The following page contain educational information regarding common spine conditions. You can explore the “Where does it hurt” diagram to localize the problem and then search the condition pages. Alternatively, you can search the common conditions, such as, sciatica, herniated disc, etc below and learn more about them. The written contents are coupled with educational videos whereby an artistic rendition helps explain each specific condition. Please feel free to explore the content and write to us with your comments and questions.
A cervical disc herniation, or cervical radiculopathy, occurs when a small portion of a disc ruptures and causes pressure on spinal nerves in the neck. Small herniations are sometimes called bulges or protrusions, and people experiencing pain from the herniation often describe it as a pinched nerve. Depending on which cervical disc has herniated, the specific pain symptoms may vary. In general, pressure on a spinal nerve causes discomfort in various sites along one or both arms, frequently down to the hand. There can be shooting, burning pains, weakness, and/or numbness.
Spine stenosis is narrowing of the spinal canal. Spinal canal is a passage way for the spinal cord and the spinal nerves. Narrowing of the passageway causes pressure on the delicate spinal cord and nerves. Symptoms vary depending on the location of the narrowing. In the neck, spine stenosis compromises the spinal cord. Initially neck pain, followed by arm pain, numbness of hands and arms are some of the early presenting symptoms. Progressive pressure on the spinal cord can lead to loss of balance and disturbance of bowel and bladder function, with weakness in the arms and legs.
Scoliosis is an abnormal curving of the spine. In cases of either increased curving or buckling of the spine to either side, scoliosis occurs. Often time patients look as if their shoulders or hips are not level. Symptoms can be pain over the curved spine, loss of flexibility, balance problems and tilting to one side. In the upper spine, arm length discrepancies, breathing problems, pain and in more severe cases, disfiguring posture can occur. In the lower back, back pain, leg pain, balance problems, and hip pain can be the presenting problems.
Cubital Tunnel Syndrome symptoms are tingling and later pain and/or numbness affecting the inner aspect of the forearm, with radiation into the pinky and ring finger. In the later stages, there is weakness of the intrinsic hand muscles, causing a weak grip and eventually wasting of the hand muscles. This is due to compression of the ulnar nerve at the elbow. A condition named ulnar nerve entrapment syndrome. This condition can occur up to years after initial trauma to the nerve at the elbow, or shortly after stretch type injuries as a result of motor vehicular accidents. The initial term “Tardive ulnar palsy” was chosen to highlight the delayed onset of this condition.
Sciatica is when pressure on a Sciatic nerve causes disruption of signal transmission, causing pain, weakness in the muscle, and numbness. Symptoms may include tingling, numbness, sharp, or pinching pain traveling down the leg. At times, the pain can be severe and may interfere with the proper functioning of the leg. In some cases, the initial sharp, shooting pain tends to subside after the first few weeks. Pain tends to be replaced by numbness, tingling and even hypersensitivity to touch. Pressure on this nerve can be caused by different conditions, such as, herniated disc, bone spurs and, spine stenosis.
Bone Spurs can occur with a condition called Osteoarthritis (a general term that describes changes in the joints that occur as a person ages). Osteoarthritis of the spine causes joints along the spine to deteriorate and may result in the formation of bone spurs. The primary cause of osteoarthritis is normal wear and tear on the body due to the aging process. Repetitive motion and injuries from sports or employment and excessive body weight can also accelerate the degenerative process. The joints become irritated and inflamed as cartilage surrounding the facet joints of the spine breaks down over time. The discs between the vertebrae also degenerate, and the decreased disc height affects how the joint moves. Pain may result from friction between the joints and the body often produces bone spurs and cysts that may also cause pressure on the spinal cord and/or nerves.d
Carpal Tunnel Syndrome is a common peripheral nerve disorder describing symptoms of median nerve compression at the wrist, and within the carpal tunnel. Individuals often experience radiating pain into the thumb, index and middle finger. Numbness, grip weakness, difficulty with holding objects in the hand and wasting of the hand muscles can develop because of the pressure on the median nerve at the wrist. Anti-inflammatory medication, bracing, steroid injections can help subside the symptoms. In case lack of improvement from these maneuvers, surgical decompression of the nerve, carpal tunnel release, can provide excellent relief and restore the function of the hand.
A Bulging Disc occurs when a small portion of a disc bulges out from the vertebrae and causes pressure on spinal nerves. Small herniations are sometimes called bulges or protrusions, and people experiencing pain from the herniation often describe it as a pinched nerve feeling. Symptoms occur when pressure on a spinal nerve from a bulging disc causes discomfort in one or both of the legs, frequently down to the ankle or foot. There can be shooting pains, weakness, and/or numbness. Pain in the leg is usually worse when sitting.
A Pinched nerve is when pressure on a nerve causes disruption of signal transmission, causing pain, weakness in the muscle, and numbness. Symptoms may include tingling, numbness, sharp, or pinching pain traveling in the arm or leg. At times, the pain can be severe and may interfere with the proper functioning of the arm or leg. In some cases, the initial sharp, shooting pain tends to subside after the first few weeks. Pain tends to be replaced by numbness, tingling and even hypersensitivity to touch. Pinching of the nerve can be caused by different conditions, such as, herniated disc, bone spurs and, spine stenosis.
Bone spurs are simply bony outgrowths. They can take on different shapes. In the spine, bone spurs can pose particular problems. They are mostly found in the neck and the lower back. They are of concern when the bony outgrowth compromises nerves or even the spinal cord. Bone spurs, unlike the normal surface of joints and vertebrae are uneven and resemble icicles hanging from the roof of the canal and passage way of the nerves and the spinal cord. The sharp and uneven surface of the bone spurs can lead to narrowing of these important passageways.
Bone spurs can lead to narrowing of the exit site of the nerve root, pinching the nerve root and cause shooting pain in the arm and leg. Later on, and depending on the extent of the pressure on the nerve, individual patient can experience muscle weakness. Pain can change into tingling and burning sensation. At times “looking-up” can cause a pinching sensation in the back of the neck and shooting pain in the shoulder and arm. In the lower back, bone spurs cause leg pain, localized back pain and muscle spasm. Most patient experience progressive worsening neck and/or back pain. Initially, over-the-counter anti-inflammatories may bring on relief. Changing work ergonomics, neck exercises and attention to better posture can help maintain and prolong the pain-free interval. In other cases pain and discomfort tends to return which may interfere with individual’s day-to-day function and work and even sleep. Pain can travel to the side of the neck, into the shoulder, arm and fingers. It will be hard to find a comfortable position to sleep.
Bone spurs can be caused by traumatic events, for example as a consequence of healed fracture. Other times they form in reaction to stress put on the joint, wear and tear and at times because of arthritis. The normal contour of the passage ways of the nerve and spinal canal is altered. Bone spurs are typically bony structures and tend not to resolve spontaneously.
Initial plain X-rays can demonstrate the foraminal (nerve passage way) narrowing. Diagnosis of the narrowing of the spinal canal can be better evaluated using cross-sectional imaging techniques like Computed Tomography (CAT scan). Newer 3-dimensional imaging techniques are also available to show the bone spur in great detail. Dr. Mobin uses 3-dimensional imaging of the spine. Please refer to the video for an example of bone spur causing narrowing of the nerve passage way in the neck. The 3-dimensional video fly-through allows for true-to-life imaging of the spine that is representative of the individual patient’s anatomy. They are a valuable tool in pre-operative planning and designing accurate surgical corridors that allow Dr. Mobin to perform the surgery through much smaller incisions than the traditional surgery. This leads to less scarring, blood loss, and a more rapid recovery.
After an appropriate diagnosis the spine specialist is called. Dr. Mobin’s treatment goal is to relive pain and restore function. After a careful and detail evaluation, Dr. Mobin will discuss a personalized treatment plan based on the individual patient’s symptoms and neurological findings. The least invasive options are entertained first. Conservative care, including physical therapy, anti-inflammatory medications, muscle relaxants and postural training are discussed. In case of failure of these measures, pain management options, such as injections may be tried. In the event of significant nerve or spinal canal compromise, surgical decompression will be discussed.
For patients that require surgical decompression, both neck and back surgeries can be done through small incisions. The surgery is done through a microscope with minimal blood loss and scarring. Most patients are able to go home the same day. Patients are encouraged to walk but avoid strenuous exercises, and bending, lifting and twisting for two weeks.
All patients are encouraged to walk. Generally patients experience significant relief of their symptoms and are able to enjoy life without constant pain. Dr. Mobin’s protocols are discussed with individual patient to ensure a rapid and pain free recovery. Patients are instructed to avoid heavy lifting, bending, and twisting for the first two weeks. Physical therapy generally begins by the third post-operative week.
Bulging disc refers to shifting of the central, soft gelatin-like nucleus of the disc, out of its normal position. A bulging disc can occur throughout the spine, in the neck, middle of the back and low back. The disc sits in between the bony vertebra, in front of the spine. The movement of the adjacent vertebra is facilitated by the disc. When the gelatin like substance is displaced to the periphery, or the tough surrounding band loses its resilience, bulging of the disc can occur.
Presentation and symptoms may vary greatly. Most patients complain of neck pain or back pain. Pain is aggravated by sitting, bending or twisting. Patients complain of a nagging pain in the back of the neck or the lower spine. As the bulge advances towards the nerve it can cause a pinched nerve, with arm or leg pain, numbness, tingling or muscle weakness.
The two major components of the disc, the tough surrounding band and the softer central gelatin substance, provide the shape and proper functioning of the disc. Traumatic damage to either component can lead to bulging of the disc. The disc loses its height and pushes into the central canal of the spine.
A careful clinical history and examination can help establish the diagnosis. Initial screening X-rays can help evaluate basic spinal alignment and the disc height. More detailed imaging may be used to evaluate the tearing or the actual bulging of the disc. MRI is a sensitive and accurate study for this condition.
Once the diagnosis of bulging disc is established, treatment is individualized for the particular symptom severity and functional loss. The goal of treatment is provide a lasting pain relief, through the least invasive treatment. In majority of cases non-surgical treatments can help. In cases of persistent pain, evaluation by a spine specialist is indicated. Dr. Mobin uses a multi-disciplinary approach for the treatment of spine disorders and bulging disc. Through his close association with physical therapists, pain management specialists and psychiatrists, patients can benefit from a wide spectrum of non-surgical interventions. For those select patients that conservative care does not provide adequate relief, minimally-invasive discectomy is recommended.
The neck and back surgery addresses the pressure effect of the bulging disc on the nerve and spine. The micro-decompression surgery is performed as an outpatient procedure, with the patient leaving for home a few hours after the procedure. After surgery you need two weeks to relax and avoid strenuous activities. The minimally-invasive procedures spare the muscles, and are carried out with smaller incisions than used in conventional surgery. Healing time is shorter and most patients are able to return to work in 3 to 4 weeks.
Patients are advised to avoid strenuous activity, bending, lifting and twisting movements for 2 weeks. During the first evaluation after surgery, Dr. Mobin will discuss the timing for increasing physical activities and strengthening exercise program.
Tumors of the spine are growths that can affect the different parts of the spine. They are either benign or malignant. In most instances, tumor cells travel from the original site of the tumor growth and lodge in the spine. With time the tumor cells replace the normal cells of the bone or the disc, and can lead to the weakening of these structures. If the bone is weakened enough, it can break and cause spine fractures, i.e. pathological fracture.
The bony parts, i.e. vertebra, or the soft parts, i.e. disc, can be involved. When the growth of the tumor extends towards the nerves and spinal cord, it can cause symptoms of a pinched nerve or spinal cord compression. Early on, individuals can complain of pain that wakes them at night and is not relieved with rest. As the pressure builds towards the nerves and the spinal cord, hand and arm numbness, muscle weakness, balance problems and urinary control issues can arise.
Tumors of lung, breast, prostate and thyroid tend to travel to the vertebrae through the blood stream. In other cases, the tumor growth starts from the spine itself. It can arise from the bone-osteoma or osteosarcoma, disc-chondrosarcoma, blood vessels within the bone-hemangioma, blood vessels surrounding the spinal canal- arteriovenous malformation and fistula, or they can arise from the spinal cord- astrocytoma, ependymomam, or the nerves- neurofibroma, schawannoma, or from the covering that surrounds the contents of the spinal canal-meningioma.
Plain X-rays can show the fractured vertebrae. Generally, MRI scans with contrast enhancement and CAT scan imaging are widely used for proper diagnosis and treatment planning.
Treatment goal is to restore function and alleviate pain and disability caused by the tumor. For patients with primary spine tumors, total surgical resection of the tumor followed by reconstructive spinal surgery can provide long term relief and prove to be curative. In patients with metastatic spine tumors, Dr. Mobin works with a multi-disciplinary group, which includes oncologists and radiation therapy specialists, to provide the patient with a comprehensive array of treatment options. In most cases, surgical resection followed by chemotherapy and radiation therapy allows for the best treatment outcomes.
Dr. Mobin has an extensive experience with microsurgical techniques and muscle-sparring approaches that allow for faster recovery and shorter hospital stay as compared to traditional surgeries. Delicate tissue handling, detailed attention to the overall well-being of the patient and use of state-of-the-art facilities provide the patient with ease and comfort during the recovery period.
Dr. Mobin’s protocols are discussed with the individual patient to ensure a rapid and pain free recovery. Patients are instructed to avoid heavy lifting, bending, and twisting for the first two weeks. Physical therapy generally begins by the third post-operative week. In case of adjuvant therapy, Dr. Mobin works closely with oncologist and radiation therapy specialist to coordinate the follow-up care.
To better understand disc herniation, let’s review some basic concepts. The vertebral bodies are the bony components of the spine, which are stacked on top of each other to give us our height. The structure in between the bony components is the intervertebral disc, or disc, for short. The disc is a complex structure, allowing motion in the front part of the spine, cushioning the adjacent vertebral bodies. By virtue of its function, the disc experiences significant sheer and rotational forces during our daily lives. The main elements of the disc are able to respond effectively to these continual forces. After trauma to the disc, the damage is usually seen as a tear in the back of the disc radial fibers (annulus fibrosis) which causes weakening of the shell of the disc. If the tear is not healed, or extends to the inner part of the disc (nucleus polposus), the center portion of the disc can extrude (herniate) through the tear, and reach the important structures that live behind the disc (i.e. spinal cord and/or nerve root).
Presentation and symptoms could vary greatly. Most patients complain of back pain and often “hear a pop” in their back. Back pain tends to move across the lower back, it’s usually burning, throbbing and grabbing. Back pain may remain or change into buttock pain. Sitting is usually worse than standing, and while sitting, tilting to side tends to diminish the pain. Although it could be the initial symptom of the ruptured disc, leg pain happens in a delayed fashion. Leg pain can be severe, and prevents the individual from walking or sitting straight.
Weakening of the outer shell of the disc predisposes the central part of the disc to extrude out and compress the nearby nerves (pinched nerve) or spinal cord.
Diagnosis may be clinical, meaning that your physician may initially treat the presenting pain with anti-inflammatory medications, muscle relaxants and pain killers. If symptoms persist or worsen after an initial trial period, the primary care doctor or chiropractor may refer the patient or the individual patient may seek a specialist for further evaluation. MRI imaging is a routine imaging tool in diagnosis of herniated disc. Together with the findings on your physical examination, the spine specialist is able to offer you a diagnosis and explanation as to the cause of your symptoms and pain.
The goals of treatment are to relieve pain and preserve function. Most patients with lumbar herniated disc experience initial back pain, described as burning sensation in the small of the back. Sometimes acutely, but more commonly in a delayed fashion, the individual experiences shooting pain in the leg, followed by cramping in the muscle, pins and needles, and “charlie horses.” Generally, pain is worse at night and sitting is worse than standing. In some instances, the shooting pain can be replaced with numbness and eventual weakness in the leg. It is not uncommon for the individual to experience urinary frequency and urgency. The majority of patients present to their primary care doctors and are treated with anti-inflammatories, muscle relaxants and narcotics. Bed rest is generally tried only for a few days. Back bracing only for short duration may be prescribed. The majority of patients do respond favorably to these maneuvers, but if you continue to experience shooting pain in the leg, numbness, weakness or urinary symptoms of urgency, you should consult a specialist. In case of loss of urinary control (incontinence) you should go to the nearest emergency room for an urgent evaluation. In case of failure of initial conservative care, you need to be evaluated with imaging studies. The imaging modality of choice is a lumbar MRI to evaluate the extent of the disc herniation. At this point you are best served by having a spine specialist evaluate you. You may be offered different types of treatments depending on your individual presentation, MRI finding and clinical examination. Annular repair is a new technology that allows the surgeon to repair the point of disc rupture during the surgery. Dr. Mobin has used the annular repair technique successfully to reduce the chance of disc re-herniation.
In case of surgical intervention, you may need a lumbar microdiscectomy. With the advent of microscopic techniques, most patients are able to go home after six to eight hours in the recovery room. Driving is limited for the first two weeks. Most patients with non-labor intensive jobs are able to return to work in 3 to 4 weeks.
During the first two weeks following the procedure, you are asked to avoid bending, lifting and twisting. Most patients are asked not to engage in high impact exercises, such as running, skiing, or snowboarding for about three months. With the use of annular repair, patients will have less chance of disc re-herniation during the recovery period. Ask Dr. Mobin during your visit if this is an option for you.
The major nerves that emerge from the spine have two parts. One can think of the nerve as a TV cable that carries different signal types. In short, pressure on the nerve can cause disruption of signal transmission, causing pain, weakness in the muscle and numbness. Pinching of the nerve can be caused by different conditions, such as, herniated disc, bone spurs and, spine stenosis.
Individual patients may experience tingling, numbness, sharp, or pinching pain traveling in the arm or leg. Pain can be severe. At times it may interfere with the proper functioning of the arm or leg. In some cases, the initial sharp, shooting pain tends to subside after the first few weeks. Pain tends to be replaced by numbness, tingling and even hypersensitivity to touch. In others, pain may not be a major presenting problem or symptom. Instead they may experience weakness in the muscles of the arm or leg.
In the younger population, common causes include bulging or herniated disc. In older individuals, spine stenosis or narrowing the spinal canal is becoming more prevalent. The common denominator among the causes of the pinched nerve is pressure or compression of the nerve. A compressed nerve is not able to transmit the signal properly. If the signal cannot reach its intended muscle, it can lead to muscle weakness and in more severe cases, complete loss of the muscle function.
Most individuals are diagnosed based on their symptoms and physical findings by a health care provider. In cases with continued pain or muscle weakness, plain x-rays, CAT scan and MRIs can be helpful to evaluate the underlying cause of the pinched nerve. The proper diagnosis is critical in devising the right treatment option for the pinched nerve.
After the proper diagnosis of pinched nerve is established, an individualized treatment plan can be devised. The goal is to provide a lasting result with the best functional recovery. After reviewing the clinical and imaging findings, Dr. Mobin focuses on the least invasive treatment first. Anti-inflammatory medications, specific physical therapy regimen and postural training are some of the initial treatment options. Pain management, including injections and manipulative therapy are tried in some others. In cases of prolonged pain and loss function, minimally invasive surgical decompression can bring the relief of pain. Unlike the other treatment options, the surgical procedures are designed to relieve the pressure from the nerve. In some instances, spinal decompression may be the first line treatment option for the pinched nerve. As stated earlier, after a careful and detailed clinical evaluation, Dr. Mobin will offer you an individualized treatment plan best suited for your particular condition.
In case of surgical intervention, you may need a lumbar or cervical decompression. Most of these procedures are performed, without an overnight stay, in one of our outpatient facilities. After a few hours of recovery at the facility, patients are able to go home. Most patients will return to work in 3 to 4 weeks after the surgery.
The first two weeks after the surgery is a time to relax and avoid strenuous activities. The incisions are small and healing takes place during this time. You will have a follow-up appointment with Dr. Mobin generally ten days after surgery for a wound check. Timing of physical therapy and strengthening exercises are discussed during this visit.
Scoliosis is abnormal curving of the spine. In cases of either increased curving or buckling of the spine to either side, scoliosis occurs. Often time patients look as if their shoulders or hips are not level. A popular screening tool for teens is to evaluate the shoulder alignment that can be disrupted with the trunk curving. The abnormal curves can occur in different directions and can lead to arm or leg length differences.
Pain over the curved spine, loss of flexibility, balance problems and tilting to one side can be some of the presenting symptoms. Symptoms are caused by the abnormally curved spine and depend on the particular part of the spine affected. In the upper spine, arm length discrepancies, breathing problems, pain and in more severe cases, disfiguring posture can occur. In the lower back, back pain, leg pain, balance problems, and hip pain can be the presenting problems.
In the younger and pre-teen patients, scoliosis may be due to abnormal formation of some of the vertebra in the spine, so called butterfly vertebrae. In others, muscle weakness on one side of the spine produces uneven forces which lead to progressive over-curving and scoliosis. In some cases, no specific cause can be identified. In the older patients, repetitive damage to the disc and joints lead to gradual weakening of the supportive structures. The normal curves are then replaced by over-curving, collapse of the disc height and pinching of the nerves.
Screening measurements and bending maneuvers are some of the ways that early childhood and teenage scoliosis is first diagnosed. Skeletal survey X-rays allow the spine specialist to obtain accurate measurements for the particular curves. The measured angles are then used to either, follow the patient, prescribe bracing, or proceed with surgical correction.
With the diagnosis of scoliosis established, treatment options are based on symptom severity, degree of curvature and progression of the curve. For the growing spine in pre-puberty and through teen years, bracing can help guide the growing spine. Again an accurate diagnosis and proper evaluation to identify possible reversible causes of scoliosis are very important prior to any intervention.
In the case of surgical intervention, Dr. Mobin emphasizes minimally-invasive techniques for the correction of the scoliotic curve. Direct lateral approaches, either through the DLIF or XLIF can provide significant correction of the curve through small surgical corridors. These are muscle sparing techniques with rapid recovery rate and minimal blood loss. Recovery involves an overnight stay, followed by physical therapy by the third week after surgery.
The first two weeks after surgery is a time to relax and let the initial healing process to take place. Dr. Mobin evaluates and discusses the exercise program and physical therapy during the first visit with him after surgery. Generally, patients are started on a physical therapy program three weeks after the surgery. Four to six weeks of bracing are recommended depending on the number of corrected levels.
Spine stenosis is narrowing of the spinal canal. The spinal canal is a passage way for the spinal cord and the spinal nerves. Narrowing of the passageway causes pressure on the delicate spinal cord and nerves.
Symptoms vary depending on the location of the narrowing. In the neck, spine stenosis compromises the spinal cord. Initially neck pain, followed by arm pain, numbness of hands and arms are some of the early presenting symptoms. Progressive pressure on the spinal cord can lead to loss of balance and disturbance of bowel and bladder function, with weakness in the arms and legs. Myelopathy is a term used to refer to this condition. In the lumbar spine (low back), stenosis causes crowding of the nerve roots. Low back pain, numbness and tingling in the legs and feet are some the early warning signals. Later on, individuals feel a sensation of heaviness in the legs with walking, relieved by sitting or bending forward. It is common to lean over the shopping cart or squat down to lessen the pain or numbness.
In the younger individuals, usually a disc herniation is the primary cause of spine stenosis. Later in life, loss of disc height, overgrowth of the ligaments and joints that surround the spine canal are the culprit. Repetitive trauma to the disc causes loss of disc height and buckling of the tough band around the disc. Similarly, the laxity of the ligaments in the back of the spine canal push in and further contribute to the narrowing of the spine.
Diagnosis is based on the presenting symptoms. Because of its gradual nature, spine stenosis is suspected with gradual worsening of pain, numbness or general functional decline. X-rays, CAT scan and MRIs are helpful tests to evaluate and correctly diagnosis this condition.
Rest, bracing, over-the-counter pain medications and weight management are some of the early interventions. With worsening pain or onset of muscle weakness and difficulty with walking, the next tier of treatment is directed by a spine specialist. It may involve pain management injections, physical therapy or surgical decompression.
In the case of surgical treatment, cervical or lumbar decompression requires an overnight stay. You may be a candidate for outpatient surgery, in which case after a few hours of recovery room stay, you are released home. The first two weeks after surgery is a time to set aside for recuperation. Bending, lifting and twisting are avoided. During the first visit after surgery, Dr. Mobin will go over the schedule for physical therapy and strengthening exercises.
During the first two week, patients are asked to avoid strenuous activities. Level of activity is gradually increased, with strengthening exercises and postural training. Most patients experience significant relief of numbness and heaviness after surgery. Most individuals are able to return to normal level of activity after the first month.