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 appt@executivespinesurgery.com Good Luck!

 

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.

pic1pic2

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.

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.

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.

I am 39 year-old woman with left leg pain and numbness. What can I do?

Your left leg pain and numbness is probably from a “pinched” nerve in your back.  This is called Sciatica.  Sciatica in a 39 year old is most commonly caused by a disk herniation.  Treatment for sciatica varies from rest, physical therapy, anti-inflammatories, steroid injections and surgery.   Pain that is not improving, very severe or associated with neurological deficits (weakness, foot drop, numbness or bowel and bladder incontinence or retention) may require spinal surgery.

In the past spinal surgery was a big deal.  You were admitted to the hospital, put to sleep under a general anesthetic and had your back half opened up to expose the spine.  The muscles were retracted and damaged and the bone was removed.  This bone removal is called a laminectomy or laminotomy, depending on how much lamina was removed.  Then the traversing nerve and thecal were retracted and the disk was found and removed.

Today disk surgery is much simpler.  Disk surgery can be done through a spinal endoscope (such as JOIMAX), this is often called Laser spine surgery, even though the laser is not necessary today.  The big advancement of “Laser spine surgery” is the used of an endoscope.  An endoscope is a pen-sized micro-video camera that is placed inside the spine to the herniated disk pinching the sciatic nerve.  Tiny instruments are inserted through the endoscope to remove the disk.   The sciatica leg pain often improves very quickly often before surgery is over.

Schedule an Appointment to learn more about endoscopic spine surgery and how it can help you!

I have a large disc protrusion compressing my L5 nerve and causing spinal stenosis. Do I need surgery?

Disc protrusion is when the disk slips out of it’s normal position in between the spinal vertebrae and extends into the spinal canal.   Other commonly used names are bulging disk, slipped disk or herniated disk, etc.  Spinal stenosis is tightness or loss of volume of the spinal canal.

Right L4-5 disk protrusion initially is treated with conservative treatment which may include rest, physical therapy, medications and steroid injections.  Surgery is considered when a patient fails conservative treatment and/or has severe pain, numbness, weakness or neurological dysfunction (such as urinary incontinence).

Today most disk surgery can be done by using extremely minimally invasive surgical techniques called endoscopic spine surgery or laser spine surgery.  This revolutionary same day surgery is done through a tiny tube the size of a pen which is placed into the spine under X-ray guidance.  The disk is found and visualized through the high definition video camera found inside the spine endoscope.   The disk is then removed with tiny little instruments taking pressure off of the nerve.  This usual provides quick relief of pain and suffering.  Often patients feel much better right after surgery.

For more information on sciatica and lumbar disk herniations click on the following link Sciatica.  Good Luck!

What does degenerative disc disease and no signal abnormality within the cord or enhancement mean?

Degenerative disc disease = “worn out” degenerated disks in your spine

No signal abnormality = spinal cord looks normal, no abnormal signal suggesting disease or damage

No enhancement = the spinal cord is not taking up contrast die.  This would suggest inflammation, infection or cancer

For more information on sciatica please click the blog below.  Please contact Executive Spine Surgery for more information on degenerative disk disease, disk herniations, sciatica and endoscopic spine surgery. Good Luck!

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

I have a knife pain on right side of mid back that radiates around ribs but I never experience severe abdominal pain.

You may have a thoracic disk herniation with a pinched nerve. You will need an MRI scan of your thoracic spine.  Thoracic disk herniations are uncommon but they can be dangerous especially if they pinch and damage the spinal cord.  Thoracic disk herniations can cause shooting pain around your rib cage and weakness, paralysis or bowel and bladder incontinence.   They are usually treated surgically if there is neurological deficits.  In the past open traditional surgery was the only option to treat thoracic disk herniations.  This was a large operation with significant risk.  Today there are new minimally invasive spine surgery (MISS) options for thoracic disk disease including laser discectomy or endoscopic discectomy.

Endoscopic discectomy involves placement of needle into the herniated disk, followed by serial dilation of the soft tissue and placement of an endoscopic port.  The endoscope is then placed through the port to the herniated disk.  The disk is then removed with small cutting and grabbing instruments under direct visualization.  After the disk is removed and the nerve is unpinched the endoscope and tube are removed allowing the soft tissues to fall back together.  Single suture  and dressing is used to close the incision.  The patient is discharged home the same day.

Click Read More to learn about treatment options.  Good Luck!

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

Sciatica is characterized by pain starting in the back and radiating down the back of the leg to the foot.  It is associated with numbness in the little toes of the foot and plantar flexion weakness (that is weakness when standing and walking on your tip toes).   The sciatic nerve is made up of spinal nerves exiting the lower spine. After exiting the spine it travels though the pelvis and down the leg.    Sciatica is commonly caused by a slipped herniated disk in the back between the L5 and S1 vertebrae.  Other causes of sciatica include stenosis, bone spurs, slippage of the spine (called spondylolithesis), fracture, tumor and infection.

Sciatica is initially treated conservatively without surgery.  Common treatments includes rest, anti-inflmmatory medicine, steroid medicine, pain medicine, physical therapy, steroid injections and spine surgery.  Traditional surgery involved a large incision, significant muscle dissection, retraction and injury and removal of a lot of bone called a laminotomy.  All these destructive changes may lead to scar tissue, spinal weakness (called instability) and chronic pain.    Today lumbar disk herniations may be removed minimally invasively with the spinal endoscope.  The spinal endoscope is a very small tube (7 mm) with a camera at the end of it.  Using x-ray guidance it can be placed directly to the herniated disk in the spine. The disk can then be removed with tiny instruments under direct visualization.

The procedure takes 1 hour and patient is discharged home after 1 to 2 hours.  There is less blood loss, tissue damage and pain compared to traditional open surgery.  Most patients have a quicker recovery and return to work.  For more information please contact Executive Spine Surgery at 908-452-5612.

Can you have a massage after lumbar fusion surgery?

Yes it is safe to have a massage after spinal fusion surgery, but I would recommend waiting until the incisions have healed.  Enjoy!

Spinal instrumentation and fusion surgery is done to strengthen, stabilize and hold the spine together.  Surgical indications for fusion surgery include spondylolithesis (slipped spine bone), spondylolysis (fracture of the pars articularis that holds the spine together), multiple disk surgery, spinal fracture, cancer, degenerative disk disease (DDD), osteoporosis, etc.

Spinal fusion is done by the placement of  screws through the pedicle into the vertebral body at 2 or more levels.  These screws are linked together with rods forming a strong construct.  Bone is placed to join or “fuse” the vertebrae together.  The bone can be placed in different locations and by different techniques.   Bone may be placed  over top of the spine [posterolateral fusion (PLF)] or between the vertebral bodies [anterior lumbar interbody fusion (ALIF), direct lateral interbody fusion (DLIF or XLIF), transforaminal lumbar interbody fusion (TLIF) or posterior lateral lumbar interbody fusion (PLIF)].  Spinal fusion can now be done endoscopic with minimal tissue damage and bone removal.  This is called endoscopic lumbar interbody fusion (ELIF).  Please call for more information. Good Luck!