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Month: January 2013

Carl Spivak, MD - Executive Spine SurgeryNews2013January
By Staff Writer Lower back pain, Pain, Relief, Sciatica, Spinal fusion, Spinal Stenosis, Treatment Options for Back Pain

My lower back is in pain all the time and my doctor did an x-ray of my lower back and it came back fine, what else could be wrong?

Low back pain is a common complaint in America.  It may arise as result of injury but ususally there is no specific cause.  There are many potential causes of low back pain.   The pain may originate from many different structures including your spine bones, disks, facet joints, muscles, ligaments,chest and abdomen, etc.  Please see What Causes Back Pain?  for more information.

X-ray is not a sufficient workup for back pain, most people need at least an MRI scan to properly evaluate their back.  Sometimes they need special diagnostic injections called pain mapping.  This may include diagnostic transforaminal nerve blocks, medial branch blocks and discogram.

Unless a serious cause of back pain is found most doctors recommend to start with conservative treatment, such as rest, physical therapy to improve core muscle strength and flexibility, non steroidal anti-inflammatory medications, pain medicine and steroid injections. Patients who do not improve may benefit from surgery.  Please see When Should I Consider Back Surgery?

Depending on the cause of the pain patients may benefit from disk surgery (What is Sciatica?), lumbar laminectomy (Overview of Spinal Stenosis), lumbar fusion (Spinal Fusion and alternate Options) or vertebroplasty or kyphoplasty (Kyphoplasty – what is it?).

For more information please Schedule an Appointment. Good Luck!

By Staff Writer endoscopic spine surgery, laser surgery, Pain, Relief, Spinal fusion, Surgery, Treatment Options for Back Pain, Treatment problems

How painful is recovery from lumbar spinal fusion surgery?

Spinal Fusion is the joining of one vertebrae to another vertebrae by a bone graft.  This bone graft acts as a bridge between the two vertebrae.  Spinal fusion is held together with metal screws and rods. It is done for symptomatic degenerative disk disease, spine fractures, cancer, spinal instability and spondylolithesis.  Large open spinal fusions may have incisions many inches long while single level minimally invasive spinal fusion can done through 1 inch incisions.

Recovery from lumbar spinal fusion depends on the patient’s health, pathology being treated  [what is actually wrong with your spine,  the number of levels affected (single vs multilevel disease) and prior surgery and complications] and the lumbar fusion technique.  Minimally invasive surgery tends to be less destructive, painful and have a quicker recovery. Most people will be on pain medication for a week to months as they recover from there surgery.

For more information please Schedule an Appointment! Good Luck!

By Staff Writer endoscopic spine surgery, Lower back pain, Relief, Spinal fusion

Do I have to wear my back brace at night?

Back brace is used to stabilize your spine after spinal fusion surgery.   These braces are used to hold the spine together until fusion occurs.  Spinal Fusion is the joining of one vertebrae to another vertebrae by bone bridge.  The two vertebrae and the bone graft eventually become one solid bone.  Spinal instrumentation acts as a internal brace to hold the fusion together.  This may consist of rods, screws, plates, clamps or wires.

The rate of spinal fusion depends on many factors including age, activity, size, location.  Spinal fusion is decreased by smoking and usage of non-steroidal anti-inflammatory medications.

Spine braces can be in the form of a neck collar after anterior cervical discectomy and fusion (ACDF), thoracic lumbar sacral orthosis (TLSO) after treatment of a thoraco-lumbar burst fracture or lumbar sacral orthosis (LSO) after lumbar fusion.

For more information on back braces please see the following blog posts:

Is it bad to use a back brace?

Should I be wearing a back brace if I have a disc injury?

Back braces are not usually worn in bed because there are less forces being applied across the surgical site and less chance of damaging the fusion and instrumentation holding the spine together.

For more information please Schedule an Appointment.   Good Luck!

By Staff Writer endoscopic spine surgery, laser surgery, Lower back pain, Relief, Surgery, Treatment Options for Back Pain, Treatment problems

What is the recovery time for lumbar fusion?

Spinal Fusion is the joining together of the spinal vertebrae with bone.  This is usually done through the disk space [called anterior lumbar interbody fusion (ALIF), direct lateral interbody fusion (DLIF) / extreme lateral interbody fusion (XLIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) or endoscopic lumbar interbody fusion (ELIF)] but can be done posteriorly over the lamina (posterior fusion), in the facet joints (facet fusion) or transverse processes [posterolateral fusion (PLF)].

The Endoscopic Lumbar Interbody Fusion is the newest development in fusion techniques and many believe will cause the least damage and pain and have the quickest recovery.   Endoscopic fusion is done through a small tube with the aid of an endoscope.   This endoscopic area of spine surgery is generally called Laser spine surgery, even though lasers are rarely used today.

Recovery time varies from person to person and from procedure to procedure. The larger the procedure (that is more exposure and therefore tissue damage and the greater number of levels fused) the longer the recovery. People recover quicker from minimally invasive procedures.  Recovery can take from a couple weeks to many months.  Most people can return to light activity (no strenuous lifting or exertion) in few weeks.

Schedule an Appointment to learn more about endoscopic lumbar interbody fusion (ELIF).

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Pain, Sciatica, Surgery, Treatment Options for Back Pain

I am 39 year-old woman with left leg pain and numbness. What can I do?

Your left leg pain and numbness is probably from a “pinched” nerve in your back.  This is called Sciatica.  Sciatica in a 39 year old is most commonly caused by a disk herniation.  Treatment for sciatica varies from rest, physical therapy, anti-inflammatories, steroid injections and surgery.   Pain that is not improving, very severe or associated with neurological deficits (weakness, foot drop, numbness or bowel and bladder incontinence or retention) may require spinal surgery.

In the past spinal surgery was a big deal.  You were admitted to the hospital, put to sleep under a general anesthetic and had your back half opened up to expose the spine.  The muscles were retracted and damaged and the bone was removed.  This bone removal is called a laminectomy or laminotomy, depending on how much lamina was removed.  Then the traversing nerve and thecal were retracted and the disk was found and removed.

Today disk surgery is much simpler.  Disk surgery can be done through a spinal endoscope (such as JOIMAX), this is often called Laser spine surgery, even though the laser is not necessary today.  The big advancement of “Laser spine surgery” is the used of an endoscope.  An endoscope is a pen-sized micro-video camera that is placed inside the spine to the herniated disk pinching the sciatic nerve.  Tiny instruments are inserted through the endoscope to remove the disk.   The sciatica leg pain often improves very quickly often before surgery is over.

Schedule an Appointment to learn more about endoscopic spine surgery and how it can help you!

By Staff Writer Neck pain, Pain, Treatment Options for Back Pain

How long does it take for anterior cervical discectomy and fusion (ACDF) surgery to fuse?

Anterior cervical discectomy and fusion is a surgical disk removal procedure through the front of the neck relieving pressure off the spinal cord and nerves.  After the neural elements are well decompressed and the endplates of the vertebrae are prepared a piece of bone is placed into the emptied disk space.   This bone may be from the patients body (usually the hip) or can be specially prepared from cadaveric bone.

The bone graft then must incorporate into the spinal vertebrae.   The bone from the upper and lower vertebrae slowly grow into the graft ultimately making one large “bone”.   This can be a slow process.  Fusion usually takes 6 to 12 months or more.   I wold not expect you to be fused in 3 months.  Initially the bone weakens and then slowly becomes stronger as the bone from the other vertebrae grow through it.  The healing is not complete until fusion is completed. I would recommend giving it more time.

Artificial disk replacement is a new option to cervical fusion.  The procedure is done in a similar manor to the anterior cervical discectomy and fusion.  The disk is removed and the endplates are prepared.  An artificial disk is then placed into the neck instead of the bone graft.  Even though artificial disks are relatively new medical technology there may be significant advantages including early return to activity since you do not have to wait for the bone to fuse and less wear and tear at the adjacent disks spaces which may lead to further spinal disease after a fusion.

Endoscopic cervical discectomy is another fusion sparing option for removal of cervical disks.  The spinal cord and nerve are decompressed, spinal motion is maintain and no metal disk is placed into the neck.

For more information please Schedule an Appointment.

Good Luck!

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

I have tailbone pain, making sitting and standing up very uncomfortable.

Tailbone pain often results form falls or injuries to your coccyx.  Rarely pain may arise from lesions in the tail bone such as cancer.  Many traumatic injuries to the tailbone may respond to hemorrhoid cushion (which takes pressure off the tailbone and helps pain and swelling settle), anti-inflammatory medicine or steroid injections, rarely patients may need tailbone surgery.  For treatment options for back pain please click Read More.  Good Luck!

By Staff Writer Pain

I have left shoulder pain radiating down to my hand.

Shoulder, arm and hand pain may arise from problems in the neck, shoulder, arm or hand. Most commonly this type of pain is secondary to a disk pinching a nerve in the neck (cervical radiculopathy) or thickened ligament pinching the median nerve in the hand (carpal tunnel syndrome), but there are many possibilities for neck and arm pain.

Many people benefit from physical therapy and anti-inflammatories for neck pain and hand brace for carpal tunnel syndrome. People who fail to improve may benefit from steroid injections and/or surgery.  For more information on treatment options please click Read More or contact Executive Spine Surgery.  Good Luck!

By Staff Writer Lower back pain, Nerve damage, Scoliosis

Is there a link between strength and the development of scoliosis?

Scoliosis is the curvature of the spine.  Scoliosis may result from juvenile scoliosis in kids (unknown cause), spine, arthritis, neurologic disease, surgery, injury, etc.  Neurologic disease such as a spine tumor may cause back muscle weakness resulting in scoliosis. Scoliosis is not caused from being out of shape or not working out at the gym (that is being weak).  I hope this information answers your question.

For more information please click on Does scoliosis cause pain?  Good luck!

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

Is it bad to use a back brace?

Frequent use of a back brace may lead to weakening of your back muscles and the development of increased back pain. It is best to strengthen your core muscles to stabilize your back to decrease back pain.  I recommend starting Yoga.  Yoga is a great exercise to strengthen your abdomen and back, improve flexibility and loose weight!  For more information please contact Executive Spine Surgery.  Good Luck!

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