A common condition that can happen in the spine is a slipped vertebrae or the more technical
term is spondylolisthesis which you may hear about.
Essentially what that means is that one vertebrae is shitfing forward on the other one.
And when that's due to a stress fracture, that's usually a fracture that occurs here
on the back side of the spine.
This circle on the side of the spine where the nerve root comes out will essentially
change shape from an oval to a pancake.
As that spine slides forward and that hole becomes more pancake-shaped, this nerve really
gets pinched.
The other type of slip is when you get arthritis in the back of the spine in these small joints
in the back of the spine.
As those joints get loose and unstable, the spine again can shift.
having a slipped vertebrae can cause a couple of things.
Usually people will have some component of back pain.
As the slip progresses and as your body develops thickened ligaments to protect it, people
can get pinched nerves.
When they start developing pinched nerves, usually people will start to have complaints
of leg pain, or pains going down their legs.
Perhaps one or the other or both.
People who have a slip from a fracture or a stress fracture usually get more severe
leg pain.
People who have a slip from arthritis can have leg pain not just in one leg or the other,
but usually in both legs.
And usually they have symptoms similar to what people experience with spinal stenosis
which is pinched nerves from arthritis.
These are usually gradual processess.
Occasionally people will have more severe pain.
Usually it builds slowly over time.
People will notice back pain with activity and occassionally some leg symptoms.
Often times that'll calm down and the symptoms will come and go.
As time goes on, the slip can get more severe and the pinching of the nerves can get more
severe.
At that time the pain in the legs can become more constant and problematic.
The condition where you have arthritis and the slipping of the spine becomes quite common
as we all age.
Many of us will develop a little bit of slipping from arthritis.
Often times that doesn't develop into much pinching of the nerves and people tolerate
that OK.
If you're doing reasonably well and you're having some intermittent back pain or leg
pains, that's usually best managed conservatively and I usually recommend people go through
a course of physical therapy to work on core strengthening or stomach strengthening.
You can take anti inflamatory medicine over the counter - tylenol.
It's good to have your weight at an appropriate level, so if you're overweight it's good to
lose some weight.
Avoid smoking - those lifestyle factors.
If your pain is increasing despite those treatments, the next step would be an injection or a cortizone
shot in the back which are called epidural injectsions.
Those are often quite beneficial for a period of time.
The time to consider surgery is when your pain is not well controlled with any of these
any treatments; or if the injections helped but are not working anymore.
And there are good surgical options for these conditions.
Surgically, when someone does a laminectomy or an area to un-pinch nerves, you remove
a small window of bone on the backside of the spine so we can get to the nerves and
take out all that excess ligament that's pinching them.
We'd also come out and open up these holes where the nerves come out on the sides.
Making sure all of your nerves aren't pinched.
Then to stabilize the two segments that are slipping we put little screws here that run
though this segment of the bone into the front.
On both sides at both levels and connect them with little rods in the back.
And then the most important part is to pack a little bit of the bone along the sides of
the spine to get these two vertebrae to essentially grow together.
In general when somebody's had a fusion and a decompression or a laminectory for slipped
vertebrae you're quite sore early on in the first several days.
We do get you up moving pretty quickly.
Usually you're up to the chair or walking on post-operative day number one.
usually somebody's in the hospital for a few days and then they go home and they're on
a walking program and we avoid them doing much bending or heavy lifting for the 8-12
weeks afterward to allow things to heal.
I think at The Nebraska Medical Center the biggest advantage is that there are so many
people to help with your care.
We have specialists in every area of medicine.
So while I'm treating your spine, I have a hospitalist that's specifically trained to
evaluate you pre-operatively and note any problems you may develop.
We have specialist physicians to follow you on the floor.
Our anesthesiologists are specialized in treating complex cases.
Your entire continuum of care is really run by people specialized in every aspect of you
getting better.
Additionally at the med center we have neurosurgical spine and orthopedic spine and we can collaborate
on cases, and do frequently so that you can get the best care that you need.