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

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.

By Staff Writer News

New Minimally Invasive Endoscopic Treatment for Neck Pain!

JOIMAX, a world leader in minimally invasive spinal surgery technology will be launching a new endoscopic system for neck surgery on April 3rd to 5th at the International Society of the Advancement of Spine Surgery (ISASS) meeting in Vancouver, BC. This advanced surgical system called CESSYS (Cervical Endoscopic Surgical System) will provide an alternative to traditional open neck surgery and will change how neck surgery is done in the future!

Cervical disk herniation is a common cause of pain, stiffness, numbness and weakness. Traditional neck surgery involves a large incision, retraction of the voice box and food tube, removal of the entire disk, and fusion that may produce ugly scars, hoarse voice, swallowing difficulty and stiffness at the fused level. Cervical fusion also may involve future neck pain and surgery because the remaining disks must compensate for the fused level and may become damaged from excessive movement. An enormous amount of research has been focused on this adjacent level disease.

The artificial cervical disk was developed to avoid fusion and prevent adjacent level disease and future surgeries. Even though the artificial disk was welcomed with great enthusiasm, long-term results are unknown, and there is concern for the longevity of these man-made disks. Minimally invasive posterior cervical discectomy was another approach developed to avoid fusion and subsequent adjacent level disease, although unfortunately, most disks are not approachable through the back of the neck. This has led to development of an endoscopic discectomy through the front of the neck, similar to, but less invasive than the traditional open neck surgery.

Endoscopic spine surgery has become a popular alternative to traditional spine surgery. The endoscope is a pen-sized, high-definition video camera that is inserted into the spine under x-ray guidance. The endoscope allows the surgeon to find and remove the herniated portion of the disk under direct visualization with very tiny instruments, relieving pain and suffering. Advantages of endoscopic surgery include a tiny skin incision, minimal tissue damage and pain, quicker recovery and same-day discharge.

JOIMAX designed the CESSYS cervical endoscopic surgery system to minimize tissue damage and be versatile enough to remove most disk herniation without the need of fusion, with the objective of decreasing the need for future surgery. The CESSYS cervical endoscopic surgical system will be available in the United States in the fall of 2013 to select JOIMAX instructors and faculty, including Dr. Carl Spivak.

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

Do I need a back brace after spinal fusion?

Spinal fusion surgery is connecting one spinal vertebrae to another spinal vertebrae. This is done through a bone “bridge”, that is bone is placed between the vertebrae. The bone is usually placed between the vertebral bodies. This is called an interbody fusion. If the fusion is done through your abdomen it is called anterior lumbar interbody fusion (ALIF), through your side/flank [Direct lateral interbody fusion (DLIF) or extreme lateral interbody fusion (XLIF)] or through your back [posterior lumbar interbody fusion (PLIF) or tranforaminal lumbar interbody fusion (TLIF)].

The surgical approach is important because it relates to pain, disability, muscle damage and complications. Fusions done through the back tend to be more painful resulting in greater recovery, time off and disability. This is appears less true for minimally invasive procedures like the endoscopic lumbar interbody fusion (ELIF). The more muscle damage the weaker the back and the higher chance of future spinal disease and pain.

There are complications related to anesthesia and surgery. All surgery has risks but the specific risk to fusion surgery is partially related to the approach to the spine:

1. Surgery done from the abdomen put major blood vessels (like the aorta and vena cava) and abdominal organs like kidneys at risk. There is even a chance for errectile dysfunction (E.D.) or retrograde ejaculation (sperm goes into the bladder not out the penis). These problems can lead to infertility.

2. Surgery from the side can injury the lumbar plexus (these are nerves that supply the legs) causing pain, numbness or weakness in the legs.

3. Surgery done through the back muscles can injure the muscles causing future pain and new spine problems. This muscle damage is decreased with minimally invasive surgery.

Most people have to wear a brace after surgery for 1 to 3 months, but it depends on the type of fusion and instrumentation surgery, number of levels fused and the reason for fusion.

For more information on lumbar fusions please click Spinal Fusion and Options or on Dr. Carl Spivak and Executive Spine Surgery please call 908-452-5612 or click Schedule an Appointment.

By Staff Writer Discectomy, endoscopic spine surgery, laser surgery, Lower back pain, Pain, Sciatica

When you have a pinched nerve, is the pinched nerve always pinched unless surgery? How does the nerve become unpinched?

The spine is made up of vertebral bodies and disks. The disks are made up of soft gelatinous nucleus pulposus and hard fibrous annulus fibrosis. As people age, there is a shift in the molecular composition of the disk with decrease in the water absorbing glycosaminoglycans producing a dry brittle disk. The whole disk may bulge out or nucleus pulposus may break through the annulus fibrosis into the disk space and compress spinal nerve causing back and leg pain called sciatica. The pain is aggravated and potentiated by inflammatory reaction around the herniated disk and nerves.

Sciatica may resolve without surgery if the inflammation or swelling resolves or the herniated disk may be broken down and removed by inflammatory white blood cells. Sciatic leg pain may resolve over few weeks to months or over many years. Most cases of sciatic that are going to resolve quickly settle in 1 to 3 months, otherwise it may take 4 years or never settle.

Please see the following links for more information on sciatica and endoscopic surgery:

What is Sciatica?

When Should I Consider Back Surgery?

Laser Spine Surgery

Click to Schedule an Appointment on-line or call 908-452-5612.

By Staff Writer endoscopic spine surgery, laser surgery, Lower back pain, Pain, Surgery, Treatment Options for Back Pain

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.

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

I have low back pain. Do I need physical therapy or MRI?

That is a good question. Back pain is a very common symptom. Most people will have back pain at some time during there life. That said not all back pain is created equal. Back pain can be good, bad or ugly.

The development of back pain may be a warning from your body that your are straining your back and about to damage it. This type of back pain can be considered good because it may prevent a more serious injury. Back pain from injured or herniated disk, or fractures may be bad. It can cause pain in your back, buttocks, hips, groin and down the legs. It may be associated with numbness, tingling, weakness and bowel and bladder dysfunction. Yes a bad disk or fracture may cause you to be incontinent of bowel movements and urination or retain them and not be able to go. Less serious cause of bad back pain is facet arthritis also called facet arthropathy. Back pain can get really ugly when it is caused by an infection or cancer. It can cause weight loss, fever, chills and sweats (called systemic symptoms) and if goes untreated may be life threatening.

Therefore it depends on how your back pain started and if it is associated with anything. If you simply pulled your back lifting and have no other neurological problems or systemic symptoms then physical therapy is the best place to start, but if you do have other bad or ugly symptoms or fail physical therapy then you should get an MRI scan.

For more information please see the following links:

What Causes Back Pain?

Back Arthritis

What is Sciatica?

Overview of Spinal Stenosis

Spinal Fusion and alternate Options

Kyphoplasty – what is it?

Please Schedule an Appointment to find out more information!

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 endoscopic spine surgery, laser surgery, Pain, Relief, Spinal fusion, Surgery, Treatment Options for Back Pain, Treatment problems

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!

By Staff Writer endoscopic spine surgery, Lower back pain, Relief, Spinal fusion

Do I have to wear my back brace at night?

Back brace is used to stabilize your spine after spinal fusion surgery. These braces are used to hold the spine together until fusion occurs. Spinal Fusion is the joining of one vertebrae to another vertebrae by bone bridge. The two vertebrae and the bone graft eventually become one solid bone. Spinal instrumentation acts as a internal brace to hold the fusion together. This may consist of rods, screws, plates, clamps or wires.

The rate of spinal fusion depends on many factors including age, activity, size, location. Spinal fusion is decreased by smoking and usage of non-steroidal anti-inflammatory medications.

Spine braces can be in the form of a neck collar after anterior cervical discectomy and fusion (ACDF), thoracic lumbar sacral orthosis (TLSO) after treatment of a thoraco-lumbar burst fracture or lumbar sacral orthosis (LSO) after lumbar fusion.

For more information on back braces please see the following blog posts:

Is it bad to use a back brace?

Should I be wearing a back brace if I have a disc injury?

Back braces are not usually worn in bed because there are less forces being applied across the surgical site and less chance of damaging the fusion and instrumentation holding the spine together.

For more information please Schedule an Appointment. Good Luck!

By Staff Writer endoscopic spine surgery, laser surgery, Lower back pain, Relief, Surgery, Treatment Options for Back Pain, Treatment problems

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).

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