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.