Posts Tagged ‘lumbar laminectomy’

Understanding Adult Idiopathic & Degenerative Scoliosis

spine-scoliosisScoliosis, or an abnormal curvature of the spine, affects an estimated 7 million people across the U.S., or approximately 2% of the American population. Often the onset of scoliosis begins during adolescence, but the condition can also exist in adults. When the condition is discovered after puberty, it is referred to as adult scoliosis.

Most scoliosis cases are considered idiopathic, meaning they have no known cause. Most idiopathic scoliosis cases among adults actually began during adolescence. It is important, whether you’re an adult who’s been living with adolescent idiopathic scoliosis for years, or an adult whose scoliosis has only recently discovered, that you have your spine regularly checked by a physician to monitor the curvature and its progression. In many cases, idiopathic scoliosis does not require surgical treatment, but in the event that the curvature worsens , intervention, including surgery, might be required.

In addition to idiopathic scoliosis, there are several other types of scoliosis, most of which predominantly affect children and teens. However, there is one other form of scoliosis, degenerative scoliosis that doesn’t develop until adulthood.

As we get older and our bones and joints begin to wear and break down, we can experience a variety of conditions ranging from osteoporosis to osteoarthritis. In some cases, these same diseases can also be a cause of degenerative scoliosis.

Degenerative scoliosis does not begin until after the age of 40 and is marked by degeneration of the discs in the lumbar spine and the development of a scoliosis curve in the spine. Often times, degenerative scoliosis presents as low back pain. There may be no curve present when symptoms begin, and a patient may simply visit the doctor due to a new, but persistent pain in the lower back

Once the degeneration progresses and the scoliosis curve has occurred, this combination can put pressure on the nerves in the spine, leading to numbness, tingling sensations, weakness, pain in the lower extremities, all of which can lead to difficulties with activities of daily living.

Treatments for degenerative scoliosis vary depending on the severity of the case. Usually, conservative treatment measures including exercise, medication, and use of braces or orthotics can provide sufficient pain relief and support for a deteriorating spine. In particular, strengthening and stretching of the lumbar musculature can be very helpful in decreasing pain, as well as providing “prehab”- that is, exercise treatment BEFORE surgery to maximize the chances of a good outcome.

Treatment of other conditions (osteoporosis, osteoarthritis) that may be playing a role in the degenerative scoliosis can also help improve symptoms or slow the progression of degenerative scoliosis. In some cases, significant nerve problems or pain and/or the development of other conditions such as lumbar stenosis can mean treating degenerative scoliosis may require surgery, such as a lumbar spinal fusion or lumbar laminectomy.

To learn more about scoliosis, visit the Emory Orthopaedics & Spine Center.

About Dr. Ananthakrishnan

ananthakrishnan-dheeraDr. Ananthakrishnan trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, she practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University, where her focus is on adult and adolescent scoliosis.

In 2009, Dr. Ananthakrishnan co-founded Orthopaedic Link, a non-profit dedicated to improving orthopaedic care in the developing world by mobilization of unused implants from the United States. She is also a candidate member of the Scoliosis Research Society.

Although Dr. Ananthakrishnan routninely performs complex spinal reconstruction surgery, an injury in 2012 caused her to reevaluate her own approach to musculoskeletal health. Her practice philosophy now focuses on strengthening, stretching and general conditioning (“prehab”) as an adjunct to surgical care of her patients.

Related Resources
Are You One of the 7 Million in the U.S. Affected by Scoliosis?

Ironman Triathlete Back on Track after Lumbar Laminectomy

Dr. Tim YoonWhen it comes to spinal disorders, there’s good news for the weekend warrior who enjoys vigorous athletic training and competitive sports activities. Being in great physical shape plays a large role both in your recovery and getting you back to an active lifestyle.

Joann Pope, one of my current patients, has an impressive athletic resume. She completed the half Ironman in Panama City, Florida, 21 times straight. She qualified for the world-famous Hawaiian Ironman seven times and finished four times. But two years ago, at the age of 74, her back started hurting and she had to stop racing due to lumbar spinal stenosis.

Lumbar spinal stenosis is a degenerative condition that causes a narrowing of the spinal column in the lower back, known as the lumbar area. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord. It can also squeeze and irritate the spinal cord itself, causing pain, numbness, or weakness, most often in the legs, feet, and buttocks.

You might think that the physical stress of being a triathlete took its toll on Joann’s back, but that isn’t the case. In fact, if she hadn’t been in such great shape, her spine might have begun degenerating long before it did. For more than 20 years, Joann has been running, biking, and swimming. She was 47 when she started running, back in 1984. After she ran the Boston Marathon, her daughter talked her into doing a triathlon, the ultimate endurance test – a grueling three-part race with no stops.

So, thanks to her level of fitness, it’s as if Joann has the body of someone 20 years younger. Despite her active lifestyle , the lumbar stenosis progressed, and Joann’s pain, which came on slowly, continued to get worse.

Before Joann came to see me, she’d been experiencing lower back pain for a year. To address it, she’d been taking pain pills twice a day and was undergoing physical therapy, the first line of defense for lumbar stenosis. But when therapy didn’t ease her pain, her physical therapist told her she needed to see a surgeon. She chose to come to the Emory Orthopaedics & Spine Center.

In July of 2010, I performed a lumbar laminectomy and fusion on Joann. This procedure, also called a decompression, relieves pressure on the spinal cord or spinal nerve by widening the spinal canal. In Joann’s case, I removed the portion of the bony roof of the spine, or lamina, that was pressing on her lumbar nerves. Then I fused the two lowest lumbar vertebra, L4 and L5, with screws. When she woke up, the pain she had before surgery was gone.

Because Joann had been in such great physical shape before the surgery, she recovered rapidly and was swimming and walking again quickly. Now she’s walking two miles a day and is working up to getting back on her bike. Joann remains pain free and plans to go back to racing.

Have you had a lumbar laminectomy, or would you like to learn how spine surgery at Emory can get you back to the active life you enjoy? We welcome your questions and feedback in the comments section below.

About S. Tim Yoon, MD:
S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and cervical spine surgery. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.