Surgery Archives - Page 3 of 4 - Carl Spivak, MD

By Staff Writer Lower back pain, Pain, Scoliosis, Surgery

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!

By Staff Writer Lower back pain, Relief, Surgery, Treatment Options for Back Pain

What is the difference between vertebroplasty and kyphoplasty?

Vertebroplasty and Kyphoplasty are very similar procedures. Kyphoplasty is a slight variation of vertebroplasty.

In both vertebroplasty and Kyphoplasty a large needle is placed into the broken vertebrae under x-ray guidance. Next plastic is injected into the fractured vertebrae in vertebroplasty, but in Kyphoplasty a ballon is blown up. The balloon may push the bone back into its original position (that is reduce the fracture). The balloon is then removed and plastic is injected into the cavity. Overall they are very similar procedures and have similar outcomes. Please click on Kyphoplasty for more information. Good Luck!

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 Neck pain, Pain, Surgery, Treatment problems

I had a cervical fusion done at C4-C7 4 years ago, but I am still in pain. Do I need it redone?

This is difficult question without seeing you and your films. Most cervical fusions heal 1 year after surgery. If the X-rays and/or CT scan showed healed fusion of C4-C7 (that is C4-5, C5-6 and C6-7) revision will unlikely help your neck pain. Your neck pain maybe from breakdown of another level of your spine such as C3-4 or C7-T1. This is called adjacent level disease. After fusion surgery, the disks beside the fusion must take up the extra movement lost by the fused levels. This may increase “wear and tear” on these disks, increasing the chance of developing future problems. It is possible one of your other disks have now become painful. You may also have neck pain from stiff weak neck muscles. You may benefit from daily neck stretches.

Please see the following blog posting for instructions on neck stretches. Please contact Executive Spine Surgery to schedule an appointment. Good Luck!

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.

By Staff Writer endoscopic spine surgery, laser surgery, Pain, Spinal Stenosis, Surgery

I’m 63 and now when I walk for a short distance the back of my right leg starts burning to the point I can hardly walk. What is this?

Leg pain from walking is called claudication. Neurogenic claudication is leg pain from nerve compression in the spine. This is called stenosis and results from thickened ligaments, bone spurs and disk herniations. Some people are at increased risk of spinal stenosis because they were born with a smaller spinal canal then normal. This is called congenital spinal stenosis. Spinal stenosis and neurogenic claudication presents with back pain and diffuse leg pain and numbness from walking which is relieved by using a shopping cart or sitting down. Some people describe it “like walking on a cloud”. Vascular claudication is leg pain from narrowed arteries in your legs. It is brought on by walking and is relieved by sitting or standing still. People usually have absent pulses, skin and hair changes in there feet.

You probably have spinal stenosis compressing your spinal nerves and decreasing blood supply to the nerves. If the nerves can not get enough blood and oxygen they “suffocate” developing pain and numbness in the legs. Stopping and sitting down or bending forwards decreases pressure on the nerve, improving blood supply and decreasing pain.

Many people benefit from rest, physical therapy, anti-inflammatories, nerve medicine (such as neurontin), steroid injections and surgery. Please click on Sciatica for more information on lumbar spinal stenosis. Please contact Executive Spine Surgery for a consultation on spinal stenosis. Good Luck!

By Staff Writer Surgery

How deep is the cut for a lumbar foraminotomy and microdiscectomy in spinal surgery?

It is not the cut deepness that matters but the size of the cut and the amount of muscle and bone damage that occurs during the surgery. There are 3 main types of surgery traditional open surgery, minimally invasive surgery and endoscopic.

Open traditional surgery requires a large skin incision and significant muscle retraction and bone removal to reach and visualize the spine. This was the original back surgery. New procedures have been developed to avoid the long term muscle and bone damage and weakness.

Minimally invasive spine surgery (MISS) is done through a METRx tube dilating rather then retracting the muscles. The tube is placed onto the spinal lamina. Part of the lamina bone is removed to get into the spinal canal. The nerve sac and spinal nerves are retracted to find and remove the herniated disk. The procedure is similar but less destructive then open traditional surgery.

Percutanous lumbar endoscopic discectomy (PLED) is usually done from the side (posterolateral) of the spine. The disk or spinal canal is entered and the herniated disk is removed with very little to no bone removal. Patients can be awake during the procedure decreasing operative risks. Endoscopic surgery appears to have less complications and pain after surgery. Other advantages include same day surgery, quicker recovery and earlier return to work, sometimes 2 days after surgery.

I do minimally invasive and endoscopic surgeries, but have switch almost entirely over to endoscopic surgery due to the greater benefits of these procedures. Please click Treatment Options for more details on these surgeries. 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!

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!

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Category: Surgery