Ron Avraham, MD
Aaron Beck, MD
Steven Leckie, MD
Brett Teran, DO
Disorders of the spinal column are unfortunately common and can be debilitating. According to the American Academy of Orthopedic Surgery, approximately 50% of people report having had neck or low back pain in the past three months, and 15% of the population visits a doctor with a primary complaint of back pain each year (www.boneandjointburden.org).
The vast majority of spine problems can be managed without surgery. Our certified physical therapists teach a spine exercise program that focuses on flexibility and core strengthening. Our Physiatrist, who specializes in interventional procedures, can inject pain medication around irritated spinal nerves and arthritic spinal joints using fluoroscopic x-ray guidance to precisely target the source of pain. If all reasonable non-operative measures have been exhausted, we offer the most up-to-date and comprehensive surgical options available. These include traditional decompression and fusion procedures, as well as new minimally invasive and motion preserving techniques. Surgery and injection procedures are performed primarily at Beth Israel Deaconess Hospital-Plymouth by our fellowship trained orthopedic spine surgeon.
Conditions we commonly treat
- Cervical Stenosis and Myelopathy: Compression of the spinal cord in the neck due to wear and tear of the spinal canal can cause neck, shoulder, and arm pain, as well as weakness, balance and walking problems, hand clumsiness, and incontinence. This common problem often goes unrecognized, leading to irreversible nerve damage. It is traditionally treated with spinal cord decompression and stabilization from either the front or the back of the neck, although some patients might be candidates for a new motion preserving surgery called "laminoplasty".
- Cervical Disc Herniation: A "slipped disc" in the neck can pinch a spinal nerve and cause severe arm pain (called radiculopathy). For 80% of people, their bodies will resorb the disc herniation and symptoms will resolve with conservative care such as medications. But for people who have symptoms that persist beyond six weeks or those who develop arm weakness or numbness, surgery can be a safe and reliable option. Surgery might entail traditional discectomy and fusion or artificial disc replacement.
- Lumbar Stenosis: Nerve compression by an arthritic lumbar spinal canal can cause debilitating back and leg pain. Many patients will benefit from physical therapy or targeted spinal injections, but some may require surgical intervention. One of the most comprehensive research studies in all of orthopedic surgery, the Spine Patient Outcome Research Trial (SPORT), demonstrated that patients with lumbar stenosis (nerve compression in the low back) or spondylolisthesis (instability of the spinal column in the low back) had a long lasting benefit from surgery. An excellent patient resource by the authors of the SPORT study is available online at www.dartmouth.edu/sport-trial/. Patients with nerve root compression benefit from laminectomy, which decompresses the pinched nerves by unroofing the spinal canal. Patients with evidence of spinal column instability benefit from fusion using metal rods, screws, and bone graft. Fusion can be performed from the back, side, or front of the spine depending on each patient's unique anatomy.
- Lumbar Disc Herniation: A "slipped disc" in the low back can cause debilitating back, buttock, and leg pain. As in the cervical spine, many patients will get better on their own. However, those who do not recover within six weeks or those who develop leg weakness (such as a foot drop) benefit from surgery. This typically entails a small incision, and patients may be able to go home on the same day as surgery. The SPORT trial also demonstrated the long-term benefits of surgery for patients who had a disc herniation.
- Spinal Deformity and Scoliosis: Patients may develop an abnormal curvature of the spine either due to degenerative changes, as a result of a previous spinal surgery, or spontaneously during adolescence. This can lead to severe chronic back pain, a forward tilted posture, or cosmetic concerns such as a prominent hump. Surgery can realign the spinal column and stabilize it in an optimum position.
- Spine Trauma: Injuries to the spinal column can range from muscle strains to broken (fractured) bones and spinal cord injury. Each injury pattern is unique. Some can be treated with braces, medications, and therapy. Others require surgical decompression or stabilization. Traditional "open" surgery, as well as minimally invasive (percutaneous) techniques are available.
We also care for rare spinal problems such as cancer, infection, rheumatological conditions, and revision surgery (patients who have had previous spinal surgery that has either failed or worn out over time). Patients are expected to play an active role in their care. Allow us to help you return to your best possible quality of life.
Contact us today to learn more about the many treatments and options we offer to treat your spine/back pain.