December 2012 - Carl Spivak, MD - Executive Spine Surgery

By Staff Writer Treatment Options for Back Pain

What can I do to prepare for vertebroplasty and kyphoplasty?

Usually you need to:

1. Stop anti-inflammatories, aspirin, ibuprofen, plavix, warfarin 1 week before surgery. It is important to stop these medicines because they can cause excess bleeding during surgery. Unfortunately, they are important to prevent heart attacks and strokes so please check with your primary care doctor or cardiologist before discontinuing these medicines.

2. Do not eat or drink anything after midnight.

3. Arrange for a ride to and from the surgery center or hospital and for someone to stay with you afterwards.

For more information on vertebroplasty and kyphoplasty please click Kyphoplasty. Good Luck!

How can I ease upper back pain?

There are many causes of upper back pain. The pain may originate from your bones, disks, muscles, joints, nerves and spinal cord, neck, shoulders, lungs and heart. Most causes of upper back pain I see is from spine fractures, pulled muscles or arthritis. Initially you may be treated with rest, anti-inflammatory medicine, muscle relaxant and sometimes pain medicine. If the pain is severe your doctor may take you out of work. If the pain does not improve or you have neurological problems (weakness, numbness, etc) then you would need a full workup which may include X-rays, MRI and sometimes blood tests. Further treatment would depends on what is found.

Click Read More for information on treatment options. Please contact Executive Spine Surgery for more information. Good Luck!

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Lower back pain, Pain, Relief, Sciatica, Spinal Stenosis, Treatment Options for Back Pain

I have a large disc protrusion compressing my L5 nerve and causing spinal stenosis. Do I need surgery?

Disc protrusion is when the disk slips out of it’s normal position in between the spinal vertebrae and extends into the spinal canal. Other commonly used names are bulging disk, slipped disk or herniated disk, etc. Spinal stenosis is tightness or loss of volume of the spinal canal.

Right L4-5 disk protrusion initially is treated with conservative treatment which may include rest, physical therapy, medications and steroid injections. Surgery is considered when a patient fails conservative treatment and/or has severe pain, numbness, weakness or neurological dysfunction (such as urinary incontinence).

Today most disk surgery can be done by using extremely minimally invasive surgical techniques called endoscopic spine surgery or laser spine surgery. This revolutionary same day surgery is done through a tiny tube the size of a pen which is placed into the spine under X-ray guidance. The disk is found and visualized through the high definition video camera found inside the spine endoscope. The disk is then removed with tiny little instruments taking pressure off of the nerve. This usual provides quick relief of pain and suffering. Often patients feel much better right after surgery.

For more information on sciatica and lumbar disk herniations click on the following link Sciatica. Good Luck!

By Staff Writer Lower back pain, Relief, Surgery, Treatment Options for Back Pain

What is the difference between vertebroplasty and kyphoplasty?

Vertebroplasty and Kyphoplasty are very similar procedures. Kyphoplasty is a slight variation of vertebroplasty.

In both vertebroplasty and Kyphoplasty a large needle is placed into the broken vertebrae under x-ray guidance. Next plastic is injected into the fractured vertebrae in vertebroplasty, but in Kyphoplasty a ballon is blown up. The balloon may push the bone back into its original position (that is reduce the fracture). The balloon is then removed and plastic is injected into the cavity. Overall they are very similar procedures and have similar outcomes. Please click on Kyphoplasty for more information. Good Luck!

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Pain, Sciatica

What does degenerative disc disease and no signal abnormality within the cord or enhancement mean?

Degenerative disc disease = “worn out” degenerated disks in your spine

No signal abnormality = spinal cord looks normal, no abnormal signal suggesting disease or damage

No enhancement = the spinal cord is not taking up contrast die. This would suggest inflammation, infection or cancer

For more information on sciatica please click the blog below. Please contact Executive Spine Surgery for more information on degenerative disk disease, disk herniations, sciatica and endoscopic spine surgery. Good Luck!

I have a pain in my left butt that goes all the way down my leg. What could that be?

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Pain, Relief, Sciatica, Surgery

I have a knife pain on right side of mid back that radiates around ribs but I never experience severe abdominal pain.

You may have a thoracic disk herniation with a pinched nerve. You will need an MRI scan of your thoracic spine. Thoracic disk herniations are uncommon but they can be dangerous especially if they pinch and damage the spinal cord. Thoracic disk herniations can cause shooting pain around your rib cage and weakness, paralysis or bowel and bladder incontinence. They are usually treated surgically if there is neurological deficits. In the past open traditional surgery was the only option to treat thoracic disk herniations. This was a large operation with significant risk. Today there are new minimally invasive spine surgery (MISS) options for thoracic disk disease including laser discectomy or endoscopic discectomy.

Endoscopic discectomy involves placement of needle into the herniated disk, followed by serial dilation of the soft tissue and placement of an endoscopic port. The endoscope is then placed through the port to the herniated disk. The disk is then removed with small cutting and grabbing instruments under direct visualization. After the disk is removed and the nerve is unpinched the endoscope and tube are removed allowing the soft tissues to fall back together. Single suture and dressing is used to close the incision. The patient is discharged home the same day.

Click Read More to learn about treatment options. Good Luck!

By Staff Writer Neck pain, Pain, Surgery, Treatment problems

I had a cervical fusion done at C4-C7 4 years ago, but I am still in pain. Do I need it redone?

This is difficult question without seeing you and your films. Most cervical fusions heal 1 year after surgery. If the X-rays and/or CT scan showed healed fusion of C4-C7 (that is C4-5, C5-6 and C6-7) revision will unlikely help your neck pain. Your neck pain maybe from breakdown of another level of your spine such as C3-4 or C7-T1. This is called adjacent level disease. After fusion surgery, the disks beside the fusion must take up the extra movement lost by the fused levels. This may increase “wear and tear” on these disks, increasing the chance of developing future problems. It is possible one of your other disks have now become painful. You may also have neck pain from stiff weak neck muscles. You may benefit from daily neck stretches.

Please see the following blog posting for instructions on neck stretches. Please contact Executive Spine Surgery to schedule an appointment. Good Luck!

I smashed my shoulder into the pool wall 5 days ago and now I can’t move my neck or shoulder without a lot of pain.

By Staff Writer Lower back pain, Pain, Spondylosis

I pulled a back muscle and collapsed 2 discs. Is this the cause of Scheuemann’s Disease?

No this probably did not cause your Scheuremann’s disease.

Scheuremann’s disease is wedge shaped spinal vertebrae. This is from uneven vertebrae growth during adolescence. The back of the vertebral body grows faster then the front forming a wedge or triangle shape to the vertebrae. When multiple vertebrae are affected these triangles cause an increase in the curvature of the back resulting in a hunchback or kyphosis. The cause of Scheuremann’s disease is not known. It does not progress after you stop growing. It can cause severe back pain, rarely it can affect your internal organs and spinal cord. Trauma or on-the-job injuries do not cause Schuermann’s disease.

Severe work injuries can cause multiple vertebral body compression fractures that maybe wrongly diagnosed as Schuermann’s disease. Work injury can also damage other spine structures like muscles, ligaments and joints causing pain unrelated to the compressed vertebrae (Schuermann’s disease). Independent on the the presence or absence of Schuermann’s disease the most important question is did you have back pain prior to the injury. If you did not then something was injured during the injury that is now causing your pain. For more information on Scheuremann’s disease or on endoscopic spine surgery please contact Executive Spine Surgery. Good luck!

By Staff Writer Relief

I started yoga again after a long break. What stretch is safe for my body?

Great! Yoga is good for improving flexibility and core strength. Unfortunately I am not an expert at yoga. I recommend discussing your workout routine with your yoga instructor. As in with any exercise it is safest to start slow and slowly increase over time. You should try to increase your stretch over many days or weeks as you recondition your body. You want to avoid very painful stretches to decrease the chance of tearing soft tissues and injuring yourself. Good luck!

By Staff Writer endoscopic spine surgery, laser surgery, Pain, Spinal Stenosis, Surgery

I’m 63 and now when I walk for a short distance the back of my right leg starts burning to the point I can hardly walk. What is this?

Leg pain from walking is called claudication. Neurogenic claudication is leg pain from nerve compression in the spine. This is called stenosis and results from thickened ligaments, bone spurs and disk herniations. Some people are at increased risk of spinal stenosis because they were born with a smaller spinal canal then normal. This is called congenital spinal stenosis. Spinal stenosis and neurogenic claudication presents with back pain and diffuse leg pain and numbness from walking which is relieved by using a shopping cart or sitting down. Some people describe it “like walking on a cloud”. Vascular claudication is leg pain from narrowed arteries in your legs. It is brought on by walking and is relieved by sitting or standing still. People usually have absent pulses, skin and hair changes in there feet.

You probably have spinal stenosis compressing your spinal nerves and decreasing blood supply to the nerves. If the nerves can not get enough blood and oxygen they “suffocate” developing pain and numbness in the legs. Stopping and sitting down or bending forwards decreases pressure on the nerve, improving blood supply and decreasing pain.

Many people benefit from rest, physical therapy, anti-inflammatories, nerve medicine (such as neurontin), steroid injections and surgery. Please click on Sciatica for more information on lumbar spinal stenosis. Please contact Executive Spine Surgery for a consultation on spinal stenosis. Good Luck!

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Month: December 2012