Degenerative Spine

Degenerative spine disease is wear and tear of the discs, joints, and ligaments that sometimes narrows the space around a nerve or the spinal cord. It can be very painful, and yet most cases do not require surgery. At a consultation in Mexico City, mechanical pain is distinguished from pain that is already affecting strength, walking, or bowel or bladder function.

A herniated disc presses on a nerve, causing sciatica or brachialgia, with pain radiating down an arm or leg and sometimes weakness in a muscle group. A narrowed spinal canal—cervical or lumbar—causes gradually increasing pressure; in the neck, it can affect the hands and walking, while in the lower back it can make you stop when walking and improve when you bend forward. Instability, such as spondylolisthesis, is a slipping vertebra; it causes pain and, if it progresses, may add compression. An X-ray showing “arthritis” does not tell you which of the three is causing the complaint.

If the exam is normal and the pain has been present for only a few days, starting with movement, simple pain relievers, and time is usually reasonable: many herniated discs stop hurting without surgery. An MRI becomes useful when there is a deficit, the pain does not improve after several weeks of appropriate treatment, or another cause is suspected (infection, tumor, fracture). Electromyography can clarify questions about a nerve root; it does not replace a clinical evaluation. Operating based on an imaging finding that does not match the symptoms is a common cause of disappointment.

The first step is activity, therapy, and controlling pain enough to allow movement. An injection, performed by someone trained in that practice, may calm an irritated nerve root; it does not “fix” the disc and cannot be recommended from a webpage. Microdiscectomy or decompression may be discussed when nerve pain persists or there is significant weakness. Fusion is reserved for confirmed instability, not all lower back pain. Each technique has its own potential complications: recurrent herniation, persistent axial pain, or nerve root injury.

Loss of bladder or bowel control, saddle anesthesia, weakness that worsens over hours, or fever with severe back pain should not wait for an appointment next week. These may be signs of acute compression of the lower nerve roots or an infection. This should be assessed in the emergency department. A recent injury with neck pain and tingling in all four limbs should not be “adjusted” at home either.

Does every herniated disc require surgery? No. A large proportion improve without a deficit. Surgery is considered for persistent nerve pain or loss of strength, not based on the size reported alone.

Will I be free of back pain? Surgery relieves pressure on a nerve more effectively than it cures pain originating in the spine itself. If the main symptom is lower back pain, without sciatica, the result is usually more modest.

Does age rule out surgery for a narrowed spinal canal? Not by itself. Walking ability, cardiac reserve, and how clearly the compression is seen all matter. So does the option of not having surgery and accepting limits on how far you can walk.

If you’d like an opinion on whether your herniated disc, spinal canal narrowing, or spondylolisthesis should be monitored or treated with surgery, send your MRI to +52 55 2193 8191. If you’ve lost bowel or bladder control or your strength is declining today, go to the emergency room.