Posts Tagged ‘Surgery’

Sharp Rise in Complex Back Surgeries.

Monday, April 26th, 2010

A new study on back surgeries has shown that there has been a significant increase in spinal surgeries between the years of 2002 and 2007. In this study, conducted by physicians at the Oregon Health and Science University in Portland and published in the Journal of the American Medical Association showed that the increase went from 1.3 to 19.9 surgeries per 100,00 medicare patients. Complex surgeries were defined as procedures in which 3 or more vertebrae were fused.

Now they didn’t draw any conclusions from this study, but certainly there are a couple of things we need to consider here.

As spinal surgery is the last option for most patients, what conservative options did they try before surgery? The statistical outcomes for these types of surgeries are still not that great- so surgeons typically don’t perform them unless there is a very good reason.

Are there lifestyle factors which increase the likelihood that we are damaging our spines to the point that surgery is necessary? Does the fact that Americans seem to be less active contribute to this? Is their a correlation to the rate of obesity?

These questions will probably be addressed in another study, but it would be hard to imagine that lifestyle and preventive considerations would not have affected these increases in a significant way. As I said, spinal surgery is a last option for most patients, and I know that there are things we can all do to decrease the likelihood that we will get to that point.

Thanks for tuning in.

-Andy

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Spinal Surgery- an introduction to disc replacement surgery, live from Masada, Dead Sea Valley

Friday, March 5th, 2010

The latest installment of my introductions to the different types of spinal surgery. I thank my daughter for working as cameraman during our trip- sorry for the shaky video.

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As I related in the video post, the disc replacement is a relatively new compared to most of what’s out there. It is a pretty elaborate procedure, and the recovery time will vary largely based upon the overall health, weight, age, and fitness of the patient prior to the surgery.

Below is an image of the prosthetic device itself.

One type of replacement disc prosthesis.

One type of replacement disc prosthesis.

Thanks for visiting, in the next installment of this surgery series, I will review the foraminotomy and a brief wrap up. Look for more posts from Israel this week.

Best,

Andy

Mini Series on Spinal Surgery: The Spinal Fusion, and Overview…

Friday, February 26th, 2010

Last week, I gave a brief introduction to spinal surgery, which can be viewed here. In this mini-series, I want to provide a brief overview of these procedures so viewers will have a basic understanding of what’s involved.

Of all of the procedures I want to review in this series, the spinal fusion is the one my viewers seem to be most interested in- likely because it has been around for some time, and many people coming to this site have either had one, know someone who has, or may be a candidate for one in the future.

Spinal fusion is used when an intravertebral disc has been so compromised, that the spinal segment (the combination of the two vertebra, linked by the disc between them) has been destabilized. This destabilization can be painful, as the associated structures of this segment can rub up against the nerve roots at that level- or alter the body mechanics at that level causing irritation to the facet joints (the small joints which articulate the spine.) So patients with this type of compromise can have back pain as well as radicular pain- like sciatica

Like most spinal surgeries, it is usually only considered when all other conservative options have been either tried or ruled out.

In this procedure, the surgeon will go to the spinal segment in question, and ‘clean up’ the area around the disc from debris which may be causing irritation as best as they are able. Then, either utilizing stabilizing hardware or a ‘glue’ made from the patients own bone (A small fragment of the patients bone is harvested, usually from the crest of their pelvic bone, which is crushed into a gravelly mixture.This mixture of live cells then ‘heals’ back into a solid structure) the affected segment is ‘fused’ into a neutral position, resulting in a reduction of pain. Below is an x-ray from a patient whose segments have been fused with hardware.

image of spinal fusion

Recovery from this surgery varies in length depending upon the overall health of the patient, and their level of conditioning prior to the procedure. Most surgeons will tell their patients not to expect the full benefits, for up to a year.

I have a fair number of patients who have had spinal fusion, and many have done well with it. There are patients for whom this is the best option, but it does have its downsides, which can become a larger issue based upon the patients age, and their overall activity level. The two most notable from a mechanical standpoint are:

-A loss of flexibility at the level of the fused segment.

-Because each disc absorbs external stress and shock- the forces which would be absorbed by the fused segment are passed onto the adjacent discs, and may cause premature wear and tear on them.

Because of these two considerations, surgeons began to look at other options to help fix the pain associated with a damaged discs for patients who are more active and wish to maintain the highest level of flexibility. In the next part of this series, we will look at one of these options, the disc replacement.

Spinal Surgery for Back Pain: Part 1: Introduction

Wednesday, February 17th, 2010

I received so many questions about the post I did a couple of weeks ago on the surgical procedure known as a foraminotomy, and many of those questions had to do with other surgeries as well. I thought I would take the opportunity to review the basics of some of these procedures in order to get a better understanding of how these procedures work.

Surgery is the most aggressive treatment option available for relief from back pain, and should be considered only after all more conservative options have been weighed. Many patients in my own practice have come to me as a last resort before deciding whether or not to have surgery.

If you google information about the outcomes of spinal surgery, you may find that the statistics are a little discouraging. The overall statistics for patients in my own practice who have had surgery for their back pain is not too different from most of the numbers you see out there- I have observed that about 30% of patients get some relief from the surgery, 30% have virtually no improvement, and about 30% report that they actually felt worse following surgery. Now, while these numbers sound kind of dismal, they improve significantly when patients are well screened, and when you are dealing with a particularly talented surgeon (and no, I ain’t namin names!)

In the next posts, I will review a few of the more common surgical procedures for treating back and neck pain as well as radicular pain such as sciatica. We will review the foraminotomy, spinal fusion, disc repair, and disc replacement.

Now, in this introduction, let me give you some basics that apply to all types of spinal surgery;

-If you have exhausted all conservative approaches to your pain, and you are considering surgery- as with any surgery, when possible get a second opinion.

-In your area, try to find people who have had surgery, and gather information about their experiences- not only about their own outcome, but about their experiences with the surgeon, their hospital, recovery, therapy, etc…

-As with any surgery, there are inherent risks such as hemorrhage, infection, etc… I am wary of any physician which describes anything as ‘risk free’ or ‘minor surgery.’ In the world of spinal surgery, there is no such thing as minor surgery- only degrees of ‘major.’

-Be prepared to do any post operative therapy your surgeon recommends- for many procedures, the follow up is just as important as the procedure itself when it comes to a favourable outcome.

-Try and recruit friends and family members to provide a network of support both pre and postoperatively. There can be significant anxiety as well as pain & discomfort associated with any of these procedures. Having emotional support before and after surgery can help hasten recovery.

These are just a few considerations when gearing up for surgery. Over the next few installments, I hope to provide you a basic understanding of what these procedures entail. If you have had surgery for back or neck pain, please share your experiences.

Best,

Andy

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Update: Upcoming topics- fibromyalgia & spinal surgery, and Happy Birthday Donna!

Wednesday, February 3rd, 2010

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There are a few topics I have been meaning to get to- I touched upon one surgery- the foraminotomy a week ago, but there are so many other procedures out there for the spine, and some viewers had some questions about what these procedures did. In light of a few recent studies regarding the outcome of these procedures, I thought now would be a good time to start a short series on the topic. Look for a post on disc replacement surgery some time in the next few days.

Also, I have been getting many questions about fibromyalgia- what it is and more importantly, what can be done about it. Look for some informational posts as well as some tips over the next several days.

Thanks for visiting- and BE WELL!

-Andy

Today is my wife, Donna's, birthday. I love you sweetheart- Happy Birthday!

Today is my wife, Donna's, birthday. I love you sweetheart- Happy Birthday!

VIDEO: Viewer Question re: Foraminotomy & Siatica

Wednesday, January 20th, 2010

foraminotomy

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A response to a viewer question regarding the surgical procedure known as a foraminotomy. In this procedure, the hole where a nerve exits the spine is enlarged in an effort to relieve impingement of the nerve, and subsequent pain. Stenosis, or reduction in the size of this hole is a common source of sciatica, and other radiating types of nerve pain. Below is an image of the neural exit foramina between two vertebrae.

foramina

Stay tuned for updates on the Fitness Challenge, and coming next week Pilates instructor Amanda Mitchell shares her One Thing.

Thanks for all of the great feedback, and be well.

-Andy

A further note on Disc Replacement Surgery…

Saturday, November 21st, 2009

This morning I received an email from Maria- “I have had disc replacement surgery, and it was the biggest mistake I ever made. How can you recommend this? I have had no relief, and had to go through major surgery and a long and painful recovery.”

She elaborated on all of the ways which the surgery had adversely affected her life.

Maria, please understand this- and it is important for all of my viewers to be aware of this; I try to make my posts educational, informative, and sometimes entertaining. My wish is to provide useful information about all of the back pain options out there. Everyone’s back pain situation is unique, and some approaches to relief will not be appropriate for other individuals.

In my post, I did not recommend disc replacement surgery- if anything, I feel I came across as too skeptical of the procedure. I am sorry that you did not get a positive outcome. There are people who are perfect candidates for the procedure, and even when everything is done perfectly, those people do not get relief. I have spoken with patients who had a 100 percent improvement in their pain- complete relief- following their procedure. I don’t know- and clearly at this point in this relatively new technology- I don’t think anyone knows a completely guaranteed way of identifying which patients will derive benefit.

In my area of back pain management/treatment, I will always lean towards the more conservative, less invasive approach to relief- but for some it simply is not enough. For those patients, surgery is the best option.

Again Maria- I am sorry you did not get the relief you were hoping for. I hope you can find an approach that works for you. Thank you for your question.

In the mean time, I am preparing some other video posts while I am still here in London.

Be Well,

-Andy

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