnosis.

What are the Treatment Options?

If lumbar spinal stenosis is established as your diagnosis, your doctor may recommend one or more of the following treatment plans based on your specific condition:

  • Physical therapy and strengthening exercises
  • Rest and a restriction of physical activity
  • Injections (corticosteroids) to help reduce the pain and swelling
  • Medications and analgesics to reduce pain and swelling

Spine Surgery

Surgical Solutions

If your symptoms do not improve with other methods, your physician may suggest spinal surgery. Surgical solutions for lumbar DDD with resultant lumbar spinal stenosis may include the following:

Spinal Fusion

Spinal fusion is a surgical procedure used to solve problems with the bones of the spine. Spine surgery is usually recommended only when your doctor can pinpoint the source of your pain. To do this, your doctor may use imaging tests, such as x-rays, computed tomography, and magnetic resonance imaging (MRI) scans. Spinal fusion may relieve symptoms of many back conditions, including:

  • Degenerative disk disease
  • Fracture
  • Spondylolisthesis
  • Spinal stenosis
  • Tumor
  • Scoliosis

PLIF is one of the options that your doctor may choose. Posterior Lumbar Interbody Fusion (PLIF) is a form of spine surgery in which the lumbar spine is approached through an incision on the back This procedure is used to stabilize the spine by fusing two or more vertebrae together. During the surgery the patient lies face down First, the surgeon makes an incision in the skin of the back over the vertebra(e) to be treated In a traditional PLIF, a 3-6 inch incision is typically required depending on the number of surgical levels A small section of the bone and disc are removed to clear a pathway for the interbody spacers

Interbody spacer

Two interbody spacers are inserted into the disc space to aid in supporting areas between the vertebrae where the disc was removed The function of the spacers is to stabilize the segment and to improve overall alignment of the spine Increasing disc height also provides more room for the nerves The central chamber and surrounding area is packed with bone graft material to help promote bone growth (fusion) between adjacent vertebrae. A variety of different interbody spacer options are available Talk to your doctor about which implants and techniques may be best to treat your condition.

Pedicle Screws and Rods

Pedicle screws and rods are used to hold the spinal segment in place while fusion occurs and for stability The screws are inserted into the vertebrae to be fused Bone graft may be added along the side of the vertebrae to support the fusion The surgeon then closes the incision and moves the patient into recovery.

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