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Spine Surgery News & Advancements Blog

Carl Spivak, MD - Executive Spine SurgeryNews
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!

By Staff Writer Pain, Relief, Spondylosis, Treatment Options for Back Pain

I strained my back muscles and hips making it is painful to walk. Will I need a wheelchair?

Pulled muscles in the back usually improve with rest, stretching and anti-inflammatoy medicine (if you can take them) and physical therapy after a few days to weeks.  Pulled muscles do not cause leg paralysis and therefore do not require a wheelchair.

The back injury may be more serious then a pulled muscle, such as fractured vertebral body (vertebral body compression fracture), injured back joints (facet arthropathy or facet joint syndrome), injured sacroiliac joint (SI), ruptured or damaged lumbar disk or slipped spine (spondylolithesis).  These circumstances may require steroid injections or surgical treatments such as kyphoplasty or vertebroplasty, endoscopic rhizotomy, endoscopic discectomy or endoscopic fusion.

If the pain does not improve or if you have developed or develop neurological problems (difficulty walking, leg numbness, weakness or bowel and bladder difficulties then you should see your doctor right away.  Good luck!

By Staff Writer Pain, Relief, Sciatica, Treatment Options for Back Pain

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

No I would not recommend a back brace to treat your injured disk.  Back brace can actually make your back more weak leading to more pain.  Back braces are used most often after a spine fracture or fusion surgery to provide extra stability to promote bone healing.   Core strengthening though yoga or other isometric exercises would be better treatment then a back brace.  For more information please contact Executive Spine Surgery.  Good Luck!

By Staff Writer Pain, Spondylosis

Can spondylosis cause paralysis in an arm?

Spondylosis is the “wear and tear” arthritis changes that occur in the spine over time.  Disk herniations, bone spurs or ligament thickening may cause compression and injury of the spinal cord and/or spinal nerves producing weakness or paralysis of the arm.   Fortunately this is not common.  Spondylosis may also cause neck pain and stiffness, electrical pain shooting down your spine with head movements, numbness, clumsiness hands, unsteadiness or falling, bowel and bladder dysfunction and paralysis.  If you have any further questions please contact Executive Spine Surgery.  Good Luck!

By Staff Writer Sciatica

Could my sciatica be caused by a car accident I was in?

Sciatica is back pain that shoots down the leg from compression of the sciatic nerve in the back.  Yes sciatica can be caused by a car accident.  To blame the accident the leg pain should start during or just after the car accident.  It is difficult to determine the cause and timing of a disk herniation on MRI.  The disk herniation may have been present prior to the MRI or herniated at the time of the accident, but without a MRI prior to the accident it is difficult to say when it herniated.   Either way, if the pain started at the accident then the sciatica was caused by the accident and the disk is new or been aggravated by the accident  (this is called an aggravation of pre-existing condition).  Good Luck!

By Staff Writer Discectomy, Relief, Sciatica, Surgery, Treatment Options for Back Pain

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 degenerate disk disease and primarily back pain may undergo a discogram (pain mapping of the disks) to confirm the symptomatic disk.   Discogram helps determine if surgery will work.

Discogram is an injection into disks.  If the injection produces your typical back pain (concordant pain) then this disk is most likely culprit of the back pain.  In addition to pain the discogram often shows leakage of dye out of the disk through a rip called an annular tear.  If the injection only causes mild pain or not typical pain then that disk is not causing the pain.   In this circumstance the patient would require additional pain mapping to identify the pain source.

The treatment options to fix painful disk include endoscopic discectomy and annuloplasty (the annular tear is isolated and burned with radiofrequency coagulation) or endoscopic fusion surgery (ELIF).  Often endoscopic discectomy is considered first to try to avoid fusion surgery.  Unfortunately surgery does not always relieve back pain from degenerated herniated disks.  Surgery should be considered the last option or not an option is some cases.  Please call and set up an appointment with Dr. Carl Spivak to discuss your back. Good Luck!

By Staff Writer Discectomy, Neck pain, Pain, Surgery

Does the donor bone graft in bone transplants come from living donors?

There are two types of bone graft commonly used autograft and allograft.  Autograft is taken from the patient during surgery, this is usually from iliac crest or bone that is removed the spine.  This is the best graft material but unfortunately can lead to new pain, deformity or complications.  Allograft is bone taken from bone bank from deceased donor.   This is almost as good as your own bone and saves you second surgical site. Recently bone substitutes made up of calcium have become available and may replace bone in the future.  For more information please contact Executive Spine Surgery today.  Good luck!

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

Does a pinched nerve (sciatica) always stay pinched unless surgery is given? Will it always show up on an MRI if surgery is given?

Disk herniations cause leg pain (sciatica) by pinching the sciatic nerve in the back.   Disk herniations may resolve on their own over a year or so, but they usually just get a little smaller as seen on multiple MRI .  Surgery is the best treatment to physically remove the disk.  Today this can be done endoscopically (endoscopic discectomy) though a very small incision the size of your finger nail. The endoscopic port is placed right onto the herniated disk and the disk is removed with tiny instruments.  This is a new minimally invasive treatment for back and leg pain.

Disk herniations may show up after surgery on MRI scan, but it usually is smaller.   Postoperatively the the disk that is seen is a combination of disk, bulging ligaments and scar tissue.

For more information on sciatica please contact Executive Spine Surgery. Good Luck!

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

L5S1 Hernation, S1 nerve compression.

You have a herniated disk in your spine pinching your left S1 leg nerve causing sciatica.  For more information please see my blog posting on sciatica.  Most of these disks can be removed by an extremely minimally invasive surgery called endoscopic spine surgery.  This surgery can be done awake through a small incision the size of your finger nail.  Pain relief is often immediate and you are usually discharged home 1 hour after surgery.  To schedule an appointment contact Executive Spine Surgery.  Good Luck!

 

By Staff Writer Neck pain, Relief, Treatment Options for Back Pain

Should I get a massage after a car accident?

Yes as long as spinal injury has been ruled out by your doctor.   Most car accidents involve jolting whiplash injuries to the spine.  These injuries respond well to massage, heat, stretching, physical therapy and anti-inflammatory medicine.  Injuries to the bones, ligaments, disks, spinal cord and nerves may require bracing or surgery.  I would recommend going to the emergency room after a car accident.  For more information please contact Executive Spine Surgery.  Good Luck!

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