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Category: Sciatica

Carl Spivak, MD - Executive Spine SurgeryNewsSciatica
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 Discectomy, endoscopic spine surgery, laser surgery, Pain, Sciatica, Surgery, Treatment Options for Back Pain

I am 39 year-old woman with left leg pain and numbness. What can I do?

Your left leg pain and numbness is probably from a “pinched” nerve in your back.  This is called Sciatica.  Sciatica in a 39 year old is most commonly caused by a disk herniation.  Treatment for sciatica varies from rest, physical therapy, anti-inflammatories, steroid injections and surgery.   Pain that is not improving, very severe or associated with neurological deficits (weakness, foot drop, numbness or bowel and bladder incontinence or retention) may require spinal surgery.

In the past spinal surgery was a big deal.  You were admitted to the hospital, put to sleep under a general anesthetic and had your back half opened up to expose the spine.  The muscles were retracted and damaged and the bone was removed.  This bone removal is called a laminectomy or laminotomy, depending on how much lamina was removed.  Then the traversing nerve and thecal were retracted and the disk was found and removed.

Today disk surgery is much simpler.  Disk surgery can be done through a spinal endoscope (such as JOIMAX), this is often called Laser spine surgery, even though the laser is not necessary today.  The big advancement of “Laser spine surgery” is the used of an endoscope.  An endoscope is a pen-sized micro-video camera that is placed inside the spine to the herniated disk pinching the sciatic nerve.  Tiny instruments are inserted through the endoscope to remove the disk.   The sciatica leg pain often improves very quickly often before surgery is over.

Schedule an Appointment to learn more about endoscopic spine surgery and how it can help you!

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

Does everyone eventually get some form of spondylosis?

Spondylosis is degenerative arthritis of the spine.  Most, if not all, people develop evidence of spondylosis on X-rays, CT or MRI, since it is normal wear and tear changes of the spine.   Fortunately many people do not develop significant pain or other symptoms from it.  For more information click on Back arthritis or Sciatica.  Good Luck!

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

What causes neck and shoulder blade pain and arm tingling?

The neck and shoulder pain and arm tingling may be from a disk pinching a nerve in your neck. This often will cause spasms in the shoulder and lower neck.   You may benefit from rest, physical therapy and/or anti-inflammatory medicine.  If the pain does not improve with conservative treatment you may benefit from steroid injections or surgery depending on the cause of the pain.  There is new endoscopic spine surgery options for treatment of symptomatic disks in the neck.  Good Luck!

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

I have a large disc protrusion compressing my L5 nerve and causing spinal stenosis. Do I need surgery?

Disc protrusion is when the disk slips out of it’s normal position in between the spinal vertebrae and extends into the spinal canal.   Other commonly used names are bulging disk, slipped disk or herniated disk, etc.  Spinal stenosis is tightness or loss of volume of the spinal canal.

Right L4-5 disk protrusion initially is treated with conservative treatment which may include rest, physical therapy, medications and steroid injections.  Surgery is considered when a patient fails conservative treatment and/or has severe pain, numbness, weakness or neurological dysfunction (such as urinary incontinence).

Today most disk surgery can be done by using extremely minimally invasive surgical techniques called endoscopic spine surgery or laser spine surgery.  This revolutionary same day surgery is done through a tiny tube the size of a pen which is placed into the spine under X-ray guidance.  The disk is found and visualized through the high definition video camera found inside the spine endoscope.   The disk is then removed with tiny little instruments taking pressure off of the nerve.  This usual provides quick relief of pain and suffering.  Often patients feel much better right after surgery.

For more information on sciatica and lumbar disk herniations click on the following link Sciatica.  Good Luck!

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Pain, Sciatica

What does degenerative disc disease and no signal abnormality within the cord or enhancement mean?

Degenerative disc disease = “worn out” degenerated disks in your spine

No signal abnormality = spinal cord looks normal, no abnormal signal suggesting disease or damage

No enhancement = the spinal cord is not taking up contrast die.  This would suggest inflammation, infection or cancer

For more information on sciatica please click the blog below.  Please contact Executive Spine Surgery for more information on degenerative disk disease, disk herniations, sciatica and endoscopic spine surgery. Good Luck!

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

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Pain, Relief, Sciatica, Surgery

I have a knife pain on right side of mid back that radiates around ribs but I never experience severe abdominal pain.

You may have a thoracic disk herniation with a pinched nerve. You will need an MRI scan of your thoracic spine.  Thoracic disk herniations are uncommon but they can be dangerous especially if they pinch and damage the spinal cord.  Thoracic disk herniations can cause shooting pain around your rib cage and weakness, paralysis or bowel and bladder incontinence.   They are usually treated surgically if there is neurological deficits.  In the past open traditional surgery was the only option to treat thoracic disk herniations.  This was a large operation with significant risk.  Today there are new minimally invasive spine surgery (MISS) options for thoracic disk disease including laser discectomy or endoscopic discectomy.

Endoscopic discectomy involves placement of needle into the herniated disk, followed by serial dilation of the soft tissue and placement of an endoscopic port.  The endoscope is then placed through the port to the herniated disk.  The disk is then removed with small cutting and grabbing instruments under direct visualization.  After the disk is removed and the nerve is unpinched the endoscope and tube are removed allowing the soft tissues to fall back together.  Single suture  and dressing is used to close the incision.  The patient is discharged home the same day.

Click Read More to learn about treatment options.  Good Luck!

By Staff Writer endoscopic spine surgery, laser surgery, Pain, Relief, Sciatica, Spinal Stenosis, Spondylosis, Treatment Options for Back Pain

What can be done? Can it be fixed easily? What are Schmorls nodes? What is an annular bulge?

These are 3 separate problems:

1. Schmorl’s nodes – Schmorl’s nodes are disk herniations into the vertebral body.  The disk squeezes out of the disk space into the bone.  This is usually not usually painful or treated.

2. L5-S1 degenerated, bulging and protruded disk – Over time disks wear out from injury, aging, wear and tear, genetics, work and sports.  Your L5-S1 disk is degenerating, wearing out and likely collapsing and bulging into the spinal canal pinching the L5 and S1 nerve root.  A protruded disk is larger then bulging disk.  This may be the source of the pain and is often fixed with discectomy or spinal fusion.  Click link to read more on sciatica and disk herniations I have a pain in my left butt that goes all the way down my leg. What could that be?

3. Spinal stenosis – is narrowing of the spinal canal.  The measurement varies but is in the range of 11 mm.  More important than the measured size of the canal is the appearance and the amount of nerve compression seen on MRI.  Spinal stenosis may be treated with pain injections or surgery.  Minimally invasive treatment options include MILD procedure and METRx tubular laminectomy.  JOIMAX is currently working on new endoscopic treatment for spinal stenosis.

I would recommend seeing a spine surgeon to determine the best treatment for your back.   Good Luck!

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!

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