About Our PracticeAbout Our Practice

Our doctors are all highly experienced and renowned in the field of orthopaedic medicine and surgery.

We offer:

  • Board Certification in Orthopaedic Surgery
  • Board Certification in Anesthesiology
  • Board Certification in Pain Medicine
  • Decades in practice helping patients

In the News!

A Second Chance by Dr. Lospinuso

Freedom To Move by Dr. Bhatnager

The following doctors have been named Jersey Choice Top Doctors 2014 by New Jersey Monthly

  • Dr. Ramil Bhatnagar, MD FAAOS
  • Michael F. Lospinuso, MD FACS
NJ Monthly Top Doctor 2014
About Our Practice
Dr. Bhatnagar's Congratulations Letter
Dr. Lospinuso's Congratulations Letter
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Common Diagnoses

Spondylolisthesis Treatment

Spondylolisthesis is a displacement of one vertebrae on another adjacent vertebrae. This slipped vertebra misaligns part of the spinal column and must be treated as soon as it is discovered in order to prevent serious complications from developing.

Symptoms associated with spondylolisthesis often include:

  • Lower back pain
  • Upper leg pain
  • Gluteal/buttocks pain
  • Oversensitive nerves near the slipped vertebrae
  • Stiffness and muscle tightness

If it remains untreated,spondylolisthesis can result in increased lordosis (swayback) or kyphosis (roundback), which can in turn lead to a pronounced slouching position, neurological deficits and decreased lung capacity.

Types of Spondylolisthesis

There are several different types of spondylolisthesis, ranging from fairly common divisions to rare congenital defects:

  • Isthmic Spondylolisthesis is considered the most common form of spondylolisthesis. It normally develops in children between the ages of five and 17, often causing no symptoms. The slip in the vertebra normally does not progress beyond its initial movement, and is thus is only treated if the slip is considered "high grade" (less than 10% of all slips), meaning that the vertebra is 50% or more displaced off of the inferior bone segment.
  • Degenerative Spondylolisthesis is a common form of spondylolisthesis that develops naturally as a person ages due to the prevalence of arthritis in the elderly. As the facets wear down over time, they shift their orientation slightly, allowing a mild slip to occur. These slips are asymptomatic and usually are not found until spinal stenosis has exacerbated the slip. This combination of spine ailments is the most frequent indication of spine surgery in the elderly population.
  • Dysplastic Spondylolisthesis is a very rare congenital defect concerning the malformation of the lumbosacral junction, also known as spondylolysis. Specifically, the facet joints are extremely underdeveloped and possess little surface area, which prevents treatment via posterolateral fusion.
  • Traumatic Spondylolisthesis is also a very rare subtype, characterized by a fracture of the pars interarticularis or interior facets that occurs as a result of a severe impact.
  • Pathologic Spondylolisthesis is an extremely rare type of spondylolisthesis that only occurs in the presence of equally rare metabolic bone diseases.


Your doctor will take a complete medical history and perform a physical examination. Spinal X-rays may be taken to determine whether a vertebra is misaligned and if there are any existing fractures.


Treatment for the various forms of spondylolisthesis is considerably less varied than the subtypes of the disorder itself. The two general forms of treatment are conservative pain management and rehabilitation, as well as surgical fusion of the vertebrae, usually of the posterolateral nature.

However, most patients are recommended to follow the rehabilitation and NSAID/acetaminophen treatment path for a suitable period of time (up to six months) before surgery is considered.

Surgery can consist of posterior lumbar laminectomy, discectomy, correction of spondylolisthesis and instrumented fusion. This may be able to be performed in a minimally invasive fashion if the anatomy allows.

Contact our office to learn more about spondylolisthesis or to schedule a consultation.

Spinal Stenosis Treatment

Spinal stenosis involves a narrowing in one or more areas of the spine as a result of injury or deterioration to the discs, joints or bones within the spinal canal.

Most cases of spinal stenosis develop later in life as a result of degenerative changes that occur in the spine. Osteoarthritis is the main cause of spinal stenosis, as it initiates the deterioration of the cartilage in the area and leads to the bones rubbing against each other and forming bone spurs. Spinal stenosis can also be caused by a herniated disc, ligament changes or spinal tumors.

Patients with spinal stenosis may experience cramping, pain and numbness in the legs, back, neck, shoulders or arms. A loss of sensation, loss of balance and bladder malfunctioning may also occur.

Spinal stenosis is often difficult to diagnose because its symptoms can come and go and may resemble the symptoms of other conditions. A diagnosis of spinal stenosis is usually achieved only after ruling out other conditions. Typically, doctors will perform imaging exams such as a spinal X-ray, MRI, CT scan and bone scan as well as ask questions about your symptoms and overall health to correctly diagnose your condition.

Most cases of spinal stenosis can be effectively treated through conservative methods such as physical therapy, nonsteroidal anti-inflammatory drugs, rest and a back brace. For more severe cases, surgical procedures such as a decompressive laminectomy, laminotomy or fusion may be required to relieve pressure and join the damaged bone back to its normal state.

A subtype of spinal stenosis is foraminal stenosis. This condition is caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through. As a result of aging or other musculoskeletal conditions such as arthritis, the foramen may gradually develop bone spurs that can press on the nerves, causing pain and other symptoms.

Patients with this condition may experience numbness, weakness and tingling sensations throughout the arms and legs, depending on which area of the spine is affected.

Effective treatment of foraminal stenosis can usually be achieved through nonsurgical techniques including anti-inflammatory medications, corticosteroid shots, physical therapy exercises or wearing a brace. Those patients whose conditions do not respond may require a surgical procedure called foraminotomy.

  • Radiculopathy
  • Spondylosis
  • Instability
  • Spondylolisthesis
  • Fracture
  • Cord compression
  • Tumor
  • Metastasis
  • Scoliosis
  • Kyphosis
  • Myelopathy

Contact our office to learn more about spinal stenosis or to schedule a consultation.

Common Diagnoses
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