Saturday, April 13, 2024

Is Back Surgery Worth It

Spine Surgery For Leg Pain

Endoscopic Lumbar Discectomy

If most of the patient’s pain is leg pain , the pain may be due to a pinched nerve. If the leg pain does not start to resolve with conservative treatment after 4 to 6 weeks, an imaging study may be recommended to determine whether or not there is nerve pinching .

If there is pressure on the nerve, then either injections or a lumbar decompression spine surgery to take pressure off the nerve may be recommended. Back surgery for a pinched nerve can usually be done with a minimally invasive approach, and will usually result in early return to normal function . The success rate for decompression spine surgery is high, with approximately 90% of patients experiencing good relief of the leg pain after the surgery.

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What Is A Lumbar Disk Replacement

A lumbar disk replacement is a type of back or spine surgery. Your spine is made up of bones called vertebrae that are stacked on top of each other. Disks between the vertebrae work like cushions to allow the vertebrae to rotate and move without the bones rubbing against each other. The lumbar vertebrae and disks are at the bottom of your spine. Lumbar disk replacement involves replacing a worn or degenerated disk in the lower part of your spine with an artificial disk made of metal or a combination of metal and plastic.

Lumbar disk replacement is generally seen as an alternative to the more common spinal fusion surgery. Fusion permanently joins 2 vertebrae together. Lumbar disk replacement is a major surgery that requires general anesthesia and a hospital stay.

Why Choose Dr Rovner

As one of the best spine surgeons in NJ, Dr. Joshua S. Rovner provides surgical treatment of pain related to the neck and entire back. Dr. Rovner is one of the few providers of spine surgery NJ has to offer that specializes in minimally-invasive spine surgery. These procedures are safer and more precise alternatives to traditional surgery and are shaping the future of spinal and orthopaedic medicine. By helping individuals leverage more progressive means of minimally-invasive spine surgery, Dr. Rovner helps his patients undergo a smoother surgery with faster recovery times.

A patient-centered and personalized approach enables Dr. Rovner and his spine surgery team to diagnose and treat problems related to deformity, trauma, and degenerative conditions. From traditional procedures like lumbar spinal fusion and disc replacement surgery to more advanced and minimally-invasive techniques like robotic spine surgery, endoscopic disectomy, laser disectomy, Yess Procedure & Joimax, Dr. Rovner is one of the most comprehensive and experienced providers of spine surgery.

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The Multidisciplinary Spine Board Reduces Spinal Fusion Recommendations Offered To Patients

  • Between March 1, 2016, and December 30, 2016, the spine board itself discussed 11 patients.
  • All patients underwent clinical examinations and radiological assessment findings that warranted elective lumbar surgery.
  • The board recommended non-surgical interventions before proceeding with the planned surgeries in all cases.
  • The board stopped or delayed 11 or 11 surgeries.

The presence of a team spine board, alone in a medical hospital caused the number of spinal fusions to be reduced by half

  • The doctors noted that before they had a Spine Board, a total of 101 elective lumbar spine surgeries were performed.
  • After the establishment of a spine board, a total of 51 elective lumbar spine surgeries were performed.
  • The surgical plan for elective lumbar spine surgery in the post-implementation period was not directly influenced by the review of the spine board because none of the cases were discussed in the conferences however, the care occurred at a hospital where the spine board was implemented.

As we discussed in the research above, if patients have information, they are more likely NOT to have spinal fusion surgery. But what if they were given a piece of information that, by itself, suggested a fusion may be necessary? What if that information was not corroborated? Then you have symptom-free patients heading for surgery.

The Spinal Ligament Repair Injection Treatment Option

New scoliosis surgery

Prolotherapy, by tightening the capsular ligaments of the spine, can improve spinal alignment through the vertebrae. Possibly relaxing spinal cord decompression and a pinched nerve.

Most patients who come to Caring Medical with low back or lumbar disc disease, and thoracic or neck pain have MRIs that show disc degeneration. On examination, we find that the MRIs disc degeneration is seldom what is causing their pain. Here are some signs/symptoms that may lead a doctor to believe that pain is not coming from the disc problem :

  • Pain on either side of the spine not on the midline
  • Sensation is intact
  • Pain is not worse with sitting
  • Pain is not worse with bending over

All of the above symptoms suggest ligament laxity of the spine or sacroiliac ligament problems. Disc problems are more indicative if the person has low back pain for instance that is:

  • Standing makes it worse
  • Bending over while standing increases the central pain.

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Spinal Surgery Success Rates

As mentioned before, several factors impact spinal surgery success rates. Your surgery method, the condition youre attempting to fix, your surgeon, aftercare plan and more play into the results you may experience. For example, your low back surgery success rate may vary, depending on whether your low back pain stems from a pinched nerve or herniated disc.

Though the percentages given in this section indicate general success rates, youll need to talk to your surgeon to determine a projected success rate for your unique situation.

Pain Radiates To The Arms And Legs

Radiating pain, also known as radiculopathy, is often an indication that there is pressure on a nerve root in the spine. In these cases, surgery can be very helpful.

Two of the most common causes of radiculopathy are herniated discs and bone spurs. Each vertebra in the spine houses a shock-absorbing disc with a tough, fibrous outer layer and a soft, jellylike inner layer. Herniation is when the inner layer pushes out through the outer layer. If this herniation then presses on a nerve root, pain can radiate to whichever area of the body that nerve serves.

Bone spurs, on the other hand, are formed as a consequence of osteoarthritis of the spine. Osteoarthritis is the wearing down of the articular cartilage that allows bones in a joint to glide smoothly together. In spinal jointsknown as facet jointsthis cartilage wears away and creates bone-on-bone contact, which can cause the formation of these bone spurs, also known as osteophytes. The bone spurs may then crowd the spinal cord or nerve roots, leading to pressure on the nerve and radiculopathy.

In most cases, nonoperative treatment is usually tried before surgery even in cases of radiculopathy. However, surgery to treat radiculopathy is particularly effective. Most procedures are aimed at either removing the source of the pressure on the nerves, such as a discectomy, or giving the spinal canal more room, such as in a laminectomy.

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Poor Candidate For Surgery

Some people with back pain may benefit from more conservative treatments. Receiving a thorough physical examination along with the appropriate diagnostic imaging can determine if back surgery is right for you. Make sure your doctor performs a comprehensive examination including understanding your medical history. X-rays, CT scans, MRIs, and bone scanning are all tests the doctor should consider when diagnosing your condition.

It is also recommended that your doctor performs a psychological review. Anxiety, depression, hypochondriasis, and other social characteristics may also play a role in your surgerys success. In fact, psychological factors may be just as important, if not more, than some of the spines structural issues.

Some individuals have conditions that can cause back surgery to do more harm than good. For example, surgery is not recommended for someone has disc degeneration at multiple levels. Surgery for this condition may cause you to lose too much mobility in your spine.

Older people may be at a higher risk of developing complications from back surgery. Their bodies may not be able to handle the rigors of recovering from surgery. There is no set age when surgery isnt considered appropriate, so be sure to consult with your doctor.

Is It Worth It To Have Back Surgery

Micro Lumbar Discectomy & Fusion ( Spine Surgery) Neuro Surgery Fortis Healthcare,India

The answer to this question is often based on the condition in which the patient is and after evaluating the benefits and complications that the back surgery might have.2 So, if you are wondering, if it is worth it to have back surgery, you need to evaluate your condition and discuss with the treating doctor.

When the pain and discomfort in the back is severe, incapacitating the patient to do anything and the conventional treatment methods are not sufficient in providing a relief, back surgery stays as the only option for treating the patient and relieving the patient off the pain.

In order to determine whether it is worth it to have back surgery, it is necessary to be aware of the benefits and weight them against the risks.3

The benefits of back surgery in this regard are.

  • The patient can move around with ease.
  • The person becomes more physically fit.
  • There is a sudden improvement in the mood.
  • The pain medicines are stopped. The pain killers are not a good option as it has tremendous side effects.
  • People can get back to normal life.
  • The person is more productive at work.

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The Pain Doesnt Go Away

Between 75 and 90 percent of acute low back pain cases resolve themselves within a month, according to a study in Journal of General Internal Medicine. That may sound like good news for people with back pain, but its cold comfort when youre two weeks in and theres likely at least two more weeks to go.

Theres no need to simply wait it out, as there are a number of treatments to try in the acute stage of back pain. These can include:

  • Physical therapy
  • Lifestyle changes such as losing weight or quitting smoking
  • Radiofrequency ablation

If these conservative options have not been able to reduce or remove the pain after about a month, it may be time to consult with a spine surgeon.

What Is Conservative Care For Back Pain

For new back pain or a recurrence of an existing back pain condition, try these measures before surgery:

  • Wait. The most time-tested cure for back pain is time itself. Many times, back pain gets better on its own. But don’t wait to see a doctor if you have “red flag” symptoms with back pain, such as fever or loss of bowel or bladder control.

  • Apply ice and heat. In the early or “acute” stage of a bout with back pain, ice can numb the pain and ease swelling of the injured tissues. After a few days, heat may provide more comfort, get the blood flowing in the injured area, and reduce stiffness.

  • Take pain relievers as needed. Over-the-counter pain relievers ease discomfort and some also reduce inflammation. Acetaminophen is gentle on the stomach but does not reduce inflammation. The other option is an anti-inflammatory pain reliever like ibuprofen , naproxen , or aspirin.

  • Stay physically active. Short periods of bed rest or sitting may be helpful during the acute phase, but extended bed rest isn’t. Keep moving as much as you can manage. The movement will help to keep you functioning.

  • Stretch and strengthen gently. As the intense pain subsides, introduce gentle stretching and strengthening exercises. Ask your doctor or a physical therapist for detailed guidance.

Images: Thinkstock

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What Our Patients Have To Say

“Doctor Rovner, Meg, and all of the office staff have been wonderful throughout the entire surgery. Everything is explained out throughly and if you have any questions, you can even email Dr. Rovner and he gets back to you right away. I was very nervous about getting spinal fusion on my L4 and L5, but I had tried everything prior to surgery and knew this was the right choice for me. I would not hesitate a moment for anyone to come here and get an opinion from Dr. Rovner. He is very kind, knowledgeable and honest! I am on the road to a great recovery and can walk without anymore excruciating sciatic pain in my leg thanks to Dr. Rovner and his amazing staff!”

“Dr. Rovner is both pleasant, professional and knowledgeable. My mother required complicated spinal surgery to fix another Drs botched efforts and he was able to walk us through the risks and potential outcomes in a more than satisfactory way. He is also one of the few doctors that has access to some state-of-the art robots.

He is easy to work with regard to complex insurance matters and I would not hesitate to recommend him.”

The Ligaments Of The Spine As The Key To Degenerative Disc Disease

Lumbar spinal stenosis surgery cost in India

In one study doctors from Brigham Young University even suggest that the ligaments may be the key to degenerative disc disease and spinal degenerative changes. The researchers suggest that it is hard for doctors and MRIs to figure out the pain sources of low back pain and that even when people have it, there are no symptoms for it, yet eventually it will develop into worsening low back pain and disc problems.

But, these researchers also say that there are patterns of discdegeneration that may provide insight into where the pain is coming from and that by addressing these patterns further disc degeneration can be managed, What do doctors need to address? Spinal ligaments.

Specifically, individuals with contiguous multi-level discdegeneration have been shown to exhibit higher presence and severity of low back pain as compared to patients with skipped-level discdegeneration .

Here is the reason: Stresses on the surrounding ligaments, facets, and pedicles at vertebral levels where there was no degeneration of the spine were generally lower than where degeneration occurred.

It should be obvious that stable ligaments equal stable spines unstable ligaments unstable spines.

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What Is Lumbar Spinal Stenosis

Lumbar spinal stenosis is the narrowing of the spinal canal in the low back. It usually occurs when bone and other tissues grow inside the openings in the spinal bones. This can squeeze the nerves that branch out from the spinal cord. The squeezing can cause pain, numbness, or weakness, most often in the back, buttocks, legs, or feet.

Symptoms may be very bad at times and not so bad at other times.

Arthritis is the most common cause of spinal stenosis. There are a lot things that can help relieve your symptoms, but they won’t make your arthritis go away. Over time, your arthritis may get worse, and symptoms of spinal stenosis may come back.

When To Avoid Back Surgery

It may be tough to consider avoiding back surgery when you have intense back pain. Considering the risks we outlined above, a conservative approach carries little to no risk, and the surgery will always be there as a second option. A conservative approach first is appropriate for conditions like bulging discs, herniations, sciatica, stenosis, and others. These are the most common back conditions that can lead to unnecessary surgery.

Many people believe that by asking for a second opinion, they are protecting themselves from unnecessary surgery. Its easy to see why this is a common practice. Its kind of like if youre having car troubles and you ask two different mechanics to evaluate the car as well. What youre trying to determine is which mechanic is being more honest with you. In the case of something that has to do with your future quality of life and movement though, a better second opinion may come from someone outside of the surgical profession. Someone who makes a living getting people better without cutting them open. This person is often a physical therapist.

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Key Points To Remember

  • Spinal stenosis in the low back can cause pain, numbness, or weakness in the back, buttocks, and legs. Symptoms may be very bad at times and not so bad at other times.
  • Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy. If one of these things doesn’t work, you can try something else or combine some of them.
  • You may want to have surgery if you have tried other treatments for a few months and your pain or other symptoms are still so bad that you can’t do your normal activities.
  • Back surgery has some risks, including infection, nerve damage, and the chance that the surgery won’t relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.
  • Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

Fusion: The Gray Areas

Step by step how to perform a lumbar laminectomy

Men end up having fusions for a variety of reasons. In some cases, the spine may show signs of changes that potentially could explain the painsuch as breakdown of the cushioning spinal discs between the vertebrae. But sometimes it’s difficult to clearly trace the pain to a specific cause. For such cases of “nonspecific” low back pain, research suggests that the benefit of fusion is hit-or-miss. “You can say half of those who have fusion will have significant pain relief, but flipping a coin is not such a great thing,” Dr. Atlas says.

When there is pain relief, it is often limited. The pain, measured on a scale of 1 to 10, may decrease from an 8 to a 4. “Your pain is typically decreased by 50 percent,” Dr. Atlas says, “but there are very few people who really have no pain after spinal fusion.” The relief may last only a few years before the condition worsens again.

Another concern about fusion is that joining the vertebrae transfers the motion of the spine to the adjacent joints. This can speed up the wear-and-tear in those other locations.

Despite these cautions, many men with nonspecific low back pain still end up choosing fusion. Often, they have already tried physical therapy and other nonsurgical measures, but still end up with disabling pain.

The alternative to fusion is an intense, long-term back rehabilitation program to control pain and maintain function. It works as well as fusion, but doesn’t involve surgery and the risk of complications.

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