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Well…Do Ya Punk?

Some people feel lucky enough to win a bet or wager. Usually these thoughts are based on instinct rather than true scientific knowledge. Clint Eastwood in Dirty Harry is famous for asking about luck.

Controversy has raged in the neurosurgical and orthopedic literature regarding the need for surgery on people who have encroachment of the spinal canal with close proximity to the spinal cord and nerves with minimum to no symptoms and no evidence of neurologic deficit or paralysis. The concern is that a minor trauma, such as a fall, may result in a major neurologic injury (paraplegia or quadriplegia). There is currently insufficient documentation that 1) encroachment of the spinal canal will result in an increased risk of spinal cord injury from minor trauma, and 2) that prophylactic decompression surgery is helpful in this patient population.

Degenerative changes of the spine are a part of the normal aging process. Most people are asymptomatic. If a disk, bone spur, or thickened ligament compresses a nerve, one may experience radiculopathy, but if it occurs in the spinal canal at the spinal cord level then myelopathy is possible. With severe encroachment, changes in the spinal cord on an MRI may occur. For those patients who are asymptomatic and have severe canal encroachment, MRI findings of spinal cord changes, ossification of the posterior longitudinal ligament, and in those who are involved in high risk activities, then prevention strategies should be developed.

One must realize that the degenerative process can be managed, but it cannot be prevented or arrested by diet, exercise, or lifestyle changes. Surgical decompression is indicated for patients with severe incapacitating pain, claudication or cramps , neurologic deficit, or myelopathy. A relative indication for surgery is for a patient with a compromised spinal canal, from either congenital or acquired spinal stenosis, to have movement (bending forward or backward) produce or exacerbate symptoms.

For those of us who have worked in spinal cord injury centers, we know that minor trauma can and does result in major neurologic injury. The physician must present and help the patient weigh the benefits, risks, and complications of each option of observation or care. This is not done to frighten but to inform. Only the patient can decide what care they wish to pursue and how they will live their lives.

To learn more about Dr. Cotler or to schedule an appointment, please call us on (713) 523-8884 or visit

Howard B. Cotler, MD, FACS, FAAOS is board certified and recertified in Orthopedic Surgery. He is a fellow of the American Academy of Orthopedic Surgery and the American College of Surgeons.

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