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.

ABOUT US:

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.

HOMEWORK:

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”.

ABOUT DR CARL SPIVAK

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.

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.

ABOUT DR CARL SPIVAK.

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.

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.

 

What is the sciatic nerve?

The sciatic nerve is made up of the spinal nerve roots exiting the lower spine. The sciatic nerve travels through the pelvis and down the leg. When disk or bone spur pinches the sciatic nerve in the back it causes back and leg pain called sciatica. This pain tends to be in the back of the thigh and calf.  This may be associated with numbness in the little toes and difficulty walking on your toes.  Bending forward or lifting your leg may aggravate the pain.  People with sciatica benefit from rest, anti-inflammatories, pain medicine, physical therapy, steroid injections and spine surgery.

Today spine surgery is not like how it used to be.  Most spine surgeries can be done with laser or spinal endoscope.  The arthroscopic procedure is done through a small incision the size of your finer nail through a tube the size of a pen.  The herniated disk is found and removed under direct visualization un-pinching the nerve relieving pain and suffering.  Patients are discharged home the same day after one to two hours.  Many people have little post-operative pain and need for pain medication after surgery and can return to most activities within a few weeks after surgery.

To learn more about sciatica and endoscopic spine surgery please see What is Sciatica? and Laser Spine Surgery.

Click to schedule-an-appointment or call 908-452-5612.

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 appt@executivespinesurgery.com Good Luck!

 

Case Report: 61 Year Old Man Felt Like He was Kicked in the Groin!

Patient History

The patient is a 61-year-old man who presented to emergency room with severe back pain and right testicular groin pain.  He said “It felt like I was kicked in the groin”.  The medical workup identified additional right leg weakness, numbness and pain.  MRI diagnosed right L3-4 slipped disk pinching the right L4 nerve.

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Treatment

Patient underwent Endoscopic Laser Spine Surgery for complete removal of the herniated disk.  The procedure was done comfortably under twilight sedation and patient had instant, complete pain relief after removal of the large disk fragment.  Patient was discharged home pain free one hour after surgery.

Case Discussion

Testicular pain is an unusual presentation of a slipped disk herniation.  If the disk becomes injured or weakens it may rupture and leak out of the disk and compress or “pinch” a nerve causing back and leg pain called sciatica.

Endoscopic Laser Spine Surgery is an advanced minimally invasive option to cure back pain.  A pen-sized video camera is inserted into the spine to identify and remove the herniated disk and un-pinch the nerve.  There is minimal skin or muscle damage or blood loss.  Patients are discharged home the same day and benefit from shorter recovery, decreased post-operative pain and quicker return to work.

What are the options for sciatica?

Your back is made up of vertebrae, disks and nerves going to you legs. The vertebrae are made up of vertebral body in the front and lamina and spinal process in the back.  The spinal cord and spinal nerves are located in-between.  If the disks in the back slip out of position and pinch the nerves going to the legs the brain registers this as leg pain even though the problem is in your back.  Sciatica is back and pain typically caused by a herniated disk compressing one of the spinal nerves that become part of the sciatic nerve.  The most common surgery for sciatica is discectomy, or removal of the piece of disk pinching the nerve.  Discectomy procedures include:

1. Laminotomy and discectomy- surgeon makes a midline skin in the lower back.  The back muscles are divided and retracted to the side.  The protective bony lamina is removed to reveal the nerve sac (theca sac) and spinal nerves.  The spinal nerves and nerve sac are retracted and the disk herniation is identified and removed. This is sometimes called a traditional, open discectomy.

2. Miscroscopic discectomy – Same as laminotomy and discectomy but a microscope is used.  The microscopic does not indicate smaller incision but the use of microscope to improve light and visualization.

3. Tubular microscopic discectomy-  Same as microscopic discectomy but instead of making a large skin incision and muscle retraction the surgery is done through a tube.  The skin and muscles are dilated.  Spine bone is removed in a similar fashion to #1 and #2.  Common tube sizes range from 18 to 27 mm in size.  This technique decreases muscle damage and likely back weakness and pain long term.

4. Endoscopic discectomy– This is a revolutionary new procedure.  A very small 8 mm tube is placed into the spine through an existing hole called a foramen.  The hole can even be enlarged if needed.  After the tube is in place, a very small high definition video camera is placed through the tube into the spine.  The disk can be found and removed with tiny instruments quickly relieving pain and suffering. Patients are discharge home right after the procedure and usually experience less postoperative pain. Many people do not take pain medicine after surgery.   As you can see spinal disk surgery has come a long way.

For more information please see the following links:

What Causes Back Pain?

When Should I Consider Back Surgery?

Read More on treatment options for back pain

least invasive, cutting-edge surgical techniques

Laser Spine Surgery

To book an appointment please call 908-452-5612 or click schedule-an-appointment.

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.