spine

Scoliosis

Scoliosis, derived from the Greek word skolios = crooked, is an abnormal curvature of the spine. When viewed from behind, the spine usually appears perfectly straight. Scoliosis on the other hand is a sideways, or lateral curvature in the spine, usually combined with some degree of rotation of the vertebral bodies themselves. On a frontal x-ray, the spine of someone with a typical scoliosis may look more like an "S" or a "C" than a straight line. Scoliotic curves by definition are curves in the spine that are greater than 10┬░degrees. These curves are usually present in only 2-3% of the population of the United States. Larger curves , for example those that are greater than 20┬░degrees, only affect about one in 2500 people. Curves which turn in a convex manner to the right are more common than those which curve towards the left.

We can distinguish the different types of scoliosis based on their presentation. They are typically classified as adult onset (a curvature caused by an uneven degeneration and collapse of the intervertebral discs), congenital (Which can be caused by vertebral anomalies present at birth), idiopathic(Which can be infantile, juvenile, adolescent, all according to when they occurred) or as having developed as a secondary symptom of another condition, such as cerebral palsy in children, or due to physical trauma. Males are more likely to have infantile or juvenile scoliosis, but there is a high female occurrence of adolescent scoliosis.

Pain is often very common and usually develops in adulthood, especially if the scoliosis is left untreated. Pain can occur because the muscles are trying their best to adapt and conform to the way the spine is curving and this often results in muscle spasms.

Scoliosis surgery is often performed for cosmetic reasons in younger patients, rather than pain alone since the surgery cannot guarantee pain relief but it can stabilize the curvature and prevent worsening therefore improving ones quality of life.

Symptoms

Lumbar stenosis can lead to chronic pain and stiffness in the lower back and buttocks that may radiate into to the lower legs, calves, feet or even toes. Patients may experience some or all of the following symptoms:

  • Uneven musculature /bumps/prominences on one side of the spine
  • A rib "hump" or a prominent shoulder blade. This is caused by the rotation of the ribcage
  • Uneven hips and shoulder levels
  • Asymmetric size or location of breasts in females
  • Lower Back pain (Which may be worse with upright activity)
  • Buttock pain
  • Back stiffness (Which may be worse with certain work activities)
  • Numbness in the thighs, calves, feet and toes
  • Weakness in the legs, thighs, calves, feet and toes
  • Trouble walking because of weakness in the legs or loss of balance
  • Grinding or popping sounds or sensations in the lower back
  • Muscle spasms (Which may originate from the back or lumbar paraspinal muscles)
  • Headaches
  • The condition can cause irritability, fatigue, and sleep disturbances
  • This may impair the ability to work or your daily activities.

Diagnosis

During your consultation, Dr. Pablo Pazmino will take a complete medical history to rule out other conditions that can cause symptoms similar to Lumbar Spinal Stenosis. Dr. Pablo Pazmino will also perform a complete and thorough physical examination. Radiography (X-rays) and other diagnostic imaging tests (MRIs, EMGs, CAT scans) will then be reviewed so that Dr. Pablo Pazmino can evaluate your bony quality, any neural compression, bone spurs and other abnormalities to reveal the extent of damage to the lumbar spine.

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Education

At Santa Monica Spine / Beverly Spine we pride ourselves in our duty to educate our patients. Dr. Pablo Pazmino uses his background as a former teacher to ensure that you understand your pathology, imaging (X-rays and MRI) and treatment options completely during each visit. Our patients often comment they are amazed at the amount of time and effort we take to review their studies. Many have never had this experience before and feel like they are a true part of the decision making process. We want our patients to be involved in every step of the process and we feel education is the first step towards achieving that goal together.

Medical History

At Santa Monica Spine / Beverly Spine we are very thorough. Dr. Pablo Pazmino will need a complete history of any medical illnesses, surgeries, or chronic conditions which you may have or for which you have seen other physicians in the past.

More specifically we will require a history of your back and leg pain itself. What is the exact location of the pain? When did the problem begin? What does the pain feel like? Has your back been injured before? Have you previously been treated for back or leg pain?

Nonsurgical Treatment

Symptoms of Lumbar degenerative discs, herniations, or slipped discs may last for several months or become chronic. Most patients with Lumbar degenerative discs, herniations, or slipped discs or Radiculopathy can be treated non-operatively. Dr. Pablo Pazmino may recommend a course of physician guided conservative management.

  • Rest. A short course of bed rest or a brace may be used to limit painful lumbar motion and relieve irritation.
  • Bracing Braces may be used to halt the progression of a scoliotic curve
  • Medication. Dr. Pablo Pazmino may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) or other non-narcotic pain relievers to relieve your pain and reduce swelling.
  • Acupuncture. Dr. Pablo Pazmino works with a team of Acupuncture specialists and may recommend this if indicated for your specific set of symptoms.
  • Chiropractic Management. Dr. Pablo Pazmino works with a reliable team of Chiropractors and may recommend this if indicated for your symptoms.
  • Physical therapy. A course of therapy guided by Dr. Pablo Pazmino may include hot and cold therapy, ultrasound or an active exercise program which may help relieve symptoms. Exercises may include core body strengthening, lumbar and lower extremity stretching, and aerobic exercises. Patients may also receive gentle massage and perform activities to improve posture.
  • Injections: A series of selective nerve root blocks or epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks. Dr. Pablo Pazmino only works with a small group of physicians who he trusts to perform these injections. Click here to see some of the recommendations Dr. Pablo Pazmino makes in regards to injections and pain management physicians.

 

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Nonsurgical treatment may take away most of the symptoms, but it does not treat the underlying structural cause. Follow-up visits are necessary so Dr. Pablo Pazmino can check if symptoms have gotten better, worse, or have stayed the same.

Surgical Treatment

For some patients with significant pain and weakness, after failure of conservative management, Dr. Pablo Pazmino may recommend a surgical treatment option. The surgical treatment options may vary and depend on the individual patient and their pathology. Surgery may be necessary for patients with progressive neurologic symptoms or severe pain that does not improve with other treatments. Surgery may remove bone spurs or disc material (Decompression) and provide lasting pain relief. (For more on surgical treatment options click the following powerpoint talks.)

In our practice, surgery is always reserved as a last option, but when necessary can have excellent results and often can improve your overall quality of life. If surgical treatment is warranted Dr. Pablo Pazmino can offer a variety of procedures for treating Lumbar degenerative discs, herniations, or slipped discs.

If surgery is necessary, Dr. Pablo Pazmino is adept in performing a variety of new minimally-invasive techniques as featured here to treat scoliotic curvatures.

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Lumbar Decompression

When Lumbar Stenosis causes unnecessary pain, Dr. Pablo Pazmino may recommend a Microsurgical Lumbar Decompression to decrease pain at this area. Immobilizing painful arthritic areas, thickened ligaments and bony spurs causing painful encroachment in a specific area of the lumbar spine should decrease pain and provide an environment where the nerves can begin to heal. Upon successful decompression and after a course of physician guided physical therapy patients can return to their activities of daily living. We are currently enrolling patients in an FDA clinical trial evaluating the Coflex as an option for certain patients with stenosis. Dr. Pablo Pazmino is currently collecting data researching the outcomes of patients who have undergone decompressions alone and his early results are promising. Patients have noted early return to work , driving, sports and sexual activities following surgery.

 

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Lumbar Fusion

When this abnormal motion from an unstable or degenerated vertebral segment causes unnecessary pain, Dr. Pablo Pazmino may recommend a Lumbar Fusion to decrease pain at this area. Immobilizing painful movement in a specific area of the lumbar spine should decrease pain generated from the degenerated discs and arthritic joints. All lumbar spinal fusion surgery involves adding bone graft, or bone graft substitutes which stimulate a biological response that causes the nearby bone to weld or fuse. Upon successful fusion, the two vertebral segments stop all painful motion, and patients can return to their activities of daily living ..

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Minimally Invasive Surgical (MIS) Lumbar Fusion

For patients with certain conditions, abnormal and excessive motion at a vertebral segment may result in pain. When this abnormal motion from an unstable or degenerated vertebral segment causes unnecessary pain, Dr. Pablo Pazmino may recommend a Minimally Invasive Surgical Lumbar Fusion, or MIS Lumbar Fusion to decrease pain at this area. Immobilizing painful movement in a specific area of the lumbar spine should decrease pain generated from the degenerated discs and arthritic joints. All lumbar spinal fusion surgery involves adding bone graft, or bone graft substitutes which stimulate a biological response that causes the nearby bone to weld or fuse. Upon successful fusion, the two vertebral segments stop all painful motion, and patients can return to their activities of daily living.

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STALIF: Stand Alone Lumbar Interbody Fusion

For patients with certain conditions, abnormal and excessive motion at a vertebral segment may result in pain. When this abnormal motion from an unstable or degenerated vertebral segment causes unnecessary pain, Dr. Pablo Pazmino may recommend an all Anterior approach to decrease pain at this area. The latest stand-alone anterior lumbar fusion cage implant used in spinal surgery from Surgicraft is manufactured from biocompatible polyetheretherketone (PEEK-OPTIMA, Invibio Ltd, Thornton, UK). The benefits this implant offers include reduced operating times, better bone fusion, restoration of height, and improved spinal alignment. In mechanics, Young's modulus (E) is a measure of the stiffness of a given material. The Young's Modulus of PEEK is similar to that of cortical bone, therefore, it offers more elasticity than metal. It can absorb energy, handle the normal weight of the body and minimize stress on adjacent levels. The material is also radiolucent (unseen on X-rays) and thereby allows an improved view of the fusion mass that is taking place. However, to be able to offer X-ray (computer tomography or magnetic resonance) imaging for optimal positioning and postoperative assessments, titanium trace wires are press fitted into the implant. Recovery for the patient is faster in many cases. Some patients need to be operated on from the back. However, the implant can be inserted through the patient's stomach where reconstructing the spine is much less invasive. Some patients only need a small incision from the front or side, and in these cases recovery can be rapid, requiring only a two- or four-day hospital stay followed by a period of recuperation to allow for fusion to occur. Immobilizing painful movement in a specific area of the lumbar spine should decrease pain generated from the degenerated discs and arthritic joints. All lumbar spinal fusion surgery involves adding bone graft, or bone graft substitutes which stimulate a biological response that causes the nearby bone to weld or fuse. Upon successful fusion, the two vertebral segments stop all painful motion, and patients can return to their activities of daily living.

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Principles behind Spinal Fusion

This presentation created by Dr. Pablo Pazmino discusses exactly how bones fuse. The theories behind spinal fusion will help you understand why screws, rods, braces, and bone stimulators are needed to obtain a successful fusion and what you can do to help this fusion proceed in the safest manner.

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Stimulators for Bone Fusion

This presentation created by Dr. Pablo Pazmino discusses exactly products can be used during surgery to stimulate bony fusion. There are a group of products, proteins, growth factors and cytokines known for their ability to induce the formation of bone and cartilage. Members of the BMP family are potentially useful as stimulators for spinal fusion. BMP-2 and BMP-7 have been shown in clinical studies to beneficial in the treatment of a variety of bone-related conditions including delayed union and non-union. BMP-2 and BMP-7 have been shown in clinical studies to be beneficial in bony fusion. Both have received Food and Drug Administration (FDA) approval for human clinical uses. The theories behind spinal fusion will help you understand why Dr. Pablo Pazmino may use these factors to obtain a successful fusion and what you can do to help this fusion proceed in the safest manner.

When Should You Seek Medical Care?

If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.

Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.

If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:

  1. Continuous and persistent
  2. Severe
  3. Accompanied by pain that radiates down the arms or legs
  4. Accompanied by headaches
  5. Accompanied by numbness, or tingling
  6. Accompanied by weakness!

Many patients seek care for Scoliosis pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Spondylolisthesis.

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