Dr. Walters' Top 10 Frequently Asked Questions

1. What is degenerative disk disease?

Degenerative disk disease is a gradual or rapid deterioration of the chemical composition and physical properties of the disc space. It can occur anywhere in the spine: low back (lumbar), mid-back (thoracic), or neck (cervical).

Under the age of 30, these disks are normally soft, and they act as cushions for the vertebrae. With age, the material in these lumbar disks becomes less flexible and the disks begin to erode, losing some of their height. As their thickness decreases, their ability to act as a cushion lessens. The less dense cushion now alters the position of the vertebrae and the ligaments that connect them. In some cases, the loss of density can even cause the vertebra to shift their positions. As the vertebrae shift and affect the other bones, the nerves can get caught or pinched and muscle spasms can occur.

Degenerative disk disease is primarily a result of the normal aging process, but it may be advanced as a result of trauma, infection, or direct injury to the disk. Heredity and physical fitness may also play a part in the process.

2. What is sciatica?

In the low back, nerves join to form the sciatic nerve, which runs down into the leg and controls the leg muscles. Sciatica is the descriptive term for when pain runs from your back or buttocks down your leg and even into your foot. It is a condition caused by either compression or trauma of the sciatic nerve. Sciatica is made worse when you cough or if someone lifts your leg up while you are lying down. Symptoms may begin abruptly or gradually, are usually irritated by movement, and often grow worse at night. Sciatica implies that there is an irritation of your nerve root in the lower part of your spine. In some instances, this could be due to a ruptured or herniated disc in your lower back.

3. What is a bulging/ruptured/herniated disk?

The disks in your spine are your "shock absorbers" between the bones (vertebras). With forces too strong for the disk to support, such as, lifting an object that is too heavy or lifting it improperly, tears in the disk or a herniation of the disk may occur. A herniated disk is also called a bulging, protruding or "slipped" disk which may cause specific pain patterns from the back into the buttocks, hips, and/or legs. The ways in which a herniated disc causes different pain patterns and problems with your back is related to the location of the herniated disc along your spine, and also to the anatomy of your spinal column.

If the injured disk is in the low back, it may produce pain, numbness, or weakness in the lower back, leg, or foot. If the injured disk is in the neck, it may produce pain, numbness, or weakness in the shoulder, arm, or hand.

4. What is radiculopathy/nerve impingement?

Radiculopathy refers to a condition in which the spinal nerve roots are irritated or compressed. Many people refer to it as having a "pinched nerve." Lumbar nerve impingement indicates that the nerve roots in the lower spine are involved, while cervical radiculopathy is associated with nerve roots in the neck. Nerve impingement is most often caused by a herniated disk or spinal stenosis.

5. What is spinal stenosis?

Stenosis refers to a narrowing of the spinal canal, usually in the lower back (lumbar) region. Stenosis produces a dull, aching pain in the lower back when standing or walking. The pain usually radiates down into the buttocks and thighs, and can be relieved by sitting, or by using a walker or a shopping cart in the grocery store. These symptoms usually slowly get worse over time, and people who suffer from spinal stenosis will notice a slow decrease in their ability to walk shorter and shorter distances.

Lumbar stenosis is a natural product of aging, and the wear and tear on the spine throughout our lives. As our bodies grow older, the ligaments and bones that make up the spine grow thicker and become stiffer. The spinal canal gradually narrows, and the spinal cord is slowly compressed. The lack of space interferes with the normal function of the spinal cord and the body becomes less able to function normally.

6. What is the difference between x-rays, MRI, and CT scan?

X-rays are a type of radiation, and when they pass through the body, dense objects such as bone block the radiation and appear white on the x-ray film, while less dense tissues appear gray and are difficult to see. X-rays are typically used to diagnose and assess bone degeneration or disease, fractures and dislocations, infections, or tumors.

MRI, or magnetic resonance imaging, combines a powerful magnet with radio waves (instead of x-rays) and a computer to manipulate magnetic elements of internal organs and tissue to create highly detailed images of structures in the body. Images are viewed as cross sections or "slices" of the body part being scanned. There is no radiation involved as with x-rays. MRI scans are frequently used to diagnose bone, joint, and soft tissue problems.

A computed tomography (CT) scan (also known as CAT scan) is similar to an MRI in the detail and quality of image it produces, yet the CT scan is actually a sophisticated, powerful x-ray that takes 360-degree pictures of internal organs, the spine, and vertebrae. By combining x-rays and a computer, a CT scan, like an MRI, produces cross-sectional views of the body part being scanned. In many cases, a contrast dye is injected into the blood to make the structures more visible. CT scans show the bones of the spine very well, so they are useful in diagnosing conditions affecting the vertebrae and other bones of the spine.

7. What is an EMG or NCS?

Electrodiagnostic studies include electromyography (EMG); nerve conduction studies (NCS); and evoked potentials (EP). Like imaging studies, these studies cannot confirm the presence or absence of pain. They are most useful in evaluating a patient when pain is present with an observed neurological deficit.

Electromyography (EMG) is the most commonly used test to assess the function of the nerve roots leaving the spine. The test is done by inserting tiny electrodes into the muscles of the arm or leg. By looking for abnormal electrical signals in the muscles, the EMG reveals nerve irritation, or pinching of the nerve, as it leaves the spinal canal.

Think of how you test the wiring on a lamp. If you place a working bulb into the lamp, and the bulb lights up, you assume that the wiring is okay. However, what if the bulb does not light up? You may safely assume that something is probably wrong with the wiring, like the lamp is unplugged, or a short circuit has occurred. By relating the muscles to the light bulb in the lamp, the EMG is able to determine the condition of the nerves that supply those muscles, like the wiring on the lamp. If the EMG machine finds that the muscles (the light bulb) are not working properly, the doctor may assume that the nerves (the wiring) must be irritated or pinched somewhere.

8. What is physical therapy?

Physical therapy is the treatment of musculoskeletal and neurological injuries to promote a return to function and independent living. Physical therapy incorporates both exercise and functional training. Exercise restores motion and strength while functional training facilitates a return to daily activities, work, or sport.

9. What is an epidural?

An epidural is a potent steroid injection that helps decrease the inflammation of compressed spinal nerves to relieve pain in the back, neck, arms or legs. Cortisone is injected into the spinal canal for pain relief from conditions such as herniated disks, spinal stenosis, or radiculopathy. Some patients may need only one injection, but occasionally more than one injection is needed to provide significant pain relief. Frequently, these are done using a transforaminal approach to selectively isolate a specific nerve root. Along with electrodiagnostics, this can help identify a specific nerve root as the pain generator.

Cortisone is a steroid that is produced naturally in the body. Synthetically-produced cortisone can also be injected into soft tissues and joints to help decrease inflammation. While cortisone is not a pain reliever, pain may diminish as a result of reduced inflammation. In orthopaedics, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendonitis, and arthritis.

10. What are facet blocks?

Like any joint in the body, facet joints may cause pain if they are irritated or inflamed. The facet joint block is a procedure where a local anesthetic medication (like the dentist uses to numb your mouth) with steroid is injected into the facet joint. The lidocaine numbs the area around the facet joint and the steroid helps reduce inflammation. If the pain resolves or is significantly reduced, the doctor or physician assistant may assume that the facet joint is a problem or at least part of the problem.

Facet blocks may be repeated. When the joint becomes irritated a third time, a rhizotomy procedure is recommended. This procedure cauterizes the tiny sensory nerve that innervates this facet region. The nerve may grow back in 6-18 months, and this procedure may be repeated. One may expect long term relief from a rhizotomy procedure if the facet blocks have effectively reduced pain.