“Dr. Kaptain is AMAZING in all aspects of being a doctor and person.”
Degenerative Spondylolisthesis and Segmental Instability
Degenerative spondylolisthesis is one of those diagnoses that tends to alarm patients more than the finding itself usually warrants. A vertebra has shifted forward, which sounds significant, but what actually determines the treatment path is whether that segment is stable and whether it’s producing symptoms that match what the patient is experiencing. Many patients are surprised to learn that the amount of slippage is often less important than whether that slippage is stable or still moving. How Degenerative Spondylolisthesis Develops...
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Lumbar Spinal Stenosis and Neurogenic Claudication
One of the most recognizable patterns I see in the office is a patient who can walk comfortably through a grocery store while leaning on a cart, but who develops heavy, aching, or tingling legs within a few minutes of standing upright or walking without support. When that pattern shows up, lumbar spinal stenosis with neurogenic claudication is almost always at the top of the list. What Narrows the Spinal Canal in Lumbar Stenosis The lumbar spinal canal houses the...
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Why Do I Have New SI Joint Pain After Lumbar Fusion?
A common pattern shows up in follow-up visits after a lumbar fusion: a patient’s original back and leg pain is gone, but a new, different pain has developed low in the back or buttock that wasn’t there before. It’s a distinct complaint, often felt more to one side, and it tends to worsen with sitting, standing from a seated position, or rolling over in bed. In many of these patients, the pain generator isn’t the fusion itself. It’s the sacroiliac...
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Disc Herniation vs. Bulge: Why the Difference Matters
When patients receive an MRI report that mentions both a disc herniation and a disc bulge, the questions that follow are almost always the same: which one is worse, which one is causing the pain, and what needs to be done about each? These are reasonable questions, and the distinction matters. A disc bulge and a disc herniation are different structural events with different implications for symptoms, prognosis, and treatment decisions. At New Jersey Brain and Spine, we evaluate patients...
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Adjacent Segment Disease After Spinal Fusion
One of the conversations I have regularly with post-fusion patients goes something like this: their fusion worked. Their original leg pain resolved, they got their function back, and life returned to something close to normal. Then, months or years later, a new pain begins. Different location, different character. They come in wondering whether their fusion has failed or whether they are facing something more serious. In many of these cases, what we are looking at is adjacent segment disease, or...
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Brain Tumors: How Location Determines Symptoms and Treatment
Where a brain tumor is located tells us nearly as much as what type of tumor it is. The symptoms a patient experiences, the degree of functional risk surgery carries, the structures that must be protected during any intervention, and the overall prognosis are all shaped substantially by the tumor's position within the brain. Two patients with the same tumor histology and the same grade can present in entirely different ways, follow entirely different treatment courses, and require entirely different...
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Cervical Myelopathy: When Neck Compression Affects Balance and Hand Function
Cervical myelopathy tends to announce itself gradually, and that gradual onset is part of what makes it easy to miss. Patients come in describing subtle changes they have been noticing for months: handwriting that has become harder to control, buttons and zippers that take more effort than they used to, a sense of unsteadiness walking on uneven ground or in dim light. Some attribute these changes to aging. Some have seen other specialists for the hand symptoms before anyone considers...
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Why Nerve Pain Travels: Understanding Radiculopathy Patterns
One of the most disorienting symptoms patients bring to us is pain that originates in the spine but travels far from it. Lower back pain that shoots down through the buttock, the back of the thigh, and into the calf. Neck pain accompanied by a burning or electric sensation that radiates into the shoulder, the arm, or the fingers. Patients often arrive having been told the pain is in their leg or their arm, having spent weeks treating the wrong...
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How Neurosurgeons Evaluate Nerve Damage
Patients come to us describing symptoms that do not fit neatly into the categories their previous workup has addressed. A hand that is progressively losing grip strength. Tingling that starts in the lower back and runs into the foot. Weakness in one arm that appeared without any clear injury. These presentations raise the same fundamental clinical question: is this a nerve problem, where in the nervous system is it originating, and what is actually happening to the nerve involved? Evaluating...
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