About the spine

The spine is made up of a chain of 29 discs, beginning at the neck and ending at the tailbone. The spinal cord passes through the hollow canal that forms in the links.

Common spine conditions and symptoms

Certain painful medical conditions place pressure on the spinal cord or its nerve roots. Examples include herniated discs (slipped, ruptured, or bulged discs) or spinal canal stenoses (narrowing caused by a congenital disorder, rheumatoid arthritis, injury, degenerative changes, or tumors in the spinal cord or surrounding membranes).

Symptoms that patients feel depend on the location of the pressure. When the pressure is on the spinal cord itself, the patient can experience limb numbness, weakness, cramps, or leg pain – typically on both sides of the body. People with more severe distress may suffer from bowel and urinary tract disorders (incontinence) or difficulty in sexual function. In rare cases, patients experience partial or complete limb paralysis.

When pressure is placed on the nerve roots, especially with herniated discs, pain may radiate to the limbs or cause sensory disturbances, muscle weakness, or, in more severe cases, may also disturb bowel movement, urination, or sexual function.

Treatment options

Assuta physicians usually begin patient treatment with non-surgical options that include non-steroidal anti-inflammatory drugs, painkillers, steroid injections (that lower inflammation and treat sharp pain that may radiate to the waist or legs), limiting exercise, physiotherapy, or supportive belts.

If these options do not help, or in more severe cases, patients may need to undergo surgery.

In the most common surgeries, surgeons remove a disc or a part of the disc that is pressing on the nerve root (discectomy, disc aspiration, or disc ablation) or surgery to remove a vertebral bone.

Laminectomy: Removal of a vertebral bone (lamina)

Laminectomy surgery performed at Assuta Hospital removes all or part of a vertebral bone to relieve spinal cord compression.

A laminectomy removes the specific vertebral bone that is causing the problem, which releases the pressure on the spinal cord and its nerve roots. Removing the vertebral bone also provides access to the spinal cord in cases where a tumor is narrowing the spinal canal. In some cases of herniated discs, surgeons perform a laminectomy to facilitate removing the disc.

Laminectomies are sometimes performed when the surgeon seeks to correct structural spinal deformities that do not place pressure on nerves, such as with kyphosis – an abnormal convex curvature of the upper spine – or scoliosis.

The operation may also include disc removal and/or fusion of several vertebrae to each other (spinal fusion) if the patient’s spine is unstable.

Surgery is usually performed under general anesthesia. Patients are able to get out of bed the next day and are typically discharged from the hospital two or three days after the surgery. Patients can return to their routines after a week or two.

Discectomy: Removal of an abnormal disc

Assuta's surgeons perform discectomies routinely to remove pressure on a patient’s spinal cord or nerve root.

About the spine and vertebrae

The spine consists of 28 vertebrae: 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 4 (sacrum) vertebrae connected to the tailbone (coccyx).

The vertebrae are connected by muscles, joints, and ligaments that give the spine flexibility and promote movement while maintaining stability. Nerve roots emerge from the spinal cord, which passes through the center of the vertebrae. These nerves give sensation and motor signals to the various parts of the body.

Intervertebral discs are connective tissues – cartilage whose main functions are to stabilize the spine and absorb shock, while promoting spine movement. Discs consist of a core (nucleus) and a shell (annulus).

Herniated discs

When the nucleus bursts out through its shell (called "disc herniation"), it may press on spinal cord and/or the nerve roots, and the patient will feel either local pain or pain that radiates to other areas of the body. Disc herniations occur most often in the lumbar spine area. Patient symptoms depend on the area of the disc herniation and the severity of the pressure on the nerves or spinal cord.

The most common symptom that patients feel is a sharp pain that radiates from the lower back to the leg, called sciatic pain or sciatica. Pain may be accompanied by numbness, burning, weakness, or muscular atrophy. Sciatica worsens with exertion, heavy lifting, bending, coughing, or sneezing. In severe cases of pressure on the
spinal cord itself, patients can experience severe neurological deficits such as loss of control of the sphincter muscles or paralysis, conditions that require urgent surgery.

Treatment options

Treatment choices for a herniated disc depend on the patient’s symptoms, occupation, and neurological impact of the condition.

Initial treatment alternatives include painkillers and anti-inflammatory drugs, chiropractic treatment (gentle manipulations of the spine to reduce the pressure on the ruptured disc), rest, and cooling of the area when the pain begins. The next level of treatment is steroid administration – epidural injections to reduce inflammation and nerve pressure.

Lumbar disc herniation surgery (discectomy)

A discectomy removes all or part of the dislocated disc that is putting pressure on the nerve – to relieve the pain. Part of the adjacent vertebra may also be removed.

A graft of bone taken from another place in the body may be implanted to stabilize the spine.

The surgery is usually performed under general anesthesia.

Most patients are discharged from the hospital the day after surgery. Bending and lifting are prohibited for about 4 to 6 weeks after surgery, but patients can return to light effort about 2 to 4 weeks after surgery. Sitting is prohibited for the first 3 to 4 weeks, except for up to 10 minutes at a time. Patients can begin light physiotherapy about 2 weeks after surgery, with the surgeon’s approval.

Minimally invasive scoliosis surgery. A short 60-minute procedure

Assuta offers a quick, minimally invasive procedure to help repair scoliosis.

About scoliosis

Scoliosis is an abnormal side-to-side curvature of the spine. Usually, scoliosis begins in childhood or adolescence, and it may worsen over time. Serious cases are more common in females. Contrary to popular belief, improper posture, unbalanced exercise, and squatting do not cause scoliosis.

Scoliosis symptoms

In addition to slanted posture, scoliosis patients can experience rapid fatigue and/or back pain during prolonged standing and difficulty bending. They may have unequal waist or shoulder heights, unequal distances between the arms and body, or uneven rib protrusions.

This disorder can cause impaired lung and heart function and nerve damage, such as feelings of pins and needles in extremities or foot drop.

Diagnosis of scoliosis

Assuta physicians diagnose scoliosis using physical examinations of the bones and limbs and an X-ray or CT scan to locate the problem and assess the level of complexity, direction, and magnitude of the deformity. The Cobb angle estimates the distortion between the highest and lowest vertebras impacted.

Scoliosis treatment options

Scoliosis treatment depends on its severity and the degree of the patient’s skeletal maturity. Common treatment options include:

• Medical follow-up
• Physical therapy
• Wearing an orthopedic corset or brace, which helps prevent the condition from worsening
• Surgery to fuse vertebrae
• Surgical implants

Innovative scoliosis surgery: ApiFix technology to correct adolescent scoliosis

Certain patients are candidates for the innovative Israeli ApiFix implant. The surgery is less invasive than traditional procedures. The surgeon attaches the implant to the spine on the concave side of the major curve. The brief, one-hour procedure requires a small incision and only several screws. The patient can return home from the hospital after 2 to 3 days.

Patients undergoing the procedure must adhere to a strict physical therapy regimen. The more a patient performs the exercises, the better his/her condition can be.

Treatment of kyphosis

Assuta’s team of surgeons has extensive experience in treating kyphosis.

About kyphosis

Kyphosis is an abnormal S-shaped convex curvature of the upper spine, manifested by a bulge in the back.

Kyphosis can be caused by an imbalance between the muscles of the upper back and the muscles of the chest or abdomen, a collapse of the vertebrae due to bone loss, inflammation of the bones or cartilage (osteochondritis), etc. Certain sitting and walking habits (such as sitting cross-legged, twisting, crouching, or stooping while carrying heavy objects) may cause spinal cord deformity and muscle imbalance. This condition has a hereditary component as well.

Kyphosis symptoms

Patients with kyphosis can have discomfort or pain in the back and chest. The condition can restrict movement and posture and impair respiratory function. Extreme cases can cause recurrent pneumonia or even death.

Treatment options

Physiotherapy treatment can sometimes strengthen and shorten upper back muscles and lengthen the chest muscles to improve kyphosis. Muscle massage, electrical stimulation, or cryotherapy (the use of cold) can reduce pain and relax muscles. In mild cases, heat therapy combined with spinal positioning and mechanical manipulation can help return the spine to normal condition.

Respiratory therapy can also improve chest movement and breathing, as well as orthopedic and neurological symptoms.

In severe cases or when the patient’s condition is life threatening, Assuta's surgeons may recommend that the patient undergo complex surgery to gently straighten the spine.