Good Morning Spine

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!

I am amazed how many patients are not adequately treated for neck or cervical disease. Many patients have weakness in their deltoids or numbness into their digits not realizing there is severe compression of spinal cord. Because their pain may not be as great compared to sciatica, useless amounts of therapy and neglect occur. Patients should know this pain and weakness relates to a combination disc herniation and secondary bone spurs that compress the spinal cord. A problem can lead to permanent loss off function. New surgical techniques using a microscope can give a great outcome if applied early in the care plan. Most patients are not properly evaluated or diagnosed. Know all your options!

A lot of my patients with neck pain do not realize they have weakness of the bicepts and deltoid muscle groups. They may have had nerve blocks,this will only correct their pain. Very important to exam patients prior to these blocks. So many patients are seen in pain clinics without full examination. Unfortunately, this masking of symptoms can lead to permanent weakness.

I believe in patients right to know as much as possible about their surgeon. In this day and age, one can easily look up credentials using the Internet. I demand that my patients look up my particular publications and training including continuing education. I also believe that using adjunct staff to perform procedures has gone too far. I perform all my own nerve blocks and. let patients know that their surgeon is performing the actual. surgery. In addition, their surgeo. needs to give the patient very precise plan how to handle post- procedure difficulties should they. arise. I give every patient my cell and home numbers for added assurance for immediate care should this happen. Unfortunately, spinal surgery is an area of medicine that has signicant degree of post- operative complications that can be easily corrected if caught early. Not to lessen the great advancements and success, a patients deserves a full committment as part of patient- doctor relationship. We practice this philosophy at SPOSI.

I find that sciatica or pain down the buttock to back of leg is still a growing cause for patients to seek out care from a spine specialist. This is usually from inflammation from the disc or blockage of nerve at lower two disc spaces. Spinal stenosis is the other big cause. Most of the times stretching in combination with nerve block under fluro removes 80 percent of the symptoms and surgery is not necessary. We then try to look at wellness and even gait to help prevent future return of pain. The main goal is return to activity such as golf,tennis,and even bowling!

The use of hardware in spinal procedures is very confusing. Patients need to have this explained in a way so they embrace the concept when necessary to stabilize the spine. Many patients with severe stenosis with leg pain have collapse of bone around the exit of the nerve roots and these devices keep the bone away from the the nerve when patients are walking.The goal is a much better quality of life after surgery which usually means less pain when standing or walking. Certainly, not all patients require these device when there is a less severe form of stenosis.

Operated on 95 year old patient with spinal stenosis and he left hospital 2 days. The newer technologies allow faster recovery and lower complications in such an extremely high risk patient. It still is very unfortunate that active senior delay due to fear the possibility of considerable pain relief and increase funtional lifestyle. Again, we tried every other option to no avail before making this difficult decision.Patients need to know all their options.

I am going to try new version of pain control device from Empi that applies direct pain control thru application of a Tens unit easily apply to the skin.The goal is to lessen the need for drugs that can have so many side effects.We have tried to find best combination of products that may lower the need for surgery.

Age is not an issue rather quality of life for decisions regarding surgery. I operated on 95 year old doctor’s father who actually was up and left hospital second day after laminectomy and fusion three levels. He was still living in his own home and driving to places. I believe there many elderly patients that do not realize withproper planning and cautious surgery they can be helped. These patients do poorly with medication for pain.