Medical Professionals Medical Professionals
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Warning Signs Of Hip And Knee Arthritis, The Spine: A Common Of Back And Leg Pain AndAging What To Expect When YouCause See Your Orthopedic Surgeon
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Written byost Frederick MD, FAAOS peopleDepaola will experience back
pain at some point in their life. As people age, their joints (such as hips and knees) experience wear and tear. The spine also consists of a complex set of joints that t is not unusual to see a patient with an arthritic problem of can degenerate. When this degeneration leads to a narrowing of the spinal the hip or knee, and the patient has mistaken his problem for canal in the lower back, it is referred to as lumbar spinal stenosis. another condition. Anatomy Most commonly hip arthritis will present as either right or left groin pain that
It is important to understand some of the basics of the anatomy of the spine to understand
worsens with stenosis. activity and withconsists rest. But theofpain may occur on lumbar spinal The improves spinal column of often a series bones connected to the one outside or posterior aspect of the hip or pelvis, making the diagnosis more difficult. another by intervening discs, joints and ligaments. The bones are referred to as vertebrae. Things such ashave bursitis, tendon even the hernias cause pain thesecord areas. The vertebrae a space withinstrains, them called spinalmay canal where theinspinal and nerve roots travel. Generally in as thetorn low back region thefemoral spinal cord has ended and there are Pre-arthritic conditions such cartilage and acetabular impingement nerve roots these that supply the legs. The sections of the spinal have can mimic symptoms as well. Back problems maycolumn also can be different mistakennames, for a hip where the low back section is referred to as the lumbar spine. condition, such as sacroiliitis which is inflammation or arthritis of the sacroiliac joint. happenspain as may the occur spinein ages? What Uncommonly the thigh and people frequently believe they are With aging, the normal discs and joints that have connect vertebrae suffering from sciatica when in reality they an the arthritic hip. degenerate. This leads to narrowing of the discs and arthritic changes of the joints, which can subsequently lead to painOther key symptoms of an arthritic hip are joint stiffness and loss of motion of in the low back. In addition, the ligaments overgrow and bone spurs form. All of these the hip.together cause the spinal canal to get narrower over time. Once the spinal canal narfactors rows Knee generally has a that more straightforward withlumbar pain orspinal to a arthritis certain point, the nerves travel to the legs getpresentation pinched causing stenosis.around the joint, and occasionally swelling and deformity in more advanced stiffness cases. time patients will report pain in the back of the knee or calf, or WhatFrom aretime the tosymptoms? The symptoms of lumbar spinal back pain, which can vary depending on pain running down the lower legstenosis makinginclude the diagnosis more difficult. severity the arthritis.isThere also be pain in theand buttocks can travel theOnce theofdiagnosis madecan treatment for hip knee that arthritis are down the back of the legs, for oftentimes referred to as “sciatica.” can also bedependent numbness orontingling individualized each patient’s symptoms, butThere are frequently the in the buttocks or legs. As the pressure on the nerves roots worsens, weakness can occur, patient’s disability and other conditions. especially in the foot. Patients will often times report that the pain is worse by standing up straight Theseand treatments may include activities thatAs aggravate the condition walking, but gets better the withavoidance sitting and of leaning forward. time progresses, such as stairclimbing, twisting, jogging andpain heavy lifting. patients will not be able kneeling, to walk assquatting, far they once did without feeling in their legs.Weight Some loss is often cited as a common recommendation to reduce joint pain in overweight patients, however, note that leaning forward on a shopping cart will allow them to walk farther without pain. patients. Often times, non-steroidal anti-inflammatories medications such as Ibuprofen or Naprosyn, may be recommended to reduce inflammation and pain in the joints. How is it treated? The treatment withshown seeingto a physician trained in dealing with thearound spine and Physical therapy begins has alsofirst been increase flexibility and strength the obtaining an accurate diagnosis. The diagnosis is made based on the history and physical joint to reduce pain. and also injections with X-raysfor andthe MRI. Generally, is started with non-surgical options. exam, Sometimes knees, such astreatment cortisone or viscosupplementation will This includes physical therapy, medications, acupuncture and steroid injections. Oftentimes help prolong the time before a joint replacement is needed. Braces are another option. patients will feel good pain relief from these treatments. If a patient has a poor quality of life In who are stenosis, too disabled or ill to undergo joint have replacement surgery, walker or duepatients to lumbar spinal and non-surgical treatments not worked or onlya worked specialized may be isrequired. temporarily, cane then surgery considered. The main stay for treating lumbar spinal stenosis is to remove In patients who do not respond to these treatments, the ligaments, bone spurs and other initial compressive factorsjoint fromreplacement placing pressure on the nerve roots. This process is referred to as decompression, or a laminectomy. surgeon becomes an option. Advances in total joint replacement in recent years haveThe been many. does not remove all of the vertebrae, only the elements in the back that are placing pressure These include medications to reduce pain and bleeding, newer prosthesis with the hope on longer the roots. Sometimes and a spinal fusion is also needed for joint various reasons. TheIlaminectomy of survivorship, newer techniques to insert replacements. personally can be done using a traditional incision, a small “mini-open” incision or a minimally invasive have begun doing the direct anterior approach for hip joint replacements in most of approach. The choice of approach will be determined based on the severity of the stenosis, my patients who require hip replacement surgery. have foundgood the use a special the individual patient and surgeon factors. Most peopleI experience painofrelief in their operating table and imaging during thenormal procedure toafter be helpful in obtaining more legs after surgery andx-ray are able to resume their lifestyle recovering from surgery. However, improvement in theaccurate back is variable. results. As you can see, it is interesting to talk about the In Conclusion . . . Lumbar spinal stenosis is diagnosis one cause of back and leg pain peoplearthritis, as they age. and treatment forthat hipaffects and knee the It is important to see a physician trained in treating this disease to obtain an accurate diag-the first step is to see your orthopedic surgeon to make nosis. Once that is achieved, there are multiple treatment options that can help improve a proper diagnosis and obtain the treatment plan that patient’s quality of life. most fits your needs.
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Praveen Yalamanchili, MD. Dr. Yalamanchili is a fellowship-trained Spine Surgeon, who completed his training at Emory University in Atlanta, Georgia. A native of New Jersey, Dr. Yalamanchili has returned home after completion of his Fellowship training. He attended medical school at UMDNJ – Robert Wood Frederick DePaola MD, FAAOS Johnson Medical School and completed his orthopaedic residency at UMDNJ- New Jersey Medical School. He specializes in the treatment of spinal disorders www.seav i ew orparticular t h o. interest comin cervical • (neck) 732660 -6as2minimally 0 0 invasive and motion sparing procedures. including degenerative, deformity and trauma and has surgery as well
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March/April 2015