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1. What’s adolescent idiopathic scoliosis?
   

   Scoliosis is a lateral deviation of the normal vertical line of the spine which, when measured by X-ray, is greater than 10 degrees. Scoliosis consists of a lateral curvature of the spine rotation of the vertebra within the curve.1
   Every patient is unique. No one set of rules fits everybody. For adolescents treatment options are observation, bracing, or surgery. Decisions are tied to the degree of curvature and the amount of growth remaining for the patient. The younger the patient and the more severe the curve, the more aggressive the treatment. If the curve has gotten worse in the last year or is associated with an unacceptable cosmesis, we would consider a surgical recommendation. If the curve is stable and the patient is happy, we would not.
   The primary indications for surgery in patients who have scoliosis are progression of the deformity or pain. Cosmesis is also a consideration. Multiple surgical options are available. . They all involve straightening the deformity with a metal rod attached to the spine with screws, hooks, or wires. The results of the different systems are comparable. Pedicle screws in this country are used primarily in the lumbar spine. Around the world some surgeons are using pedicle screws in the thoracic spine as well. The most important part of the procedure is not the metal implant. If the bone does not heal in a fusion, the implants will eventually fail. Bone graft is usually added to enhance the probability of a fusion. Sources of the bone graft could be from the rib, from the pelvis, from a bone bank or a bone substitute. Rib resection adds to the cosmetic improvement dramatically by reducing the rib hump. With time, the rib grows back, but in a better position. These procedures involve all the potential complications of major surgery.
   The indications for bracing are a curve of less than 40 degrees in a patient who is skeletally immature. After skeletal maturation, the probability of progression is low and bracing is no longer indicated. For curves greater than 40 degrees, the efficacy of the brace is small. There is no statistical proof that any exercise program or activity prohibition or special bed will make a difference in the outcome. For growing patients at risk for progression, bracing makes a difference in probability of progression.

   The hormonal relationships we know are that the curves get worse during rapid growth periods - typically the year before and after menarche. At menarche the rate of growth is already showing and the risk of further progression is diminishing. The onset of skeletal and sexual maturity is on the average later - perhaps two years or more - for women with idiopathic scoliosis as compared to the rest of the population. Also, women with scoliosis are at higher risk for osteoporosis than their peers. Menstrual irregularity has not been a feature of idiopathic scoliosis. Breast assymmetry is a frequent complaint related to the rotational deformity of the spine and ribs.
2. What’s cervical herniated disks?
   

   Neck pain with intermittent numbness and pain in the arms suggest a nerve compression symdrome in the neck which could be a herniated disc. Sometimes the level can be located by the pattern of the pain and numbness. If the pain is to the thumb side of your hand, it is probably the C5-6 level. If it is to the long finger of your band, it is probably the C6-7 level and if it is to the little finger side of your hand it is probably the C7-Tl level. If you have those symptoms, or symptoms of a myelopathy (more general symptoms related to spinal cord compression) that have not responded to a reasonable trial of non-operative treatment then you are a candidate for surgery.
   Most people will not require surgery. The technique for surgery is controversial. The particular procedure involved would depend on the individual pathology and the surgeon's preferences. In our hands it is usually anterior decompression with discectomy or corpectomy and fusion with auto graft - your own bone. Long term studies suggest that the symptoms will get better with time. In general, there has been a fairly high satisfaction rate in patients who have painful herniated cervical disc who undergo anterior cervical fusions.
   The usual treatment is time, activity modification such as avoiding overhead work or extremes of motion of the neck and vibratory stresses, occasional use of splinting and traction and pain medicines. Risks involved in non-operative treatment are continued pain. There is a small risk of progression of the neurologic deficit but it is very small.

3. What’s a laminectomy?
   

   A laminectomy means removal of a portion of the spine bone. The back of the vertebra is called the lamina. Removing a portion of the lamina gives the surgeon access to the spinal canal.

4. What’s Lumbar Instability?
   

   Spinal instability is the term used to describe a loss of function of the spinal tissues. Typically, this results in abnormal movement of the tissues of the spine during normal activities. One common form of spinal instability involves a slippage of one vertebral bone relative to another. This is known as "subluxation" or "spondylolisthesis".

5. What’s the microdiskectomy procedure?
   

   Microdiscectomy means a small incision perhaps up to an inch long and visualiation of the surgical field with an operating microscope.
   Microdiscectomy has been relatively successful. We employ it in our practice. Assuming that you have an accurate diagnosis in the sense that the anatomic defect seen on the imaging corresponds well with your neurologic defect and pain pattern, the probability of you having relief from your pain is high. This does not return the disc to normal but removes a portion of the compromised disc. The wear and tear of degenerative changes present will continue.
   There are risks involved in any procedure including microdiscectomy. The particular risks involved other than the general statement of risk to life and limb are injuries to the structures that live close to the operative site such as the nerve roots to the lower limbs, great vessels to the lower limbs, risk of infection and risk of arachnoiditis.
   Most patients are home from microdiscectomy in 24 hours, back to sedentary work in a week, back to moderate activity in a month, return to vigorous activity in 3 - 4 months.

6. What’s a myelogram?
   

   A myelogram is an injection of contrast material into the spinal canal in the space where the spinal fluid is. The purpose is to evaluate for neuro compression. Pain varies from minimal to moderate from patient to patient. Side effects are infrequent - range from headache due to CSF leak to rarely, seizures, to allergic reaction to the contrast material. With any invasive procedure there is risk to life and limb. In some cases, MRI is a good alternative.

7. What’s a pseudoarthrosis?
   

   Pseudoarthrosis is a false joint literally. It is a failure of the bone healing process. Motion occurs at the spot where bone healing was to occur. If your pain is due to a nonunion or pseudoarthrosis, the options are to live with it or fix it.
   Living with it involves activity modification, aerobic conditioning to increase trunk muscle strengthening, corset during peak activity hours, non-steroidal anti-inflammatory drugs, pain medications sparingly, anti-depressant medicines as needed and a good support system - all depending on the severity of symptoms.
   Fixing it would involve instrumentation and autologous bone grafts at the level of the pseudoarthrosis. The possibilities are: anterior/posterior surgery with bone graft using autologous graft; secure fixation with interbody spacers; pedicle instrumentation and interbody spacers; and electrical bone stimulators.

8. What’s Retrolisthesis?
   

   Retrolisthesis is the relative posterior displacement of vertebra on the one below it. Retrolisthesis is the result of degenerative disc changes. Indications for surgery are based on severity and duration of symptoms and a neurologic deficit rather than on degree of slip. Also, if there is an obvious increase in deformity, surgery is indicated.
   The pinch occurs due to buckling of the post longitudingal ligament and narrowing of the spinal canal as a result of displacement of the two vertebra. Treatment initially is activity modification and meds for pain control. If the pain is unrelenting despite best efforts or if a progressive neurologic deficit develops, then surgery may be indicated.

9. What’s Spina Bifida?
   

   Spina bifida is a birth defect in which the bones of the spine (vertebrae) do not form properly around the spinal cord. It can occur anywhere along the spine. The mildest and most common form of the birth defect is spina bifida occulta, in which the defect is hidden under the skin. It rarely causes symptoms or problems. If spina bifida is severe, it leaves a portion of the spinal cord exposed and can cause physical handicaps, mental retardation, and death.
   Spina bifida develops in a fetus early in pregnancy, often before a woman knows she is pregnant. A lack of folic acid in a woman's diet can increase her chances of having a child with spina bifida. (Folic acid is a B vitamin found in leafy green vegetables, liver, certain types of beans, and other foods.) Women of childbearing age who take folic acid supplements can reduce their chances of having a baby with spina bifida.
   When spina bifida is mild and does not cause symptoms, it usually does not need treatment. In severe cases of spina bifida, surgery may be needed soon after birth.

10. What’s Spondylolysis?
    

    A defect of pars interarticularis or spondylolysis, is a crack in the pars mainly related to repetitive micro trauma over a period of time. This injury is prevalent in weight lifters and gymnasts. Spondylolysis is present in about five percent of the population. Some ethnic groups have a much higher rate.
    The treatment would be conservative at first with exercise, physical therapy and bracing. If the pain is intractable and does not respond to conservative measures, surgery is an option.

11. What’s Spondylosis?
    

    Spondylosis or degenerative disc disease means wear and tear changes in the disc that cause narrowing of the spinal canal. The narrowing of the canal causes compression of the neural elements which interferes with the function. All of us have it to some degree. Nearly everyone has signs of degeneration of lumbar discs after age 40. Some people show evidence of changes much earlier. Most of us are relatively asymptomatic with these changes. Others have backaches. A few people have severe pain or even nerve compression causing loss of muscle function. The usual course of treatment is TLC. If there is no relief from bracing, PT, pain meds, anti-inflammatory meds, low impact aerobics (walking and swimming) then fusion may be an alternative. Surgery is indicated for intractable pain or a progressive neurologic deficit. Before considering a fusion or any surgery, you should exhaust all non operative methods of treatment. Fusion techniques will vary with the surgeon.

12. What’s the Transitional Vertebra?
    

    The transitional vertebra means that you have an abnormal articulation at the lumbosacral junction. Our observation is that patients with those anomalies are more likely to have pain. There is no statistical evidence published from a review of radiographs of the lumbar spine that would support that conclusion. Although the abnormal motion segment may induce degenerative changes that would result in pain, the transitional vertebral body alone is not a source of your pain.