Month: March 2014

5 Common Questions About Sciatica & Minimally Invasive Spine Surgery

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

Sciatica is back and leg pain resulting from pinching the sciatic nerve. This is most commonly caused by a slipped disk in the back. Today lumbar disc herniations may be removed minimally invasively with the spinal endoscope

2) I think I have sciatica. Should I see a GP or a Chiropractor?

I would recommend seeing your primary care doctor to orchestrate the workup and treatment of your pain. You will likely require anti-inflammatory medicine, physical therapy, an MRI scan and possibly steroid injections or surgery.

3) Will sciatica caused by a herniated disc get better without surgery?

Disc herniations rarely resolve on their own. It is more common for them to get a little smaller over time then resolve. Surgery is the best treatment to physically remove the damaged disc. Today this can be done endoscopically though a tiny incision.

4) What kinds of surgeries can help sciatica?

Sciatica is leg pain usually caused by a slipped disk in the spine pinching the sciatic nerve. The most common surgery for sciatica is discectomy, or removal of the piece of disk pinching the nerve. Today this can be done through a very small incision with an endoscope. Usually the pain resolves before you leave the operating room!

5) How successful is a discectomy at relieving back pain?

Discectomy best relieves sciatica leg pain. Back pain may be relieved after discectomy but it is not as consistent as leg pain. Patients with back pain without leg pain and degenerated herniated disk usually undergo a diagnostic test called a discogram to help determine if surgery will work.

Who Can Spine Surgery Help?

Pain in the lower back and legs can be caused by almost any structure in the back and many other organ systems. Patients with severe back and leg pains may have little abnormal findings on MRI scan and patients with no pain may have severe abnormalities, therefore it can be difficult to determine the exact causes of the pain. A good history and physical examination, radiological tests and nerve studies can identify most causes. The best outcome is when the person has typical symptoms (complaints), physical exam findings and MRI abnormalities. The less typical the complaints, the less likely the patient will benefit from surgery. If the exact cause cannot be identified or there are many possible causes, then pain mapping may be beneficial pinpoint the cause of the pain.

Pain mapping is the usage of spinal injections to delivery numbing or provocative solutions to suspected causes of the pain. Numbing medicine may block the pain and provocative medicine may worsen the pain.

The results of surgery are also affected by motivation, coping skills, psychological problems, drug addiction, lawsuits and worker’s compensation.

Failed Back Syndrome is when patients fail to improve or worsen after spine surgery. These patients often continue to take pain medicine and are unable to return to work. Failed back syndrome is not one specific problem but a generalized term for people who did not do well.

There are many causes for failed back syndrome including unrealistic expectations (they wanted to feel like they were twenty), incorrect diagnosis and treatment, correct diagnosis but wrong surgery or the problem was not properly fixed. There may be additional pain from a partially or unrecognized source. Bleeding, nerve damage or spinal leak may complicate surgery. A new problem may form after surgery, such as disc herniation, blood clot, infection or scar tissue. Muscle damage or bone removal may lead to spinal weakness, instability and new pain. The prospect of loss of income, personal attention or returning to a poor work situation may hamper recovery.

The potential for failed back syndrome can be limited if both doctor and patient are positive and have good communication and honesty. Thorough studies and an accurate diagnosis of the problem are essential as well. The attitude and expectations of the patient as well as his or her life situation must be considered by the treating physician as well for the optimum outcome.

What is Cervical Spinal Stenosis?

Spinal stenosis is the narrowing of the spinal canal, in this case the spinal canal in the neck, not the back (lumbar spinal stenosis).This may be inherited, that is you were born with a small spinal canal, or acquired, in which case the spinal canal became smaller over time from degeneration. This could include bulging discs, bone spurs and thickened ligaments.

As people age, the neck begins to “wear out”. This begins with the drying out and collapse of the cervical discs. In some patients, this is severe enough to be considered cervical disc degeneration. A collapsed disc in the cervical spine can change the forces across the spine and results in abnormal motion. To stop this motion, the body strengthens the neck by thickening the spinal ligaments and stabilizing the mobile joints with bone spurs. This is especially seen behind the vertebral bodies, around the facet joints located at the side of the spine and in the ligamentum flavum (yellow ligament) at the back of the spinal canal. These changes lead to decrease in the size of the spinal canal and may result in spinal cord compression.

Cervical spinal stenosis may cause spinal cord injury and dysfunction called myelopathy. This may be due to compression, abnormal spinal motion or poor blood supply. Myelopathy commonly presents in older people with neck pain, clumsy hands and difficulty walking. This may be associated with pain, numbness, tingling, weakness, coordination problems (doing up buttons, fastening bra and eating), arm and leg stiffness, and bladder and bowel dysfunction. Head movements may cause electrical shocks to shoot down their spine. At times people may show slow decline in mobility: from a cane to walker to wheelchair. Rarely spinal stenosis causes paralysis.

Thankfully this condition can frequently be treated with minimally invasive spine surgery. Tools and a camera are inserted through a very tiny incision to remove bulging discs, bone spurs and impinging ligaments. If you are suffering from cervical spinal stenosis, make an appointment with a spine surgeon today to see if you are a candidate for life-changing minimally invasive spine surgery.

What is the MILD Procedure for Lumbar Spinal Stenosis?

MILD Stands for Minimally Invasive Lumbar Decompression. If your lumbar spinal stenosis is caused by excess spinal ligaments, then this quick out-patient procedure could be for you. Tiny instruments are inserted through an incision the size of a dime or smaller. These specialized tools allow your surgeon to remove the excess tissue that is causing your spinal canal to narrow, which reduces symptoms such as pain and tingling, and restores mobility. This relatively simple surgery does not require general anesthesia, and it does not even require stitches. Patients who have undergone the MILD procedure report increased standing time and a much greater ability to walk without pain or numbness. Like most minimally invasive surgeries, the MILD procedure has a very low risk of complications.

How do I know if the MILD procedure is for me?

If you are suffering from numbness, pain or tingling in your legs and/or buttocks when walking or pain or numbness in your lower back when standing, you may be suffering from lumbar spinal stenosis. You should should see a spine surgeon to evaluate the cause of your pain and see if the MILD procedure is an effective treatment for you.

What Do I Do For My Broken Back? Treating Osteoporosis Spine Fractures

As we age, a common problem, especially for women, is osteoporosis – the thinning and weakening of bones. One of the many problems caused by this dangerous condition is stress fractures of the spine, also known as wedge fractures, burst fractures, collapsed vertebrae, and broken back. As the body ages, the square vertebral body of the spine can weaken or be injured with excessive force. It may break and flatten like a pancake, causing back pain and misery. Osteoporosis is the major cause of vertebral body compression fractures; other less common causes include severe trauma, infection or cancer.

Pain is the most common complaint from spine fractures. Any movement causes micro-motion in the broken bone, which produces severe pain. This pain usually decreases when the patient lies down, and increases with standing, walking and lifting. Sometimes people have no pain at all. Rarely fractures may cause numbness, weakness, paralysis or bowel and bladder dysfunction from spinal cord or nerve compression. Fortunately, the severe back pain often improves during the first month after injury.

X-ray, CT, bone scan and MRI may diagnose spinal fractures. Besides diagnosing the fracture, MRI scans can determine if the fracture is new and rule out nerve or spinal cord compression.

Is there a surgical treatment for spine fractures?

Patients who do not respond to conservative treatment may benefit from surgical treatment. The key to surgical treatment is stabilizing the fracture. The spine, like a broken arm, must be “cast” to stop abnormal bone movement and prevent pain. Surgical options include vertebroplasty, kyphoplasty and major spine surgery. Major spine surgery is not commonly needed to treat osteoporotic compression fractures.

Vertebroplasty and kyphoplasty are the most common treatment for osteoporotic compression fractures. These procedures involve the placement of a needle into the fractured vertebral body for the injection of liquid cement. Once the liquid cement hardens it stabilizes the vertebral body decreasing painful movements. If there is concern for cancer then a bone biopsy is sent to pathology for examination.

Vertebroplasty is an outpatient procedure, done under conscious sedation like a colonoscopy, but can be done under local anesthesia in high-risk patients or rarely general anesthesia. A needle is placed into the fractured vertebral body under x-ray guidance and then liquid plastic is slowly injected to harden and stabilize the fracture.

Kyphoplasty is similar to vertebroplasty, but kyphoplasty involves the placement of two needles on each side of the spine and balloons into the broken vertebra under x-ray. The balloons are slowly inflated to expand the collapsed “pancake” vertebral body and create cavities to hold the plastic. Plastic is then injected after the balloons are removed to support and stabilize the broken vertebrae.

Women who developed vertebral body compression fractures are at least four times higher risk of developing future spine fractures. Elderly patients with bone fractures should undergo investigation and treatment for osteoporosis.