Good Morning Spine

Archive for the ‘Spinal Medicine’ Category

I find that majority of disc herniations respond to nerve blocks and therapy. Newer medication such as Lyrica may also help. In those patients that fail this treatment,a small incision removing very little bone is required to remove this disc material pressing on the Sciatic nerve. However, I also believe the primary issue is safety! Too much is being promoted by doctors about incision size rather then removing the full blockage. Many herneation have the disc tethered to nerve room and adequate exposure during surgery is a must. This may require a larger incision to see that all material that circles the nerve is fully removed without damage to the nerve.in my exoerice patients are most satisfied when their leg pain is gone 80 percent after surgery.

We are very careful to explain potential complications of nerve blocks. Patients need to understand synthetic steroids can cause your adrenal glands to stop making natural steroids leading to a condition called Addison’s disease. This can be very dangerous as our body needs natural steroids to function. This is why I try to limit these blocks to two and possibly a third but space over a period of time. Unfortunately, they can give such relief that patients will demand them too often. Your physicians needs to monitor this if they feel you are stopping your own natural production. Combination of other things such as medication or even acupuncture can be a substitute.

There are several types of injections using small needles that can be used to inject small amounts of medication to stop neck pain called blocks.Under Xray control they are safe and usually I see results within 24 hours. I then try to get patients working with therapist or performing stretching exercises. Even a disc rupture will respond in most cases. However, when these do not relieve symtoms newer surgeries Balso use smaller incision that allow brapid recovery. Prevention still is a vprimary goal that includes exercises that put constant load on spine Vcsusing your body to make disc and bone stronger.

It is very important to listen to patients and be open-minded to their options. I now offer acupuncture as an option rather then them takng strong pain medications. This has satisfied many of my patients and helps build a bridge of trust. More traditional treatments with a physical therapist are just as important as a Patient choice. Some patient want to go directly to surgery as they have already tried many options and understand removing a disc fragment or opening up spinal canal as a treatment for their stenosis is their best chance for return to activity.Managing options and patients expectations is extremely important!

In my practice, I always look to avoid surgery unless there are neurological changes such as weakness and pain that affects reflexes or function. I saw a patient yesterday with only neck pain scheduled for neck surgery without any attempt at pain management. I always try a series of injection, medication, and therapy first and surgery as a last resort. I also want patients to understand all their options by using Internet sites like spineuniverse.com. We even have added acupuncture as an option. The goal is to use all reasonable modalities prior to offering sugery and to also let patients review their options. New technology can also make a tremendous difference in successs and outcomes.

Many patients come to me only to ask for minimally invasive procedures. I can assure you that most spinal problems other then a simple disc herneations will be needing the addition of stabilization if there is severe changes on MRI. Certainly, I prefer smaller incisions and fast recoveries but the focus must be on proven results! I believe strongly on a new breed of implants called interspinous process devices that have worked out well.

Most surgeries now are extremely well trained and make small incision and manytimes in outpatient setting.These surgeries still should be a last resort after injection and therapy. Most disc ruptures occur at lower two spinal levels. We tend to fuse only when there are reccurrent surgeries or structural bony weakness.I do not put patients on chronic narcotics as this was a primary reason for the surgery to decrease pain.

Patient need to know this term should not be confused with good outcomes. Most spinal problems other then simple disc surgery require very thought surgical techniques . Manytimes, an incision will be more extensive as multiple problems including removal of compression spinal cord and insertion of stabilizing devices.Do not be fooled by issues that are cosmetic rather then proven peer- reviewed results.Look for articles published about claims of laser as well as other products such as distraction tables.Spine surgery should always be a last resort for most patients. Stem cell research is going on but not yet effective for most patients. A team aproach with neurologist and therapist helping the spinal surgeon real can be rewarding.

Most patients need to understand that spinal stenosis is a natural aging process not really rare or unexpected to occur as we all get older. The real issue is when this condition causes symptoms that change your quality of life. This maybe leg or buttock pain or weakness as regular examples. Fortunately, very few patients need surgery! Usually, a minor injection under fluro and therapy will substantially alleviate symptoms. Yes the problem is still there but quality of active life returns quickly. Dr Geisse and myself working as a team have lowered the need for surgery to 5 percents as most patients are functioning well with very little medication. Look at the videos on this site for more details.

Patients need to have a real understanding of results ! I see so many failures of these techniques.The patients should be shown published outcomes.