Degeneration of disks and joints in the low back and neck is very common. Most people will get some degree of degeneration as part of the normal aging process. In the majority of cases, this does not cause any pain or problems. However, it can cause severe problems for some people.

The most common symptoms are neck and low back pain. This can range from slight stiffness or achiness to more severe pain. As the spine starts to wear out, the disks will bulge and push back into the spinal canal. As the facet joints (the joints in the back of the spine) become arthritic, they will overgrow (called hypertrophy) and form bone spurs. The ligament in the back of the spine (the ligamentun flavum) can also overgrow. These degenerative changes can cause pressure on the nerves. Compression of the nerves can cause different types of symptoms depending on the location of the pressure:

• Radiculopathy: Compression of the nerves as they exit the spine can cause radiculopathy. This is pain, numbness, or weakness that extends into the arms or legs. It is similar to the pain caused by herniated disks. • Stenosis: Degeneration can also cause narrowing of the spinal canal. This is called stenosis. Symptoms of stenosis in the lower back are very different from symptoms of stenosis in the neck. This is because the spinal cord ends in the upper lumbar region. Below this is a group of nerves called the cauda equina, which continue on into the legs. When they are compressed as a result of stenosis, patients can experience a variety of issues. Symptoms of lumbar stenosis generally include pain in the low back, buttocks, and legs. Patients often say their feet feel heavy or weak. Symptoms are generally worse when standing and walking, and better when sitting or leaning forward. In some cases, patients may also have instability in the spine, meaning that one vertebra will start to shift relative to another. This is called a spondylolisthesis. Stenosis in the cervical spine can lead to a condition called myelopathy, or spinal cord dysfunction. This does not necessarily cause pain, although many patients will have some degree of neck pain associated with it. More commonly, it causes problems with balance, coordination, and dexterity. Patients often report worsening handwriting, problems securing buttons or doing other fine tasks with their fingers, and state that they look drunk while walking even though they have not been drinking. Diffuse numbness in the hands and legs is also common. Abnormal reflexes are often seen on physical examination.

Treatment depends on the nature and the severity of the symptoms. The majority of symptoms can be managed with physical therapy, medications, and injections. For lumbar stenosis, surgery may be considered if non- operative care fails and the symptoms continue to be severe. The goals of surgery are to relieve the pressure from the nerves and, in select cases, to stabilize the spine. In most instances, Dr. Gebauer will perform a procedure called laminectomy. If there is severe compression or a spondylolisthesis, a fusion may need to be considered. Myelopathy and the associated compression of the spinal cord is a much more serious condition. The spinal cord is a sensitive structure and there is a greater risk of permanent nerve damage the longer the spinal cord is compressed. For this reason, surgery is often considered more urgently with myelopathy than with other spine conditions. In these cases, Dr. Gebauer may recommend surgery. Typical surgeries for this condition include anterior cervical decompression and fusion (ACDF), cervical disk replacement (CDR), or posterior cervical decompression and fusion (PCDF).

Cervical (neck) • Cervical Stenosis, Myelopathy and Radiculopathy - KnowYourBack - NASS  • Cervical Spondylosis (Arthritis of the Neck) - OrthoInfo - AAOS  • Cervical Spinal Cord Compression - OrthoInfo - AAOS 

Lumbar (low back) • Lumbar Spinal Stenosis - OrthoInfo - AAOS  • Spinal Stenosis Animation - OrthoInfo - AAOS  • Lumbar Spinal Stenosis - KnowYourBack - NASS  • Lumbar Spondylolisthesis - KnowYourBack - NASS  • Adult Spondylolisthesis in the Low Back - OrthoInfo - AAOS  • Spondylolysis and Spondylolysthesis - KnowYourBack - NASS  • Spinal Fusion - KnowYourBack - NASS 