annular tear

How to Tell if Your Pain is Caused by an Annular Tear

Unfortunately for us, most people suffer from some type of back pain at some point in their lives. In fact, 80% of people will have back pain at some point, and it’s the leading cause of disability worldwide.

But there’s a difference between a sore back after hunching over your computer all day and a serious back injury. An annular tear is one type of back injury that you shouldn’t ignore.

But how can you tell whether your back pain is the result of an annular tear or if it’s just sore because you slept funny on your mother-in-law’s guest bed?

We’re going to go over exactly what an annular tear is, how you can tell if that’s what you have, and what you can do to treat your symptoms.

What Is an Annular Tear?

Our spines are made up of bones called vertebrae. In between the vertebrae are discs that help to protect and cushion the bones. This cushioning helps them to absorb any large shocks or pressure applied to the spine as well as distribute the pressure/weight on our back evenly to avoid one part of the back taking too much weight.

These discs are made of two distinct materials. One part is a soft, gel-like fluid that serves as the cushion.

The other part of the disc is made of something called annulus fibrosus. These are strong fibers that hold the disc together and keep them in place.

An annular tear is when these fibers, well, tear. These tears can be minor and small at the beginning with little to no symptoms. However, they get progressively worse, which can lead to the inner “gel” of the disc to leak out.

When this happens, the nerves in the spine can be impacts, which leads to a great deal of pain.

What Causes Annular Tears?

Most annular tears occur in the lumbar spine, which is a fancy way of saying the lower back. While it’s not impossible for them to happen in other parts of the spine, they’re most common in the lower back.

But what causes this to happen? One of the main causes is something we can’t do much about aging.

As we get older, normal wear and tear lead to parts of our body to weaken. This includes the parts of our back like the vertebrae and the discs. When these parts get weaker, it’s easier for injuries like tears to occur.

There are other factors that can lead to annular tears. If you’re overweight or obese, you’re at a higher risk of an annular tear. The extra weight puts excess pressure and weight on the spine, which leads to tears.

Annular tears can also be the result of accidents, especially ones with sudden or jarring movement of your weight. This could be a car accident, a sports injury, or even just lifting a heavy box incorrectly. When you combine these physical activities with age or obesity, you’re at a much higher risk.

Symptoms of an Annular Tear

Minor or small annular tears usually have no symptoms. However, as the tear gets bigger, symptoms will begin to appear.

The main symptom of annular tears is pain. You’ll have pain in your back that could radiate from the point of the tear to other parts of your back. You may also experience pain in your legs as well.

Difficulty Sitting And/Or Standing

We use our back for almost every movement or activity, even if you don’t realize it. Because of this, you may have trouble getting any relief at all when you have an annular tear.

Even sitting or standing can be very painful.

Consistent Symptoms

As we said before, we use our back all the time. This means that pretty much no matter what you’re doing, you’re going to still have pain if you have an annular tear.

Doesn’t matter if you’re on a hike, sitting in your car, or laying down on a fluffy soft bed. You’ll still be feeling pain.

Worsening Symptoms

If your tear isn’t treated, the condition will get progressively worse. You’ll experience:

  • Worsening pain
  • Tingling
  • Numbness in the limbs/affected area
  • General discomfort
  • Bulging Disc

If you notice symptoms worsening, you should definitely see a doctor that can diagnose an annular tear.


On that topic, let’s look at how you can diagnose an annular tear. If you have any or all of the above symptoms, there’s a chance that it’s an annular tear. The likelihood that your pain is an annular tear increases if it’s lower back pain, if you’re older, if you’re overweight, and if you have all of the symptoms listed.

However, to get an official diagnosis you’ll need to see a doctor. They’ll do a full work-up and will probably order an MRI. An MRI will be able to definitively show an annular tear (if that’s what you have).

The doctor can also use a CT scan or a discogram to determine the exact location of the tear.

Treatment Options

If you do have an annular tear, there are several treatment methods. You’ll probably start conservatively in order to avoid surgery: pain medication, anti-inflammatories, weight loss regimens, physical therapy, etc. Annular tears can take up to 2 years to fully heal.

Only when these treatment methods fail, or if your condition is worsening, will a doctor recommend surgery. There are traditional surgery options, endoscopic surgical techniques, and even some experimental stem cell treatments you can try.

Contact Us for More Information

If you have an annular tear, it can progress into a serious and painful condition. Any sort of consistent or recurring back pain should be discussed with a doctor as soon as possible to rule out any serious condition and to get you started on a treatment plan as soon as possible.

Contact us to set up an appointment or to ask any other questions you have.

spinal arthritis

How to Soothe Spinal Arthritis Pain Before Your Treatment

Arthritis, which affects some 54 million American adults, is the leading cause of disability. If you are among those patients who have been diagnosed with spinal arthritis, you likely experience back pain on a regular basis — and perhaps you are even scheduled for non-invasive back surgery.

Having surgery or another treatment scheduled can give you peace of mind, knowing that there is relief in sight. In the meantime, there are a variety of ways you can ease your aching back. Let’s take a look at some of the most common.

Heat or Ice?

Chances are you have a heating pad or a hot water bottle lying around, in which case you should press them into service right away. If not, it’s pretty easy to make your own or pick up a reusable heat pack at the pharmacy. The soothing effect of the heat can help you live with lower or upper back pain.

Ice is generally used for acute injuries, to reduce swelling and help numb pain. Chronic arthritis pain tends to respond better to heat. However, use whichever one brings relief; just don’t use an ice pack for more than 20 minutes at a stretch.

Water Feels Wonderful

Many spinal arthritis patients find that it feels wonderful to be immersed in water. The buoyancy helps ease pressure on aching muscles. Taking warm baths, attending gentle aqua fitness classes, or sitting in a jacuzzi are all great ways to soothe your spine pain.

Massage Therapy

Is there anyone who doesn’t enjoy getting a nice massage? Aside from the blissful feeling of having your knots and kinks worked out, massage can also provide lasting pain relief for anyone with arthritis.

Yes, it’s true that arthritis directly affects the joints, not the muscles, but remember that everything in your body is connected. If you have joint pain, your muscles will do extra duty to help move your body — and they can get pretty sore as a result.

Chiropractic Care

Similarly, your knees, hips, feet, and other joints may suffer due to spinal arthritis. A chiropractic session may help realign your body and temporarily take away the pain.

Be sure to inform your chiropractor of your arthritis diagnosis. First-timer and nervous about the adjustment? It’s OK to ask that your chiropractor go easy on you, or to find one who uses spinal mobilization rather than spinal manipulation.


Like chiropractic care, acupuncture can sound a little scary. Who would choose to have needles jabbed into them? In fact, plenty of people not only make this choice but report tremendous benefits from this ancient practice.

Ensure that your acupuncturist is licensed in your state and certified by the National Certification Commission for Acupuncture and Oriental Medicine. They should also use only disposable, single-use needles.

Gentle Exercises

No matter how active you were pre-diagnosis, the pain from spinal arthritis is probably restricting your mobility and activity level. High-impact exercises like running or playing basketball will have to wait. In the meantime, try two ancient and very gentle forms of movement: yoga or tai chi.

Both disciplines emphasize breathwork as well as slow, steady movements. They can improve your balance, flexibility, and overall well being, too. Start out slowly with videos for beginners, and make sure to get your doctor’s approval beforehand.

Get Some Rest — But Not Too Much

It would be nice to use your spine pain as an excuse to lie in bed or camp out on the couch, catching up on the latest Netflix offerings. However, too much inactivity won’t do you any favors. The human body is designed to move, after all.

Do what you can within the limits of your pain. It’s important to find a balance between your activity level and the signals your back sends you to be still.

Shed Those Extra Pounds

Nor is this the time to engage in emotional eating. If spinal problems have you temporarily sidelined, make sure to adjust your calorie intake downward to avoid gaining weight.

Anyone who is already overweight would do well to drop a few pounds prior to spinal surgery. Control your portion sizes, and choose foods that are nutrient-rich instead of processed junk. Slimming down somewhat will help your body feel better in general, and can speed up recovery time, too.

Find New Ways to Relax

This tip for spinal arthritis patients is especially important if lying down and taking it easy are hard for you to do. Maybe you’re accustomed to relieving stress by playing a sport or heading to Zumba class three times a week. Or, at the other end of the spectrum, your go-to in times of tension is a date with Ben and Jerry.

There are plenty of relaxation techniques to try. Journaling, coloring or sketching, guided meditation, and self-hypnosis are all healthy ways to chill out.

Pain Medication

Some people are hesitant to start taking medication for their pain — and that’s understandable, given how serious the opioid crisis in the United States has become. In some cases, however, prescription medication is a viable option. There are a number of drugs you can try before restoring to highly addictive painkillers.

Over-the-counter NSAIDs like ibuprofen or analgesics such as Tylenol are a good place to start. If those don’t do the trick, your doctor may prescribe a muscle relaxer or non-opioid pain medication.

Topical Treatments

Another way to get relief is by using topical preparations. These include Ben-Gay, Aspercreme, Tiger Balm, IcyHot, and BioFreeze. You can find them at the drugstore, and some even come in roll-on or spray versions for easier application.

Spinal Arthritis Pain? Not Anymore!

As you can see, there are many approaches to pain relief that you can try while you’re waiting for more serious treatments, like spinal arthritis surgery. No two back pain patients are the same, so it may take some experimentation to see what works for you.

Have you found relief from any of these non-invasive spinal pain treatments? What has worked best for you? Let us know in the comments!

reduce back pain

What Are the Best Sleeping Positions to Reduce Back Pain at Night?

The American Association of Neurological Surgeons estimates that 75 to 85 percent of Americans face back pain at some point in their lives. That’s a pretty alarming number!

Back pain can prevent you from doing many things you enjoy such as sleeping, working out, or traveling.

Does your back pain keep you up at night? Is it hard to find the perfect position that gives you the best pain relief?

Here are some helpful sleeping positions that will reduce back pain so you can rest easy.

1. On Your Side with a Pillow Between Your Knees

Try shifting to your side instead of laying flat on your back.

  • Your shoulder and side of the body you sleep on should touch the mattress
  • Put the pillow between your knees
  • If your waist does not touch the mattress, add a small pillow
  • Don’t always sleep on the same side – rotate

Why the side position? It’s not sleeping on your side that makes you feel better – it’s the pillow that aligns your pelvis, hips, and spine.

2. On Side in the Fetal Position

If you have a herniated disk, you should try this position. It gives a little extra support.

  • Start on your back and then roll to your side gently
  • Tuck your knees into your chest
  • Curl your torso toward your knees
  • Switch sides regularly to prevent imbalance

Each of your disks has soft cushions between them. When your disk becomes herniated, the disk is out of its normal spot which causes the pain and weakness. This position helps your disk by opening up space between each of vertebrae.

3. On Your Stomach with a Pillow Under Abdomen

Sleeping on your stomach can be uncomfortable if you have back pain. It could add stress to your neck.

If you love sleeping on your stomach, you can try:

  • Putting a pillow under your pelvis and lower abdomen
  • Removing the pillow from under your head

You can feel the pressure in your neck if you turn your head to the side. To relieve pressure on your neck, use a small pillow or rolled-up towel under your forehead. Facing your head down is best for your neck.

If you have degenerative disk disease, you may benefit the most from stomach sleeping with a pillow. It relieves the stress pushing on the space between your disks.

4. On Your Back with a Pillow Under Your Knees

Sleeping on your back may be your best option for pain relief. To get the most support:

  • Lay straight on your back
  • Put a pillow below knees
  • Use a small rolled up towel under back for additional support

This position helps because your weight is distributed evenly. Your weight is also spread across the widest part of your body.

This allows your spine and organs to be aligned and relieves strain on the pressure points. The pillow is key to keeping your lower back in a curve.

5. On Your Back Reclining Position

Have you slept in a recliner? This position can be beneficial if you have isthmic spondylolisthesis, which is a condition causing one of your vertebra to slip over the next vertebra underneath.

Reclining helps because it creates an angle between your trunk and thighs, which reduces pressure on the spine.

You can also choose to invest in an adjustable bed for additional support and the best alignment.

Alignment is Key

As you can see, there are a variety of sleep position options if you have back pain. Keeping proper alignment is the most important part of getting a comfortable night’s sleep.

Be sure you align your ears, hips, and shoulders. Add any pillows to fill gaps between your body and the bed. These gaps strain your muscles and spine.

You can also mess up your alignment when you turn in bed. Try to keep your entire body together as you move. Keep your core tight and pull your belly button in.

If needed, you may bring your knees to your chest to roll over for added support.

Key Points About Choosing a Pillow

Now that we have discussed sleep positions – it’s important to talk about your pillow. There are a variety of pillows and some are better suited for different sleep positions.

Your main head pillow should promote the natural neck posture. It should also support your spine.

You want this pillow to not only be comfortable but also adaptable. It should keep its shape after use.

You should change your pillow every 12-18 months.

If you sleep on your back, a thinner pillow may be the best option because it doesn’t raise the head too much. Memory foam is a suitable option because it forms into the shape of the neck and head.

If you sleep on your side, you should consider a thick pillow. You want this pillow to completely fill in the space between the mattress and the neck.

Stomach sleepers should also consider a thin pillow or forego having a pillow. If your pillow is too thick, it will put pressure on your neck by pushing the head back. A small firm pillow can be used to support the forehead.

How to Choose a Mattress

Your mattress needs to be supportive and comfortable. People with lower back pain may want to consider a medium-firm mattress. If your mattress is too firm, it will put strain on your pressure points and get your body out of alignment.

Your size, shape, and proportions determine the amount of support you need. You want to feel like you are floating on air with no pressure on your body.

If your mattress is too soft, it can twist your joints and get your spine out of alignment.

There are several mattress styles to choose from including innerspring, memory foam, latex, and air.

You should replace your mattress every 10-15 years.

Still Looking to Reduce Back Pain?

It’s hard to get a good night’s sleep when you have back pain. If you feel like you need more help to reduce back pain, contact Dr. Carl Spivak today for a no-cost MRI review.

He will work with you to see if you are a candidate for his minimally invasive procedures to reduce your back pain.

facet thermal ablation

How to Prepare for Facet Thermal Ablation

Back pain is an unfortunately common occurrence with an estimated 80% of the world population suffering from back pain at some point in their life. When that pain becomes chronic or when it is nerve pain, everyday activities can become excruciating.

Spinal and nerve pain caused by arthritis and/or joint degeneration can:

  • Limit mobility
  • Cause chronic pain
  • Make simple tasks impossible

Fortunately, there is a procedure called facet thermal ablation that can potentially alleviate this pain caused by issues in the facet joints of your spine.

Keep reading to learn about facet thermal ablation and how it can potentially help you.

What is Facet Thermal Ablation?

Facet thermal ablation is a minimally invasive procedure performed to alleviate pain in patients suffering from issues in the facet joints.

The facet joints in your spine refer to the joints in between the vertebrae the make your spine flexible. Cartilage is also found in these joints between the vertebrae to cushion the joints and the bones in your back.

When the cartilage wears down or when you’re suffering from disorders like arthritis, the way your facet joints line up and the way the bones touch changes. This can cause grinding, inflammation, tearing, and a loss of mobility.

These joints have a high concentration of sensitive nerves, making any damage or negative effects very painful. A facet thermal ablation is a procedure that can alleviate the pain and immobility caused by affected facet joints.

How Does Facet Thermal Ablation Work?

Unlike intense open surgical procedures that require anesthesia, this procedure is minimally invasive and requires no anesthesia. Instead, your back will be numbed and you’ll be given medication to help you relax.

You’ll be kept on conscious sedation so the doctor can ask you questions during the procedure. This might seem scary, but you’ll be completely relaxed and you probably won’t remember the procedure.

Next, the doctor will insert a needle into your back. The doctor will use something called a fluoroscope to guide the need into your back and find the areas causing pain and immobility.

Once in position, the doctor will insert a charged electrode into the tube. Using jolts of weak electricity via the electrode will essentially “numb” the nerves of the damaged facet joint.

This will prevent the nerves from sending pain signals to your brain, which will reduce the pain you feel in your back.

This is repeated for each joint that is in pain. The entire procedure only takes around 40 minutes and will produce little to no scarring.

What Conditions Can Be Helped with This Procedure?

You could be experiencing facet joint pain for a number of different reasons. A few of the most common conditions that can be helped with a facet thermal ablation procedure are:

  • Osteoarthritis
  • Facet Joint Syndrome
  • Joint Degeneration
  • Facet Hypertrophy
  • Facet Disease

Since each of these conditions affect the facet joints and result in joint and nerve pain, this procedure is commonly used as a treatment.

What Symptoms Will This Procedure Relieve?

Facet thermal ablation essentially numbs the nerves in the facet joints that are causing pain and immobility. This will help a number of your symptoms.

Pain. Because the nerves in the affected joints will be numbed by this procedure, you won’t feel the persistent or chronic pain that you were experiencing because of the joint degeneration.

Mobility. Patients find that this type of procedure can help their mobility in their neck and back.

Inflammation. Joint inflammation is a common symptom of arthritis and facet joint diseases. This procedure can reduce the inflammation in the joint and help reduce pain caused by that inflammation.

How to Prepare for Facet Thermal Ablation

Here’s what to expect:

Getting Approved

In order to be approved as a candidate for this procedure, you’ll need to make an appointment with an appropriate physician. They will be able to talk with you about your condition, examine you, and determine whether this procedure will benefit you.

Some physicians may recommend getting an X-ray or an MRI to examine your spine. You also likely won’t be approved for this procedure if you haven’t tried other treatments such as physical therapy or medication.

The Procedure

Once you are approved to get this procedure, you’ll be able to schedule an appointment. This is a minimally invasive outpatient procedure, which means it doesn’t require as much prep as a more intense and more invasive procedure.

The procedure itself takes around 30 minutes with an added 1-2 hours for observation and preparation pre- and post-procedure. Be sure to schedule this on a day when you don’t have work or school, as you will likely be out of commission for that day.


You should also arrange for a friend or family member to accompany you. Because of the sedation and the pain you might feel after the procedure, you’ll need them to drive you home.

Be sure to plan some low-key days in the 2 or 3 days following the procedure. You shouldn’t be doing any exercise or strenuous activity as you heal.

It can’t hurt to prepare some “sick day” supplies for the days following the procedures, like some comfort food or your favorite movies!

Wrapping Up

A facet thermal ablation can be a lifesaver for those suffering from chronic back pain. That might seem dramatic, but relief from chronic pain and immobility can give someone the freedom they need to live a normal life.

At Executive Spine Surgery, Dr. Carl Spivak will provide you with high-quality care that will make you feel safe and taken care of. If you have any questions or want to schedule an appointment to learn more about this procedure, contact us.

back pain massage

How Back Pain Massage Therapy Can Help You Feel Better

Ever feel like you’re in more pain every single day?

A surprising cause for your pain might come from your back. This discomfort can affect you while you sit at work, while you walk around, and even while you try to sleep at night.

Back pain massage may be the key to a healthier and happier you. Recent studies show 50% of participants who get regular massages report significant improvement of their pain symptoms.

Some felt such pain relief that they were no longer considered clinically disabled!

Before deciding if massage therapy is right for you, you need to understand what it is.

What Is Back Pain Massage?

Back pain massage is a specialized form of neuromuscular massage therapy. It concentrates on pain in your back. The act of massaging the affected area can bring immediate pain relief, and provide longer-term benefits as well.

In the same study we mentioned earlier, 75% of those who reported improvement after their massage therapy said they still felt better three months later without further therapy sessions.

Pleasure or Pain

As with any other neuromuscular massage, there is the potential for mild pain during a session.

Intense back pain sometimes requires intense massage to induce relief. However, the overall experience is pleasurable, and it can bring you a number of surprise benefits.

Headache Relief

You may be surprised to learn that a back massage can actually relieve your headaches, too.

Recent research discovered it only takes one session of massage therapy to ease the pain of patients, including those who regularly suffer from headaches.

The reason behind this discovery? Many headaches are caused by tension in different muscles within your body. Back pain massage helps to ease that tension and relieve pressure on your nerves, leading to instant relief.

Natural Muscle Relaxer

Much of the pain in your back and other parts of your body comes from having sore or tense muscles.

Massaging the affected areas can provide immediate relief in a way similar to rubbing your elbows after banging them on a hard surface.

Back pain massage provides a healthy and natural way of relieving your muscles and making you feel better.

The Cure to Posture Pain

We now understand the different kinds of muscle pain associated with sitting in the same position for long periods of time.

However, not everyone has the money or space to install something like a standing desk to counteract this pain.

Back pain massage helps provide immense relief to pain in your neck and shoulders, areas of your body most affected by sitting at a desk all day.

Massage restores your body and posture back to its proper balance and can make you both healthier and more productive.

Improved Immunity

Going into the winter season, many people are concerned about catching a cold or the flu. Another surprising benefit of massage therapy is that it boosts your immunity and helps you ward off sickness.

Your immunity is powered by white blood cells within your body. The act of massage and other forms of this therapy serves to increase the number of white blood cells within your body.

This uptick gives you a healthy and natural defense against all kinds of illnesses.

Less Anxiety

In addition to physical problems such as back pain and sore muscles, many people suffer anxiety and depression. A massage serves to provide relief for both of these maladies almost instantly.

Human touch releases oxytocin and other chemicals within your body. Patients who regularly get massages have reduced feelings of depression and anxiety. They also report an increase in their overall happiness.

Better Sleep

A good night’s sleep is difficult for many people to obtain. Busy work schedules and family lives make it hard to catch enough Zs. Many people struggle to get to sleep and stay that way the entire night.

Massage therapy has been shown to help patients sleep better, particularly those who have difficulty falling asleep. Research has shown regular massages work on patients of varying age levels, including young infants.

Patients undergoing stressful treatments such as chemotherapy also find massages helpful. This therapy provides a healthy and natural way to relax. It also reduces anxiety and provides a better sleeping experience.

No Lengthy Recovery Time

Those experiencing back pain often worry about treatment involving surgery. Surgeries often have lengthy recovery times, greatly impacting your family life and workplace productivity. Fortunately, back pain massage provides a better alternative.

It’s a completely outpatient procedure, offering a personalized treatment for your pain, getting you back to enjoying your life. You’ll also have peace of mind as trusted massage professionals help you find pain relief.

Treat Yourself to Expert Care

For Dr. Carl Spivak, your back pain relief is his profession. He’s both a neurosurgeon and the President of Executive Spine Surgery P.C. He offers a wide variety of treatments and surgeries.

Dr. Spivak is highly trained and belongs to a number of prestigious organizations, including the North American Spine Society, the American Association of Neurological Surgeons, and the Royal College of Physicians and Surgeons of Canada.

One look at his patient’s testimonials and you will see Dr. Spivak’s ability to take away your back pain and transform your life for the better.

To begin your journey toward being free of back pain, call Dr. Spivak’s office at 908-452-5612 today or book online. With his expert care, you’ll become healthier, happier, and more productive. Come find out what it means to be flexible and pain-free!

6 Signs of Herniated Disk or Slipped Disk


  1. Leg pain – this may be pain radiating down the back or the side of the leg to the knee or foot.   Sometimes this pain is felt in the front or inner thigh or even the groin.  The pain may worsen with straightening the leg or siting up.   Arthritis pain is different from slipped disk.  arthritis pain  is usually only found in the hip, knees or ankle and does not radiate down the whole leg.
  2. Numbness and tingling – this may be felt as pins and needles, burning or decreased or absent feeling in the area of the pain or beyond it.  Sometimes numbness may appear without pain.
  3. Weakness – the leg may give out or drag.  You may have problems getting up from sitting, stepping onto a stool or moving your foot.
  4. Reflex loss – patients may loose reflexes at their knee or ankle or from the bottom of their foot.  Usually this is picked up from your doctor.
  5. Walking – the leg may drag or catch on the floor, you may have to lift the leg high to avoid this
  6. Bowel and bladder – if the disk compresses the cauda equina (the nerves to the bowel and bladder)  the bowel and bladder may stop working.  You may retention of pee or bowel movements or become incontinent of them.  If this happens you should seek medical attention immediately.

About Dr. Carl Spivak

Dr. Spivak is the president of Executive Spine Surgery and has offices in New York and New Jersey.  He is well known for his cutting-edge, minimally invasive endoscopic spine surgeries and regularly teaches courses throughout the USA.  For more information please call 908-452-5612 or click on schedule-an-appointment.

6 Best Treatments for Back Pain

1. Physical therapy focusing on core strength and flexibility.

2. Weight loss.  Weight loss alleviates back pain by reducing stress and strain on your back and decreases damage to disks and joints.

3. Steroid injections may relieve back pain.  Steroids and local anesthetics work to decrease inflammation, washout chemicals that cause pain and directly reduce pain often breaking the destructive pain cycle.  Steroid injections are an effective treatment for conditions that cause back pain such as arthritis of the spine (called facet arthropathy) and disk disease.

4. Stem Cell Therapy.  Disk regeneration is a new therapy where stem cells taken from your hip are injected  into your damaged disk to regenerate the disk.  The stem cells make new disk cells increasing the fluid and size of the disk reducing back pain and suffering.

5. Endoscopic Laser Discectomy.  As the disk wears out, or degenerates, it turns black on MRI, collapses, bulges and may tear causing back pain.  Removal of the degenerated disk and treatment of the annular tear has been found to reduce back pain and suffering.   The discectomy and annuloplasty can be done with the spinal endoscope.  A scope the size of a pencil can be placed through an incision the size of your finger nail.  The disk is found and repaired under direct visualization.

6. Endoscopic Fusion. Painful degenerated disks, spinal instability, spondylolithesis may lead to severe back and/or leg pain.  This pain can be disabling.  Patients that have failed other treatments may be a candidate for fusion surgery.  Today fusion surgery can be done through a very small incision with the aid of an spinal endoscopic to reduce soft tissue and bone damage and quicken recovery.


Dr. Spivak is the President of Executive Spine Surgery and is a leader in Endoscopic Laser Spine Surgery.  He see patients in New York and New Jersey and teaches doctors his advanced surgical techniques throughout the United States.  For more information please call 908-452-5612 or click schedule-an-appointment.

Can spinal epidural steroid injection hurt my brain?

Spinal epidural injections are very common treatments for back pain and sciatica.  Sciatica is leg pain running down the back of your leg caused by a slipped disk pinching a nerve.  Imagine the disk is a marshmallow (even though it really isn’t).  The disk like a marshmallow may expand out if you squeeze it.


You can try this at home – take a marshmallow and squeeze it from the top and bottom.  See how the marshmallow expands out as you flatten it.  This is similar to a herniated disk .  The bulging disk may pinch a nerve causing the nerve to swell up and get “hot” called inflammation causing back and leg pain.

Spinal epidural steroid injections are the placement of steroid medicine into the spine onto the hot and swollen nerve to cool down the inflammation and relieve the pain and suffering.  Think of it like putting an aspirin on the nerve.

Even though spinal injections are generally safe there are risks and side effects to all medical procedures. These include bleeding, infection, dural puncture or “wet tap” causing headaches and nerve damage.  Patients may also experience increased pain, headaches, red face, anxiety, problems sleeping, fever, high blood sugar, decreased immunity, stomach ulcers, severe arthritis, cataracts and menstrual irregularities.

TO ANSWER YOUR QUESTION the most common way spinal epidural steroid injections affect your brain is through headaches.  Usually these headaches will resolve with time.  If they are related to “wet tap” you may require bed rest, caffeine, fluids and rarely blood patch.  Blood patch is the injection of blood into the spine to stop spinal fluid leak and “plug” the hole from the “wet tap”.


Dr. Spivak is a neurosurgeon fellowship trained in minimally invasive spine surgery and spinal epidural steroid injections.  He has practices in New York and New Jersey.  For more information on spinal epidural injections or laser endoscopic spine surgery please call Executive Spine Surgery at 908-452-5612 or click schedule-an-appointment.

How can I get relief from my bad back pain?

Sorry to hear about your back and sciatica. The L5-S1 disk is probably pinching your sciatic nerve causing leg pain called sciatica. Lumbar disk surgery may be considered if steroid injections have not relieved the pain. Traditionally lumbar disk surgery was done through a large incision with significant muscle retraction, damage and bone removal to get to the disk. Today most lumbar disk herniations can be removed minimally invasively with the spine endoscope. This outpatient surgery is done with a small camera the size of a pen through an incision the size of your finger nail. Most people have quick relief from their pain and decreased recovery.

Patients are admitted to the hospital or surgery center for same day surgery.  They change into a gown and IV and EKG stickers are placed by the nurse and taken to the preoperative area.  The patient is seen by the surgeon, anesthesia and nursing.  The risks and benefits of surgery are explained to the patient if not already done.  The patient then signs an informed consent sheet verifying they understand the risks and benefits of surgery and want to go ahead with surgery. The patient is then taken into the operating room.  The patient is sedated (called conscious sedation) or put to sleep (general anesthesia) by the anesthesiologist and then position face down onto the operating room bed. The back is cleaned with a disinfectant and then a drape is placed over the patient.  X-ray machine and endoscopic equipment are brought to the bed.  After the surgery is completed the patient is transferred back onto their bed and taken to the recovery room.

For more information on minimally invasive spine surgery (MISS), endoscopic spine surgery or laser spine surgery please call Executive Spine Surgery at 908-452-5612 or click on schedule-an-appointment.

Can scoliosis cause chronic back pain?

The spine is made up of a stacked alternating vertebral bodies and disks.  The spine is usually straight on anterior posterior x-ray.  Scoliosis is an abnormal curvature of the spine.  The spine may look like a C or S on X-ray. Scoliosis may arise from birth abnormalities where the spine was formed wrong, such as missing half of a vertebrae or from changes resulting from arthritis.  The cause of scoliosis in young people is unknown and is called idopathic even though certain genetic traits have been defined.

Children are commonly screened at school for scoliosis, especially at the time of the growth spurt when the development and progression is most common.  Patients suspected of having scoliosis undergo a history and physical and relevant laboratory investigations.  This may include x-rays, serial x-rays, CT and MRI.  Patients found to have a spinal curvature of greater than 10 degrees are diagnosed as scoliosis.

Scoliosis alters the mechanics of the back and puts significant strain on the vertebral bodies, disks, muscles and even the nerves leading to chronic pain and suffering.

Treatment is complex and requires individualization.  Smaller curvatures are watched while larger curvatures greater then 20 to 30 degrees may require bracing. Surgery is usually reserved for very large curvatures greater then 45 to 50 degrees which have high likelihood to progress even more.  Other indications for surgery include pain, weakness, difficult mobilizing and breathing.  Surgery usually involves spinal fusion surgery, this may be done through the front (anterior), side (lateral) or back (posterior) combined with spinal instrumentation (screws and rods).

Overall prognosis of scoliosis depends on the likelihood to progress.  Patients with larger curvatures, thoracic curves, double curves and immature spines (such as adolescents) have higher chance or progressing.


Dr Spivak is a neurosurgeon who specialized in minimally invasive endoscopic spine surgery.  He is a well known teacher and speaker in laser spine surgery.  For more information on scoliosis, other spinal disorders or laser spine surgery please call 908-452-5612 or click schedule-an-appointment.