What Dr. Boody treats, and what each one is.

What is it? A nerve root pressed as it leaves the neck, usually by a herniated disc or a bone spur. Each root supplies a specific part of the arm, so pain, tingling, or weakness follows a predictable path down the shoulder, arm, or hand, and the pattern tells the level.

When is surgery considered? Most cases settle with time, physical therapy, medication, and sometimes an injection. Surgery is discussed for weakness, symptoms that have not settled after conservative care, or pain that is not tolerable.

What is it? Pressure on the spinal cord itself in the neck, from disc degeneration, bone spurs, thickened ligament, or OPLL. Because the cord carries signals to the whole body below, symptoms are broad: clumsy hands, changed handwriting, an unsteady walk, and sometimes bladder urgency. Neck pain may be mild or absent.

When is surgery considered? Unlike a pinched nerve, myelopathy does not tend to improve on its own, and function lost while waiting is often not recovered. Once symptoms are present, surgery to decompress the cord is usually recommended to stop progression. Dr. Boody has published on when compression seen on MRI should be treated.

What is it? A ligament that runs down the back of the vertebral bodies, directly in front of the spinal cord, gradually turns to bone. As it thickens it narrows the canal, often across several levels, and can press on nerve roots, the cord, or both. It is often found on a CT ordered for another reason.

When is surgery considered? When the cord is compressed and there are myelopathy symptoms, or when radiculopathy does not settle. Whether the decompression is done from the front or the back depends on how many levels are involved and the alignment of the neck. Dr. Boody co-authored a review of cervical OPLL with Dr. Alexander Vaccaro (International Orthopaedics, 2019).

What is it? A broken vertebra in the neck, mid-back, or low back after a fall, crash, or sports injury, or from weakened bone. The first question is stability: whether the injury has damaged the structures that hold the spine in line and protect the cord. A CT usually answers it.

When is surgery considered? Many fractures are stable and heal in a brace with follow-up X-rays. Surgery is considered when the spine is unstable, when bone has pushed into the canal, when the fracture is causing deformity, or when there is any nerve or cord injury. Stabilization can often be done with percutaneous screws through small incisions.

What is it? Damage to the spinal cord itself, usually from a fracture or dislocation that crushes or stretches it. Signals to and from everything below the level are disrupted, causing weakness or paralysis, sensory loss, and changes in bladder and bowel control. It is an emergency treated through the ER and the hospital, not the clinic.

When is surgery considered? Surgery aims to take pressure off the cord and stabilize the spine so it cannot be injured further. Dr. Boody manages the surgical side of spinal cord injury and follows patients through recovery and rehabilitation. How much function returns depends on the severity of the initial injury.

What is it? Bacteria, or less often tuberculosis, reach the disc (discitis), the vertebra (osteomyelitis), or the space around the nerves (epidural abscess), usually through the bloodstream. The typical picture is back pain that is constant, worse at night, and out of proportion to any injury, sometimes with fever. Diagnosis relies on MRI, blood tests, and often a biopsy to identify the organism.

When is surgery considered? Most spinal infections are treated with weeks of antibiotics guided by the culture. Surgery is considered when an abscess is pressing on the nerves or cord, when there is neurologic change, when bone destruction has made the spine unstable or deformed, or when antibiotics are not working. Dr. Boody wrote a 2018 review on evaluating and managing pyogenic and tubercular spine infections.