laser surgery Archives - Page 2 of 3 - Carl Spivak, MD

By Staff Writer endoscopic spine surgery, laser surgery, Lower back pain, Spinal fusion

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.

By Staff Writer Case report, Discectomy, endoscopic spine surgery, laser surgery, Sciatica, Treatment Options for Back Pain

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.

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.

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Sciatica, Surgery, Treatment Options for Back Pain

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.

By Staff Writer endoscopic spine surgery, laser surgery, Lower back pain, Relief, Spinal fusion, Treatment Options for Back Pain

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.

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Lower back pain, Pain, Sciatica

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.

By Staff Writer endoscopic spine surgery, laser surgery, Lower back pain, Pain, Surgery, Treatment Options for Back Pain

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.

By Staff Writer endoscopic spine surgery, laser surgery, Pain, Relief, Spinal fusion, Surgery, Treatment Options for Back Pain, Treatment problems

How painful is recovery from lumbar spinal fusion surgery?

Spinal Fusion is the joining of one vertebrae to another vertebrae by a bone graft. This bone graft acts as a bridge between the two vertebrae. Spinal fusion is held together with metal screws and rods. It is done for symptomatic degenerative disk disease, spine fractures, cancer, spinal instability and spondylolithesis. Large open spinal fusions may have incisions many inches long while single level minimally invasive spinal fusion can done through 1 inch incisions.

Recovery from lumbar spinal fusion depends on the patient’s health, pathology being treated [what is actually wrong with your spine, the number of levels affected (single vs multilevel disease) and prior surgery and complications] and the lumbar fusion technique. Minimally invasive surgery tends to be less destructive, painful and have a quicker recovery. Most people will be on pain medication for a week to months as they recover from there surgery.

For more information please Schedule an Appointment! Good Luck!

By Staff Writer endoscopic spine surgery, laser surgery, Lower back pain, Relief, Surgery, Treatment Options for Back Pain, Treatment problems

What is the recovery time for lumbar fusion?

Spinal Fusion is the joining together of the spinal vertebrae with bone. This is usually done through the disk space [called anterior lumbar interbody fusion (ALIF), direct lateral interbody fusion (DLIF) / extreme lateral interbody fusion (XLIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) or endoscopic lumbar interbody fusion (ELIF)] but can be done posteriorly over the lamina (posterior fusion), in the facet joints (facet fusion) or transverse processes [posterolateral fusion (PLF)].

The Endoscopic Lumbar Interbody Fusion is the newest development in fusion techniques and many believe will cause the least damage and pain and have the quickest recovery. Endoscopic fusion is done through a small tube with the aid of an endoscope. This endoscopic area of spine surgery is generally called Laser spine surgery, even though lasers are rarely used today.

Recovery time varies from person to person and from procedure to procedure. The larger the procedure (that is more exposure and therefore tissue damage and the greater number of levels fused) the longer the recovery. People recover quicker from minimally invasive procedures. Recovery can take from a couple weeks to many months. Most people can return to light activity (no strenuous lifting or exertion) in few weeks.

Schedule an Appointment to learn more about endoscopic lumbar interbody fusion (ELIF).

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Pain, Sciatica, Surgery, Treatment Options for Back Pain

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!

By Staff Writer endoscopic spine surgery, laser surgery, Lower back pain, Pain, Relief, Treatment Options for Back Pain

Does everyone eventually suffer from degenerative disc disease?

Degenerative disk disease is the wearing out of your disks in your back. This is a slow process resulting from drying out of the nucleus pulposus changing how the disk manage forces. Over time the disk may darkens, collapse, bulge, tear and rupture producing leg pain called Sciatica.

Everyone or at least most people develop radiologic evidence of degenerative disk disease if they live long enough, but not everyone will have pain and suffering as a result of it. There are many new treatments for degenerative disk disease including artificial disk replacement, endoscopic discectomy and annuloplasty, Endoscopic Spinal Fusion (that is Endoscopic Lumbar Interbody Fusion or ELIF).

Schedule an Appointment to learn more how Executive Spine Surgery can help. Good Luck!

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Category: laser surgery