Spinal Disorders & Treatments | South Denver, Littleton, Colorado

A multidisciplinary team of specialists including neurosurgeons, orthopedic surgeons, neuroradiologists, pain management physicians and therpists, works together to provide a comprehensive, personalized diagnosis and treatment for every spine patient. This team encompasses expertise in all levels of care, from rehabilitation medicine and physical therapy to minimally invasive and microsurgical techniques to complex spinal reconstruction. See surgical treatments for spinal disorders.

Providing compassionate care is the top priority at South Denver Neurosurgery. Quality is achieved by the dedicated assessment of each spine case and the provision of individualized treatment options, including conservative approaches, such as pain management and physical therapy for:

Degenerative Disc Disease 
Disc Herniation 
Spinal Stenosis 
Spondylolisthesis 

Degenerative Disc Disease

Degenerative disc disease (DDD) is part of the natural process of growing older. Unfortunately, as we age, our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The fibrous outer portion of the disc, called the annulus fibrosis, becomes brittle and is more prone to tearing. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, starts to dry out and shrink. The combination of damage to the intervertebral discs, the development of bone spurs, and a gradual thickening of the ligaments that support the spine can all contribute to degenerative arthritis of the spine.

To a certain degree, this process happens to everyone. However, not everyone who has degenerative changes in their spine has pain. Every individual is different, and it is important to realize that not everyone with degenerative changes as seen on an MRI and x-ray films develops symptoms, and not everyone who develops symptoms does so as a result of degenerative disc disease.

When DDD becomes painful or symptomatic, it can cause several different symptoms, including pain and weakness that results from compression of the nerve roots. These symptoms result because worn out discs are a source of pain since they do not function as well as they once did, and as they shrink, the space available for the nerve roots also shrinks. As the discs between the vertebrae start to wear out, the entire spine becomes less flexible. As a result, people complain of pain and stiffness, especially towards the end of the day, and with more activity.

Furthermore, the less flexible degenerative spine is more susceptible to injuries. When a degenerative spine is subject to loads that it can no longer handle, the disc can tear, bulge or extrude (herniate) through a tear (resulting in nerve root compression and pain, numbness, tingling and/or weakness); and/or irritate nerve roots, which become swollen and inflamed (also resulting in leg symptoms). Back to top

Disc Herniation

Herniation describes an abnormality of the intervertebral disc that is also known as a "slipped," "ruptured," or "torn" disc. This process occurs when the inner core of the intervertebral disc (nucleus pulposus) bulges out through the outer layer of ligaments that surround the disc (annulus fibrosis). This tear in the annulus fibrosis causes pain at the point of herniation. If the protruding disc presses on a spinal nerve, the pain may spread to the area of the body that is served by that nerve. Between each two vertebrae in the spine are a pair of spinal nerve roots, which branch off to a specific area in the body. Any part of the skin that can experience hot and cold, pain or touch refers that sensation to the brain through one of these nerves. In turn, pressure on a spinal nerve from a herniated disc will cause pain in the part of the body that is served by that nerve.

Most disc ruptures will occur when a person is in his or her 30s or 40s when the nucleus pulposus is still a gelatin-like substance. Oddly enough, most disc herniations will occur in the morning. The causes of this phenomenon are not entirely known, but are probably due to the physiology of the spine and the changes in the water content of the disc that occur throughout the day.  Back to top

Spinal Stenosis

Spinal stenosis is narrowing of the spinal canal that occurs when excessive growth of bone and/or ligament reduces the size of the canal through which the nerves travel. Typically, this condition affects those in their 60's, 70's and 80's. This narrowing can squeeze and irritate the nerve roots that branch out from the spinal cord, or in the neck it can squeeze and irritate the spinal cord itself. This may cause pain, numbness, or weakness, most often in the legs, feet, and buttocks. Severe disability is not common. Symptoms from spinal stenosis most often worsen when standing up and improve when sitting or lying down.

Spinal stenosis occurs most often in the lower back (lumbar) area. When it does occur in the neck (cervical) area, the spinal cord may become compressed, which if untreated can lead to nerve damage and paralysis. For this reason, cervical stenosis is often treated more urgently than lumbar stenosis.  Back to top

Spondylolisthesis

The spinal column is formed by many bones stacked on top of one another. The joints between them (the intervertebrial disc and the facet joints) allow for bending forward and backward, moving from side to side, and even rotations, but not slippage. This usually is a reflection of degenerative or arthritic weakening of the joint which progresses typically over many years. When spondylolisthesis occurs, nerves passing by or exiting the spine at that level can be compressed or irritated. Pain can also be caused by the joint itself, where bone rubs abnormally on bone during slippage of the joint.

Spondylolysis is the fracture or deficient development of the articulating parts of the vertebra. It can range from a serious condition to a mild one. Spondylolysis may permit forward slippage of a vertebra onto the next vertebra below it, producing a spondylolisthesis. Spondylolysis occurs in 6% of the population. Spondylolysis is more common among athletes active in sports that require repetitive hyperextension, such as diving, weight lifting, wrestling and gymnastics.

The magnitude of symptoms does not always correlate with the severity of the slipped vertebra. Many people with this condition don't require treatment. Spondylolysis or low-grade spondylolisthesis may be managed conservatively without surgery. However, young ("skeletally immature") people with more than 30 to 50% slippage are at increased risk for progression and are candidates for spinal fusion without delay. For other patients, treatment can vary from surgery to physical therapy to modification of activities.

Symptomatic spondylolisthesis has an emotional impact because pain can limit function and impair quality of life. Education is important in giving the patient a sense of control and the information necessary to make informed treatment decisions.  Back to top