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Spinal Disorders

Symptoms, Diagnosis, Treatment & More

Your backbone, or spine, consists of 26 bone discs, called vertebrae. The vertebrae protect your spinal cord and allow you to stand and bend. Several problems can change the structure of the spine, or damage the vertebrae and the surrounding tissue. These problems include infections, injuries, tumors, conditions, and bone changes, such as spinal stenosis and herniated discs.



Pinpoint your pain.

Because of the way that the spinal cord functions and are organized, damage to the cord often produces specific patterns of symptoms based on where the damage occurred. The following may occur:● Weakness● Numbness or tingling● Changes in reflexes● Loss of bladder control● Loss of bowel control● Paralysis● Back pain



Get the answers you need.

Often, orthopaedic doctors can recognize a spinal cord disorder based on its characteristic pattern of symptoms. Doctors always do a physical examination, which provides clues to the diagnosis and, if the spinal cord is damaged, helps doctors determine where the damage is located. An imaging test is usually then done to confirm the diagnosis and determine the cause. Magnetic resonance imaging (MRI) is the most accurate imaging test for spinal cord disorders. MRI shows the spinal cord, as well as abnormalities in the soft tissues around the cord and in bone. If MRI is not available or cannot be done, myelography with computed tomography (CT) is used.



Life’s too short to put up with pain.

With a team of experts behind them, our patients benefit from the expertise of a variety of specialists at Kayal Orthopaedic Center. Common spinal treatments include physical therapy and minimally invasive surgery, depending on the type and severity of the spinal disorder, with the overall goals of treatment being pain relief and restoration of functional capacity.

Spinal Disorders

Bulging Discs

Treat Bulging Discs and Alleviate Pain

Bulging discs are a normal spine condition experienced by most people. The spine contains 33 bones, or vertebrae, with a doughnut-shaped disc, cushioned between many of them. As the surrounding bones push into the discs, they flex and naturally bulge, allowing for movement and flexibility in the spine.

Most people with bulged discs will live their entire lives without any problems or symptoms. However, when spinal discs deteriorate too quickly, the discs can bulge excessively and lead to complications and pain.

  • Causes

    There are many causes of bulging discs and it’s a common problem as people age. Here are a few of the reasons people may experience bulging discs:● Wear & Tear: It’s natural for discs to deteriorate over time, which makes them more prone to bulging during day-to-day activity. Also, the way you sit, sleep or stand can also put a strain on the body that will cause a bulged disc over time. Maintaining good posture and avoiding unnatural positions can help prevent bulging discs.Occupational and recreational activities can also cause bulging discs if you are sedentary or perform repetitive tasks throughout the day. People with desk jobs and those who frequently lift, bend or stand are at an increased risk of bulging discs.● Injury: Contact sports and other athletic activities can put an unnatural strain on the back and body, leading to bulging discs from accelerated disc deterioration or injury.● Obesity: Excessive weight on the body can put a strain on the back as well, which can also cause bulged discs in some people. Maintaining a healthy weight can help prevent bulging discs.

  • Symptoms

    Many people with bulging discs don’t experience any symptoms and can maintain ordinary, healthy lives. When symptoms of bulging discs do occur, it’s typically the result of the bulged disc impacting the nerves or spinal cord and those symptoms will vary based on the disc’s location. As a result, it can be challenging for people to diagnose bulged discs without the expertise of an orthopaedic doctor. However, common symptoms of bulging discs include:● Pain or muscle spasms in the lower back● Sciatica or shooting pain from the buttocks to the legs● Radiating pain in the middle or upper back● Tingling or pain in the neck, shoulders, arms and hands
    In some extreme cases, bulging discs may also lead to a loss of bladder or bowel control.

  • Diagnosis

    Kayal Pain & Spine Center experts will initially diagnose your bulging disc based on your history and symptoms and may have the potential diagnosis corroborated by a physiotherapist. Imaging tests such as an MRI or CT scan will then be used to confirm the diagnosis, providing an accurate view of the discs within your spine.

  • Treatment

    Numerous treatments are available for bulging discs and your Kayal Pain & Spine Center specialist will work with you to identify the optimal treatment for your needs. In many cases, conservative treatments that include rest, over-the-counter medication and physical therapy can alleviate the symptoms of bulging discs.

    Minimally invasive surgery is also an option when conservative approaches don’t provide relief. Your Kayal Pain & Spine Center doctor may discuss laminectomy, laminotomy, disc replacement or other simple surgical procedures, depending on the location and symptoms of your bulging disc.

Disc Degeneration

Take Steps Toward Pain Relief

The flexible discs between the vertebrae are the part of the spine that allow bending and twisting in healthy individuals. Spinal discs are designed to be shock absorbers between the spinal bones and are constructed to allow flexibility in the back. Through the process of aging, these rubbery discs eventually become smaller and lose rigidity.

Disc degeneration refers to back or neck pain caused by normal wear-and-tear on spinal discs, sometimes causing weakness, numbness or shooting pains in the arms or legs. Typically, the disease causes steady and low-level chronic pain with brief occurrences of more severe pain.

  • Causes

    Degenerative disc disease is pain caused by a disc that has lost integrity—it’s not an actual disease. Since spinal discs consist of a tough, outer wall and a gelatinous inner wall (the “nucleus pulposus”), there is very little blood supply. Once the disc is injured, it is unable to repair itself and the deterioration can cause pain.

    For this reason, several factors contribute to the degeneration and pain involved. Age is a common factor, contributing to discs drying out and losing some of their ability to absorb shocks. Normal, daily activities and sports can contribute to tears in the outer area of the disc and injuries can cause slight swelling and pain.

  • Symptoms

    The most common symptom of disc degeneration will be continuous but low-grade pain around the disc. Occasionally, this can flare up into more severe pain arising from abnormal strains on the spine. However, this severe pain can sometimes arise from no obvious activity at all. These occurrences can last anywhere from a day or two to several weeks before returning to lower pain levels.

    It is important to recognize disc degeneration pain can be felt in a number of ways throughout the body. Other symptoms can include an increase in pain with activities that involve bending or twisting the spine or lifting heavy objects. Muscle spasms can be a symptom, as well as an increase in back pain when sitting or standing for long periods of time. Similarly, pain in the neck when looking down can be a symptom, as can pain that feels unreasonably hot. This hot, sharp pain is often felt in shoulders, arms, hips or the back of the leg.

  • Diagnosis

    Degenerative disc disease is difficult to diagnose. It develops gradually and is attributed to many possible related problems. The experts at Kayal Pain & Spine Center will discuss your medical history, understand your symptoms and often perform X-rays and spinal imaging tests to find the cause of your pain. Once disc degeneration is confirmed, we will develop a specialized treatment plan. This plan will help you manage your pain and travel the road to recovery.

  • Treatment

    For many individuals, disc degeneration can be treated successfully with nonsurgical care, often consisting of medication that will control the inflammation. This medication can be taken orally or through epidural injections as is often combined with physical therapy, strengthening exercises and low-impact aerobic conditioning.

    Surgical options, such as disc replacement, will usually only be considered when the patient is still experiencing pain more than six months after nonsurgical care has begun. In this case, your Kayal Pain & Spine Center specialist will discuss and recommend the best surgical approach for your pain.

Herniated Disc Management

We Can Restore Your Long-Term Spine Health

Discs are flat, rubbery cushions that maintain spinal flexibility and act as shock absorbers for the spine. A herniated disc (slipped/ruptured disc) is one of the most widespread causes of leg, neck, and back pain.
Herniated discs occur when pressure from the vertebrae impacts the discs in between. The disc’s soft, gel-like center (nucleus pulposus) pushes through a weak or damaged section of its outer layer (annulus). The herniated disc then presses on nerves, resulting in what can be severe pain.
Herniated discs usually occur in the lower (lumbar) section of the spine, but they also occur in the neck (cervical) and thoracic spine. No matter where the condition occurs, herniated disc management is required as an intervention treatment to help restore spine strength and prevent long-term damage.

  • Causes

    Several factors can contribute to a herniated disc, including:● Aging and degeneration: Herniated discs occur more often in people between the ages of 35 and 55.● Excessive weight: Doctors believe that extra weight increases the stress on the lumbar spine.● Physically demanding work: A sudden strain from heavy lifting or sudden twisting.● Gender: Men have twice the risk for herniated discs compared to women.● Family history: Disc-degeneration can be hereditary and is associated with an increased risk for a herniation.

  • Symptoms

    Some of the symptoms you may experience with a herniated disc include:● Arm or leg pain: If your herniated disc is in your lower back, you will feel the most intense pain in your buttocks, thigh, calf and foot. If your herniated disc is in your neck, the pain will usually be concentrated in the arm and shoulder. This pain may shoot into your arm or leg if you cough, sneeze or move in a certain way.● Numbness or tingling in the affected area.● Weakness: Muscles connected to the affected nerves tend to weaken. This could cause you to fall or be unable to lift or hold everyday items.
    You could also have a herniated disc without knowing it. Some people show no symptoms, but the condition will show up on a scan.

  • Diagnosis

    The orthopaedic team at the Kayal Pain & Spine Center specializes in herniated disc management. Our award-winning experts will direct the diagnosis and treatment of herniated discs, regardless of location and severity. We provide world-class treatment for patients in Bergen County and beyond. Diagnosis is achieved through physical examinations and imaging tools, such as X-rays, MRIs and CT scans.

  • Treatment

    If conservative treatments and physical therapy are unsuccessful, surgery may be needed to repair the disc herniation. If your herniated disc remains persistently painful, a visit to a Bergen County spine specialist is advised. With state-of-the-art diagnostic tools, the award-winning experts at the Kayal Pain & Spine Center will tailor an appropriate treatment plan for your unique case. Herniated disc management is based upon the specific herniated disc(s), along with your age, physical condition, and other medical issues.

Lower Back Pain

Get Your Back Back

Lower back pain is one of the most common medical problems reported by patients. While the severity and cause of back disorders vary, one thing common to most of these disorders is the major impact that lower back problems can have on patients’ lives.
Regardless of the cause and severity, our surgeons are specialists in diagnosing and treating lower back conditions, including spinal fractures, herniated discs, pinched nerves, sciatica, spinal stenosis, and degenerative disc disease, and bulging discs.

  • Prevention

    You may be able to avoid back pain or prevent its recurrence by improving your physical condition, and learning and practicing proper body mechanics.

    To keep your back healthy and strong:
    ● Exercise. Regular, low-impact aerobic activities—those that don’t strain or jolt your back—can increase strength and endurance in your back, while allowing your muscles to function better. Talk with your doctor about which activities are best for you.● Build muscle strength and flexibility. Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together. Your doctor or physical therapist can tell which exercises are right for you.Maintain a healthy weight. Being overweight strains back muscles.

  • Diagnosis

    At some time in their lives, most people will suffer from lower back pain. This pain can be due to a wide range of causes. For some lower back pain patients, there is a genetic component to their condition. Others may suffer through lower back pain brought on by a mechanical problem. Most often, lower back conditions are caused by injuries or the wear-and-tear of aging. The good news is that the majority of cases improve on their own. For pain that persists, a visit to a spine specialist is a necessity. Our orthopaedic surgeons provide expert treatment for patients with lower back pain and disorders. Diagnosis is accomplished through a combination of physical examinations and imaging tests, such as MRIs and CT scans.

  • Treatment

    After diagnosis, Dr. Kayal and his expert team can determine appropriate treatment for each patient. Conservative treatment may include rest or limited activity, anti-inflammatory medications, physical therapy, braces, and steroidal injections. If lower back symptoms continue, surgery might be necessary.

Neck Injuries

Get Advanced, Long-Lasting Relief

The neck is vulnerable to a wide range of disorders. Herniated discs, degenerative disc disease, fractures and persistent pain—which can also be felt in the back, shoulders and arms—are just a few common neck problems. These conditions have the potential to limit nearly every aspect of a person’s life, causing disabling pain and reduced range of motion.
The surgeons at our practice specialize in diagnosing and treating neck conditions of varying degrees of severity, including herniated discs; degenerative disc disease and bulging discs; osteoporosis and osteoarthritis; scoliosis; sprains, strains, and spinal fractures; myelopathy and radiculopathy; pinched nerves and sciatica; and spinal stenosis.

  • Symptoms

    Symptoms of neck injuries include:● Mild to severe pain● Numbness● Tingling● Weakness

  • Diagnosis

    Diagnosis is accomplished through a combination of physical examinations and imaging tools, such as X-rays, MRIs, and CT scans. These diagnostic tools provide Dr. Kayal and his team with the information needed to develop a treatment plan specific to each patient.

  • Treatment

    In minor cases, basic treatment (such as rest, stretching and anti-inflammatory drugs) may minimize neck pain. However, orthopaedic intervention may be necessary to manage more serious disorders. Our surgeons provide expert treatment for patients with neck disorders. Ideally, conservative treatments will be effective. These may include: limited or altered activity, anti-inflammatory medications, physical therapy and exercise, bracing or neck supports, and steroidal injections. Should neck pain and immobility persist, surgical intervention may be required.


Helping to Correct Structural Spine Issues

Scoliosis causes a curve in your spine, often in the shape of a C or S. While this curvature can appear at any age, it often appears between the ages of 10 and 12 or in the early teen years. A structural curve will be permanent and may be related to other issues. However, a nonstructural curve will be temporary and can disappear with time and treatment.

  • Causes

    Scoliosis has several possible causes, the most predominant being neuromuscular conditions. These conditions affect the muscles and nerves and can include muscular dystrophy or cerebral palsy. Other causes can be specific genes that have been inherited, as well as osteoporosis (bone degeneration) or even slightly uneven bone lengths in the legs. Scoliosis can also appear in conjunction with other diseases such as neurofibromatosis or Marfan’s syndrome.

    Your risk of scoliosis is slightly higher if you are female. You also are more prone to the condition if a family member has it.

  • Symptoms

    Some tell-tale signs of scoliosis are slightly uneven shoulders or one shoulder blade that protrudes more than the other. In some case, one hip may be raised higher than the other as a result of slightly uneven leg lengths. If a scoliosis S- or C-curve worsens further, the spine may twist slightly. In this case, the ribs on one side of the body will likely protrude further than the other side.

    Infants with scoliosis may lie curved to one side much more frequently. However, a spinal curve can sometimes develop without you or your child realizing it because the condition can develop gradually and without pain. If you notice small curves in your child’s spine, you should schedule an appointment with the expert team at Kayal Pain & Spine Center. Our team handles every case with care and compassion but is particularly sensitive to the needs of children and their parents or guardians.

  • Diagnosis

    Your Kayal Pain & Spine Center specialist will thoroughly check medical history and discuss any recent growth or body changes. A physical exam will be conducted, where the child or adult patient may be asked to stand and then bend forward from the waist to determine if the rib cage protrudes more on one particular side.

    A neurological check may be conducted to highlight any muscle numbness, weakness or abnormal reflexes. Imaging tests such as X-rays or an MRI may be done to confirm the scoliosis diagnosis and illustrate any underlying conditions that may be causing it.

  • Treatment

    Your doctor at Kayal Pain & Spine Center will work directly with you to determine the best treatment plan. Most children with scoliosis will have mild curvature and will usually not require surgical treatment. They may require visits to Kayal Pain & Spine Center every four to six months to monitor any changes in the spine.

    Your specialist at Kayal Pain & Spine Center will recommend treatment on an individual basis. A variety of factors, including the severity, pattern and location of the curve, will be considered. If your child’s bones are still growing and his or her scoliosis is more moderate, your doctor may suggest a brace. This will not cure the scoliosis but it will prevent further progression. For more severe cases, your doctor may recommend surgery. At Kayal Pain & Spine Center, our compassionate experts will spend as much time with you as needed to answer all of your questions and address all of your concerns.

Spinal Stenosis Treatment in Your Backyard

Reverse Spinal Stenosis Symptoms With Specialized Treatment Plans

Spinal stenosis is pain that results from conditions that cause the spinal canal to become smaller or compress. The spinal canal is the open cavity that runs through the center of each vertebra and houses the spinal cord. When this hole gets compressed, it can pinch the spinal cord or its nerve roots, causing spinal stenosis.
Spinal stenosis is most likely to impact women over the age of 50 and is especially common in individuals with osteoarthritis. The pain and overall impact of spinal stenosis vary by patient, but no person should live with this discomfort long term.

  • Causes

    Spinal stenosis has several causes, most of which are due to unpreventable changes in the spine that occur as people age. Osteoarthritis is the most common cause of spinal stenosis, as bony growths invade some of the spinal cavity’s space, while other common causes include:● Bone spurs● Paget’s disease● Thickened ligaments● Herniated discs● Spinal tumors● Spinal injuriesAny of these conditions can cause the spinal cavity to narrow, providing less space for the spinal cord and nerves, which may result in spinal stenosis.

  • Symptoms

    Symptoms of spinal stenosis vary by the condition’s location. Spinal stenosis in the lower back is called lumbar stenosis, while spinal stenosis in the neck is called cervical stenosis. The third type of stenosis called thoracic stenosis occurs in the mid-spinal region but is much less common than lumbar and cervical stenosis.

    Lumbar stenosis often presents itself with lower back and leg pain or cramping that worsens with walking. You may find that symptoms subside when laying down, sitting or bending forward, only to return when in the upright position. In some cases, tingling, numbness or weakness in a foot or leg is also a symptom of lumbar stenosis.

    Cervical stenosis commonly produces neck pain and walking or balance problems. You may also experience numbness, tingling or weakness in your arm, hand, foot or leg. Bowel or bladder incontinence can also occur in progressed stages of spinal stenosis.

    In the most extreme cases, either form of spinal stenosis can result in severe weakness or paralysis. Spinal stenosis tends to worsen over time.

  • Diagnosis

    Kayal Pain & Spine Center uses diagnostic imaging to accurately identify spinal stenosis in our patients if symptoms suggest that the condition may be present. During diagnosis, you will receive an X-ray, MRI, CT scan, or combination of these, to identify the degenerative damage and narrowed spinal canal that results in spinal stenosis.

  • Treatment

    Kayal Pain & Spine Center offers several different spinal stenosis treatments and our strategy will vary depending on the extent and location of your pain. Steroid injections and physical therapy are often the first-line treatments against spinal stenosis symptoms, effectively eliminating spinal stenosis pain for many patients. However, if spinal stenosis persists, our dedicated surgeons will consider surgical options to widen the spinal canal.

Rheumatoid Arthritis

Diagnose, Treat & Relieve Pain

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s defense system turns against itself and causes attacks on healthy joints, cartilage and tissues throughout the body, along with damage to blood vessels, nerves and tendons. Typically, individuals affected by the condition are between the ages of 40 and 60, and are three times more likely to be women than men.

  • Causes

    The exact causes of RA are unknown, yet there are indications that genetics play an impactful role in the condition’s development.

  • Symptoms

    Rheumatoid arthritis symptoms often begin in small joints such as the knuckles of the hands and the toes of the feet. The most common symptoms are pain, swelling and stiffness in the joints. Typically, these symptoms transpire in multiple joints throughout the body. Since this condition is a systemic disease, an affected individual may feel more diffuse symptoms including fever, loss of appetite, body tiring easily, and lumps developing near the joints.

  • Diagnosis

    Diagnosis of rheumatoid arthritis involves a thorough physical examination of the affected area and an evaluation of the patient’s medical history. The Kayal Orthopaedic Center physicians in Bergen County will look for specific physical characteristics that indicate the presence of RA. These include:● Skin. The presence of callouses indicates areas where abnormal pressure is being applied.● Joint shape. RA weakens ligaments, which causes joint deformities, such as bunions, claw toes, finger angulation, and flat feet to arise.● Flexibility. A joint’s flexibility directly relates to the stage of the condition. If the joint still has a decent level of flexibility, then the condition is in its early stages. If flexibility is limited or barely present, it’s a good indication that there has been a significant loss of cartilage and the condition has progressed.● Tenderness. To determine which joints RA has affected and the severity of treatment required, our physicians will apply pressure to specific areas to see which joints react to the pressure and which remain unbothered.There are other tests our physicians may request to further confirm the affected patient’s diagnosis, including an X-ray, a CT scan, and an MRI scan, which can be conveniently scheduled at Kayal Medical Imaging in Bergen County. A blood test is frequently utilized to test the patient’s blood for certain autoimmune markers.

  • Treatment

    Once a diagnosis has been made, Dr. Kayal and his team will assist patients, who can choose from several convenient offices in Bergen County, with deciding on treatment options. Although there is no existing cure for rheumatoid arthritis, there are progressive approaches that may alleviate symptoms and slow down the progression of the condition. Conservative, non-surgical treatment measures may involve steroid injections, orthotic devices, and viscosupplementation, in which lubrication fluid is injected into the joint. Medications can also help to slow down the progression of the disease. For more severe cases, surgical options may be recommended based on our physician’s discretion. Possible surgical treatment options include:● Minimally invasive arthroscopy to remove diseased cartilage● Fusion for severely damaged joints or ligaments● Total ankle replacement to restore the ankle’s range of motion

Your Sciatica Doctor Can Relieve Symptoms

Restore Your Health With Professional Sciatica Therapy

Sciatica occurs when the sciatic nerve, which runs from your feet to your hips, becomes irritated and inflamed, causing pain and often numbness in the leg. The condition usually only lasts four to six weeks, but, in some cases, it can persist for a longer period. Those with severe sciatica—who experience significant leg weakness or bladder/bowel changes—could require surgical intervention.


It’s important to understand the underlying medical cause behind sciatica, as effective treatment will focus primarily on addressing the pain’s root cause as well as improving acute symptoms. The condition usually only affects one side of the body.
Common causes include:● Herniated disc: Occurs when the soft inner material of the disc leaks out through the fibrous outer core and irritates the nerve root.● Degenerative disc disease: While some level of disc degeneration is natural due to aging, for some people one or more degenerated discs in the lower back can irritate a nerve root and cause sciatica.● Isthmic spondylolisthesis: Occurs when a small stress fracture allows one vertebral body to slip forward on another.● Lumbar spinal stenosis: This condition (caused by natural aging in the spine) commonly causes sciatica due to a narrowing of the spinal canal. It’s relatively common in adults aged 60 and above.● Piriformis syndrome: If the piriformis muscle in the buttock irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain.● Sacroiliac joint dysfunction: Irritation of the sacroiliac joint at the bottom of the spine can also irritate a nerve at the top of the sacroiliac joint, inducing sciatica-type pain.


With sciatica, pain severity varies from a mild ache to an excruciating burning sensation that restricts movement. Some patients report exacerbated discomfort when they are static for a long period, bent down, or engaging in walking, running, or weight lifting.
Possible sciatica symptoms include:● Stabbing, shooting, radiating, or burning pain in your buttocks, on the backs of your legs, and in your feet and toes. You may feel the discomfort almost anywhere along the nerve pathway● Tingling that resembles “pins and needles”● Numbness and weakness● Symptoms may worsen when moving, sneezing, or coughingYou may also have back pain, but it won’t be as bad as the pain in your buttocks, legs, or feet.


The sciatica doctors at Kayal Pain & Spine Center—based in Franklin Lakes, Glen Rock, Westwood and Paramus—specialize in the diagnosis and treatment of sciatica and its root causes. After performing a thorough physical exam, one of our doctors may recommend X-rays, MRIs or CT scans.


Milder cases of sciatica usually resolve themselves with rest, ice and over-the-counter medication. In some cases, you may need your sciatica doctor at Kayal Pain & Spine Center to treat you with cortisone shots, physical therapy or even minimally invasive surgery. These minimally invasive procedures expedite the healing process, leave little scarring and allow you to resume regular activities faster than conventional surgery options. If you’re in the Westwood area and suffering from sciatica, choose Kayal Pain & Spine Center.

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