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!

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!

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!

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!

How successful is a discectomy at relieving back pain?

Discectomy best relieves sciatica leg pain.  Back pain may be relieved after discectomy but it is not as consistent as leg pain. Patients with degenerate disk disease and primarily back pain may undergo a discogram (pain mapping of the disks) to confirm the symptomatic disk.   Discogram helps determine if surgery will work.

Discogram is an injection into disks.  If the injection produces your typical back pain (concordant pain) then this disk is most likely culprit of the back pain.  In addition to pain the discogram often shows leakage of dye out of the disk through a rip called an annular tear.  If the injection only causes mild pain or not typical pain then that disk is not causing the pain.   In this circumstance the patient would require additional pain mapping to identify the pain source.

The treatment options to fix painful disk include endoscopic discectomy and annuloplasty (the annular tear is isolated and burned with radiofrequency coagulation) or endoscopic fusion surgery (ELIF).  Often endoscopic discectomy is considered first to try to avoid fusion surgery.  Unfortunately surgery does not always relieve back pain from degenerated herniated disks.  Surgery should be considered the last option or not an option is some cases.  Please call and set up an appointment with Dr. Carl Spivak to discuss your back. Good Luck!

Does a pinched nerve (sciatica) always stay pinched unless surgery is given? Will it always show up on an MRI if surgery is given?

Disk herniations cause leg pain (sciatica) by pinching the sciatic nerve in the back.   Disk herniations may resolve on their own over a year or so, but they usually just get a little smaller as seen on multiple MRI .  Surgery is the best treatment to physically remove the disk.  Today this can be done endoscopically (endoscopic discectomy) though a very small incision the size of your finger nail. The endoscopic port is placed right onto the herniated disk and the disk is removed with tiny instruments.  This is a new minimally invasive treatment for back and leg pain.

Disk herniations may show up after surgery on MRI scan, but it usually is smaller.   Postoperatively the the disk that is seen is a combination of disk, bulging ligaments and scar tissue.

For more information on sciatica please contact Executive Spine Surgery. Good Luck!

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!


Should I get a massage after a car accident?

Yes as long as spinal injury has been ruled out by your doctor.   Most car accidents involve jolting whiplash injuries to the spine.  These injuries respond well to massage, heat, stretching, physical therapy and anti-inflammatory medicine.  Injuries to the bones, ligaments, disks, spinal cord and nerves may require bracing or surgery.  I would recommend going to the emergency room after a car accident.  For more information please contact Executive Spine Surgery.  Good Luck!

Lower back problem. GP, chiropractor, or specialist?

If you have intermittent back pain you could start with either.  If you have other symptoms such as constant, worsening back pain, leg pain, numbness, tingling, bowel and bladder problems, weight loss, fevers, chills, night sweats, significant back injury or history of cancer, then you should start with primary care doctor, pain doctor or spine surgeon.  If you do not get relief from the chiropractor then I would recommend seeing a medical doctor, preferably spine specialist.

Sciatica – see a General Practitioner (GP) or a Chiropractor?

I would recommend seeing your primary care doctor to orchestrate the workup and treatment of your pain.  You may require anti-inflammatory medicine, physical therapy, chiropractic manipulation and MRI scan of the spine .  Depending on the results of these tests and treatment you may need to see an interventional pain doctor or spine surgeon to determine the benefit of steroid injections or spine surgery.  Today many spine surgeries can be done minimally invasively through a spinal endoscope decreasing tissue damage, pain and recovery time from surgery.  Please contact us for more information.  Good Luck!

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