Good Morning Spine

I am now requring prevention as part of treatment. We have started looking at wellness as fundemental part of spine treatment. I find that less invasive surgery is already very much improving as a treatment option when patients are in better condition. Again, I treated a patient with lumber stenosis also with a pacemaker,defibulator, mechanical heart valve using new techniques as this would not have been possible 5 years ago.The advances for patients with stenosis or herniated disc is very much different then just a few years ago.

Remember that first disc surgery performed about 1935 so what happen prior to that time? People were more physically active causing the outer portion of the disc to be stronger so less likely for the nuclear material would leak out as a rupture with compression of sciatic nerve. Patients most do more weight bearing and exercise to keep the outer disc strong. Real health means prevention including exercise low carb diet without processed foods.There is so very much unnecessary surgery!

Patients should be asking their doctors undergoing surgery when implants are placed whether there is FDA apprroval? All surgeons use products that are not cleared but the reason must be well understood. Technology that has proven outcomes should be the goal. I still find many patients that do not know what was put in their back by the previous surgeon. I try to use models and detailed information when preparing patients for surgery. I never ever suggest better then70 to 80 percent outcome for improvement.

I try to teach patient not to overreact to MRI results as 40 percent of normal patients without any symtoms will show herniated disc. Do not panic! Most of the time the pain Is from unrelayed causes and not related to the disc herniation. Simple therapy and pain management work in 95 percent of my patients.

I see so much degenerative changes in patients that have increased body weight. I am starting to ask them to record what they eat each day prior to next visit. I also believe in low carb diet control and to also try to limit intake of processed foods.It is now much easier to find stores with organic food with no additives such as steroids to meat.Prevention and wellness are a primary goal in my practice these days. I want patients to understand their responsibility in preventing premature spinal aging.

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.