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 degenerate disk disease and primarily back pain may undergo a discogram (pain mapping of the disks) to confirm the symptomatic disk.   Discogram helps determine if surgery will work.

Discogram is an injection into disks.  If the injection produces your typical back pain (concordant pain) then this disk is most likely culprit of the back pain.  In addition to pain the discogram often shows leakage of dye out of the disk through a rip called an annular tear.  If the injection only causes mild pain or not typical pain then that disk is not causing the pain.   In this circumstance the patient would require additional pain mapping to identify the pain source.

The treatment options to fix painful disk include endoscopic discectomy and annuloplasty (the annular tear is isolated and burned with radiofrequency coagulation) or endoscopic fusion surgery (ELIF).  Often endoscopic discectomy is considered first to try to avoid fusion surgery.  Unfortunately surgery does not always relieve back pain from degenerated herniated disks.  Surgery should be considered the last option or not an option is some cases.  Please call and set up an appointment with Dr. Carl Spivak to discuss your back. Good Luck!

Does the donor bone graft in bone transplants come from living donors?

There are two types of bone graft commonly used autograft and allograft.  Autograft is taken from the patient during surgery, this is usually from iliac crest or bone that is removed the spine.  This is the best graft material but unfortunately can lead to new pain, deformity or complications.  Allograft is bone taken from bone bank from deceased donor.   This is almost as good as your own bone and saves you second surgical site. Recently bone substitutes made up of calcium have become available and may replace bone in the future.  For more information please contact Executive Spine Surgery today.  Good luck!

Does a pinched nerve (sciatica) always stay pinched unless surgery is given? Will it always show up on an MRI if surgery is given?

Disk herniations cause leg pain (sciatica) by pinching the sciatic nerve in the back.   Disk herniations may resolve on their own over a year or so, but they usually just get a little smaller as seen on multiple MRI .  Surgery is the best treatment to physically remove the disk.  Today this can be done endoscopically (endoscopic discectomy) though a very small incision the size of your finger nail. The endoscopic port is placed right onto the herniated disk and the disk is removed with tiny instruments.  This is a new minimally invasive treatment for back and leg pain.

Disk herniations may show up after surgery on MRI scan, but it usually is smaller.   Postoperatively the the disk that is seen is a combination of disk, bulging ligaments and scar tissue.

For more information on sciatica please contact Executive Spine Surgery. Good Luck!