Orthopedic & Spine Conditions

Learn More about General Orthopedic and Spine Conditions

Lumbar degenerative disease and herniation.


 This  image shows 3 different MRIs showing degenerative issues at the L4-5 disc.  When compared to the disks above and below, the disc appears darker color because it is lost water content, i.e. desiccation.  This weakening of the disk allows the disc to push back on the nerve roots to the legs.  This can cause a combination of back and leg pain.  The image on the left shows a bulge which we generally treat non operatively.  The image on the right shows an extrusion, which is a disc fragment that  has completely separated from the remaining disc.  We generally treat this with a microdiscectomy surgery removing that fragment.  The middle image showing a herniation, can be treated either conservatively or with surgery depending on the size of the herniation and the patient's symptoms.


Microdiscectomy  is performed with a small incision in the back with removal of bone allowing us to get to the disc area which is pinching the nerve.  That area of herniated disc is removed.  On thin patients, this can be done through a 1 inch incision on an outpatient basis.  Return to work within several days or weeks as possible depending on work type.

Lumbar Degenerative Disk Disease

This is a sagittal view of a lumbar MRI.  You can see that most of the disks are white colored, and that is because the disks are healthy and are able to retain water.  The bottom L5/S1 disk (between the Lumbar 5 and Sacral 1 vertebrae) is severely degenerated.  This allows the bone to rub on bone causing unrelenting pain.  Also, because the disks are no longer taking the load the facet joints in the back of the spine have to take more load which causes thickening (hypertrophy) of the facets which can pinch the nerves going to the legs.  Generally for this condition I recommend opening up the disk space and performing a fusion.  Please look at the patient cases in the next page for examples. 

Lumbar Degenerative Disk Disease

This MRI shows severe disk disease at both the L4/5 and L5/S1 level.  You can see a two level anterior lumbar inter body fusion (ALIF) was performed by opening up the spaces and placing a plastic (PEEK) interbody device with screws to hold it in place.  I generally place screws and rods from the back via a percutaneous minimally invasive method to give stability and allow fusion to occur within the PEEK cages.