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 [email protected] Good Luck!


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.

I have synovial (ganglion) cyst in my spine. Help?

Synovial cysts commonly may arise throughout the body.  Synovial cysts are sometimes called ganglion cysts.  Synovial cysts that arise in the spinal canal can cause severe back and leg pain.  They are usually small painful cysts located in the epidural space inside the spinal canal.  They arise from degenerated “worn out” spinal facet joints.  They have a fibrous wall and are filled with thick mucus fluid similar to synovial cysts found in other areas of the body.

As synovial cysts grow they cause pressure or “pinch” near by nerves producing pain.  They can also produce numbness, tingling and weakness.  They are usually slow growing but sometimes form rapidly.

Treatment of synovial cysts include: observation, epidural steroid injection, intra-cyst steroid injection to rupture the cyst and surgery.  Surgery usually requires large incision with significant bone and ligament removal to enter the spinal canal and remove the cyst.  Since the degenerated facet joint is the source of the cyst it is possible for the synovial cyst to recur.  Future resections may entail partial or complete removal of the facet joint and lumbar fusion.

Today many of these synovial cysts can be removed through the spinal foramen with little to no bone removal with the spinal endoscope.  Endoscope is a video camera connected to a high definition scope the size of a pen which can be placed into the spine to the synovial cyst for direct visualized removal.  Patients often feel immediate pain relief and are able to return back to normal activity much faster then with traditional open spinal surgery.

For more information on endoscopic spine surgery please see Laser spine surgery and endoscopic spine surgery.

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!

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).

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!

Will my pain go away after L4-L5 spinal fusion surgery?

Pain may improve, stay the same or worsen after fusion surgery.  The majority of people will see improvement in there pain, but few people will have complete pain relief.  Unfortunately spine surgery does not give you a new uninjured back.   I would discuss what the likelihood of you improving with your surgeon.

Spinal fusion surgery  is usually done through an open traditional technique causing significant skin, muscle and bone damage.  Recently open traditional fusion surgery is being replaced by percutaneous endoscopic fusion techniques I call Endoscopic Lumbar Interbody Fusion (ELIF).  These surgeries appear to have less bleeding, soft tissue and bone damage compared to open traditional fusion surgery.  Due to less soft tissue and bone damage these endoscopic surgeries appear to have less post-operative pain and a quicker recovery.

For more information on percutaneous endoscopic fusion surgery please contact Executive Spine Surgery.   Good Luck!

I am having back pain and trouble urinating.

Trouble urinating may be stress incontinence (urinary dribbling or wetting when you cough), urinary urgency (sudden urge to go to the bathroom and may wet yourself if you can not get there in time, this is commonly associated with pain), urinary incontinence (no or little control over urinating resulting in peeing your pants) and urinary retention (unable to start to urinate, bladder fills with urine and may cause abdominal discomfort).

Back pain and problems urinating can be a surgical emergency called cauda equina syndrome.  This may be associated is numbness in the perineum (butt and groin), leg weakness, numbness or pain (such as Sciatica), urinary retention (unable to pee), urinary incontinence ( unable to control your peeing causing you to wet your pants) and bowel incontinence (uncontrolled bowel movements).  If you develop these symptoms you should immediately go to the emergency room.    You may have herniated disk (or something else) pinching your nerves that innervate your bladder and may need emergency surgery to remove it. Good Luck!

What happens if scoliosis goes untreated?

Scoliosis is an abnormal curvature of the spine. This usually involves the thoracic and lumbar spine.  When the spine is viewed from behind the patient the spine may look “C” or “S” shaped.  It can also cause a hunch back called kyphosis.

Treatment of scoliosis depends on the age of the patient, the severity of the scoliosis and types of problems it is causing. Children are watched annually for scoliosis during their growth spurt. If the scoliosis is treated early with a brace sometimes future surgery can be prevented. If scoliosis becomes severe it can cause pain, numbness and weakness and affect the posture, walking, lungs, heart and gut function. People with significant scoliosis should be closely monitored by spine surgeon. Good Luck!

Call us now