When can I have Sex after back surgery?

Patients often ask when they can safely have sex after back surgery.  This is a common concern for the patient and for their significant other.

Often their sex life has already been affected.  Back pain may interfere with intimacy, decrease sex drive (libido) and interfere with sexual enjoyment.  Patients with pelvic numbness or nerve dysfunction may feel less stimulation and pleasure or have difficulties developing or sustaining an erection or orgasm. Even worse, sex might aggravate the back injury, causing a great deal of pain and ultimately making sex unpleasant and unwanted.  Back pain can also lead to depression or be associated with depression, another factor that can affect your sex life.

No wonder people are concerned!

I am happy to tell you that sex is safe after back surgery.  For patients undergoing traditional back surgery, doctors commonly recommended waiting 6 to 12 weeks before resuming sexual activity. These operations involved a large midline incision, muscle retraction and bone resection, and patients suffered intense pain from muscle damage. These surgeries are very different from today’s advanced endoscopic spinal surgery. Endoscopic surgery is done through a tiny incision the size of your finger nail, using a little high definition video camera the size of a pen! There is minimal skin, muscle and bone damage.  Most people recover in a few weeks and the incision is small and less likely to be torn open.

The great advancements that have been made in minimally invasive back surgery means that patients treated endoscopically can start having sex again after only 2 weeks if their incision is healing well, their pain has resolved or significantly improved, and their sex drive has returned.  The healing time will increase for other more invasive surgeries or surgeries involving spinal instrumentation.  As with all activity, the patient should approach sex in a safe, gentle manner and take on a passive role. The patient should avoid heavy lifting, bending and twisting. They should stop if pain develops. As an old colleague of mine told his patients, “No shaking the trailer!”

They may benefit from small pillow under their low back, stacked pillows under their knees to bend the hips and support the legs, and taking a well-supported position.  They may also benefit from taking pain medication prior to sex. Their partner should avoid putting their full weight on them.  The patient may have less pain starting with missionary position, lying down on their side or standing and bending over a chair.

Since all patients and surgeries are different, you should discuss your return to sexual activity with your doctor. Though you might feel awkward bringing it up, don’t worry. It’s a very normal, healthy concern.

 

Should I hire a nurse after spinal fusion?

Spinal fusion surgery is the joining of one backbone to another backbone (bony vertebrae to another bony vertebrae).  This is usually done for instability, that is when the spine is weak and falling apart.  Spinal fusions can be large, painful and debilitating procedures, but hiring a nurse is not usually not necessarily required after lumbar fusion surgery.   That said each person, spinal disease and surgery is different.  If you are very concerned you could set up just in case.

Minimally Invasive Spine Surgery (MISS) tends to be less painful and debilitating then open surgeries. Multilevel surgery is more painful then single level surgery.  Minimally invasive surgery is less painful then open traditional surgery because there is less tissue destruction.  In traditional surgery there is a large skin incision, signifiant retraction of the back muscles and a lot of bone removal resulting in severe pain.

Tissue damage is minimized with minimally invasive surgery.  The skin incision is small instead of large.  The muscles are dilated (pushed apart) rather than retracted.  Muscle retraction damages muscles producing scar tissue and weakness resulting in pain.  Little if any bone needs to be removed during minimally invasive fusion (this is especially true for endoscopic lumbar interbody fusion (ELIF).  These benefits results in less pain then with traditional fusion surgery.

For more information on spinal fusion click Spinal Fusion and Options

For more information on how Executive Spine Surgery can help you please call 908-452-5612 or inquire at schedule-an-appointment.

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.

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!

 

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.

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.

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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.

Do I need a back brace after spinal fusion?

Spinal fusion surgery is connecting one spinal vertebrae to another spinal vertebrae.  This is done through a bone “bridge”, that is bone is placed between the vertebrae.  The bone is usually placed between the vertebral bodies.  This is called an interbody fusion.  If the fusion is done through your abdomen it is called anterior lumbar interbody fusion (ALIF), through your side/flank  [Direct lateral interbody fusion (DLIF) or extreme lateral interbody fusion (XLIF)] or through your back [posterior lumbar interbody fusion (PLIF) or tranforaminal lumbar interbody fusion (TLIF)].

The surgical approach is important because it relates to pain, disability, muscle damage and complications.  Fusions done through the back tend to be more painful resulting in greater recovery, time off and disability.  This is appears less true for minimally invasive procedures like the endoscopic lumbar interbody fusion (ELIF).  The more muscle damage the weaker the back and the higher chance of future spinal disease and pain.

There are complications related to anesthesia and surgery.  All surgery has risks but the specific risk to fusion surgery is partially related to the approach to the spine:

1.  Surgery done from the abdomen put major blood vessels (like the aorta and  vena cava) and abdominal organs like kidneys at risk.  There is even a chance for errectile dysfunction (E.D.) or retrograde ejaculation (sperm goes into the bladder not out the penis).  These problems can lead to infertility.

2. Surgery from the side can injury the lumbar plexus (these are nerves that supply the legs) causing pain, numbness or weakness in the legs.

3. Surgery done through the back muscles  can injure the muscles causing future pain and new spine problems.  This muscle damage is decreased with minimally invasive surgery.

Most people have to wear a brace after surgery for 1 to 3 months, but it depends on the type of fusion and instrumentation surgery, number of levels fused and the reason for fusion.

For more information on lumbar fusions please click Spinal Fusion and Options or on Dr. Carl Spivak and Executive Spine Surgery 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 have synovial (ganglion) cyst in my spine. Help?

Synovial cysts commonly may arise throughout the body.  Synovial cysts are sometimes called ganglion cysts.  Synovial cysts that arise in the spinal canal can cause severe back and leg pain.  They are usually small painful cysts located in the epidural space inside the spinal canal.  They arise from degenerated “worn out” spinal facet joints.  They have a fibrous wall and are filled with thick mucus fluid similar to synovial cysts found in other areas of the body.

As synovial cysts grow they cause pressure or “pinch” near by nerves producing pain.  They can also produce numbness, tingling and weakness.  They are usually slow growing but sometimes form rapidly.

Treatment of synovial cysts include: observation, epidural steroid injection, intra-cyst steroid injection to rupture the cyst and surgery.  Surgery usually requires large incision with significant bone and ligament removal to enter the spinal canal and remove the cyst.  Since the degenerated facet joint is the source of the cyst it is possible for the synovial cyst to recur.  Future resections may entail partial or complete removal of the facet joint and lumbar fusion.

Today many of these synovial cysts can be removed through the spinal foramen with little to no bone removal with the spinal endoscope.  Endoscope is a video camera connected to a high definition scope the size of a pen which can be placed into the spine to the synovial cyst for direct visualized removal.  Patients often feel immediate pain relief and are able to return back to normal activity much faster then with traditional open spinal surgery.

For more information on endoscopic spine surgery please see Laser spine surgery and endoscopic spine surgery.