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Category: Relief

Carl Spivak, MD - Executive Spine SurgeryNewsRelief
By Staff Writer endoscopic spine surgery, laser surgery, Relief, Spinal fusion, Surgery, Treatment Options for Back Pain

Should I hire a nurse after spinal fusion?

Spinal fusion surgery is the joining of one backbone to another backbone (bony vertebrae to another bony vertebrae).  This is usually done for instability, that is when the spine is weak and falling apart.  Spinal fusions can be large, painful and debilitating procedures, but hiring a nurse is not usually not necessarily required after lumbar fusion surgery.   That said each person, spinal disease and surgery is different.  If you are very concerned you could set up just in case.

Minimally Invasive Spine Surgery (MISS) tends to be less painful and debilitating then open surgeries. Multilevel surgery is more painful then single level surgery.  Minimally invasive surgery is less painful then open traditional surgery because there is less tissue destruction.  In traditional surgery there is a large skin incision, signifiant retraction of the back muscles and a lot of bone removal resulting in severe pain.

Tissue damage is minimized with minimally invasive surgery.  The skin incision is small instead of large.  The muscles are dilated (pushed apart) rather than retracted.  Muscle retraction damages muscles producing scar tissue and weakness resulting in pain.  Little if any bone needs to be removed during minimally invasive fusion (this is especially true for endoscopic lumbar interbody fusion (ELIF).  These benefits results in less pain then with traditional fusion surgery.

For more information on spinal fusion click Spinal Fusion and Options

For more information on how Executive Spine Surgery can help you please call 908-452-5612 or inquire at schedule-an-appointment.

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 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 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!

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, Lower back pain, Relief, Spinal fusion

Do I have to wear my back brace at night?

Back brace is used to stabilize your spine after spinal fusion surgery.   These braces are used to hold the spine together until fusion occurs.  Spinal Fusion is the joining of one vertebrae to another vertebrae by bone bridge.  The two vertebrae and the bone graft eventually become one solid bone.  Spinal instrumentation acts as a internal brace to hold the fusion together.  This may consist of rods, screws, plates, clamps or wires.

The rate of spinal fusion depends on many factors including age, activity, size, location.  Spinal fusion is decreased by smoking and usage of non-steroidal anti-inflammatory medications.

Spine braces can be in the form of a neck collar after anterior cervical discectomy and fusion (ACDF), thoracic lumbar sacral orthosis (TLSO) after treatment of a thoraco-lumbar burst fracture or lumbar sacral orthosis (LSO) after lumbar fusion.

For more information on back braces please see the following blog posts:

Is it bad to use a back brace?

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

Back braces are not usually worn in bed because there are less forces being applied across the surgical site and less chance of damaging the fusion and instrumentation holding the spine together.

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

Is it bad to use a back brace?

Frequent use of a back brace may lead to weakening of your back muscles and the development of increased back pain. It is best to strengthen your core muscles to stabilize your back to decrease back pain.  I recommend starting Yoga.  Yoga is a great exercise to strengthen your abdomen and back, improve flexibility and loose weight!  For more information please contact Executive Spine Surgery.  Good Luck!

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