Common Conditions
Alabama Neurosurgeons provides the most advanced treatment for conditions of the brain, spine and nerves. Below you will find more information about several conditions we treat.
SpondylolisthesisNormal Pressure Hydrocephalus
Low Back Pain
Sciatica
Slipped Disc
Other Conditions
Spondylolisthesis is a condition where one vertebral body (bone) slides forwarded with respect to the vertebral body below it. This can result either in significant and chronic midline low back pain, or at times by trapping the nerves as they exit sideways out canals between the vertebrae (called neuroforamen), pain in the sciatic distribution (down the hip and leg), and on one or both sides.
There are several causes for spondylolisthesis including a bony defect that is first noted about puberty, trauma itself, and ligaments becoming “lose” as we age.
Treatment for a condition such as this may be conservative, or involve fusion with instrumentation.
Various types of fusions are available, including fusion across the transverse processes, which have been done for many years, the newer interbody fusion either by PLIF or TLIF (technical words as to how devices are placed between the vertebral bodies in the disc space), and even anteriorly by way of ALIF (through the abdomen, although this is a limited option for patients with spondylolisthesis).
This condition is not uncommon, and can even be found on routine x-rays. Further diagnostic evaluation frequently is necessary by way of flexion and extension views: to determine instability or stability, and even MRI scans and myelograms / CAT scans to further evaluate prior to treatment.
An associated defect with spondylolisthesis is called a pars defect. This is a separation of bone in the area called pars interarticularis and not uncommonly predisposes spondylolisthesis.
Continuing advances are made in not only materials, but also in regards to the placement of the instrumentation and fusion itself.
At times, this operation can be performed through a “percutaneous” approach with radiological localization as opposed to an “open” operation. You are encouraged to ask your physician about options.
 View the Spondy Animation |
One of the treatable causes of dementia (or difficulty thinking) is NPH, or normal pressure hydrocephalus. Inside the brain are cavities where the spinal fluid is made, these are called ventricles, at times they can be enlarged. Frequently, they are enlarged because of increased pressure in the brain. However, at times, they enlarge without this accompanying pressure at least on a constant basis, and this can result in a triad of symptoms:
- Dementia or difficulty thinking. Recent memory may be affected first.
- Difficulty ambulating. A magnetic gait is noted where the patient seems to be adherent to the floor, yet can sometimes walk fairly well with merely guidance holding a patient's fingertips (as opposed to complete support of the patient’s body) in order to ambulate. Great difficulty rising from a chair is frequently noted.
- Incontinence of urine. Losing a small amount of urine is frequent as we get older, especially in women, but serious loss of urine, can suggest the third leg of this triad of symptoms.
Not all 3 complaints are necessary for this diagnosis to made. There are pros and cons as to the various diagnostic techniques utilized to confirm this diagnosis. None are completely without problems.
An MRI scan and CAT scan can give a good idea as to the diagnosis especially when accompanied by the appropriate symptoms. At times, drainage of the spinal fluid in the hospital over several days can be useful in determining whether or not a shunt procedure may be helpful in treating this condition. There are increased risks for infection, including meningitis and there still may still be some error with this technique. A radionuclide cisternogram is a study performed with a radionuclide or radioactive material, to determine if the spinal fluid flow is abnormal. Used for decades to assist in making this diagnosis, recent literature suggests the usefulness of this technique is very limited.
Once the diagnosis of NPH is made, a shunt may be considered. This is a small tube, which is placed into the ventricles of the brain and brought beneath the skin, to the abdominal cavity, where the fluid is absorbed.
Some patients can report a remarkable response in reduction of symptoms. It truly is one of the few treatable causes of dementia commonly seen.
Newer techniques with adjustable valves (also, placed below the skin), make the “fine tuning” of spinal fluid regulation safer and more predictable.
Adjustment can be done after surgery in the doctor’s office without intervention, using a small magnetic instrument that calibrates the internal device. Please see the video on the treatment of normal pressure hydrocephalus patient below.
View the Normal Pressure Hydrocephalus presentation |
Low back pain is one of the most common complaints in medicine. It is usually quite benign and treated conservatively. Especially when associated with trauma or in the elderly, a more significant cause may be found. Chronic pain in the midline low back pain also should be evaluated. Generally, surgical treatment for a midline low back is either fairly small or fairly substantial. There is little between-ground.
At times, a diskogram may be of use in helping diagnose the condition after various studies such as MRI scans and CAT scans have been done. This is seldom the first test performed. “Dye” is placed inside several discs with a needle, and pressure monitored.
The pain may be coming from the facet joint themselves (see anatomy of the low back), from the interspace through disc “micro fractures”, secondary to spondylolisthesis, tumor, infection, and a list that is quite lengthy. A good deal of the serious chronic low back problems can be excluded by a simple MRI scan.
This is a rather ancient term referring to pain in the sciatic nerve distribution. The pain starts frequently on the back on one or both sides, goes down the hip, thigh, and occasionally the leg as far as the foot and toes. While multiple causes can cause the above complaint, the most common ones are a simple disc herniation or arthritis causing compression of the nerve root in the spine. The majority of the patients with sciatica have an identifiable abnormality on the lumbar MRI scan. However, some patients do not.
Included in those are individual who have pain down the hip and leg for multiple years (where the original cause has resolved) and now the patient has intrinsic nerve damage, direct trauma to the nerve root such as a fall on the buttocks precipitating pain, or a more unusual syndrome such as piriformis syndrome.
Arachnoiditis is scarring of the nerve roots inside the spinal sac and is less common then it was some decades ago, when a material called pantoque was used for myelograms.
However, this still is seen at times now, especially if blood was ever present inside the thecal sac that caused scarring. The thecal sac is the sac that is filled with spinal fluid inside the spinal canal, which contains the nerves going to the legs.
Of course, it is best to treat the cause if possible, but if this is not an option, symptomatic relief can be obtained by following sciatic “precautions”, pain blocks, and rehabilitative care. It should be cautioned that hamstring stretching or straight leg raising could irritate this nerve. “Whenever the hip is flexed”, we encourage patients to “bend the knee.“
A slipped disc is not slipped! There are various types of disc herniations, Schmorel’s node where the disc goes inside the vertebral body (seldom symptomatic), a disc protrusion, disc extrusion, disc sequestration ...., in increasing severity, reflects the degree of disc herniation present. Generally, a disc bulge is normal for most patients over the age of 40. You cannot “push a disc back in.” It seldom is necessary to replace a disc for a simple operation where a nerve is compressed causing pain down the hip and leg. Technology exists, but simply because it “can be done does not mean it should be done.”
Brain TumorsSubaracnoid Hemorrhage
Mechanical Disorders and Disc Herniation
Inflammatory & Infectious Disorders
Tumors of the Spine and Spinal Cord
Neck Trauma
Herniated Disc and Arthritis
Mechanical Disorders
Inflammatory & Infectious Disorders
Back Truama
Osteoporosis
Carpal Tunnel Syndrome
Cubital Tunnel Syndrome