What is laser spine surgery?
Contrary to popular belief, “laser spine surgery” rarely, if ever, involves a “laser.” The term “laser spine surgery” originated decades ago when a “laser” was used to cauterize the disc in a percutaneous manner. The idea of a minimally invasive approach to spine surgery subsequently evolved and became associated with the term “laser.”
What has now become known as laser spine surgery is simply minimally invasive spine surgery performed through a small incision with the aid of a tubular retractor system and the visual guidance of either a microscope or an endoscope. This kind of minimally invasive surgery is attractive because of minimal tissue disturbance and faster recovery. It is technically challenging, however, and requires a specially trained spine surgeon, like Dr. Eubanks, to achieve good outcomes.
When is spine surgery needed?
Unless you have a neurologic deficit or intractable pain, most spine problems can and should be initially treated non-operatively. Low back pain, neck pain and even radiculopathy (radiating nerve pain), will often improve with non-operative management such as physical therapy, traction, medications, steroid injections, acupuncture, and other treatments.
What are common causes of low back pain?
Low back (lumbar) pain can be caused by many factors. The low back is made up of bone and soft tissue, including discs, muscles, ligaments, and nerves. All of these factors can contribute to low back pain. Degenerative discs and arthritic changes, or normal aging and wear on the body, are common causes. Other frequent sources include muscle strains, nerve impingement, or ligament tears.
Less common sources of back pain are caused by broken bones, stenosis or narrowing around the nerves, and illness. Back pain can also be referred from other organ symptoms in the abdomen and pelvis.
What are common causes of neck pain?
Similar to the low back, the neck, or cervical spine, is made bone and soft tissue. All of these can cause neck pain as well. Common causes are degenerative discs, arthritic changes, and muscle strains. Sometimes neck pain can be caused by spinal cord or nerve impingement.
What is a muscular strain?
A muscular strain happens when the muscle itself is torn or damaged. The muscle can become inflamed, swollen, and even spasm. Lumbar strains occur in the low back, whereas, cervical strains occur in the neck. There are other types of muscular strains throughout the body. Muscular strains typically improve uneventfully over time without the need for surgery. Most strains respond to non-operative treatments such as: stretching, light exercise, ice/heat, and anti-inflammatories. Sometimes a medical provider may prescribe a muscle relaxant.
What can protect against low back pain?
The best techniques to protect against low back pain include regular cardiovascular exercise, core strengthening exercises, maintaining a healthy weight, and being a nonsmoker. Cardiovascular exercises include anything that raises the heart rate, including walking, running, swimming, hiking, etc. The core includes the muscles of the abdomen and low back. They support the back. Good posture and alignment are helped by a strong core. Smoking contributes to degenerative disc disease and is highly correlated with chronic low back pain.
What are non-operative treatments for low back pain?
Non-operative (conservative) treatments for low back pain typically include a referral to physical therapy. A therapist will then teach the best stretches and exercises to reduce and help prevent low back pain and injuries. Good posture techniques may also be taught. This is also true for neck pain.
Acetaminophen (Tylenol) or over the counter anti-inflammatories, such as ibuprofen or naproxen, are typical first-line medications. Sometimes a medical provider may add in a prescription for a medication that is stronger. Narcotics, or opioid based medications, are not a good treatment for low back and neck pain. Many times pain is caused by inflammation and narcotics do not help with inflammation.
What is radiculopathy?
Radiculopathy is nerve pain radiating from the spine. This means the nerve is being pinched or irritated in one place but is felt in another. Common types include cervical radiculopathy (nerves impinged in the neck) and lumbar radiculopathy (nerves impinged in the low back).
Cervical radiculopathy typically refers to pain felt in the arm or upper extremities. Lumbar radiculopathy is pain felt in the buttocks and leg or lower extremities. Lumbar radiculopathy is a form of Sciatica.
Radicular symptoms can present in different ways. It may be felt as pain, weakness, numbness, and/or tingling.
What are non-operative treatments for radiculopathy?
Similar to low back and neck pain, non-operative treatments for radiculopathy may include a referral to physical therapy. A therapist will then teach the best stretches and exercises to reduce nerve pain. For cervical radiculopathy, traction is often helpful. Traction is gentle pulling on the neck.
Again, acetaminophen (Tylenol) or over the counter anti-inflammatories, such as ibuprofen or naproxen, are typical first-line medications. Sometimes a medical provider may add in a prescription for a medication that is stronger, such as an oral steroid. Many times pain is caused by inflammation. Narcotics do not help with inflammation and are not always appropriate for radicular pain.
Dependent on what is causing the radicular pain, steroid injections may be appropriate. These are typically done by Pain Management doctors. Steroid is injected around the nerve to help calm down nerve pain.
For more information, read Dr. Eubanks research on non-operative treatment of cervical radiculopathy here.
What is the difference between degenerative discs, disc bulges, and herniated discs?
Intervertebral discs sit between the bones of the spine. They are made of two parts, a fibrous tough ring called the annulus fibrous, and a soft center, called the nucleus pulposus. With aging the discs become less fluid filled and lose height. This is a degenerative disc. It can be determined by a radiograph, or x-ray, by seeing the loss of space between the vertebrae.
Disc bulges and herniated discs are seen on an MRI and sometimes a CT scan. A herniated disc is when a piece of the inner soft nucleus pulposus breaks off and moves past the annulus into the spinal canal where the spinal cord and nerves are. If it touches a nerve, it may cause radiculopathy. A bulging disc is a degenerative disc that is not herniated. Other injuries that can occur to a disc include annular tears. A layer of fibers of the annulus may be injured or torn. This may cause inflammation and pain.
When do I need an MRI?
Most low back pain, neck pain and even initial nerve pain can be treated without an MRI. An MRI is needed by your surgeon when he or she is discussing potential surgical intervention. These days, most insurance companies will not pay for an MRI until you have done 4-6 weeks of non-operative management (physical therapy, chiropractic care, pain management, etc.). Sometimes an MRI is needed more acutely, however, when a patient has a neurologic deficit or there is concern for spinal cord compression or the presence of a tumor or metastasis.
What is cervical myelopathy?
Myelopathy is a term used to describe spinal cord dysfunction arising from compression in the cervical or thoracic spine. Myelopathy typically presents with balance disturbance, coordination problems, numbness and tingling in the extremities, weakness in the arms or legs, and even muscle wasting.
Typically, it arises from chronic spinal cord compression secondary to degenerative arthritis. It often develops so slowly that the effects go unrecognized and get chalked up to “just getting old.” Sometimes, myelopathy can present more acutely secondary to a large disc herniation in the neck or trauma. Myelopathy often requires surgery to decompress the spinal cord and stabilize the spine to prevent ongoing and further neurologic deterioration.
What is spinal stenosis?
Spinal stenosis is the term used to describe narrowing of the spinal canal. This can be congenital (meaning we are born with a small diameter in the spinal canal), degenerative (secondary to arthritis), traumatic (secondary to a spine fracture or dislocation), or pathologic (because of a spinal tumor). By far, the most common kind of spinal stenosis is degenerative. Degenerative spinal stenosis occurs when arthritis, thickened ligament, and/or disc bulges concentrically narrow the spinal canal and compress the spinal cord or nerve roots.
What is the difference between an Orthopedic Spine Surgeon and a Neurosurgeon?
The difference between and orthopedic spine surgeon and a neurosurgeon is largely one of background. Whereas an orthopedic spine surgeon spends part of his or her training doing orthopedics, a neurosurgeon spends part of their time doing brain surgery.
An orthopedic spine surgeon is typically specialty trained, doing a fellowship in spine surgery, and typically does exclusively spinal surgeries. A neurosurgeon typically does not have fellowship training and may do brain surgery as well as spine surgery. However, both a well-trained orthopedic spine surgeon and neurosurgeon are capable of handling most spine procedures. When selecting between an orthopedic spine surgeon and a neurosurgeon, pick the surgeon who only does spine surgery and performs a high number of procedures every year.