The Spine Center

AHMC Anaheim Regional Medical Center offers comprehensive spine services from outstanding Spine Specialists.  Back and neck problems are one of the most common reasons that motivates individuals to seek medical attention. A person's ability to completely function on a daily basis: walking, running, sitting, and standing all depend upon your spine-which is the main support for your entire body.  Injuries to the spine, however, can leave one debilitated. For problems that are recurrent and do not resolve themselves over time surgical or non-surgical forms of treatment can be beneficial, relieving pain and restoring patients back to health.

Experts at AHMC Anaheim Regional Medical Center have been involved with massive spinal care advancements.  These advancements have enabled the doctors' of AHMC Anaheim Regional Medical Center to accurately diagnose conditions, leading them to determine appropriate forms of treatment.  The team of physicians, physical and occupational therapists, and registered nurses are nothing less than superior at AHMC Anaheim Regional Medical Center and offer incomparable patient and medical care.

For more information about our services, or if you have any questions or concerns, please contact:

Anaheim Regional Medical Center

(714) 774-1450

1111 W. La Palma Ave.

Anaheim, CA 92801

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Conditions Treated at The Spine Center

• Cauda Equina Syndrome  
• Cervical Radiculopathy (Pinched Nerve)
• Congenital Torticollis 
• Herniated Disc 
• Kyphosis
• Low Back Pain 
• Neck Pain  
• Neck Sprain 
• Spinal Stenosis 
• Spondylolysis and Spondylolisthesis 

Additional Services:

• Pain Management
• Rehabilitation -- Physical & Occupational Therapy

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 Cauda Equina Syndrome

 Cauda Equina is a rare condition that occurs when the nerve roots at the end of the spinal column are compressed or paralyzed, resulting in a loss of sensation or movement in the lower body, including bladder and bowel functions.      

 Causes: 

•  Children born with abnormalities that cause Cauda Equina
•  Fracture
•  Infection
•  Narrowing of the spinal canal
•  Ruptured disc
•  Trauma (car accident, gunshot, fall, etc.)
•  Tumor

Symptoms:

• Bladder/Bowel dysfunction - unable to hold it, or retaining waste
• Loss of sensation in lower body
• Pain, numbness, or weakness spreading to one or both legs that may cause you difficulty in getting up from a chair or causes you to stumble.

Diagnosis:

In order to make a diagnosis, the physician may:

• Look at your medical history
• Perform a physical examination
  • To test: stability, sensation, strength, reflexes, motion.
• Order diagnostic imaging
  • CT scans
  • X-rays
  • MRI (magnetic resonance imaging) scans

Treatment:

In order to relive the pressure or pinching of nerves, the substance is causing it needs to be removed through surgery. It is really important that a patient with Cauda Equina Syndrome seeks medical attention immediately because surgery may prevent further damage to nerves that is irreversible and cannot be repaired.

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Cervical Radiculopathy (Pinched Nerve)

A nerve root injury, also known as a 'pinched nerve' can occur within the cervical spine (this is the upper part of the spine comprised of the neck and upper back). A pinched nerve can cause an individual to experience pain in his/her neck that radiates down to the shoulders and arms.

Causes:

Aging - bones become more brittle over time and the discs (which cushion the bones in the spine, preventing them from grating against one another) begin to thin.

Symptoms:

• Sharp pains
• Numbness
• Feeling weak in certain activities

Diagnosis:

In order to diagnose cervical radiculopathy, your physician may:

• Look at your medical history
• Perform a physical examination
• Order other imaging studies:
  • X-rays
  • CT Scan
  • MRI Scans
  • Electromyelography - this is a type of nerve conduction study which can differentiate between symptoms caused by pressure on the spinal nerve roots or are the result of other conditions.

Treatment:

• Nonsurgical Options
  • Medication
    • Anti-Inflammatories
      • Drugs such as ibuprofen or aspirin can help reduce swelling and pain.
    • Oral corticosteroids
      • These can help reduce swelling as well as pain.
    • Spinal Injections
      • These injections consist of inserting steroids directly into the area where the pain occurs
  • Physical Therapy
    • Physical therapy can assist in stretching the neck muscles, easing the pain, and increase the strength of muscles.
  • Soft Collars
  • By limiting the neck muscle motion, a soft collar allows the neck muscles to rest. This can help ease the pain when moving the neck but should not be used long-term  

Surgical Options

• Depending on several factors, your physician will determine which type of surgical treatment is best for you based on:
  •  Medical history
  • The type and location of the pain  
• Anterior Cervical Diskectomy and Fusion (ACDF)
  • This procedure restores the alignment of the spine from the front at the neck area, which will in turn ensure that there is enough space available for nerve roots to leave the spine.
• Posterior Cervical Laminoforaminotomy
  • In a posterior cervical laminoforaminotomy, your physician will, from the back of the neck, relieve the pressure on the spinal nerves by removing parts of the bone that compresses them.
• Artificial Disc Replacement (see right)
  • Recently approved by the FDA, artificial disc replacement is similar to a hip or knee joint  replacement. An artificial disc is inserted in the area where bone is removed, acting as a normal disc would.
  • Artificial discs:
    • Allow motion to continue after the degenerated disc is removed
    • Can relieve pressure
    • Can widen the spinal canal through which major nerves pass through
    • May restore the high in between vertebral bodies.

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Congenital Torticollis

This is a condition that is discovered within the first few months of an infant's life. An infant with torticollis will tilt his or her head to the side and will have difficulty turning it to the other side.

Cause:

• First born children are more likely to have torticollis.
  • During pregnancy, intrauterine packing or muscle contraction can cause trauma to the baby's hip and neck muscles resulting in a dislocated hip and overstrained neck muscles.
  • Because the correlation between hip location and torticollis is high, clinicians will screen any infant born with a dislocated hip for torticollis.
• There may be a genetic factor. Studies have shown that torticollis runs within families.

Symptoms:

• Limited range of motion
• One shoulder is high on one side of the body
• Stiffness and/or swelling of neck muscles
• The head tilts to one side and the chin points to the opposite shoulder.

Diagnosis:

• Physical examination: to prove that there is in fact difficulty moving the neck from one side to the other, showing the shortened muscles as well.
• Diagnostic Imaging: to determine that there is no other cause of head or neck pain

Treatment:

• Physical Therapy
  • Stretching and positioning treatments are used in order to strengthen the muscles in the neck.
  • Surgical Procedures
• Surgery may be needed to correct torticollis and can lengthen the short muscle.

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Herniated Disc

A disc is a soft, rubbery pad that cushions the vertebral bones in the spinal column. This prevents the bones from rubbing against one another and allows for movement, such as bending or flexing.  

When we look up close at a disc from the top-down, we can see that discs are made up of an outer ring of cartilage, and an inner ring of a gel-like substance, where the nucleus resides. This pad sits directly in front of the spinal canal, which allows the spinal cord to run from the brain down to the end of the spine.

A herniated disc, commonly referred to as a 'ruptured' disc, can cause pain in the neck, lower back, arms, or legs.

Cause:

When the nucleus of the disc expands, it splits or ruptures causing the gel-like substance of the nucleus to leak out. This can be the result of daily wear and tear on the spine, incorrect lifting or twisting that aggravates a weak disc, but it can also be caused by an injury or pinched nerves that progress in severity over time.

Risk Factors:

• Aging (individuals between 30-50 are at high risk)
  • As children, discs in the spinal column have high water content, which means that discs are more flexible. The water content, however, decreases with age. As the discs shrink, the cushioning between the vertebrae gets smaller, weakening them.
• Additional conditions that can weaken discs are:
  • Excessive body weight that adds stress to the discs, particularly in the lower spine
  • Improper lifting of heavy objects
  • Repetitive physically strenuous activities

Symptoms:  

• dull or sharp pain
• loss of bladder and/or bowel control, which are indicative of Cauda Equina
• muscle spasm or cramping
• tingling (pins and needles)
• weakness
  • one leg - when pain occurs in the lower back
  • one arm - when pain occurs within the neck

Diagnosis:

• Medical History
  • prior injuries, neck/back pain that has gradually increased over time
• Physical Examination
  • used to determine where the pain occurs, while also assessing what nerve roots are implicated and how seriously.
• Diagnostic Imaging
  • MRI
  • CT Scan

Treatment:

After nonsurgical treatment, most patients (90%) with herniated discs heal over time (1-6 months).

• Nonsurgical Treatment:
  • Rest for a period of time, followed by a gradual increase in activity
  • Medication to control the inflammation and pain
  • Physical Therapy
    • Exercises recommended to reduce pain and increase strength in the muscles that support the spine, preventing further injuries
  • Resorption
    • The body can reabsorb the tissue or fragments from a herniated disc that has ruptured, essentially healing itself.
• Surgical Treatment:
  • Required in less than 10% of patients who suffer from a herniated disc.
  • Surgery may be recommended for individuals who have severe weakness or numbness, pain that cannot be relieved, or have progressive nerve damage.

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Kyphosis

Kyphosis is a deformity of the spine that results in a segment of the spine curving more than is normal. Since the vertebrae are no longer stacked properly, the muscle and nerve functions are altered and can cause pain and impaired nerve function. At its worst, the abnormal curvature of the spine can result in a hunchback.

Causes:

• Kyphosis in children is due to abnormal development either at birth or during adolescence. Kyphosis can also be caused by poor posture.
• Other causes:
  • Fractures to the spine
  • Infection
  • Injury
  • Osteoporosis (degeneration of the vertebral bones)
  • Tumors
• This can be prevented by:
  • Accident prevention
  • Avoiding smoking
  • Consistent and sensible exercise
  • Good nutrition
  • Maintaining good posture
  • Proper lifting

Symptoms:

• Can develop rapidly or grow in intensity over time
• Impaired nerve function and pain 

Diagnosis:

• Physical examination to determine the extent of the curvature
• Diagnostic Imaging
  • X-rays

Treatment:

• Nonsurgical Options
  • Anti-inflammatory medications
    • This is to help provide pain relief.
  • Back Brace
    • Recommended for children until skeletal maturity is reached since the spine can be manipulated during the growth process.
  • Physical Therapy
    • Includes exercises that strengthen spine muscles as well as relieve pain. These exercises target the hamstrings and abdominal areas, which are also crucial to posture and strong healthy spine muscles.
• Surgical Options
  • Fusion with Bone Graft
    • In essence, the fusion with bone graft is a 'welding' procedure whereby two vertebrae are fused together with bone grafts or instrument such as metal rods.
  • Fusion with Instrumentation
    • By fusing vertebrae together the range of motion is limited. But, if we fuse spinal instrumentation to prove stability to the spine after two vertebrae have been fused together, the spine will be able to bend and rotate.  
  • Kyphoplasty
    • This procedure is used to treat kyphosis caused by fractures to the spine or is the result of osteoporosis.

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Low Back Pain

This type of pain can be short or long term and the intensity can vary but it is one of the most common health complaints. In most cases, the exact cause of low back pain cannot be determined.

Causes:

• Arthritis
• Cancer that involves the spine
• Certain medical conditions
• Degenerative disc disease
• Herniated disc
• Kidney infection or stones
• Medical conditions that affect the female reproductive organs
• Muscle or ligament strains or tears
• Osteoporosis
• Spinal Stenosis
• Spine curvatures, such as Kyphosis 

Acute Low Back Pain (Short-term)

Short-term lower back pain occurs immediately after an injury occurs, such as lifting a heavy object improperly or a car accident. This pain may result in feeling a sharp pain, burning sensation, or a dull achy feeling and can vary in intensity from mild to severe enough that you are unable to move.

Individuals who suffer from acute lower back pain will recover within 4-6 weeks. Your physician may recommend physical therapy to increase muscle strength, stability, and prevent future injuries.

Chronic Low Back Pain (Long-term)

Long term lower back pain affects every aspect of an individual's life from daily movements, such as standing, to one simple motion such as bending from the waist. This pain not only lasts over a period of time, but also increases in intensity.  

Risk Factors of Chronic Low Back Pain if you:

• Are over age 30
• Are overweight
• Are pregnant
• Do not exercise
• Feel stressed or are depressed
• Have arthritis or osteoporosis
• Smoke
• Your occupation involves heavy lifting, bending, or twisting, or whole body vibration

Diagnosis:

Your physician, in a physical examination, will ask you a series of questions about your injury and how it occurred. He or she may also have your perform a series of movements in order to determine where the pain is radiating from as well as to determine how serious the injury is.  Diagnostic imaging may include: X-rays, CT scans, and/or MRI scans.

Treatment:

For both acute and chronic low back pain, your physician may recommend physical therapy to strengthen the muscles that support the spine, promote healthy dietary habits in order to promote weight loss, and stress the importance of good posture when lifting heavy objects.

Acute Low Back Pain

If you are suffering from acute low back pain, your physician will direct you to stop your normal physical activity for the first few days. It will not only help reduce the swelling, but can calm the symptoms you are experiencing as well. Your physician will also help you manage your pain. Individuals with acute low back pain may be advised to use cold packs for 15-30 minutes several times a day along with some anti-inflammatory medications and pain relievers, such as aspirin.

Chronic Low Back Pain 

Those with chronic low back pain may be prescribed pain medicines to help decrease swelling as well as to ease the pain.

If the pain is not eased with medication, the following procedures may be recommended based on your medical history and individual circumstances.

• Diskectomy
  • A diskectomy procedure is done to remove all or part of the cushion that is in between the vertebra, protecting the spinal column. This procedure is commonly done for individuals who suffer from a herniated disc, but is also used to relieve the pressure and pain in the lower back if it is chronic and persistent.  

• Foraminotomy
  • In a posterior cervical foraminotomy, your physician will, from the back of the neck, relieve the pressure on the spinal nerves by cutting or shaving away parts of the open to open the nerve root opening (foramen) in the lumbar area, where the spinal nerves branch out to the lower extremities.  

• Laminectomy
  • A laminectomy removes the lamina, two small bones that make up a vertebra. This is another procedure that is used to relieve pressure placed on the spinal nerves. By removing the bones, more space is created in the spinal column, giving the nerves more room.

• Spinal fusion
  • A spinal fusion may be performed after a foraminotomy or a laminectomy to further stability. This surgery will fuse together two vertebral bones together, one on top of another, so that there is no longer any movement between them. This fusion can be done with screws, plates, or cages. Depending on your individual medical history and current health status, our spine specialists may recommend an artificial disc replacement instead of a spinal fusion.

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Neck Pain 

The cervical spine (neck) is made up of the vertebrae that start in the upper back and end at the base of the skull. The ligaments attached to the vertebrae provide stability; muscles allow for movement and support of the weight of the head.

The neck is susceptible to injury and various disorders that result in pain and limited motion. For many, neck pain may be a temporary condition and resolves itself over time. For others, however, medical treatment is needed to relieve the pain and restore the range of motion.

Causes:

• Inflammatory Disease
  • Rheumatoid arthritis, a condition where joints in the upper neck may be destroyed causing severe stiffness and pain.
• Injury
  • Fall 
  • Spondylolysis (click here to read more about this condition)
  • Sports Injury
  • Whiplash

Symptoms:

• Abnormal sensations, such as prickling or burning
• Dizziness
• Headache
• Neck pain
• Neck stiffness
• Shoulder or upper back pain

When to Seek Medical Care:

• Immediate medical care should be sought when an injury causes neck pain that shoots down the arms and legs.
• Pain or numbness that present in the arms and legs without serious neck pain.
• If there has not been an injury and you experience neck pain that is:
  • Severe
  • Consistent and persistent over a period of time
  • Accompanied by pain in the arms and legs
  • Accompanied by headaches, dizziness, tingling, or weakness in the legs   

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Neck Sprain

The cervical spine is made up of seven vertebrae, which are attached to each other through ligaments. The major function of the neck is to support the weight of the head while enabling it to move. A sprain can occur when a ligament, or several, is overextended.

Causes:  

• A hard fall  
• Car accident that involves whiplash
• Contact sports injuries

Symptoms:

• Headache in the back of the head
• Muscle spasms and pain in upper shoulders
• Neck stiffness or decreased range of motion (sideways, up and down, circular)
• Numbness, tingling, or weakness in arm or hand
• Pain in the back of the neck that worsens with movement
• Pain that gets worse a day or so after the injury, not immediately
• Sore Throat

Diagnosis:

Your physician will conduct a physical exam, including questions about your injury and how it occurred. He or she may also measure the range of motion of your neck, looking also for locations where pain or tenderness may occur.

Treatment:

Neck sprains will heal gradually with time (4-6 weeks) and the proper treatment as most sprains throughout the body tend to. One of the more common forms of treatment is a soft collar which is worn around the neck. This will assist in supporting the head and relieve the pressure on the ligaments, giving them time to heal.

For pain management, our physicians recommend the use of pain relievers such as aspirin or ibuprofen that will reduce pain and swelling. To further reduce swelling, patients find that using an ice pack for 15 to 30 minutes at a time several times a day for a few days after the injury helps. To ease muscle spasms that may occur, muscle relaxants may be prescribed.  

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Spinal Stenosis

Stenosis refers to a narrowing of an opening that is normally larger. In spinal stenosis, the normally clear opening of the spinal canal has narrowed, resulting in a channel that is too small for the spinal cord. Approximately 75% of spinal stenosis cases involve the lumbar spine and commonly affect older patients (about age 60) due to the degeneration of the spine over time.

Causes:

• Bone diseases
• Genetic or congenital problems can influence the development of the spinal cord
• Obesity
• Poor dietary habits
• Poor posture and body mechanics
• Physical abuse
• Smoking

Symptoms:

Sciatica - cramping, tingling, weakness or numbness that radiates from the lower back to the buttocks and legs and worsens with activity

Diagnosis:

Your physician will conduct a physical exam that may require you to do a series of movements to determine where the pain is in the legs and lower back as well as to determine your strength and your ability to move. To assess nerve function, your physician may use a rubber hammer to check your reflexes.

Diagnostic imaging tests may be ordered that include: CT scan of the spine, EMG, MRI of the spine, and/or X-rays.

Treatment:

• Foraminotomy
  • In a posterior cervical foraminotomy, your physician will, from the back of the neck, relieve the pressure on the spinal nerves by cutting or shaving away parts of the open to open the nerve root opening (foramen) in the lumbar area, where the spinal nerves branch out to the lower extremities.  

• Laminectomy
  • A laminectomy removes the lamina, two small bones that make up a vertebra. This is another procedure that is used to relieve pressure placed on the spinal nerves. By removing the bones, more space is created in the spinal column, giving the nerves more room.

• Spinal fusion
  • A spinal fusion may be performed after a foraminotomy or a laminectomy to further stability. This surgery will fuse together two vertebral bones together, one on top of another, so that there is no longer any movement between them. This fusion can be done with screws, plates, or cages. Depending on your individual medical history and current health status, our spine specialists may recommend an artificial disc replacement instead of a spinal fusion.

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Spondylolysis and Spondylolisthesis

One of the most common causes of lower back pain in adolescents who are involved in athletics is a stress fracture of the vertebra in the lumbar region of the spine, which can be seen on an x-ray. The stress fracture(s) in this particular region of the spine is known as spondylolysis.

If the stress fracture weakens the vertebra so much that it cannot support or maintain it's proper position, shifting them out of place, it is no longer spondylolysis, but another condition -- spondylolisthesis. It is likely that the shifting of these vertebras can press on the spinal nerves, causing pain and a limited amount of motor function such that surgery may be required to correct the condition. 

Causes: 

• Genetics
  • Individuals who develop these conditions may have been born with a thin vertebrae that is susceptible to stress fractures
  • Periods of rapid growth can also put pressure on the vertebrae, increasing the risk of stress fractures
• Overuse
  • Participating in some sports, can put a tremendous amount of stress on the bones in the lower back. These include: ballet, gymnastics, lifting weights, and contact sports.
    • Stress fractures seen in spondylolysis are due to constant flexing or overstretching of the spine.
  • Many who have spondylolysis and spondylolisthesis do not exhibit any obvious symptoms.

Symptoms: 

• Pain usually spreads across the lower back and may feel like a muscle strain.
• Spondylolisthesis can cause spasms that stiffen the back and tighten the hamstring muscles
  • This can change your posture and gait.

Diagnosis:
Your physician will conduct a physical examination to determine where in the lower back the tenderness and pain occur. Then, he or she may order an x-ray of your lower back to view the position of the vertebra in the lumbar spine to confirm that there are fractures of slippage, confirming the diagnosis of spondylolysis (for fractures) or spondylolisthesis (shifting of vertebra forward).

Treatment: 

• Nonsurgical treatment
  • Physicians seek to treat spondylolysis non surgically before resorting to surgical treatments.
    • Your physician will recommend that you take a break from your normal activities and suggest that you take anti-inflammatory medications that may reduce your back pain.
    • A back brace or physical therapy may be recommended by your physician. Stretching and strengthening exercises for the back and abdominals can help prevent future injuries.   
• Surgical treatment
  •   Spinal Fusion
    • This surgery will fuse together two vertebral bones together, one on top of another, so that there is no longer any movement between them. This fusion can be done with screws, plates, or cages. Depending on your individual medical history and current health status, our spine specialists may recommend an artificial disc replacement instead of a spinal fusion.

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  For more information about The Spine Center at

Anaheim Regional Medical Center please call:

Anaheim Regional Medical Center

(714) 774-1450

1111 W. La Palma Ave.

Anaheim, CA 92801

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