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Category: Pain

Carl Spivak, MD - Executive Spine SurgeryNewsPain
By Staff Writer Discectomy, Pain, Relief, Sciatica, Surgery, Treatment Options for Back Pain

I have a pain in my left butt that goes all the way down my leg. What could that be?

Sciatica is characterized by pain starting in the back and radiating down the back of the leg to the foot.  It is associated with numbness in the little toes of the foot and plantar flexion weakness (that is weakness when standing and walking on your tip toes).   The sciatic nerve is made up of spinal nerves exiting the lower spine. After exiting the spine it travels though the pelvis and down the leg.    Sciatica is commonly caused by a slipped herniated disk in the back between the L5 and S1 vertebrae.  Other causes of sciatica include stenosis, bone spurs, slippage of the spine (called spondylolithesis), fracture, tumor and infection.

Sciatica is initially treated conservatively without surgery.  Common treatments includes rest, anti-inflmmatory medicine, steroid medicine, pain medicine, physical therapy, steroid injections and spine surgery.  Traditional surgery involved a large incision, significant muscle dissection, retraction and injury and removal of a lot of bone called a laminotomy.  All these destructive changes may lead to scar tissue, spinal weakness (called instability) and chronic pain.    Today lumbar disk herniations may be removed minimally invasively with the spinal endoscope.  The spinal endoscope is a very small tube (7 mm) with a camera at the end of it.  Using x-ray guidance it can be placed directly to the herniated disk in the spine. The disk can then be removed with tiny instruments under direct visualization.

The procedure takes 1 hour and patient is discharged home after 1 to 2 hours.  There is less blood loss, tissue damage and pain compared to traditional open surgery.  Most patients have a quicker recovery and return to work.  For more information please contact Executive Spine Surgery at 908-452-5612.

By Staff Writer Pain, Sciatica, Spinal Stenosis, Spondylosis, Surgery

Can stress fractures cause other medical problems like degenerative disc disease, stenosis, bone spurs?

Stress fractures of the pars interarticularis (the bone that hooks the upper vertebrae to the lower vertebrae preventing them from slipping apart) are called spndylolysis.  Lysis means split or in this case break or fracture.  Spondylolysis commonly happens in childhood during the growth spurt.  It may also break from physically demanding sports like football or gymnastics.  Sometimes these fractures may heal with rest and bracing, or they may stay the same or progress resulting in slippage of the spine called spondylolithesis.  Spondylolithesis is when the upper vertebrae slips forward on the lower vertebrae.  This may cause back pain from abnormal alignment and instability (increased spine movements).  Spondylolithesis may also cause leg pain from bone, ligament and/or scar tissue pinching the nerves going to the legs.  This tightness is called spinal stenosis.   The pars fracture and spondylolithesis (slip) may stress the disks, facet joints, ligaments and muscles leading to degenerative disk disease and bone spurs.

Today there are many surgical options for spondylolysis (pars fracture) and spondylolithesis (slip) including endoscopic foraminotomy (opening up the tightness around the nerves), endoscopic rhizotomy (cutting the facet pain nerves like a “root canal” for the spine) and endoscopic fusion (placement of screws, rods and bone to stabilize the spine strengthen the spine and prevent abnormal spine movements called instability).  For more information please contact Executive Spine Surgery.  Good Luck!

By Staff Writer Neck pain, Pain, Relief, Spondylosis, Treatment Options for Back Pain

I smashed my shoulder into the pool wall 5 days ago and now I can’t move my neck or shoulder without a lot of pain.

You probably pulled a muscle, but other possibilities included injury to your facet joints or disk.  If you think you broke your neck or have any arm or leg pain, numbness, weakness, clumsiness or bowel and bladder problems you should see your doctor right away.  If not I would recommend rest, anti-inflammatory medicine like ibuprofen or naproxen (if fine with your doctor) and neck stretching.

Neck Stretch Routine: Take a hot shower and heat and loosen your neck:

1. Bend neck forward and hold in position with arm stretching neck 30 seconds

2. Bend neck backwards 30 seconds

3. Bend neck right 30 seconds

4. Bend neck left 30 seconds

5. Turn neck right 30 seconds

6. Turn left 30 seconds

Complete 3 sets of stretching routine. Good Luck!

If pain persists or you develop any arm or leg pain, numbness, weakness, clumsiness or bowel and bladder problems you should see your doctor right away.  If this fails to help you may benefit formal physical therapy and consultation with spine surgeon.   For more information please contact Executive Spine Surgery.  Good Luck!

By Staff Writer Discectomy, Pain, Relief, Sciatica, Surgery, Treatment Options for Back Pain

Can you have a massage after lumbar fusion surgery?

Yes it is safe to have a massage after spinal fusion surgery, but I would recommend waiting until the incisions have healed.  Enjoy!

Spinal instrumentation and fusion surgery is done to strengthen, stabilize and hold the spine together.  Surgical indications for fusion surgery include spondylolithesis (slipped spine bone), spondylolysis (fracture of the pars articularis that holds the spine together), multiple disk surgery, spinal fracture, cancer, degenerative disk disease (DDD), osteoporosis, etc.

Spinal fusion is done by the placement of  screws through the pedicle into the vertebral body at 2 or more levels.  These screws are linked together with rods forming a strong construct.  Bone is placed to join or “fuse” the vertebrae together.  The bone can be placed in different locations and by different techniques.   Bone may be placed  over top of the spine [posterolateral fusion (PLF)] or between the vertebral bodies [anterior lumbar interbody fusion (ALIF), direct lateral interbody fusion (DLIF or XLIF), transforaminal lumbar interbody fusion (TLIF) or posterior lateral lumbar interbody fusion (PLIF)].  Spinal fusion can now be done endoscopic with minimal tissue damage and bone removal.  This is called endoscopic lumbar interbody fusion (ELIF).  Please call for more information. Good Luck!

By Staff Writer Pain, Relief, Spondylosis, Treatment Options for Back Pain

I strained my back muscles and hips making it is painful to walk. Will I need a wheelchair?

Pulled muscles in the back usually improve with rest, stretching and anti-inflammatoy medicine (if you can take them) and physical therapy after a few days to weeks.  Pulled muscles do not cause leg paralysis and therefore do not require a wheelchair.

The back injury may be more serious then a pulled muscle, such as fractured vertebral body (vertebral body compression fracture), injured back joints (facet arthropathy or facet joint syndrome), injured sacroiliac joint (SI), ruptured or damaged lumbar disk or slipped spine (spondylolithesis).  These circumstances may require steroid injections or surgical treatments such as kyphoplasty or vertebroplasty, endoscopic rhizotomy, endoscopic discectomy or endoscopic fusion.

If the pain does not improve or if you have developed or develop neurological problems (difficulty walking, leg numbness, weakness or bowel and bladder difficulties then you should see your doctor right away.  Good luck!

By Staff Writer Pain, Relief, Sciatica, Treatment Options for Back Pain

Should I be wearing a back brace if I have a disc injury?

No I would not recommend a back brace to treat your injured disk.  Back brace can actually make your back more weak leading to more pain.  Back braces are used most often after a spine fracture or fusion surgery to provide extra stability to promote bone healing.   Core strengthening though yoga or other isometric exercises would be better treatment then a back brace.  For more information please contact Executive Spine Surgery.  Good Luck!

By Staff Writer Pain, Spondylosis

Can spondylosis cause paralysis in an arm?

Spondylosis is the “wear and tear” arthritis changes that occur in the spine over time.  Disk herniations, bone spurs or ligament thickening may cause compression and injury of the spinal cord and/or spinal nerves producing weakness or paralysis of the arm.   Fortunately this is not common.  Spondylosis may also cause neck pain and stiffness, electrical pain shooting down your spine with head movements, numbness, clumsiness hands, unsteadiness or falling, bowel and bladder dysfunction and paralysis.  If you have any further questions please contact Executive Spine Surgery.  Good Luck!

By Staff Writer Discectomy, Neck pain, Pain, Surgery

Does the donor bone graft in bone transplants come from living donors?

There are two types of bone graft commonly used autograft and allograft.  Autograft is taken from the patient during surgery, this is usually from iliac crest or bone that is removed the spine.  This is the best graft material but unfortunately can lead to new pain, deformity or complications.  Allograft is bone taken from bone bank from deceased donor.   This is almost as good as your own bone and saves you second surgical site. Recently bone substitutes made up of calcium have become available and may replace bone in the future.  For more information please contact Executive Spine Surgery today.  Good luck!

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

L5S1 Hernation, S1 nerve compression.

You have a herniated disk in your spine pinching your left S1 leg nerve causing sciatica.  For more information please see my blog posting on sciatica.  Most of these disks can be removed by an extremely minimally invasive surgery called endoscopic spine surgery.  This surgery can be done awake through a small incision the size of your finger nail.  Pain relief is often immediate and you are usually discharged home 1 hour after surgery.  To schedule an appointment contact Executive Spine Surgery.  Good Luck!

 

By Staff Writer Pain, Surgery, Treatment problems

Is it common for the rod in a spinal fusion to break after 3 months?

It is not common for a rod to break at all, especially 3 months after surgery.  The rod is just a solid metal rod.  It is unlikely for the rod to be defective.  Factors that may lead to breakage of the rod include multi-level fusion (greater stress on the rod), very weak spine (often broken back places large forces across the rod), deformed spine requiring surgical correction (again places large forces across the rod), bent rod (may weaken the rod but is usually necessary to align the spine), smaller diameter rod (less strong but necessary at certain areas of the spine), large patient, too active patient or someone who falls or involved in an accident (increased forces across the rod).  Good Luck!

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