Good Morning Spine

I wonder how difficult patients must have making clear decisions given all the misconceptions about spinal procedures. I try to let them know that non- surgical choices are good as long as there is real improvement. However, I see a lot of patients using drugs that are just masking symtoms that really do not address the compression of the spinsl nerves. If one has weakness lifting their arms or difficulty walking from leg eakness this is very serious. Most of the time, surgery is to remove compression of nerves by either a disc or bony overgrowth that cannnot be avoided. My best outcomes occur if a decision for surgery occur before there is permanent damage to the spinal nerves from chronic compression in either neck or back. Be very careful with overuse of pain medications or prolong therapy!

I strongly believe spine surgeons should discuss all serious potental complications with surgical patients.I feel that patients should be a little nervous if they are properly prepared for surgery. The results are good but not perfect In most situations. Managing each patients expectations is extemely important. I also find the other extreme, where patients with very correctible problems , are told surgery on their neck or back will not work. In fact, surgery has come along way over past five years with newer technology and more more highly trained spine specialists. Too much narcotics are being prescibed that have no proper role for treatment of stenosis or herniated disc disease.

Living longer, healthier and happier have always interested me. It becomes confusing when you read article after article about what to do and what not to do. After years of research and constantly talking to our patients over 95 it comes down to multi- vitamins ( no particular name brand)  and lowering your caloric intake. Scientist from Cornell University have suspected that calorie restrictions could extend the life span of animals since 1935. The researchers suggest reducing calories by 25%. Try it and see how you feel (at least 6 months)anything we understand better we have at least a shot at controlling better. Who knows feeling better with a little weight loss is a form of renewed youth, but getting some extra years would be even better.

I read a lot of articles about repeat spinal surgical procedures and want my patients to understand some basic reality.In most cases, the underlying process is a form of aging with degeneration of structures such as disc or facet joints. This ongoing process cannot be changed with surgery. Rather we try to lessen the symtoms of pain or weakness so a patient can be more functional. The undelying process may then pass on to other levels with time requring either non-surgical or possibly more surgery in the future. This process is seen quite often in heart surgery as well. Coronary arteries at other level also nay get blockage over time needing second and even third surgeries. I clearly relay this process to all my patients. Fortunately, new techniques for spine surgery make recovery very rapid from just a few years ago.

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!