News

5 Frequently Asked Questions About Disc Herniation & Endoscopic Discectomy

1) Are herniated discs able to heal up over time?

Lumbar discs go through a process of degeneration. They undergo chemical changes that result in the drying out of the disc. During this process the discs collapse, turn black, start to bulge and form bone spurs in order to attempt to fuse the disc in place. Though the blood supply to discs are poor in adults and rarely heal up internally, disc herniations (protrusions, sequestrations and extrusions) may heal up on their own, especially when they are large. The body’s inflammatory system may break them down relieving pressure off the nerves (unpinching the nerves). The pain you experience may remain stable, improve or worsen over time. There is significant work being done in stem cell research (adult mesenchymal stem cells) for disc regeneration and the early results are encouraging, showing improved disc height and fluid level. There are other surgical procedures that are being investigated, such as making holes in the disc endplates with an endoscope to improve the blood supply to the disk. This has been shown to help heal degenerated discs. Over the next few years there will likely be many new treatments for degenerative disc disease.

2) Is a discectomy a permanent solution?

Discectomy does not remove the entire disc, only the part of that is causing problems. Most patients do very well with the surgery, particularly if it is performed endoscopically. There is 10% chance of the disc recurring or regrowing. There is also risk of the disc degenerating, leading to back pain and the spine falling apart (called slipped spine or spondylolithesis) which also could require further surgery. Spine degeneration is rarely limited to one disc and often people have multiple discs wearing out and any of them or a new one may become a problem in the future.

3) What is the recovery time for a discectomy?

Recovery time depends on the type of discectomy surgery you have, how long you have had the problem, and the presence (or lack) of nerve damage. Patients recover quicker from minimally invasive and endoscopic discectomies than traditional open surgeries. People who have had the problem longer or who have nerve damage usually take longer to recover. Most people recover from surgery in between 2 and 12 weeks.

4) Is a herniated disc the same as a disc protrusion?

Disc herniation and disc protrusion are generalized terms for describing a disc displaced or sticking out of the disc space into the spinal canal. Disc protrusion may be used more specifically to describe a disc displacement when the height is less than the width. Since the terms for describing disc herniations vary from doctor to doctor and there is little consistency to how they are named, the best way to determine if your disc has worsened is by having a radiologist or back surgeon directly compare your MRI films.

5) For disc problems, is there an alternative to spinal fusion?

Endoscopic discectomy “laser spine surgery” is an alternative to spinal fusion for degenerative disc disease. The disc is removed through a pencil sized endoscope via an incision the size of a finger nail. There is decreased tissue damage, pain, and recovery time compared to spinal fusion.

5 Common Questions About Sciatica & Minimally Invasive Spine Surgery

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

Sciatica is back and leg pain resulting from pinching the sciatic nerve. This is most commonly caused by a slipped disk in the back. Today lumbar disc herniations may be removed minimally invasively with the spinal endoscope

2) I think I have sciatica. Should I see a GP or a Chiropractor?

I would recommend seeing your primary care doctor to orchestrate the workup and treatment of your pain. You will likely require anti-inflammatory medicine, physical therapy, an MRI scan and possibly steroid injections or surgery.

3) Will sciatica caused by a herniated disc get better without surgery?

Disc herniations rarely resolve on their own. It is more common for them to get a little smaller over time then resolve. Surgery is the best treatment to physically remove the damaged disc. Today this can be done endoscopically though a tiny incision.

4) What kinds of surgeries can help sciatica?

Sciatica is leg pain usually caused by a slipped disk in the spine pinching the sciatic nerve. The most common surgery for sciatica is discectomy, or removal of the piece of disk pinching the nerve. Today this can be done through a very small incision with an endoscope. Usually the pain resolves before you leave the operating room!

5) 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 back pain without leg pain and degenerated herniated disk usually undergo a diagnostic test called a discogram to help determine if surgery will work.

Who Can Spine Surgery Help?

Pain in the lower back and legs can be caused by almost any structure in the back and many other organ systems. Patients with severe back and leg pains may have little abnormal findings on MRI scan and patients with no pain may have severe abnormalities, therefore it can be difficult to determine the exact causes of the pain. A good history and physical examination, radiological tests and nerve studies can identify most causes. The best outcome is when the person has typical symptoms (complaints), physical exam findings and MRI abnormalities. The less typical the complaints, the less likely the patient will benefit from surgery. If the exact cause cannot be identified or there are many possible causes, then pain mapping may be beneficial pinpoint the cause of the pain.

Pain mapping is the usage of spinal injections to delivery numbing or provocative solutions to suspected causes of the pain. Numbing medicine may block the pain and provocative medicine may worsen the pain.

The results of surgery are also affected by motivation, coping skills, psychological problems, drug addiction, lawsuits and worker’s compensation.

Failed Back Syndrome is when patients fail to improve or worsen after spine surgery. These patients often continue to take pain medicine and are unable to return to work. Failed back syndrome is not one specific problem but a generalized term for people who did not do well.

There are many causes for failed back syndrome including unrealistic expectations (they wanted to feel like they were twenty), incorrect diagnosis and treatment, correct diagnosis but wrong surgery or the problem was not properly fixed. There may be additional pain from a partially or unrecognized source. Bleeding, nerve damage or spinal leak may complicate surgery. A new problem may form after surgery, such as disc herniation, blood clot, infection or scar tissue. Muscle damage or bone removal may lead to spinal weakness, instability and new pain. The prospect of loss of income, personal attention or returning to a poor work situation may hamper recovery.

The potential for failed back syndrome can be limited if both doctor and patient are positive and have good communication and honesty. Thorough studies and an accurate diagnosis of the problem are essential as well. The attitude and expectations of the patient as well as his or her life situation must be considered by the treating physician as well for the optimum outcome.

What is Cervical Spinal Stenosis?

Spinal stenosis is the narrowing of the spinal canal, in this case the spinal canal in the neck, not the back (lumbar spinal stenosis).This may be inherited, that is you were born with a small spinal canal, or acquired, in which case the spinal canal became smaller over time from degeneration. This could include bulging discs, bone spurs and thickened ligaments.

As people age, the neck begins to “wear out”. This begins with the drying out and collapse of the cervical discs. In some patients, this is severe enough to be considered cervical disc degeneration. A collapsed disc in the cervical spine can change the forces across the spine and results in abnormal motion. To stop this motion, the body strengthens the neck by thickening the spinal ligaments and stabilizing the mobile joints with bone spurs. This is especially seen behind the vertebral bodies, around the facet joints located at the side of the spine and in the ligamentum flavum (yellow ligament) at the back of the spinal canal. These changes lead to decrease in the size of the spinal canal and may result in spinal cord compression.

Cervical spinal stenosis may cause spinal cord injury and dysfunction called myelopathy. This may be due to compression, abnormal spinal motion or poor blood supply. Myelopathy commonly presents in older people with neck pain, clumsy hands and difficulty walking. This may be associated with pain, numbness, tingling, weakness, coordination problems (doing up buttons, fastening bra and eating), arm and leg stiffness, and bladder and bowel dysfunction. Head movements may cause electrical shocks to shoot down their spine. At times people may show slow decline in mobility: from a cane to walker to wheelchair. Rarely spinal stenosis causes paralysis.

Thankfully this condition can frequently be treated with minimally invasive spine surgery. Tools and a camera are inserted through a very tiny incision to remove bulging discs, bone spurs and impinging ligaments. If you are suffering from cervical spinal stenosis, make an appointment with a spine surgeon today to see if you are a candidate for life-changing minimally invasive spine surgery.

What is the MILD Procedure for Lumbar Spinal Stenosis?

MILD Stands for Minimally Invasive Lumbar Decompression. If your lumbar spinal stenosis is caused by excess spinal ligaments, then this quick out-patient procedure could be for you. Tiny instruments are inserted through an incision the size of a dime or smaller. These specialized tools allow your surgeon to remove the excess tissue that is causing your spinal canal to narrow, which reduces symptoms such as pain and tingling, and restores mobility. This relatively simple surgery does not require general anesthesia, and it does not even require stitches. Patients who have undergone the MILD procedure report increased standing time and a much greater ability to walk without pain or numbness. Like most minimally invasive surgeries, the MILD procedure has a very low risk of complications.

How do I know if the MILD procedure is for me?

If you are suffering from numbness, pain or tingling in your legs and/or buttocks when walking or pain or numbness in your lower back when standing, you may be suffering from lumbar spinal stenosis. You should should see a spine surgeon to evaluate the cause of your pain and see if the MILD procedure is an effective treatment for you.

What Do I Do For My Broken Back? Treating Osteoporosis Spine Fractures

As we age, a common problem, especially for women, is osteoporosis – the thinning and weakening of bones. One of the many problems caused by this dangerous condition is stress fractures of the spine, also known as wedge fractures, burst fractures, collapsed vertebrae, and broken back. As the body ages, the square vertebral body of the spine can weaken or be injured with excessive force. It may break and flatten like a pancake, causing back pain and misery. Osteoporosis is the major cause of vertebral body compression fractures; other less common causes include severe trauma, infection or cancer.

Pain is the most common complaint from spine fractures. Any movement causes micro-motion in the broken bone, which produces severe pain. This pain usually decreases when the patient lies down, and increases with standing, walking and lifting. Sometimes people have no pain at all. Rarely fractures may cause numbness, weakness, paralysis or bowel and bladder dysfunction from spinal cord or nerve compression. Fortunately, the severe back pain often improves during the first month after injury.

X-ray, CT, bone scan and MRI may diagnose spinal fractures. Besides diagnosing the fracture, MRI scans can determine if the fracture is new and rule out nerve or spinal cord compression.

Is there a surgical treatment for spine fractures?

Patients who do not respond to conservative treatment may benefit from surgical treatment. The key to surgical treatment is stabilizing the fracture. The spine, like a broken arm, must be “cast” to stop abnormal bone movement and prevent pain. Surgical options include vertebroplasty, kyphoplasty and major spine surgery. Major spine surgery is not commonly needed to treat osteoporotic compression fractures.

Vertebroplasty and kyphoplasty are the most common treatment for osteoporotic compression fractures. These procedures involve the placement of a needle into the fractured vertebral body for the injection of liquid cement. Once the liquid cement hardens it stabilizes the vertebral body decreasing painful movements. If there is concern for cancer then a bone biopsy is sent to pathology for examination.

Vertebroplasty is an outpatient procedure, done under conscious sedation like a colonoscopy, but can be done under local anesthesia in high-risk patients or rarely general anesthesia. A needle is placed into the fractured vertebral body under x-ray guidance and then liquid plastic is slowly injected to harden and stabilize the fracture.

Kyphoplasty is similar to vertebroplasty, but kyphoplasty involves the placement of two needles on each side of the spine and balloons into the broken vertebra under x-ray. The balloons are slowly inflated to expand the collapsed “pancake” vertebral body and create cavities to hold the plastic. Plastic is then injected after the balloons are removed to support and stabilize the broken vertebrae.

Women who developed vertebral body compression fractures are at least four times higher risk of developing future spine fractures. Elderly patients with bone fractures should undergo investigation and treatment for osteoporosis.

What is Lumbar Spinal Stenosis?

Spinal stenosis is the narrowing of the spinal canal. As people age, the lumbar discs dry out and collapse. In response, the body stiffens the spine by thickening the spinal ligaments and hardening the disc and facet joints with bone spurs. Unfortunately, these changes result in the narrowing of the spinal canal and the compression of the spinal cord, nerves and blood vessels. This decreases the blood supply and oxygen to the nerves, which produces leg pain. The brain thinks the legs are the cause of the pain when it is actually the pressure in the back.

Spinal stenosis usually develops in patients between fifty and eighty years old. It is characterized by slowly worsening back and leg pain, numbness, tingling and weakness. The pain may be constant, but is usually brought on by walking (called neurogenic claudication) or certain positions. It is relieved by sitting, lying down or using a shopping cart. People sometimes feel like they are walking on a cloud or cotton wool or that their legs do not belong to them. On rare occasions, patients may develop urinary and bowel incontinence or retention. If this happens they should immediately contact their doctor and go to the emergency room.

An MRI scan is the best test to see if spinal stenosis is compressing the nerves. A CT scan or CT myelogram (contrast dye injected into the spinal canal) is usually reserved for patients who cannot have an MRI. EMG (electromyelography) nerve studies can help confirm nerve irritation and injury.

Are there surgical treatments for lumbar spinal stenosis?

Patients who have not responded to conservative treatment may benefit from surgical treatment. Traditionally a large skin incision was made over the spine, and the back muscles were retracted to expose the spine in order to remove the lamina bones and ligaments compressing the spinal nerves. This is called a laminectomy.

Traditional surgery is more destructive in the approach to the spine compared to new minimally invasive surgery. The larger the incision, the more damage to skin, muscle, ligaments and bone. This collateral tissue damage may result in more pain, muscle weakness, spinal instability and scar tissue, which may lead to future difficulties. Many surgeons recommend the addition of a bone fusion and instrumentation with screws and rods with a laminectomy, due to the increased chance of the spine falling apart in the future due to damage from the surgery.

Minimally invasive surgery is done through a skin incision less than 1-inch, but it is more than just a small incision. The surgery is done through a tube in between back muscles to decrease muscle damage and weakness caused by muscle retraction.

New “extremely” minimally invasive endoscopic spinal surgeries are being developed for the treatment of spinal stenosis. The advantages of these procedures will include twilight sedation, very small incision (size of finger nail), minimal postoperative pain and shorter recovery then current minimal invasive or traditional spine surgery.
 

The Most Common Question About Back Pain

How can I relieve my lower back pain?

I am asked this question regularly in both social and medical situations. It seems that the majority of the population suffers from lower back pain at some point in their lives. The first step to treating lower back pain is to rule out deterioration in the back disks and joints. Ruling out spinal degeneration and fractures is key to determining the proper treatment of lower back pain. X-rays or an MRI scan may be necessary to figure out if the problem is caused by a spinal issue.

Other causes may include muscle knots (myofascial trigger points) or spasms, a misaligned or abnormally shaped spine (spondylolithesis, scoliosis). In my practice, I often find that arthritic facet joints are very common cause of back pain and are readily treated with an endoscopic rhizotomy. I would recommend seeing your physician to determine the cause of your back pain. Sometimes pain issues can be resolved simply by stretching more and strengthening the postural muscles. While surgical intervention is not always needed, this is not a problem that should be neglected, as even non-surgical problems can continue to worsen and cause a great deal of pain.

10 Frequently Asked Questions About Scoliosis

1. Does scoliosis cause other health problems?

If scoliosis is severe it can affect your heart, lungs, gut, spinal cord and nerves, producing a large range of problems ranging from difficulty to breathing to difficulty walking. Fortunately this is not common. Many cases of scoliosis respond to conservative treatment (such as bracing) and do not require surgery.

2. Is there a link between muscle strength and the development of scoliosis?

Scoliosis is the curvature of the spine. The spine may look like a “C” or “S” on x-ray. Scoliosis may result from juvenile scoliosis in children (unknown cause), diseases or injury of the spine, arthritis, neurological disease, surgery, etc. Neurological disease such as a spine tumor may cause back muscle weakness, which can result in scoliosis. It is not caused from being out of shape or weak.

3. What happens if scoliosis goes untreated?

Untreated scoliosis can cause a hunch back called kyphosis. Treatment depends on the age, the severity of the scoliosis and whether it is causing problems. Children are watched for scoliosis during their growth spurts. If the scoliosis is treated early with a brace then sometimes future surgery can be prevented. If scoliosis becomes severe it can affect posture, walking, lungs, heart, gut and strength, as well as causing pain. People with significant scoliosis should be closely monitored by their doctor or spine surgeon.

4. Does scoliosis ever develop later in life?

Yes, scoliosis can develop later in life from injury, back surgery, cancer, or arthritis.

5. Can scoliosis prevent a person from being able to walk?

Severe scoliosis can cause significant spinal deformity, which alters the shape of the back, causing weakness and difficulty walking. If you think your scoliosis is hindering your movement, I would recommend seeing spine surgeon who specializes in scoliosis surgery.

6. Can scoliosis cause chronic back pain?

Yes, scoliosis can cause back pain. As you age the spine wears out in a process called degeneration. This wearing out can worsen the scoliosis. Scoliosis can cause pain and usually the pain and dysfunction is related to severity. That is the more severe the scoliosis the more pain and dysfunction.

7. How does scoliosis affect the back muscles?

The back muscles can be affected by: 1) A neurological problem such as s spinal cord tumor can cause weakness in the muscles resulting in scoliosis. 2) The curved spine can strain the back muscles. 3) The curved spine can pinch off spinal nerves, weakening the back muscles.

8. Can a chiropractor help with scoliosis?

The chiropractor may help pain, but is unlikely to improve the deformity. Brace or surgery is usually needed to correct or stop the progression of scoliosis. I would discuss it with your spine surgeon.

9. Does scoliosis progress after a person is done growing?

Typical childhood (idiopathic) scoliosis progresses during the child’s growth spurt and is less concerning after you stop growing. It may worsen from arthritis in old age. Other rare types of scoliosis may progress after you stop growing.

10. Do people that have untreated scoliosis generally become shorter over time?

Mild scoliosis has little effect on height. Severe scoliosis causes a severe curve in the back and often a hunched back (kyphosis) making the patient shorter.