Where do you get the bone for spinal fusion?

People often ask 2 questions about spinal fusion:

1) Why do you need bone?

Bone is a key ingredient in spinal fusion.  Spinal fusion is done when the spine is weak and needs to be made stronger.  One vertebral body is connected to another vertebral body with metal screws and rods.  Bone is placed in-between the vertebrae so the vertebrae will grow together and form one solid bone.  If bone isn’t placed  and a solid spinal fusion is not obtained the screws and rods will eventually loosen and fall out or break.

2) Where do you get the bone from?

In the old days the bone was taken from your body.  Usually a piece of your hip would be cut out and then used as graft for the fusion.  Sometimes only the inside of the hip bone would be scraped out.  Today  donor bone or synthetic bone alternatives like hydroxyapatite are usually used.. Bone removed during the operation is rarely used.  This may still be done if the person last fusion surgery failed to fuse and now the surgery was been redone or if they are very high risk for the fusion failing such as smoker, sick or on chronic anti-inflammatory medications.

About Dr. Carl Spivak and Executive Spine Surgery

Dr Spivak is a neurosurgeon with expertise in minimally invasive spine surgery and is a pioneer in endoscopic spine surgery.  He routinely teaches workshops and courses for doctors throughout the United States for JOIMAX USA.  For more information on how Dr. Spivak can help you, please call 908-452-5612 or click schedule-an-appointment.

Will a back brace help alleviate my lower back pain?

Back braces are commonly used for back pain.  They provide support for the back and may relieve pain.  They are best used to help brace the back to prevent injury (such as a work belt) rather to treat pain.  They may be useful during flareups, but wearing a back brace all the time can lead to weakening of the back muscles and increased ironically more back pain.

A properly fitted back brace will limits spinal movement. It may affect participation in sports, especially if a lot of back movements are involved.

Back braces are commonly used after spinal surgery, especially fusion surgery.  They limit movement, support and most importantly remind patients to not over do it.

Back surgery today is not like 10 or even 5 years ago.  Most back surgeries can be done using a small spinal endoscope through an incision the size of your fingernail (index.php).  Since the surgery is minimally invasive their is less tissue damage and as a result pain.  Patients may forget they just had surgery and over do it.  Heavy lifting, strenuous activity or running may re-injure their back.  Wearing  back brace may remind the patient to take it easy.

About US:  Dr. Spivak is president of Executive Spine Surgery.  He specializes in extremely minimally invasive spine surgery utilizing new endoscopic technology recently introduced from Germany. Dr. Spivak has offices in Manhattan, NY, West Orange, NJ and Hackettstown, NJ.  Please call 908-452-5623 or click on 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.

How does spinal fusion help low back pain?

There are many causes of low back pain.  Back pain may arise from the muscles, tendons, joints, disks, bones, nerves and spinal cord.  Rarely back pain may arise from other organs in the abdomen or chest.

Black disks called degenerative disk disease (DDD) may produce back pain.  This may be caused by  injury to the disk called an annular tear.  Scientists believe annular tears cause pain from ingrowth of pain nerves into the disk.  As the disk disease progresses this can lead to weakness in the spine called instability.  Instability produces pain from abnormal movements in the spine.

Facet joint damage can also cause back pain.  The facet joints hold the back of the spine together.  If the joints are injured they can be a source of pain.  This is called facet arthropathy  and is common when people have severe arthritis in there spine.  If the facet joints wears out or break and can no longer hold the spine together then the spine may slip apart.  This is called a spondylolithesis.

If the back pain arises from the torn disk then pain is relieved by removing the painful disk and replacing it with cage and bone. If the problem is instability (that is weakness and abnormal movement) the fusion and instrumentation holds the spine together preventing these abnormal movements.

Today spinal fusion can be done minimally invasively with the spinal endoscope (endoscopic lumbar interbody fusion or ELIF).  This decreases skin and muscle damage, pain and suffering after surgery and allows you to get gong quicker.

Please see Spinal Fusion and Options for more information about spinal fusion or 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.

I have low back pain. Do I need physical therapy or MRI?

That is a good question.  Back pain is a very common symptom.  Most people will have back pain at some time during there life.  That said not all back pain is created equal.  Back pain can be good, bad or ugly.

The development of back pain may be a warning from your body that your are straining your back and about to damage it.  This type of back pain can be considered good because it may prevent a more serious injury.  Back pain from injured or herniated disk, or fractures may be bad.  It can cause pain in your back, buttocks, hips, groin and down the legs.  It may be associated with numbness, tingling, weakness and bowel and bladder dysfunction.  Yes a bad disk or fracture may cause you to be incontinent of bowel movements and urination or retain them and not be able to go.  Less serious cause of bad back pain is facet arthritis also called facet arthropathy.  Back pain can get really ugly when it is caused by an infection or cancer.  It can cause weight loss, fever, chills and sweats (called systemic symptoms) and if goes untreated may be life threatening.

Therefore it depends on how your back pain started and if it is associated with anything.  If you simply pulled your back lifting and have no other neurological problems or systemic symptoms then physical therapy is the best place to start, but if you do have other bad or ugly symptoms or fail physical therapy then you should get an MRI scan.

For more information please see the following links:

What Causes Back Pain?

Back Arthritis

What is Sciatica?

Overview of Spinal Stenosis

Spinal Fusion and alternate Options

Kyphoplasty – what is it?

Please Schedule an Appointment to find out more information!