Pain Archives - Page 3 of 7 - Carl Spivak, MD

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

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.

By Staff Writer Pain

Sharp shooting pain in my left arm.

Neck and back pain are very common problems seen in spine clinics today. Patient may develop neck pain from damaged degenerating disk, arthritis is in the facet joints, muscle spasms, broken bones, looseness or instability of the spine. If these problems lead to compression of the spinal cord or neck nerves then arm pain may develop. Moving the neck may worsen the arm pain. This pain may be associated with numbness and tingling, pins and needles and/or weakness in the arm. They may develop weakness or poor coordination in the hands and unsteadiness when they walk leading to falling.

Patients with pain, numbness and tingling may benefit from rest, physical therapy and anti-inflammatories prior to considering surgery. Patients with more severe problems including weakness or coordination require more urgent surgical consultation.

Traditionally surgery was done with a decompression, inter-body fusion and instrumentation either through the front or back of the neck. There are new options today! JOIMAX has just developed and released a new Cervical Endoscopic Surgical System (CESSY) operating on neck problems. Through a very tiny incision a tiny camera is placed through the neck into the disk space. The slipped herniated disk is found under direct vision and removed with very tiny instruments. No fusion or spinal hardware is needed.

The first course on this new Cervical Endoscopic Surgery was hosted in Baltimore , MD in July 2013. These techniques are now available at select practices in the USA.

For more information please contact 908-452-5612 in New Jersey or 212-547-8005 in New York City or contact us through the web by schedule-an-appointment.

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

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.

By Staff Writer Neck pain, neck stretch, Pain, Relief

Neck Stretch Exercises for Stiff Painful Neck.

Does your neck get stiff? Do you ever feel like you need to “crack it”? Do you get severe neck pain?

If you answered yes to any of these questions then Neck Stretching may be the answer for you.

Neck pain causes a viscous cycle of stiffness, weakness and pain. For example you twist your neck and develop neck pain. Every movement worsens the pain. You respond by not moving your neck or putting on a neck collar. Unfortunately this weakens your neck muscles and weak tight neck muscles hurt more. You are making the pain worse.

Stretching is the best way to break the pain, stiffness and weakness cycle! Neck stretching stretches the muscles, improves neck mobility and decreases pain.

NECK STRETCH ROUTINE

I recommend a hot shower before stretching to relax and loosen the neck. You need 5 to 10 minutes to properly stretch the neck. You must flex neck forward and hold the neck in that position with your hand on the back of your head. You must simultaneously relax your neck. Hold this stretch for 30 seconds. Repeat this exercise for the rest of the neck stretch positions. After the whole set is complete repeat the set 2 more times. You need to do exercise 3 times in total.

EXERCISE SEQUENCE

Flex head forward x 30 seconds

Extend head backwards x 30 seconds

Turn head right x 30 seconds

Turn head left x 30 seconds

Bend head right x 30 seconds

Bend head left x 30 seconds

Repeat whole sequence for a total of 3 times.

For more information please contact Executive Spine Surgery at 908-452-5612 or email at [email protected]

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

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 [email protected] Good Luck!

By Staff Writer Lower back pain, Pain, Spinal fusion

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.

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 Lower back pain, Pain, Relief, Treatment Options for Back Pain

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!

By Staff Writer Lower back pain, Pain, Relief, Sciatica, Spinal fusion, Spinal Stenosis, Treatment Options for Back Pain

My lower back is in pain all the time and my doctor did an x-ray of my lower back and it came back fine, what else could be wrong?

Low back pain is a common complaint in America. It may arise as result of injury but ususally there is no specific cause. There are many potential causes of low back pain. The pain may originate from many different structures including your spine bones, disks, facet joints, muscles, ligaments,chest and abdomen, etc. Please see What Causes Back Pain? for more information.

X-ray is not a sufficient workup for back pain, most people need at least an MRI scan to properly evaluate their back. Sometimes they need special diagnostic injections called pain mapping. This may include diagnostic transforaminal nerve blocks, medial branch blocks and discogram.

Unless a serious cause of back pain is found most doctors recommend to start with conservative treatment, such as rest, physical therapy to improve core muscle strength and flexibility, non steroidal anti-inflammatory medications, pain medicine and steroid injections. Patients who do not improve may benefit from surgery. Please see When Should I Consider Back Surgery?

Depending on the cause of the pain patients may benefit from disk surgery (What is Sciatica?), lumbar laminectomy (Overview of Spinal Stenosis), lumbar fusion (Spinal Fusion and alternate Options) or vertebroplasty or kyphoplasty (Kyphoplasty – what is it?).

For more information please Schedule an Appointment. Good Luck!

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Category: Pain