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By Staff Writer Relief

I started yoga again after a long break. What stretch is safe for my body?

Great! Yoga is good for improving flexibility and core strength. Unfortunately I am not an expert at yoga. I recommend discussing your workout routine with your yoga instructor. As in with any exercise it is safest to start slow and slowly increase over time. You should try to increase your stretch over many days or weeks as you recondition your body. You want to avoid very painful stretches to decrease the chance of tearing soft tissues and injuring yourself. Good luck!

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 Relief, Treatment Options for Back Pain

Is it better to go to a pain clinic or spine surgeon?

I would recommend seeing a doctor who specializes in interventional pain management and spine surgery to best determine what treatment will benefit you. I usually recommend spinal injections first and surgery to people who have failed injections. Unfortunately few doctors do shots and surgery and you will need to see 2 doctors. Click to read more about Treatment Options. Good Luck!

By Staff Writer endoscopic spine surgery, laser surgery, Pain, Relief, Sciatica, Spinal Stenosis, Spondylosis, Treatment Options for Back Pain

What can be done? Can it be fixed easily? What are Schmorls nodes? What is an annular bulge?

These are 3 separate problems:

1. Schmorl’s nodes – Schmorl’s nodes are disk herniations into the vertebral body. The disk squeezes out of the disk space into the bone. This is usually not usually painful or treated.

2. L5-S1 degenerated, bulging and protruded disk – Over time disks wear out from injury, aging, wear and tear, genetics, work and sports. Your L5-S1 disk is degenerating, wearing out and likely collapsing and bulging into the spinal canal pinching the L5 and S1 nerve root. A protruded disk is larger then bulging disk. This may be the source of the pain and is often fixed with discectomy or spinal fusion. Click link to read more on sciatica and disk herniations I have a pain in my left butt that goes all the way down my leg. What could that be?

3. Spinal stenosis – is narrowing of the spinal canal. The measurement varies but is in the range of 11 mm. More important than the measured size of the canal is the appearance and the amount of nerve compression seen on MRI. Spinal stenosis may be treated with pain injections or surgery. Minimally invasive treatment options include MILD procedure and METRx tubular laminectomy. JOIMAX is currently working on new endoscopic treatment for spinal stenosis.

I would recommend seeing a spine surgeon to determine the best treatment for your back. Good Luck!

By Staff Writer Pain, Scoliosis

Does scoliosis cause pain?

Yes scoliosis can cause pain. Please read on for more information about scoliosis.

The spine is made up of column of vertebrae separated by disks which form 3 gentle alternating curves in the cervical, thoracic and lumbar spine when viewed from the side of the person. The spine should not have any curves or rotation when viewed from behind.

A “C” or “S” shaped curve viewed from behind the patient is called scoliosis. This is an abnormal curvature of the spine. There are many causes of scoliosis, for example you may have been born with abnormal spine bones producing the abnormal spine shape (congenital), it may develop during growth spurt (idiopathic), from neurological disease (neurological), injury (traumatic), cancer or arthritis (degenerative), etc. Scoliosis can cause pain and usually the pain and neurological dysfunction (such as numbness, weakness, difficulty walking and bowel and bladder dysfunction) is related to the severity of the scoliosis. That is the more severe the scoliosis the more pain and dysfunction the patient may have. Severe scoliosis may interfere with basic functions such as breathing, walking and activities of daily living.

Patients with scoliosis should see a spine surgeon to determine the best treatment. For more information please contact Executive Spine Surgery. 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 Neck pain, Pain, Relief, Spondylosis, Treatment Options for Back Pain

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.

You probably pulled a muscle, but other possibilities included injury to your facet joints or disk. If you think you broke your neck or have any arm or leg pain, numbness, weakness, clumsiness or bowel and bladder problems you should see your doctor right away. If not I would recommend rest, anti-inflammatory medicine like ibuprofen or naproxen (if fine with your doctor) and neck stretching.

Neck Stretch Routine: Take a hot shower and heat and loosen your neck:

1. Bend neck forward and hold in position with arm stretching neck 30 seconds

2. Bend neck backwards 30 seconds

3. Bend neck right 30 seconds

4. Bend neck left 30 seconds

5. Turn neck right 30 seconds

6. Turn left 30 seconds

Complete 3 sets of stretching routine. Good Luck!

If pain persists or you develop any arm or leg pain, numbness, weakness, clumsiness or bowel and bladder problems you should see your doctor right away. If this fails to help you may benefit formal physical therapy and consultation with spine surgeon. 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!

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