Good Morning Spine

Archive for June, 2010

I read a lot about laser for spine surgery. This tool is very easy to use but has very little role for treatment of spinal disorders. There are reasons most advanced trained surgeons do not use it. We would if it help with outcomes. Most of these “lasercenters” do not have peer-reviewed content or doctors that have felllowships in spine. Procedures are performed outside a hospital where Bthere is much monitoring of complications and efficacy. If u are thinking of this option do a complete Internet search of a center including complaints to board of medicine,lawsuits,and community chat centers. Be careful!

I wonder how difficult patients must have making clear decisions given all the misconceptions about spinal procedures. I try to let them know that non- surgical choices are good as long as there is real improvement. However, I see a lot of patients using drugs that are just masking symtoms that really do not address the compression of the spinsl nerves. If one has weakness lifting their arms or difficulty walking from leg eakness this is very serious. Most of the time, surgery is to remove compression of nerves by either a disc or bony overgrowth that cannnot be avoided. My best outcomes occur if a decision for surgery occur before there is permanent damage to the spinal nerves from chronic compression in either neck or back. Be very careful with overuse of pain medications or prolong therapy!

I strongly believe spine surgeons should discuss all serious potental complications with surgical patients.I feel that patients should be a little nervous if they are properly prepared for surgery. The results are good but not perfect In most situations. Managing each patients expectations is extemely important. I also find the other extreme, where patients with very correctible problems , are told surgery on their neck or back will not work. In fact, surgery has come along way over past five years with newer technology and more more highly trained spine specialists. Too much narcotics are being prescibed that have no proper role for treatment of stenosis or herniated disc disease.

I read a lot of articles about repeat spinal surgical procedures and want my patients to understand some basic reality.In most cases, the underlying process is a form of aging with degeneration of structures such as disc or facet joints. This ongoing process cannot be changed with surgery. Rather we try to lessen the symtoms of pain or weakness so a patient can be more functional. The undelying process may then pass on to other levels with time requring either non-surgical or possibly more surgery in the future. This process is seen quite often in heart surgery as well. Coronary arteries at other level also nay get blockage over time needing second and even third surgeries. I clearly relay this process to all my patients. Fortunately, new techniques for spine surgery make recovery very rapid from just a few years ago.

I believe patients can be very confused about spinal injections. There are several types that can be safe and very effective to treat back pain as well as leg pain from stenosis or arthritis of the facet joints in either neck or lower back. I usually attempt less invasive medial branch block and facet steroids for senior patient that have pain with standing extention associated with leg pain. If a patient only has leg pain , then a transforaminal nerve block is all that is required. Not all injections are the same and precision is very important. I feel succcess is high and surgery in less then 5 percent.

I see more patients confused about which procedures are their best options. When asking about success ,I always give a percentage that is based on reported results in the published liturature. If doctor are being honest, they should also stress the complications that may occur. In reality, newer less invasive surgeries have really improved the outcome to lessen pain or weakness in conditions associated with disc herniation or spinal stenosis. I also reveal the number of procedures performed each year. Patients should look up their doctors credential using the Internet as well. Be prepared!