What are the options for sciatica?

Your back is made up of vertebrae, disks and nerves going to you legs. The vertebrae are made up of vertebral body in the front and lamina and spinal process in the back.  The spinal cord and spinal nerves are located in-between.  If the disks in the back slip out of position and pinch the nerves going to the legs the brain registers this as leg pain even though the problem is in your back.  Sciatica is back and pain typically caused by a herniated disk compressing one of the spinal nerves that become part of the sciatic nerve.  The most common surgery for sciatica is discectomy, or removal of the piece of disk pinching the nerve.  Discectomy procedures include:

1. Laminotomy and discectomy- surgeon makes a midline skin in the lower back.  The back muscles are divided and retracted to the side.  The protective bony lamina is removed to reveal the nerve sac (theca sac) and spinal nerves.  The spinal nerves and nerve sac are retracted and the disk herniation is identified and removed. This is sometimes called a traditional, open discectomy.

2. Miscroscopic discectomy – Same as laminotomy and discectomy but a microscope is used.  The microscopic does not indicate smaller incision but the use of microscope to improve light and visualization.

3. Tubular microscopic discectomy-  Same as microscopic discectomy but instead of making a large skin incision and muscle retraction the surgery is done through a tube.  The skin and muscles are dilated.  Spine bone is removed in a similar fashion to #1 and #2.  Common tube sizes range from 18 to 27 mm in size.  This technique decreases muscle damage and likely back weakness and pain long term.

4. Endoscopic discectomy– This is a revolutionary new procedure.  A very small 8 mm tube is placed into the spine through an existing hole called a foramen.  The hole can even be enlarged if needed.  After the tube is in place, a very small high definition video camera is placed through the tube into the spine.  The disk can be found and removed with tiny instruments quickly relieving pain and suffering. Patients are discharge home right after the procedure and usually experience less postoperative pain. Many people do not take pain medicine after surgery.   As you can see spinal disk surgery has come a long way.

For more information please see the following links:

What Causes Back Pain?

When Should I Consider Back Surgery?

Read More on treatment options for back pain

least invasive, cutting-edge surgical techniques

Laser Spine Surgery

To book an appointment please call 908-452-5612 or click schedule-an-appointment.

New Minimally Invasive Endoscopic Treatment for Neck Pain!

JOIMAX, a world leader in minimally invasive spinal surgery technology will be launching a new endoscopic system for neck surgery on April 3rd to 5th at the International Society of the Advancement of Spine Surgery (ISASS) meeting in Vancouver, BC. This advanced surgical system called CESSYS (Cervical Endoscopic Surgical System) will provide an alternative to traditional open neck surgery and will change how neck surgery is done in the future!

Cervical disk herniation is a common cause of pain, stiffness, numbness and weakness. Traditional neck surgery involves a large incision, retraction of the voice box and food tube, removal of the entire disk, and fusion that may produce ugly scars, hoarse voice, swallowing difficulty and stiffness at the fused level. Cervical fusion also may involve future neck pain and surgery because the remaining disks must compensate for the fused level and may become damaged from excessive movement. An enormous amount of research has been focused on this adjacent level disease.

The artificial cervical disk was developed to avoid fusion and prevent adjacent level disease and future surgeries. Even though the artificial disk was welcomed with great enthusiasm, long-term results are unknown, and there is concern for the longevity of these man-made disks. Minimally invasive posterior cervical discectomy was another approach developed to avoid fusion and subsequent adjacent level disease, although unfortunately, most disks are not approachable through the back of the neck. This has led to development of an endoscopic discectomy through the front of the neck, similar to, but less invasive than the traditional open neck surgery.

Endoscopic spine surgery has become a popular alternative to traditional spine surgery. The endoscope is a pen-sized, high-definition video camera that is inserted into the spine under x-ray guidance. The endoscope allows the surgeon to find and remove the herniated portion of the disk under direct visualization with very tiny instruments, relieving pain and suffering. Advantages of endoscopic surgery include a tiny skin incision, minimal tissue damage and pain, quicker recovery and same-day discharge.

JOIMAX designed the CESSYS cervical endoscopic surgery system to minimize tissue damage and be versatile enough to remove most disk herniation without the need of fusion, with the objective of decreasing the need for future surgery. The CESSYS cervical endoscopic surgical system will be available in the United States in the fall of 2013 to select JOIMAX instructors and faculty, including Dr. Carl Spivak.

Do I need a back brace after spinal fusion?

Spinal fusion surgery is connecting one spinal vertebrae to another spinal vertebrae.  This is done through a bone “bridge”, that is bone is placed between the vertebrae.  The bone is usually placed between the vertebral bodies.  This is called an interbody fusion.  If the fusion is done through your abdomen it is called anterior lumbar interbody fusion (ALIF), through your side/flank  [Direct lateral interbody fusion (DLIF) or extreme lateral interbody fusion (XLIF)] or through your back [posterior lumbar interbody fusion (PLIF) or tranforaminal lumbar interbody fusion (TLIF)].

The surgical approach is important because it relates to pain, disability, muscle damage and complications.  Fusions done through the back tend to be more painful resulting in greater recovery, time off and disability.  This is appears less true for minimally invasive procedures like the endoscopic lumbar interbody fusion (ELIF).  The more muscle damage the weaker the back and the higher chance of future spinal disease and pain.

There are complications related to anesthesia and surgery.  All surgery has risks but the specific risk to fusion surgery is partially related to the approach to the spine:

1.  Surgery done from the abdomen put major blood vessels (like the aorta and  vena cava) and abdominal organs like kidneys at risk.  There is even a chance for errectile dysfunction (E.D.) or retrograde ejaculation (sperm goes into the bladder not out the penis).  These problems can lead to infertility.

2. Surgery from the side can injury the lumbar plexus (these are nerves that supply the legs) causing pain, numbness or weakness in the legs.

3. Surgery done through the back muscles  can injure the muscles causing future pain and new spine problems.  This muscle damage is decreased with minimally invasive surgery.

Most people have to wear a brace after surgery for 1 to 3 months, but it depends on the type of fusion and instrumentation surgery, number of levels fused and the reason for fusion.

For more information on lumbar fusions please click Spinal Fusion and Options or on Dr. Carl Spivak and Executive Spine Surgery please call 908-452-5612 or click Schedule an Appointment.

When you have a pinched nerve, is the pinched nerve always pinched unless surgery? How does the nerve become unpinched?

The spine is made up of vertebral bodies and disks.  The disks are made up of soft gelatinous nucleus pulposus and hard fibrous annulus fibrosis.  As people age, there is a shift in the molecular composition of the disk with decrease in the water absorbing glycosaminoglycans producing a dry brittle disk. The whole disk may bulge out or nucleus pulposus may break through the annulus fibrosis into the disk space and compress spinal nerve causing back and leg pain called sciatica.  The pain is aggravated and potentiated by inflammatory reaction around the herniated disk and nerves.

Sciatica may resolve without surgery if the inflammation or swelling resolves or the herniated disk may be broken down and removed by inflammatory white blood cells.   Sciatic leg pain may resolve over few weeks to months or over many years.  Most cases of sciatic that are going to resolve quickly settle in 1 to 3 months, otherwise it may take 4 years or never settle.

Please see the following links for more information on sciatica and endoscopic surgery:

What is Sciatica?

When Should I Consider Back Surgery?

Laser Spine Surgery

Click to Schedule an Appointment on-line or call 908-452-5612.