May 3, 2007
Treatment advances improve spine care
A healthy spine protects the spinal cord and spinal nerves. The bony segments of the spine shield these important structures, and the discs that separate the spinal bones provide shock absorption. When this protection system is compromised, the spinal cord and nerves can be injured.
Spine trauma, from a car accident, a shallow water dives or falls, can damage the spinal cord and nerves. Traumatic spinal cord injury is the most common cause of paralysis in young adults. As we age, the spine naturally undergoes degenerative changes, with bone loss, called osteoporosis, and drying of the disks. These normal degenerative changes can cause problems by making less space for the spinal cord and nerves. This may lead to pain, weakness and diminished sensation.
Dr. Virany Hillard is an assistant professor of neurosurgery, newly arrived at the UW, who specializes in spine disorders. She sees a variety of patients with spine problems, which include ruptured disks, spine and spinal cord tumors, spine deformities, abnormal bone growths, osteoporosis, and many other back and neck problems.
Hillard explains that, “because nerves in the spine are neatly organized, symptoms often reveal the type and location of nerve or spinal cord injury.” Older people, whose neck or back bones compress the nerves or spinal cord may have an unstable gait, an aching neck or back and weakness in the legs or arms. Bending forward often makes them more comfortable, by reducing pressure on the nerves and spinal cord.
“This is why it’s so important to listen carefully when patients describe their symptoms,” Hillard says, “to note where they have pain, where they have lost sensation, which parts of their bodies are weak, and what makes them feel worse or better. It’s also why those who suffer other difficulties in addition to back pain — shooting pains down the leg, urinary incontinence, numbness, or stumbling — should seek medical care. These warning signs suggest more than a muscle strain.”
In addition to analyzing symptom patterns, Hillard performs a physical exam, and may order an X-ray, CT scan or magnetic resonance imaging. Some patients undergo a myelogram. In this test, a dye is injected into the spinal fluid around the spinal cord, and then X-rays are taken. The test shows if, and where, the spinal nerves and cord are pinched.
Hillard considers several factors before recommending any treatment options: the cause, severity, and whether the problem will go away, stay the same, or progress.
“Some disorders are managed best without surgery,” says Hillard, who works with a multidisciplinary team of back-care specialists. Non-surgical treatments include combinations of physical therapy, medications to reduce inflammation, exercises, braces, or pain relievers, such as infrared heat or cortisone injections.
In other cases, early surgery yields better results, and delays may be harmful. “New devices and techniques make spine surgery easier and safer for patients,” Hillard says. “These techniques include minimally invasive surgery performed through a small opening instead of a large incision.”
“Some procedures can be performed as day surgery, take less than an hour in the operating room, and require only local anesthesia, which is safer for older patients,” Hillard says. (For example, a new interspinous process device for treating lumbar stenosis — narrowing of the lower backbones — will be approved shortly at the UW.)
She adds, “Traditional, open surgery, however, may be the preferred option for more complex spine problems.”
Hillard, a Harvard graduate who has been interested in treating spine disorders since her first day at New York University Medical School, has been trained by some of the nation’s leading spine surgeons and neuroscience researchers.
“I’ve been fortunate to have had excellent mentors,” she says. She remembers them as role models of good patient/physician communication and wise decision-making. They continue to inspire her career as a scientist, teacher, and surgeon.