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Category: Sciatica

Carl Spivak, MD - Executive Spine SurgeryNewsSciatica
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 Sciatica, Surgery, Treatment problems

Is it common to develop sciatica after back surgery?

Sciatica is back and leg pain produced by a pinched nerve in the back.  Unfortunately sciatica may recur after back surgery, but it is not very common.  The cause of it depends on your original back problem and what type of back surgery you had.  For example after:

Lumbar discectomy – The disc is not as strong after back surgery and it is possible for new piece of disc to break off, herniate and pinch the sciatic nerve.  This is called recurrent disk herniation.  Other times the sciatica may be caused by scar tissue.  This is less common with endoscopic surgery.

Lumbar laminectomy – Stenosis (tightness) may develop from new bone or ligament formation or the development of instability and slip of the spine called spondylolithesis.

Lumbar fusion – the instrumentation may break or fusion fail producing instability, slip and sciatica.  Alternatively the spinal disease may worsen at the level above or below the fusion (that is at L3-4 or L5-S1 level after L4-5 fusion) due to increased strain to the surrounding spine due to the immobile fused segment or just from worsening degenerative spine disease.  This is called adjacent segment disease.

I would recommend you see a spine surgeon. You will likely require new X-rays and MRI of the lumbar spine. Make sure you have the MRI with and without contrast to rule out scar tissue.  For more information please contact Executive Spine Surgery.  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 Sciatica

Could my sciatica be caused by a car accident I was in?

Sciatica is back pain that shoots down the leg from compression of the sciatic nerve in the back.  Yes sciatica can be caused by a car accident.  To blame the accident the leg pain should start during or just after the car accident.  It is difficult to determine the cause and timing of a disk herniation on MRI.  The disk herniation may have been present prior to the MRI or herniated at the time of the accident, but without a MRI prior to the accident it is difficult to say when it herniated.   Either way, if the pain started at the accident then the sciatica was caused by the accident and the disk is new or been aggravated by the accident  (this is called an aggravation of pre-existing condition).  Good Luck!

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

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!

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

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!

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 Sciatica, Spinal Stenosis, Treatment Options for Back Pain

One inch incision for Stenosis, Degenerative Disc Disease, Sciatica, etc.

Spine surgery done through an inch or smaller incision is called minimally invasive surgery.  This may be done by a neurosurgeon who specializes in minimally invasive surgery.  The procedure involves placing sequentially larger tubes in the back to dilate and separate the skin, muscle and soft tissues to get access to the spine.   Click to Read More on treatment options.  Good Luck!

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

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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