Lumbar Spinal Disorder

Information on Lumbar Spinal Disorder

Pain, numbness, and weakness can affect extremities, too

Spinal disorders affect millions of people. The spine can be affected by arthritis, degenerative wear and tear problems affecting the joints and discs, as well as a variety of other abnormalities that cause pain, numbness and weakness. Problems in the low back or lumbar spine can affect the leg and foot, while problems in the cervical spine of the neck can affect the arms and hands.
Modern spinal care is very complex. When surgery is needed, patients should seek out highly trained experts. Dr. Aaron G. Filler is a former director of the Comprehensive Spine Program at UCLA and is an associate of the Institute for Spinal Disorders at Cedars Sinai Medical Center. He is the author of a book about spinal problems from Oxford University Press and is an expert in spinal surgery. Through the Center for Advanced Spinal Neurosurgery in Santa Monica Dr. Filler offers a complete range of spinal surgery. His expertise includes complex fusion and failed fusion. In addition, he specializes in the evaluation and treatment of patients who have already had spine surgery need a revision. When pain and nerve symptoms are not relieved or are made worse by spine surgery, there is often a correctable problem that explains the failure and Dr. Filler is an expert in finding what needs to be fixed.

Treatment of Lumbar Spinal Disorders

Evaluation and Repair of Failed Spine Surgery

The reasons why some spinal surgeries fail can usually be attributed in three categories:
1) the diagnosis was wrong: the problem is affecting a nerve and is not in the spine.;
2) the surgery was technically inadequate: this means that the surgeon did not actually accomplish what was planned or the plan was wrong or insufficient;
or 3)there has been a recurrence: the original surgery worked for a brief period of time,but the problem has recurred.
At NIMA in Santa Monica, California, Dr. Aaron G. Filler is committed to helping patients with failed surgeries. Using advanced diagnostic imaging techniques, as well as new minimally invasive surgical methods, many difficult spinal problems can be solved.
Having completed an advanced Spinal Neurosurgery Fellowship and personally developed several new treatment techniques, Dr. Filler is committed to finding the solution to difficult spinal surgical problems.

Treatment of Lumbar Spinal Disorders

Causes of Persistent Pain after Lumbar Discectomy

Animation: MR Neurography in patients with persistent radiculopathy after spine surgery.
(A) MR Neurography demonstrates flattening of the exiting nerve root (**) by a persistent fragment of disc material (fr) in the foramen. The contralateral nerve root (*) has a normal caliber.
(B) 36-year-old man with right S1 dysesthetic pain after microdiscectomy. Post-operative imaging showed good decompression, but the Neurography demonstrated persistent hyperintensity of the dorsal root ganglion (DRG) consistent with intraoperative mechanical trauma. No further surgical treatment was recommended.

Distal Foraminal Impingement

Animation: Lumbar neurography for evaluation of sciatica of non-disc origin. Distal foraminal lumbar nerve root entrapment.
(A) Normal anatomy of the L3, L4 and proximal L5 nerve roots and lumbar spinal nerves as they exit the spine traveling in essentially linear fashion.
(B) Exiting right L5 nerve root (*) of 65-year-old woman with persistent right L5 radiculopathy after two spine surgeries. The course of the exiting root is distorted; there exists both focal narrowing and a region of hyperintensity (n).
(C) Myelogram of same patient obtained just prior to MR Neurography. The L5 root abnormality is too distal to be appreciated in the myelogram (*) and the study was read as showing a normal L5 root with no impingement. After the Neurographic diagnosis, the patient had a distal foraminotomy with excellent lasting relief of her radiculopathy.

Foraminal Impingement after Disc Surgery

Animation: Complete S1 spinal root and spinal nerve image demonstrating proximal right sided pathology and distal left sided pathology.
This case involves a 66-year-old woman with bilateral radicular symptoms and non-diagnostic lumbar MRI who did not improve after two decompressive lumbar spine surgeries.
(A) Anterior image plane demonstrated distal right S1 foraminal impingement with hyperintensity in the nerve root seen in A (*) and in B (**).
(B) Posterior image plane (3mm slices, no spacing) confirms hyperintensity in distal S1 root. The right proximal sciatic nerve is broadened and flattened at the sciatic notch with mild edema and increased caliber of fascicles. Her physical exam was consistent with a piriformis syndrome on the left only.
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