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Year: 2016

Carl Spivak, MD - Executive Spine SurgeryNews2016
By Staff Writer Treatment Options for Back Pain

History of Endoscopic Spine Surgery

Endoscopic spine surgery, also called laser spine surgery by the public, is spine surgery done through a small endoscope. The endoscope allows direct visualization of the surgery on the spine without large skin incisions, muscle retraction, bone removal, pain and general anesthesia. Initially, it was used to treat small, contained disk prolapses, but with improvement in endoscopes, surgical equipment and techniques this technique expanded to treat most spinal disorders.

Endoscopic spine surgery developed out of the clinical and laboratory research of Dr. Parviz Kambin in the early 1970’s in Philadelphia, PA. His initial work was the removal of the nucleus pulposus, which is the soft, gel-like material in the center of a lumbar disk. Dr. Kambin studied the anatomy of the disk and defined a safe zone into the disk which was later named Kambin’s triangle. This triangle is free of critical structures and is surrounded by the exiting nerve root, traversing nerve root and the inferior vertebral body margin. It allows safe passage into the disk for removal of the nucleus pulposus. Dr. Kambin also developed a percutaneous surgical instrument set to remove the disk under x-ray guidance. The disk or spine could not be directly visualized.

In 1989, Dr Schreiber was first to place an arthroscope into the disk to directly visualize the disk material.

In the 1990’s, Dr. Anthony Yeung developed the first spinal arthroscope (“YESS”) spine endoscope. He was largely responsible for the popularization of endoscopic spine surgery. Dr. Yeung developed the “Inside Out” technique. The endoscope was placed into the disk space to remove the nucleus pulposus and then the endoscope was pulled out of the disk space to remove any disk material in the foramen.

Thomas Hoogland developed a set of endoscopic instruments which included trephines or reamers to enlarge the lumbar in 1994. He later worked with MEDI-Tech and then JOIMAX to produce the THESSYS system. This revolutionary system allowed the surgeon to open up the foramen to provide direct access into the spinal canal. This was called the “Outside In” technique because you started outside of the disk and then moved into the disk as needed. Endoscopic spine surgery was no longer limited to working inside the disk and the foramen. This new access allowed visualization of the nerves and spinal canal for the removal of disk herniations that move outside of the disk wall (annulus fibrosis), permitting “traditional” spine surgery to be done through the endoscope.

JOIMAX continued to refine and develop these techniques which were later renamed TESSYS after Dr. Hoogland left the company. The surgical techniques continue to grow and expand with the development of new power drills, endoscopes and other surgical equipment. This continued innovation and development by JOIMAX is exciting, considering most areas of spine surgery development have a plateau.

Dr. Carl Spivak is the president of Executive Spine Surgery in Hackettstown, NJ, and a board-certified neurosurgeon. He is recognized worldwide for his expertise in innovative, noninvasive and state-of-the-art endoscopic spinal surgery.

Endoscopic spine surgery, also called laser spine surgery by the public, is spine surgery done through a small endoscope. The endoscope allows direct visualization of the surgery on the spine without large skin incisions, muscle retraction, bone removal, pain and general anesthesia. Initially, it was used to treat small, contained disk prolapses, but with improvement in endoscopes, surgical equipment and techniques this technique expanded to treat most spinal disorders. Endoscopic spine surgery developed out of the clinical and laboratory research of Dr. Parviz Kambin in the early 1970’s in Philadelphia, PA. His initial work was the removal of the nucleus pulposus, which is the soft, gel-like material in the center of a lumbar disk. Dr. Kambin studied the anatomy of the disk and defined a safe zone into the disk which was later named Kambin’s triangle. This triangle is free of critical structures and is surrounded by the exiting nerve root, traversing nerve root and the inferior vertebral body margin. It allows safe passage into the disk for removal of the nucleus pulposus. Dr. Kambin also developed a percutaneous surgical instrument set to remove the disk under x-ray guidance. The disk or spine could not be directly visualized. In 1989, Dr Schreiber was first to place an arthroscope into the disk to directly visualize the disk material. In the 1990’s, Dr. Anthony Yeung developed the first spinal arthroscope (“YESS”) spine endoscope. He was largely responsible for the popularization of endoscopic spine surgery. Dr. Yeung developed the “Inside Out” technique. The endoscope was placed into the disk space to remove the nucleus pulposus and then the endoscope was pulled out of the disk space to remove any disk material in the foramen. Thomas Hoogland developed a set of endoscopic instruments which included trephines or reamers to enlarge the lumbar in 1994. He later worked with MEDI-Tech and then JOIMAX to produce the THESSYS system. This revolutionary system allowed the surgeon to open up the foramen to provide direct access into the spinal canal. This was called the “Outside In” technique because you started outside of the disk and then moved into the disk as needed. Endoscopic spine surgery was no longer limited to working inside the disk and the foramen. This new access allowed visualization of the nerves and spinal canal for the removal of disk herniations that move outside of the disk wall (annulus fibrosis), permitting “traditional” spine surgery to be done through the endoscope. JOIMAX continued to refine and develop these techniques which were later renamed TESSYS after Dr. Hoogland left the company. The surgical techniques continue to grow and expand with the development of new power drills, endoscopes and other surgical equipment. This continued innovation and development by JOIMAX is exciting, considering most areas of spine surgery development have a plateau. Dr. Carl Spivak is the president of Executive Spine Surgery in Hackettstown, NJ, and a board-certified neurosurgeon. He is recognized worldwide for his expertise in innovative, noninvasive and state-of-the-art endoscopic spinal surgery.

By Staff Writer Treatment Options for Back Pain

History of Endoscopic Spine Surgery

Endoscopic spine surgery, also called laser spine surgery by the public, is spine surgery done through a small endoscope. The endoscope allows direct visualization of the surgery on the spine without large skin incisions, muscle retraction, bone removal, pain and general anesthesia. Initially, it was used to treat small, contained disk prolapses, but with improvement in endoscopes, surgical equipment and techniques this technique expanded to treat most spinal disorders.

Endoscopic spine surgery developed out of the clinical and laboratory research of Dr. Parviz Kambin in the early 1970’s in Philadelphia, PA. His initial work was the removal of the nucleus pulposus, which is the soft, gel-like material in the center of a lumbar disk. Dr. Kambin studied the anatomy of the disk and defined a safe zone into the disk which was later named Kambin’s triangle. This triangle is free of critical structures and is surrounded by the exiting nerve root, traversing nerve root and the inferior vertebral body margin. It allows safe passage into the disk for removal of the nucleus pulposus. Dr. Kambin also developed a percutaneous surgical instrument set to remove the disk under x-ray guidance. The disk or spine could not be directly visualized.

In 1989, Dr Schreiber was first to place an arthroscope into the disk to directly visualize the disk material.

In the 1990’s, Dr. Anthony Yeung developed the first spinal arthroscope (“YESS”) spine endoscope. He was largely responsible for the popularization of endoscopic spine surgery. Dr. Yeung developed the “Inside Out” technique. The endoscope was placed into the disk space to remove the nucleus pulposus and then the endoscope was pulled out of the disk space to remove any disk material in the foramen.

Thomas Hoogland developed a set of endoscopic instruments which included trephines or reamers to enlarge the lumbar in 1994. He later worked with MEDI-Tech and then JOIMAX to produce the THESSYS system. This revolutionary system allowed the surgeon to open up the foramen to provide direct access into the spinal canal. This was called the “Outside In” technique because you started outside of the disk and then moved into the disk as needed. Endoscopic spine surgery was no longer limited to working inside the disk and the foramen. This new access allowed visualization of the nerves and spinal canal for the removal of disk herniations that move outside of the disk wall (annulus fibrosis), permitting “traditional” spine surgery to be done through the endoscope.

JOIMAX continued to refine and develop these techniques which were later renamed TESSYS after Dr. Hoogland left the company. The surgical techniques continue to grow and expand with the development of new power drills, endoscopes and other surgical equipment. This continued innovation and development by JOIMAX is exciting, considering most areas of spine surgery development have a plateau.

Dr. Carl Spivak is the president of Executive Spine Surgery in Hackettstown, NJ, and a board-certified neurosurgeon. He is recognized worldwide for his expertise in innovative, noninvasive and state-of-the-art endoscopic spinal surgery.

By Staff Writer Treatment Options for Back Pain

Lumbar Disc Herniation Treatment

A lumbar ruptured disc, also known as a herniated disc or a slipped disc, can cause hip, lower back, leg and foot pain. The pain can develop gradually or suddenly. It can be sharp or dull, mild or severe, and it may or may not be accompanied by sciatica. Bending over, coughing, even sneezing can make the pain worse.

What Is Lumbar Disc Herniation?

A herniated disc occurs when a disc breaks down and starts to degenerate. As the deterioration continues, tears and rips can develop on the outer surface of the disc, allowing the inner core of the disc to leak out through the opening. The damaged part of the disc then puts pressure on the surrounding nerves. Even the slightest pressure on these nerves can bring about severe pain.

What Is Sciatica?

Sciatica is the most common symptom of a herniated lumbar disc. If the herniated disc is situated in the lumbar (or lower) region of the back, it can put direct pressure on the sciatic nerve and cause sciatica. The sciatic nerve consists of several spinal nerve branches that extend from the lower spine to the bottom of the feet. When a damaged disc is pressuring the sciatic nerve, a patient can experience weakness, numbness, tingling, burning and pain down the entire length of the leg. Leg pain can occur with or without lower back pain; but if lower back pain is present, the leg pain will almost always be worse. In rare cases, sciatica can bring about a lack of function in a leg. It can also cause a lack of function in the bladder or bowel. Symptoms of sciatica usually occur in one leg only, but sometimes both legs are affected.

How Is Lumbar Disc Herniation Treated?

At Executive Spine Surgery, Dr. Spivak believes in minimally invasive treatments for spinal conditions like a lumbar herniated disc. Ninety-percent of herniated discs can be effectively healed with treatments such as exercise, application of ice, physical therapy, spinal injections and pain medication. Dr. Spivak believes that surgery should be reserved as a treatment of last resort for those whose pain has not improved or has gotten worse after six months of noninvasive and nonsurgical treatments.

When Is Surgery The Best Treatment For Lumbar Disc Herniation?

If you think you have a herniated disc, consult with a board certified neurosurgeon like Dr. Spivak as soon as possible, preferably within six weeks after the onset of your symptoms. The sooner you start treatment, the more effective that treatment will be. During your consultation, Dr. Spivak will perform a thorough examination of your back and consult with you about the most effective noninvasive treatment options. In most cases, nonsurgical treatments will be sufficient to bring about a healing. If nonsurgical treatments don’t solve the problem after six weeks, Dr. Spivak may suggest endoscopic spine surgery. This is a minimally invasive surgical procedure where tiny skin incisions are used to repair a herniated disc.

Dr. Spivak is the president of Executive Spine Surgery in Hackettstown, NJ, and a board-certified neurosurgeon. He is recognized worldwide for his expertise in innovative, noninvasive and state-of-the-art endoscopic spinal surgery

By Staff Writer Treatment Options for Back Pain

Degenerative Disk Disease Surgery

Degenerative Disk Disease SurgeryMost of us have suffered from lower back pain at one time or another. Lower back pain is often caused by degenerative disk disease. Degenerative disk disease usually affects adults age 30 to 60, and it occurs naturally as part of the aging process.

What Is Degenerative Disk Disease?

Degenerative disk disease is a condition wherein a vertebral disk is damaged. The damaged disk can cause chronic lower back pain and/or leg pain (sciatica) in the lumbar spine. A damaged vertebral disk can also cause chronic neck and/or arm pain in the cervical spine. Along with pain, a damaged or degenerated disk can cause numbness and weakness. Pain caused by a damaged disk can become chronic and last for years. The pain could also be periodic, coming and going but never really resolving. There are also people with degenerative disk disease who experience no pain whatsoever. For those who do experience pain, that pain can range from very mild to extremely severe.

What Causes Degenerative Disk Disease?

A disk can be damaged by an injury that involves twisting of the lower back. More often, it occurs naturally as part of the aging process. Given enough time, everyone experiences disk degeneration to one degree or another. Over time, disks wear out. As a result of injury or degeneration, the inner and/or outer areas of a disk tear. The tearing exposes nerves in the spine and irritates them, sometimes causing pain. Injured disks can herniate and pinch spinal nerves, thus causing the sharp pain in the legs known as sciatica. A degenerated disk can also cause instability in the surrounding vertebrae because it can no longer hold that vertebral segment together properly.

How Is Degenerative Disk Disease Treated?

Disks have no blood supply and few nerve endings. The lack of a blood supply prevents a disk from healing itself. In spite of the name, this condition is not necessarily degenerative, and it is not even technically a disease. Rather, the name applies to the progressive deterioration of the disk itself. Pain levels generally do not get worse over time. In fact, the pain can actually decrease over time. Dr. Spivak will initially treat pain associated with degenerative disk disease by prescribing physical therapy and/or chiropractic treatments. Other noninvasive treatments he may suggest include weight loss for patients who are overweight, stem cell therapy, and/or injections of steroids and local anesthetics.

Surgical Treatments For Degenerative Disk Disease

When the noninvasive treatments mentioned above are ineffective and pain is severe, Dr. Spivak may want to explore surgical options with you. A number of innovative surgical treatments for degenerative disk disease are available today. Two surgical interventions used to treat degenerative disk disease are endoscopic laser discectomy and endoscopic fusion. Dr. Spivak will discuss all surgical options with you and help you to decide whether a surgical intervention for degenerative disk disease would be right for you.

As a board-certified neurosurgeon and the president of Executive Spine Surgery in Hackettstown, NJ, Dr. Carl Spivak is internationally recognized for his commitment to minimally invasive spinal surgery and state-of-the-art endoscopic spinal techniques.

By Staff Writer Treatment Options for Back Pain

Spinal Nerve Block Injections

Spinal pain is often caused by an inflammatory reaction in the body that produces swelling and damage to the spine, joints, disks, bones or ligaments. This reaction can be triggered by conditions such as a herniated disc, sciatica or spinal stenosis. Sciatica is a type of spinal pain where a ruptured disk pinches the sciatic nerve and triggers an inflammatory reaction that causes leg pain. The initial treatment for spinal pain is to reduce inflammation with steroid, analgesic and anti-inflammatory medications taken orally. Although these medicines can be very helpful under certain conditions, their diffuse and widespread effects in the body when taken by mouth are not concentrated enough to effectively relieve spinal pain.

What Are Spinal Nerve Block Injections?

At Executive Spine Surgery in Hackettstown, NJ, Dr. Carl Spivak treats spine pain with nerve block injections. These injections can effectively reduce spine pain without surgery. Spinal pain injections are performed with the help of x-ray guidance so that Dr. Spivak can deliver precise doses of steroidal, anti-inflammatory and analgesic medications in high concentrations directly AROUND (REMOVE into) the nerves or INTO trigger points where the inflammation exists.

Injecting these medications into an inflamed nerve in a highly concentrated form can reduce inflammation and swelling, relieve pain and flush irritants from the body. The relief that patients typically experience as a result of spinal nerve block injections in Hackettstown can last for one year or more. In the meantime, the body may be able to heal the nerve damage enough to eliminate discomfort.

What’s Involved In Trigger Point Injection Procedures In Hackettstown?

Trigger point injections are a noninvasive treatment for spinal discomfort. Injections are performed on an outpatient basis, so the risks involved in spine surgery are avoided. The treatment itself takes only 20 to 30 minutes. After the nerve block injection procedure is complete, the patient rests for 45 minutes while under observation.

How Long Do The Results Of Nerve Block Injections Last?

Just one trigger point injection can reduce or eliminate pain, swelling and inflammation so effectively that spine surgery is no longer necessary. Many patients require three injections to obtain optimal relief, whereas other patients experience great relief after only one or two treatments. Patients can receive up to three spinal nerve block injections two or three weeks apart over a six-month period. Just one spinal injection can deliver significant relief within a day or two after treatment. Spinal nerve block injections are even more effective when paired with physical therapy. Patients who combine these two treatments often go on to enjoy an active and pain-free life.

Are There Any Side Effects Associated With Spinal Pain Injections?

Many patients experience a mild tenderness at the injection site after a spinal pain injection. Dr. Spivak will consult with you about any possible side effects prior to giving you an injection.

Why Choose Executive Spine Surgery?

Dr. Carl Spivak takes a conservative approach to spine surgery and prefers minimally invasive treatments whenever possible. As the President of Executive Spine Surgery and a board-certified neurosurgeon, Dr. Spivak is well known for his innovative use of state-of-the-art endoscopic spinal techniques and other cutting-edge technologies.

By Staff Writer Treatment Options for Back Pain

Neck Pain Treatment

What Is Neck Pain?

Neck pain, also called cervical pain, is a common affliction that can be caused by conditions like degenerative disc disease, whiplash and other neck injuries, a pinched or inflamed nerve or a herniated disc. Neck pain can present as a dull ache in the neck, inability to move the head, shooting pains, tingling, numbness and dizziness, problems swallowing, enlarged lymph nodes and head, shoulder, back and facial pain.

How Is Neck Pain Treated?

Treatment for neck pain includes traction, muscle relaxants, a neck collar, massage, ultrasound treatments, antibiotics, exercise, physical therapy, pain medication, acupuncture and applications of heat and cold. If the neck pain is caused by an inflamed nerve in the epidural space, an epidural injection of anti-inflammatory and steroidal medications may reduce inflammation and relieve pain.

If these treatments don’t bring pain relief, the only other option is neck surgery. Until recently, the surgical treatment for neck pain was open neck surgery. Because of its highly invasive nature, open neck surgery is considered a last resort when less invasive treatments have been ineffective.

What’s Involved In Traditional Open Neck Surgery?

A common cause of neck pain is cervical disk herniation. In addition to neck pain, a cervical disk herniation may produce numbness, weakness and stiffness. Traditional open neck surgery involves making a large incision in the neck, moving the food tube and voice box, removing the herniated disk and performing fusion. Open neck surgery requires several days as a hospital inpatient, and healing can take up to one year. The recovery period could involve problems swallowing, hoarseness, stiffness at the site of the fusion and significant scarring. If the remaining disks don’t heal properly, the neck pain can continue, and additional neck surgery may be necessary.

Are There Less Invasive Surgical Treatments For Neck Pain?

Yes. The Cervical Endoscopic Surgical System (CESSYS), for example, is a new, non-invasive and cutting edge technology that can be used to perform neck surgery and relieve pain without the risks, discomfort and long recovery time associated with open neck surgery.

How Does The Cervical Endoscopic Surgical System Work?

With CESSYS, a video camera is inserted into the spine so the surgeon can easily find and extract the herniated part of a disk. This procedure is performed using very small instruments and guided by x-ray. The surgery requires only a small incision, so the surrounding tissues are not damaged. There is minimal pain, a much shorter recovery time and no overnight hospital stay.

If you suffer from neck pain that has not been relieved by nonsurgical treatments, schedule a consultation with Dr. Carl Spivak at Executive Spine Surgery to see if the Cervical Endoscopic Surgical System would be an appropriate treatment for your case.

By Staff Writer Treatment Options for Back Pain

What Is Lower Back Pain?

Most of us have had lower back pain at one time or another. It can be anything from a sharp pain that appears quickly and inhibits movement to a dull pain that develops slowly and gets worse over time. Acute lower back pain is quite common. It’s often caused by an injury, and it tends to clear up in a few weeks with or without treatment. Chronic lower back pain is less common. The cause may not be known, and the pain can last for months or even years.

What Causes Lower Back Pain?

Lower back pain can be caused by anything from chronic stress to poor posture. Other reasons for back pain include:

Aging. The older you get, the more likely you are to have back pain.

Other conditions. Arthritis, scoliosis, cancer, kidney stones and infections can all cause back pain.

Weight gain. Being overweight can cause back pain when the extra pounds are excessively straining the back.

Work. If your job involves lifting, pushing, pulling and twisting, it can cause back pain or back injury.

Lack of fitness. Those who are out of shape are more likely to experience lower back pain.

Genes. In some cases, back pain may be hereditary.

Injuries. Sprains, falls, accidents and fractures can all cause back pain.

Osteoporosis. Thinning and weakening bones can cause stress fractures and back pain, especially for women.

Spinal degeneration, muscle knots, spasms, inflamed nerves and deterioration of the back joints and disks can also cause lower back pain.

How Is Lower Back Pain Treated?

Acute lower back pain can be treated with hot and cold packs, ibuprofen, acetaminophen, aspirin and topical analgesics. Chronic back pain may be treated with massage, manipulation, physical therapy, stretching exercises, acupuncture and acupressure. Spinal injections of steroids, anti-inflammatory medications and painkillers can relieve lower back pain for up to 12 months. During this time, the condition causing the back pain may be able to heal itself.

I Have Lower Back Pain. Will I Need Back Surgery?

Most of the time, people with lower back pain do not require surgery. Back surgery is considered only after less invasive treatments have failed to provide relief. When back surgery is indicated, it is usually associated with conditions like:

Spinal stenosis

Degenerative disk disease

Herniated disk

Spondylolisthesis

Fractured vertebrae

If you live in the Hackettstown, NJ, area, and you’re suffering from lower back pain, it’s time to get relief. Dr. Carl Spivak, President of Executive Spine Surgery and a board certified neurosurgeon, specializes in minimally invasive treatments and cutting edge endoscopic spinal techniques to provide effective and lasting relief from chronic lower back pain.

Call us now