Can scoliosis cause chronic back pain?

The spine is made up of a stacked alternating vertebral bodies and disks.  The spine is usually straight on anterior posterior x-ray.  Scoliosis is an abnormal curvature of the spine.  The spine may look like a C or S on X-ray. Scoliosis may arise from birth abnormalities where the spine was formed wrong, such as missing half of a vertebrae or from changes resulting from arthritis.  The cause of scoliosis in young people is unknown and is called idopathic even though certain genetic traits have been defined.

Children are commonly screened at school for scoliosis, especially at the time of the growth spurt when the development and progression is most common.  Patients suspected of having scoliosis undergo a history and physical and relevant laboratory investigations.  This may include x-rays, serial x-rays, CT and MRI.  Patients found to have a spinal curvature of greater than 10 degrees are diagnosed as scoliosis.

Scoliosis alters the mechanics of the back and puts significant strain on the vertebral bodies, disks, muscles and even the nerves leading to chronic pain and suffering.

Treatment is complex and requires individualization.  Smaller curvatures are watched while larger curvatures greater then 20 to 30 degrees may require bracing. Surgery is usually reserved for very large curvatures greater then 45 to 50 degrees which have high likelihood to progress even more.  Other indications for surgery include pain, weakness, difficult mobilizing and breathing.  Surgery usually involves spinal fusion surgery, this may be done through the front (anterior), side (lateral) or back (posterior) combined with spinal instrumentation (screws and rods).

Overall prognosis of scoliosis depends on the likelihood to progress.  Patients with larger curvatures, thoracic curves, double curves and immature spines (such as adolescents) have higher chance or progressing.


Dr Spivak is a neurosurgeon who specialized in minimally invasive endoscopic spine surgery.  He is a well known teacher and speaker in laser spine surgery.  For more information on scoliosis, other spinal disorders or laser spine surgery please call 908-452-5612 or click schedule-an-appointment.

Why do I have a pain in the butt?

Butt pain commonly arises from the sacroiliac joint (SI joint).  This pain is called sacroiliitis.   SI joint pain maybe felt under your jean pocket.    SI joint may cause back, buttock and leg pain. The pain is worse sitting especially on the butt cheek and with activity.

Causes of SI joint pain include arthritis (degenerative sacroiliitis), separation or weakness of the joint (SI joint disruption or laxity), abnormal joint from birth (sacral dysgenesis), inflammation and swelling (ankylosing spondylitis, Reiter’s syndrome or inflammatory bowel disease (IBD)), break or fracture, infection, bone disease and tumor.

The sacroiliac joint is the located between the spine (sacrum)  and the hips (ilium).  It is a large joint held together by strong muscles and ligaments.

SI joint pain can be difficult to diagnose and often is associated with spinal disease.  SI joint pain can be diagnosed by careful history, physical examination and diagnostic injections.  A needle is placed into the joint under x-ray or CT scan and steroid and pain medicine is injected.   Pain relief confirms the diagnosis of SI joint pain.

People may benefit from physical therapy, anti-inflammatory medicine and steroid injections. Patients who fail conservative treatment may consider fusion surgery.   Fusion surgery “fuses” the sacrum to the ilium to prevent pain.  This is done by surgically placed implants.  Many  people will have coexisting spinal disease requiring spinal surgery.


Dr. Spivak is a neurosurgeon who is fellowship trained in minimally invasive spinal surgery (MISS).  He treats a variety of disorders of the neck, back and SI joints. For more information on spine or SI joint treatment please call 908-452-5612 or click schedule-an-appointment.

Where do you get the bone for spinal fusion?

People often ask 2 questions about spinal fusion:

1) Why do you need bone?

Bone is a key ingredient in spinal fusion.  Spinal fusion is done when the spine is weak and needs to be made stronger.  One vertebral body is connected to another vertebral body with metal screws and rods.  Bone is placed in-between the vertebrae so the vertebrae will grow together and form one solid bone.  If bone isn’t placed  and a solid spinal fusion is not obtained the screws and rods will eventually loosen and fall out or break.

2) Where do you get the bone from?

In the old days the bone was taken from your body.  Usually a piece of your hip would be cut out and then used as graft for the fusion.  Sometimes only the inside of the hip bone would be scraped out.  Today  donor bone or synthetic bone alternatives like hydroxyapatite are usually used.. Bone removed during the operation is rarely used.  This may still be done if the person last fusion surgery failed to fuse and now the surgery was been redone or if they are very high risk for the fusion failing such as smoker, sick or on chronic anti-inflammatory medications.

About Dr. Carl Spivak and Executive Spine Surgery

Dr Spivak is a neurosurgeon with expertise in minimally invasive spine surgery and is a pioneer in endoscopic spine surgery.  He routinely teaches workshops and courses for doctors throughout the United States for JOIMAX USA.  For more information on how Dr. Spivak can help you, please call 908-452-5612 or click schedule-an-appointment.

Will a back brace help alleviate my lower back pain?

Back braces are commonly used for back pain.  They provide support for the back and may relieve pain.  They are best used to help brace the back to prevent injury (such as a work belt) rather to treat pain.  They may be useful during flareups, but wearing a back brace all the time can lead to weakening of the back muscles and increased ironically more back pain.

A properly fitted back brace will limits spinal movement. It may affect participation in sports, especially if a lot of back movements are involved.

Back braces are commonly used after spinal surgery, especially fusion surgery.  They limit movement, support and most importantly remind patients to not over do it.

Back surgery today is not like 10 or even 5 years ago.  Most back surgeries can be done using a small spinal endoscope through an incision the size of your fingernail (index.php).  Since the surgery is minimally invasive their is less tissue damage and as a result pain.  Patients may forget they just had surgery and over do it.  Heavy lifting, strenuous activity or running may re-injure their back.  Wearing  back brace may remind the patient to take it easy.

About US:  Dr. Spivak is president of Executive Spine Surgery.  He specializes in extremely minimally invasive spine surgery utilizing new endoscopic technology recently introduced from Germany. Dr. Spivak has offices in Manhattan, NY, West Orange, NJ and Hackettstown, NJ.  Please call 908-452-5623 or click on schedule-an-appointment.

Sharp shooting pain in my left arm.

Neck and back pain are very common problems seen in spine clinics today.  Patient may develop neck pain from damaged degenerating disk, arthritis is in the facet joints,  muscle spasms, broken bones, looseness or instability of the spine.  If these problems lead to compression of the spinal cord or neck nerves then arm pain may develop.   Moving the neck may worsen the arm pain.  This pain may be associated with numbness and tingling, pins and needles and/or weakness in the arm. They may develop weakness or poor coordination in the hands and unsteadiness when they walk leading to falling.

Patients with pain, numbness and tingling may benefit from rest, physical therapy and anti-inflammatories prior to considering surgery.  Patients with more severe problems including weakness or coordination require more urgent surgical consultation.

Traditionally surgery was done with a decompression, inter-body fusion and instrumentation either through the front or back of the neck. There are new options today!  JOIMAX has just developed and released a new Cervical Endoscopic Surgical System (CESSY) operating on neck problems.  Through a very tiny incision a tiny camera is placed through the neck into the disk space.  The slipped herniated disk is found under direct vision and removed with very tiny instruments.  No fusion or spinal hardware is needed.

The first course on this new Cervical Endoscopic Surgery was hosted in Baltimore , MD in July 2013.  These techniques are now available at select practices in the USA.

For more information please contact 908-452-5612 in New Jersey or 212-547-8005 in New York City or contact us through the web by schedule-an-appointment.

When can I have Sex after back surgery?

Patients often ask when they can safely have sex after back surgery.  This is a common concern for the patient and for their significant other.

Often their sex life has already been affected.  Back pain may interfere with intimacy, decrease sex drive (libido) and interfere with sexual enjoyment.  Patients with pelvic numbness or nerve dysfunction may feel less stimulation and pleasure or have difficulties developing or sustaining an erection or orgasm. Even worse, sex might aggravate the back injury, causing a great deal of pain and ultimately making sex unpleasant and unwanted.  Back pain can also lead to depression or be associated with depression, another factor that can affect your sex life.

No wonder people are concerned!

I am happy to tell you that sex is safe after back surgery.  For patients undergoing traditional back surgery, doctors commonly recommended waiting 6 to 12 weeks before resuming sexual activity. These operations involved a large midline incision, muscle retraction and bone resection, and patients suffered intense pain from muscle damage. These surgeries are very different from today’s advanced endoscopic spinal surgery. Endoscopic surgery is done through a tiny incision the size of your finger nail, using a little high definition video camera the size of a pen! There is minimal skin, muscle and bone damage.  Most people recover in a few weeks and the incision is small and less likely to be torn open.

The great advancements that have been made in minimally invasive back surgery means that patients treated endoscopically can start having sex again after only 2 weeks if their incision is healing well, their pain has resolved or significantly improved, and their sex drive has returned.  The healing time will increase for other more invasive surgeries or surgeries involving spinal instrumentation.  As with all activity, the patient should approach sex in a safe, gentle manner and take on a passive role. The patient should avoid heavy lifting, bending and twisting. They should stop if pain develops. As an old colleague of mine told his patients, “No shaking the trailer!”

They may benefit from small pillow under their low back, stacked pillows under their knees to bend the hips and support the legs, and taking a well-supported position.  They may also benefit from taking pain medication prior to sex. Their partner should avoid putting their full weight on them.  The patient may have less pain starting with missionary position, lying down on their side or standing and bending over a chair.

Since all patients and surgeries are different, you should discuss your return to sexual activity with your doctor. Though you might feel awkward bringing it up, don’t worry. It’s a very normal, healthy concern.


Can I do yoga after spinal fusion?

Spinal fusion is a surgery to connect one vertebrae to another vertebrae.  This is done by the placement of bone in between the vertebrae and connecting the vertebrae with rods and screws or other fixation devices.

The patient’s activity is restricted after spinal fusion.  Most patients are restricted from twisting, bending and lifting after spinal fusion.  Walking and light activity is encouraged.  Yoga is a series of postures and breathing exercises.  There are many benefits of yoga including improving flexibility, strength, posture and breathing.

Flexibility is improved by slow gradual stretches decreasing stiffness in muscles, ligaments and joints.  Strength in legs, back and arms are improved by holding specific postures.  Yoga is important for core strengthening.  This is especially important in people with back problems.  Posture is improved through core strengthening.  Some yoga can be aerobic but  breathing is controlled to promote relaxation.

Yoga may be helpful after spinal fusion.  Treatment should be direct by an yoga teacher experience in spinal fusion treatment.  Extreme bending and twisting movements should be avoided until your back is fused to prevent screws and rods from breaking.

For more information on spinal fusion please see Spinal Fusion and Options.

Click schedule-an-appointment to set up a consultation.

Do I need rehab after spinal fusion?

Spinal fusion surgery is the joining one spinal vertebrae to another.  This is usually done by placing bone in between the vertebrae and then connecting the vertebrae together with screws and rods, hooks, wires or clamps.

Even though spinal fusion surgery can be painful and initially limit activity, the main reason for rehabilitation after surgery is general weakness and reconditioning.  Severe back pain may lead to decreased level of functioning and de-conditioning.   Rehab also helps people to manage with activities of daily living (eating, preparing food, bathing, dressing, cleaning, etc), proper usage of assistive devices such as canes, walkers, wheelchairs and usage of spinal braces.  Sometimes back braces can be tricky to take off and put on, especially for people who have weakness or arthritis in there hands.  Rehab is also more common with big surgeries.

The amount of rehab depends on general health, functional ability, severity of the disease, the type of surgery done and the number levels fused. Rehab can vary from none to inpatient. People who need rehab usual need outpatient physical therapy 2 to 3 times per week. Elderly patients may require in patient for many days to weeks depending on their physical condition and the level of support they have at home.

Please see Spinal Fusion and Options for more information.

To set up a consultation please call 908-452-5612 or schedule-an-appointment online.

Should I hire a nurse after spinal fusion?

Spinal fusion surgery is the joining of one backbone to another backbone (bony vertebrae to another bony vertebrae).  This is usually done for instability, that is when the spine is weak and falling apart.  Spinal fusions can be large, painful and debilitating procedures, but hiring a nurse is not usually not necessarily required after lumbar fusion surgery.   That said each person, spinal disease and surgery is different.  If you are very concerned you could set up just in case.

Minimally Invasive Spine Surgery (MISS) tends to be less painful and debilitating then open surgeries. Multilevel surgery is more painful then single level surgery.  Minimally invasive surgery is less painful then open traditional surgery because there is less tissue destruction.  In traditional surgery there is a large skin incision, signifiant retraction of the back muscles and a lot of bone removal resulting in severe pain.

Tissue damage is minimized with minimally invasive surgery.  The skin incision is small instead of large.  The muscles are dilated (pushed apart) rather than retracted.  Muscle retraction damages muscles producing scar tissue and weakness resulting in pain.  Little if any bone needs to be removed during minimally invasive fusion (this is especially true for endoscopic lumbar interbody fusion (ELIF).  These benefits results in less pain then with traditional fusion surgery.

For more information on spinal fusion click Spinal Fusion and Options

For more information on how Executive Spine Surgery can help you please call 908-452-5612 or inquire at schedule-an-appointment.

Dr. Spivak Imports Cutting Edge German Technology for Spine Repair

Dr. Carl Spivak, board-certified Neurosurgeon and specialist in minimally invasive spine surgery, has returned from Germany with the latest techniques and technology. Dr. Spivak dedicates himself to keeping up with the latest innovations in spine repair and disk regeneration.

Back and neck pain is often caused by the herniation of spinal disks. Traditional methods to repair damaged disks involve a large incision and retraction of the muscle around the spine so that the disk can be removed and replaced or fused. When performed on the neck, there is even more potential for damage, as the voice box and the esophagus must be retracted as well. This can cause unpleasant side effects such as difficulty swallowing and a hoarse voice, as well as scarring. In the case of disk fusion, rather than replacement, there is potential need for future neck surgery, as the remaining disks must compensate for the missing disk and may eventually become damaged by the strain.

To avoid these and other complications, much research has been done in the realm of endoscopic and other minimally invasive techniques. Endoscopic spine surgery is a becoming a popular alternative to more invasive procedures. The pen-size endoscope is a high-definition camera that is inserted with x-ray guidance. The endoscope allows the surgeon to remove the herniated section of the disk with tiny instruments. This relieves pain and suffering with minimal tissue damage and a same day discharge.

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.

German doctors and research scientists have been refining and perfecting endoscopic techniques. Dr. Spivak has spent the past week meeting with them and furthering his knowledge of endoscopic spine surgery. His newly acquired knowledge of pioneering German technology will help him perform even more advanced endoscopic techniques, minimizing tissue damage and potential complications.

Upon his return from Germany, Dr. Spivak also celebrated the launch of his new Manhattan office. He will now be available at the new Manhattan location, which features an on-site surgical center.