- Anesthesiologist specializing in non-surgical spine care
Fellowship-trained in Interventional Spine
A. With healthcare, Americans can easily be attracted to new technology or gadgets as the miracle cure for any ailment. The concept of a laser with surgery certainly sounds high tech. However, on second thought, lasers are often used to burn through metal doors and panels. Do you really want that type of cutting device near your spinal cord?
With that said, there are differing opinions about the use of lasers with spine surgery, just as there are differing opinions about many advances in technology in medicine.
At Baptist Health Spine Center we don’t believe laser spine surgery provides an advantage over minimally invasive spine surgery and in some cases could present some risks that are avoidable. The spine surgery process for minimally invasive spine surgery and laser spine surgery both involve a “laminectomy” or “laminotomy” where parts of the bone in the spinal vertebra are removed to provide a window for the surgeon to access the damaged disc.
Under traditional spine surgery, the surgeon using a microscope or endoscope visualizes the part of the disc that is pressing on a nearby nerve root and simply removes the problematic disc tissue with a tiny incisor tool. With laser spine surgery, the surgeon at this juncture uses the laser to heat and vaporize the disc tissue. The Cochrane Review, which summarizes complex medical research, as well as the North American Spine Society, doesn’t cite any superior benefit for the use of laser spine surgery, and that is the personal opinion or our spine surgeons as well.
With that said, we believe very much in using appropriate technology where it shows benefit to the patient. Use of restraint with any new technology is key to maximizing the benefit while lessening risk of new emerging technology.
A: Back pain is a working person’s problem. It’s relatively rare up to age 18 (except for scoliosis) and becomes less of an issue beyond age 70. Ironically, it’s somewhat like Mother Nature taking care of us in old age, because even though the discs in the back become more brittle and prone to herniation with old age, the nerve pathways also become less effective transmitting pain signals as we age.
The prime age for back and neck pain is the forties and fifties, and it cuts across all occupations from laborers to white collar workers. There are certain occupations like garbage collectors who have highest risk because of the motion of lifting and twisting the trunk.
As we get older, into our forties and fifties, we become less flexible. At the same time, we believe we can lift the same heavy objects we lifted in our twenties and thirties. Lifting something too heavy or lifting it incorrectly, can cause a strain of ligaments and muscles in the back. Or, this can also herniate a disc which then affects a nerve root. Symptoms of a herniated disc can include pain that radiates into an arm or leg, or weakness and numbness in an arm or leg.
Most the time, a strain or herniated disc can build up over the years, until one Saturday when you lift a bag of fertilizer in the yard drops you to your knees in agony. Other factors such as smoking, being overweight or obese, and poor posture can all raise your risk of back pain.
The exercises shown in this site when done in front of the TV on a regular basis can help make your back stronger, more flexible, and resistant to strain. As you start with them, you will see how limited your flexibility is, and with continued use, you will stretch out your hamstrings and trunk muscles so you are more flexible.
In a sense, just as you floss your teeth to avoid cavities, you need stretching exercises to prevent back and neck strain.
A: With age, our bones and muscles lose tone and elasticity. They become
less able to properly cushion the vertebrae and more likely to spasm or break.
When a spinal disc ruptures or bulges, it places pressure on the surrounding
nerves and results in pain signals traveling to the brain. Other factors such
as smoking, obesity, poor posture and lack of sleep can also contribute to back
A: Prevention is the best strategy for coping with back pain and can save a great deal of time and agony. Become an educated health care consumer by learning about effective prevention methods.
A: Applying ergonomics can help prevent repetitive motion injuries such as carpal tunnel syndrome, particularly if you are constantly working at a computer.
A: By receiving care from spine specialists within multiple
fields, the diagnosis and treatment process is less likely to become
biased or limited. Multidisciplinary care involves a team of specialists
that pools together its expertise for the greatest benefit of the patient.
Surgery is reserved as the last card to be played. As a patient, instead
of being limited to one medical specialty, you can benefit from the
combined expertise of many physicians.
A: Within this Internet site is a symptom chart and information about herniated discs. The good news is that you never need surgery for a muscle or ligament strain. The emergency symptoms that imply a disc has herniated badly and is pressing dangerously on a nerve root off the spinal cord are loss of control of the bowel or bladder, or numbness/weakness in a foot or hand. These symptoms need to be seen by a spine specialist within 48 hours to prevent permanent paralysis of the nerves which would cause the symptom become permanent.
Watchful waiting can be used for pain that radiates into a leg or arm, perhaps for a month. Although there is some research that implies the longer a person goes with these symptoms can affect the complete relief of these symptoms with surgery. Think of a car sitting on a hose in the driveway. If too much time goes by, even if you move the car, the hose may still be crimped. In this sense, some surgeons believe there is a window of time, about three to six months, for optimal relief of symptoms from a herniated disc pressing on a nerve root.
A: A fellowship is the highest level of training available to
a specialized physician in the U.S. It involves a financial grant for
advanced study or training or to allow payment for work on a special
project. It provides a stipend, and, in some cases, the miscellaneous
expenses involved in the study, training or project (Source: Mosby’s
A: Lying in bed causes muscles to weaken, which inhibits recovery.
Even though activity may be uncomfortable or hurt a bit, this doesn’t
mean that it’s worsening your condition. On the contrary, building
strength in the muscles surrounding the vertebrae can help achieve
a full return to activity. Also, on the mental side, being bedridden
can lead to feelings of frustration and hopelessness, which can slow
you down. Regardless, studies have shown again and again that activity
leads to a quicker return to work.
A: Minimally invasive surgical techniques provide the opportunity
to successfully treat back problems with minimal interruption to the
patient’s regular, active lifestyle. Results achieved from these
methods have been proven to match that of conventional "open surgery." The
surgeon makes smaller incisions, sometimes only a half-inch in length.
Through these tiny incisions, the surgeon inserts special surgical
instruments and probes in order to access the damaged disc in the spine.
By using minimally invasive techniques, access and repair to the damaged
disc or vertebrae is achieved without harming nearby muscles and tissues.
Other benefits of minimally invasive techniques include shorter surgery
duration and recovery time, less visible scars and reduced pain and
A: Osteoporosis can have extremely serious consequences on the
spine. Because osteoporosis often progresses undetected, the first
indication could be as disastrous as a bone fracture. These fractures
typically strike an area of the body that carries the most stress,
such as the spine, wrists or hips. Spinal fractures can occur without
notice, as vertebrae simply compress. Compression fractures can be
very painful and may lead to stooped posture, loss of height and risk
of serious neurological damage to spinal nerves.
A: Scoliosis is a disease characterized by an abnormal curvature
to the spine, in which the vertebrae twist like a bent corkscrew. In
less severe cases, scoliosis may cause the bones to twist slightly,
making the hips or ribs appear uneven. Scoliosis can progress into
a serious health problem if bones become so severely twisted that they
compress vital organs or if the spinal deformity is so severe that
spine health and posture is threatened. If this happens, surgery may
be necessary. If left untreated, severe cases of scoliosis can shorten
a person's life span. The best way to care for scoliosis is to achieve
early detection and take measures to minimize its progression.
A: A natural byproduct of aging is the loss of resiliency in
spinal discs and a greater tendency for them to herniate, especially
when placed under a weighty load, like when we lift heavy objects.
Additionally, some people have a family history of degenerative disc
disease, which increases their own risk of developing it. When a natural
disc herniates or becomes badly degenerated, it loses its shock-absorbing
ability, which can narrow the space between vertebrae.
A: The artificial disc is the best alternative to date for fusion
surgery. More than 200,000 spinal fusion surgeries are performed each
year in the U.S. to relieve pain caused by damaged discs in the low
back and neck areas. Some experts estimate that over the next 10 years,
more than half of patients who would otherwise receive a fusion will
receive an artificial disc instead.
A: Patients with a diseased disc between L4 and L5 or between
L5 and S1 (all in the lower back) that is worn out or become injured
and causes back pain are candidates for the artificial disc. Other
candidates include those with degenerative disc disease (DDD) whose
bones (vertebrae) have moved less than 3mm. Your physician will help
you determine whether or not the artificial disc is a good choice for
you. Factors that will be considered include your activity level, weight,
occupation and allergies (Source: Charite Artificial Disc).
A: Generally speaking, those who receive artificial disc replacements return to activity sooner than traditional fusion patients. Also, because there is no need to harvest bone from the patient’s hip, there is no discomfort or recovery associated with a second incision site. Some of the overall benefits of artificial disc surgery include:
A: When treating knee and hip replacement patients, orthopedic surgeons try to postpone the implantation of an artificial joint until a patient is at least 50 years old so that they do not outlive their artificial joint, which typically lasts anywhere from 15 to 20 years. Revision surgery, which may be necessary to replace a worn-out artificial joint, can be complex.
This is also a concern with
the artificial disc. Unlike knee and hip replacement patients who are
typically in their 50s or 60s, many patients can benefit from artificial
disc technology at a much younger age — in their 20s or 30s.
Therefore, the implantation of an artificial disc in younger patients
can raise a surgeon’s concern about the potential life span of
the artificial disc in the spine and the need for revision surgery
to replace a worn-out artificial disc, which can be complex.