2013 - Page 3 of 6 - Carl Spivak, MD - Executive Spine Surgery

By Staff Writer Spinal fusion, Treatment problems

Does the body ever reject the materials used in spinal fusion?

Spinal fusion is the connecting of one vertebrae to another vertebrae to strengthen the spine and decrease pain. This is usually done with screws and rod or sometimes a metal clamp. Bone is placed between the vertebrae to cause the vertebrae to grow together to make a solid continuous bone. This is the fusion part of spinal fusion.

It is uncommon for the body to reject spinal fusion materials. Spinal fusion is usually done with bone, plastic (PEEK) or titanium cages and titanium screws and rods. Spinal clamps are becoming more popular and sometimes are used as an alternative to pedicle screws. Bone or bone alternatives are packed into the disk space, facet joints or beside the spine for fusion to happen. It is very rare to have a reaction to bone, PEEK or titanium. Very rarely patients develop an allergic reaction to donor bone. If they use your own bone your body should not react to it. Bone alternatives like calcium phosphate may cause reaction but again this is unlikely.

Rest assured most people go through a spinal fusion without rejection to the fusion materials. To learn more information on spinal fusions please click Spinal Fusion and Options.

To book an appointment please contact Executive Spine Surgery at 908-452-5612 or click schedule-an-appointment.

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

What is the sciatic nerve?

The sciatic nerve is made up of the spinal nerve roots exiting the lower spine. The sciatic nerve travels through the pelvis and down the leg. When disk or bone spur pinches the sciatic nerve in the back it causes back and leg pain called sciatica. This pain tends to be in the back of the thigh and calf. This may be associated with numbness in the little toes and difficulty walking on your toes. Bending forward or lifting your leg may aggravate the pain. People with sciatica benefit from rest, anti-inflammatories, pain medicine, physical therapy, steroid injections and spine surgery.

Today spine surgery is not like how it used to be. Most spine surgeries can be done with laser or spinal endoscope. The arthroscopic procedure is done through a small incision the size of your finer nail through a tube the size of a pen. The herniated disk is found and removed under direct visualization un-pinching the nerve relieving pain and suffering. Patients are discharged home the same day after one to two hours. Many people have little post-operative pain and need for pain medication after surgery and can return to most activities within a few weeks after surgery.

To learn more about sciatica and endoscopic spine surgery please see What is Sciatica? and Laser Spine Surgery.

Click to schedule-an-appointment or call 908-452-5612.

By Staff Writer Treatment problems

My foot continues to flop after surgery. Should I have another surgery?

Herniated disk at the L4-5 level is a common cause of foot drop. Foot drop is weakness bending your foot upwards towards your nose. This may range from mild to severe. As the weakness increases the foot tends to slap down when walking or must be lifted up high to prevent it from snagging on the floor. The weakness may be from dysfunction of the nerve from compression or from nerve damage. The damage may increase the longer the foot drop is present. Usually early surgery is recommended to prevent damage.

The purpose of surgery is to remove the disk and “un-pinch” the nerve. Normal back surgery mainly decompresses the L5 nerve root, but endoscopic transforaminal surgery (such as JOIMAX) enters through the foramen and opens up the foramen taking pressure off the L4 nerve in the foramen and L5 nerve in the spinal canal. Therefore second surgery or surgical approach is not needed. Other advantages include pen sized scope, very small skin incision, minimal muscle damage, same day surgery and quick recovery.

If the foot drop continues after surgery then there may be continued compression at that level or maybe unrecognized compression at the L5-S1 foramen or more likely nerve damage. Nerve damage may improve over months or years or may be permanent.

Sometimes scar tissue is found on post-operative MRI in people who are not improving. Removal of the scar tissue will unlikely help your nerve improve. Continued foot drop after surgery is likely due to preoperative nerve damage.

For more information please contact Executive Spine Surgery at 908-452-5612.

By Staff Writer Neck pain, neck stretch, Pain, Relief

Neck Stretch Exercises for Stiff Painful Neck.

Does your neck get stiff? Do you ever feel like you need to “crack it”? Do you get severe neck pain?

If you answered yes to any of these questions then Neck Stretching may be the answer for you.

Neck pain causes a viscous cycle of stiffness, weakness and pain. For example you twist your neck and develop neck pain. Every movement worsens the pain. You respond by not moving your neck or putting on a neck collar. Unfortunately this weakens your neck muscles and weak tight neck muscles hurt more. You are making the pain worse.

Stretching is the best way to break the pain, stiffness and weakness cycle! Neck stretching stretches the muscles, improves neck mobility and decreases pain.

NECK STRETCH ROUTINE

I recommend a hot shower before stretching to relax and loosen the neck. You need 5 to 10 minutes to properly stretch the neck. You must flex neck forward and hold the neck in that position with your hand on the back of your head. You must simultaneously relax your neck. Hold this stretch for 30 seconds. Repeat this exercise for the rest of the neck stretch positions. After the whole set is complete repeat the set 2 more times. You need to do exercise 3 times in total.

EXERCISE SEQUENCE

Flex head forward x 30 seconds

Extend head backwards x 30 seconds

Turn head right x 30 seconds

Turn head left x 30 seconds

Bend head right x 30 seconds

Bend head left x 30 seconds

Repeat whole sequence for a total of 3 times.

For more information please contact Executive Spine Surgery at 908-452-5612 or email at [email protected]

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

Can I have surgery for an old ruptured disk?

The spine or back bone is composed of vertebrae separated by disks. The disks support and cushion the spine. Over time the disks may become damaged and wear out causing back pain. If the outer disk lining (annulus fibrosis) tears the inner jelly nucleus (nucleus pulposus) may herniate out of the disk and “pinch” a leg nerve causing sciatica. This usually is felt as back pain shooting down the back or side of the leg.

The disk pushing on the nerve causes inflammation around and in the nerve leading to irritation, swelling and pain. The pain and inflammation may settle quickly over a few weeks in some people, but other people the pain may continue for years. Unfortunately long term nerve pinching may cause breakdown of the nerve myelin covering and loss of nerve fibers causing nerve damage. Nerve damage may or may not improve even after the nerve is “un-pinched”.

People with a pinched nerve and pain, numbness and weakness usually require removal of the disk “pinching” the nerve. Sometimes recovery will be longer if the nerve has been “pinched” for a long time.

Yes it is recommended to have surgery for an old ruptured disk if:

1) The disk is still pinching nerve on recent MRI (usually 6-12 months old)

2) The disk causes the type of pain the patient has

3) The disk causes the type of weakness or numbness the patient has

Today Endoscopic Spine Surgery is a new answer to disk surgery. The disk can be found with a small high definition video camera that is inserted into the spine through a skin incision the size of a finger nail. The nerve is then “unpinched” relieving pain and suffering. For more information on minimally invasive endoscopic laser spine surgery please contact Executive Spine Surgery 908-452-5612 or email [email protected] Good Luck!

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

Will I be able to play sports after spinal fusion?

Spinal fusion is the connection of one spinal vertebrae to another spinal vertebrae though a bony bridge. Eventually the vertebrae and bone bridge join together forming a strong “solid bone”. During the healing the bones are “braced” or held in position by titanium screws and rods. The rods and screws prevent the bones from falling apart. Excessive forces placed across spinal instrumentations (screws and rods) may break them preventing the spinal fusion from healing. It may take a year or so for the spine to fuse.

You can return to light activity right away. Most people can return to sports before the spinal fusion heals.

Return to sports depends upon the type of sports, professional or amateur, contact or non-contact, reasons the spinal fusion was needed in the first place, patient’s age, patient’s health, location of the fusion, how many levels were fused and other patient , disease and bio-mechanical factors.

People returning to strenuous, contact and /or professional sports may need to wait 1 year or until the fusion has completely healed.

For more information please see Spinal Fusion and Options. Please call 908-452-5612 to schedule an appointment or click schedule-an-appointment to discus your problem and see if you are a candidate for endoscopic spinal fusion surgery.

By Staff Writer News Endoscopic Spinal Surgery

Study Finds Endoscopic Spinal Surgery Early Discharge

New Jersey-based Executive Spine Surgery alerts spine surgery patients to a recent academic study that showed patients treated with endoscopic spine surgery were discharged quicker then after open traditional spine surgery or minimally invasive microscopic spine surgery.

Back pain suffers who need spine surgery now have evidence that patients who undergo endoscopic spine surgery have quicker recovery and discharge home, say physicians at West Orange-based Executive Spine Surgery. They point to a recently presented academic study that showed patients treated with endoscopic discectomy recovered and were discharged home 94% earlier then open surgery.

Presented at International Society of Advancement of Spine Surgery (ISASS) meeting in Vancouver, BC on April 3, 2013, the study led by the University of Columbia’s Reginald Knight, MD examined the results of almost 300 lumbar decompression patients from Prospective Spine Registry at Bassett Healthcare, a rural multispecialty employed physician-hospital.

Drs. Knight and Spivak and their colleagues used the database to review 283 consecutive elective lumbar degenerative spine cases from years 2010 to 2012, looking at outcomes after traditional-open surgery, minimally invasive tubular microscopic surgery and endoscopic surgery.

The results: All three treatment groups showed remarkable improvements in back pain, leg pain and disabilities scores over the course of the study, but there was significant differences in the length of stay after these surgeries. Patients who underwent open-traditional surgery, minimally invasive surgery and endoscopic surgery had average stays of 1.8, 1.0 and 0.1 days respectively.

“This study emphasizes that endoscopic spine surgery is extremely minimally invasive even for minimally invasive surgery. The exact reason for early discharge is unknown, it is likely due to less tissue damage and pain from the surgery” comments Dr. Carl Spivak. “This is why I make every effort to provide the least invasive, cutting-edge surgical techniques available.”

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

Case Report: 61 Year Old Man Felt Like He was Kicked in the Groin!

Patient History

The patient is a 61-year-old man who presented to emergency room with severe back pain and right testicular groin pain. He said “It felt like I was kicked in the groin”. The medical workup identified additional right leg weakness, numbness and pain. MRI diagnosed right L3-4 slipped disk pinching the right L4 nerve.

Treatment

Patient underwent Endoscopic Laser Spine Surgery for complete removal of the herniated disk. The procedure was done comfortably under twilight sedation and patient had instant, complete pain relief after removal of the large disk fragment. Patient was discharged home pain free one hour after surgery.

Case Discussion

Testicular pain is an unusual presentation of a slipped disk herniation. If the disk becomes injured or weakens it may rupture and leak out of the disk and compress or “pinch” a nerve causing back and leg pain called sciatica.

Endoscopic Laser Spine Surgery is an advanced minimally invasive option to cure back pain. A pen-sized video camera is inserted into the spine to identify and remove the herniated disk and un-pinch the nerve. There is minimal skin or muscle damage or blood loss. Patients are discharged home the same day and benefit from shorter recovery, decreased post-operative pain and quicker return to work.

By Staff Writer Lower back pain, Pain, Spinal fusion

How does spinal fusion help low back pain?

There are many causes of low back pain. Back pain may arise from the muscles, tendons, joints, disks, bones, nerves and spinal cord. Rarely back pain may arise from other organs in the abdomen or chest.

Black disks called degenerative disk disease (DDD) may produce back pain. This may be caused by injury to the disk called an annular tear. Scientists believe annular tears cause pain from ingrowth of pain nerves into the disk. As the disk disease progresses this can lead to weakness in the spine called instability. Instability produces pain from abnormal movements in the spine.

Facet joint damage can also cause back pain. The facet joints hold the back of the spine together. If the joints are injured they can be a source of pain. This is called facet arthropathy and is common when people have severe arthritis in there spine. If the facet joints wears out or break and can no longer hold the spine together then the spine may slip apart. This is called a spondylolithesis.

If the back pain arises from the torn disk then pain is relieved by removing the painful disk and replacing it with cage and bone. If the problem is instability (that is weakness and abnormal movement) the fusion and instrumentation holds the spine together preventing these abnormal movements.

Today spinal fusion can be done minimally invasively with the spinal endoscope (endoscopic lumbar interbody fusion or ELIF). This decreases skin and muscle damage, pain and suffering after surgery and allows you to get gong quicker.

Please see Spinal Fusion and Options for more information about spinal fusion or schedule-an-appointment.

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

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.

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Year: 2013