Here is the final part in our series about secrets your doctor may have about back and spine surgery. We hope you’ve learned something new and that you have a better understanding of how to protect yourself and get the care you need. If you need a great spine care surgeon and live in the Seattle area, contact us at Spine Institute Northwest. Our skilled surgeons would be happy to help you find relief.

Secret #21: Be Honest with Your Doctor

Many patients lie about their medical history, but this can be detrimental to your care. Be honest about all surgeries you’ve received, including plastic surgery. Past surgeries can pose unique challenges to doctors and the outcome will be better if your doctor has time to prepare. Being honest about your medical history will help you to get the best care possible.

Secret #22: Ask What Will Happen After Surgery

Some spinal surgeries have extensive recovery times while others will bring only momentary discomfort. Ask what you can expect after your surgery and what type of care you will need. This will help you prepare and know if there is a potential problem.

Secret #23: Find Out Who Will Manage Your After Care

After your surgery you may need follow up care as your body heals. Ask who will handle this care. In some practices you will continue to meet with a doctor or surgeon while in other practices you will meet with a nurse or trained assistant.

Secret #24: Ask About Banking Blood Before a Procedure

If you are getting elective surgery you may be able to bank your own blood or have a family member donate for you should the need occur. This will help you avoid blood bank blood from an unknown source. If you are interested in this, talk with your doctor well in advance of your procedure to see if this is possible and necessary.

Secret #25: Some Procedures Are Unnecessary

Surgery is often necessary to fix back and spine problems, but it isn’t always needed. Some procedures are unnecessary. Make sure you carefully weigh your options before each procedure and that you work with a doctor or surgeon that you trust.

Secret #26: Scar Creams Reduce Scarring

Scar creams can reduce the appearance of scarring after a procedure. Ask your doctor if you can use a scar cream and which they recommend.

Secret #27: Minimally Invasive Spine Surgery is Often Your Best Bet

Minimally invasive procedures are easier to heal from than traditional surgeries. If a minimally invasive procedure is available, take advantage of it, especially if it offers the same level of results as a traditional surgery.

Secret #28: Pre-Op and Post-Op Instructions Are Critical

Make sure you follow your doctor’s pre and post-op instructions closely. If you want the best results from your procedure, you need to do exactly what your doctor says to prepare. If you have questions, please ask.

Secret #29: You May Need Help After Your Procedure

You may be sore for a few days after a procedure. Getting help around the house and having someone around to meet your needs may really help with your recovery. At the very least have someone available to bring you home from your procedure and make sure you have everything you need.

Secret #30: Some Doctor’s Recommendations Are to Prevent Future Problems

Your doctor may recommend a procedure just to avoid future problems, not because it is necessary. Before consenting to a surgery find out what will happen if you don’t get surgery and weigh your options accordingly. You may also want to ask what will happen if you wait to get surgery.

This is the final part of our three part series on secrets your doctor may have about spine surgery. Make sure you choose a doctor that has experience and your best interests at heart.

One of the many benefits of modern medicine is a wide variety of different surgeries and procedures to bring you back pain and sciatica relief in Seattle. We are pleased to offer many of the latest procedures in our offices. To help you better understand some of the options that may be available to you, we are going to highlight several minimally invasive back surgery options. Your doctor can help you decide which is right for you. Stay tuned; with so many great procedures, this is going to take three blog posts to cover.

Endoscopic Decompression

Conditions treated: spinal stenosis, bulging/herniated disc, pinched nerves, bone spurs, sciatica, arthritis of the spine, foraminal stenosis.

Endoscopic decompression is a revolutionary procedure unlike any previous surgical option. It is minimally invasive and uses the latest technologies to make the easier recovery and effective pain relief. We make a small incision near your spine through which an endoscope (also known as an arthroscope) to see your spinal column. We can find and visualize damaged discs and repair them from the inside. Damaged tissue is removed and bulging discs are shrunk back to the proper size using lasers and radio frequency (RF).

Since this procedure is done endoscopically it minimizes pain, recovery time and tissue damage. Previous surgeries required cutting through the adjacent muscles and tissue, which could lead to long and difficult recoveries. Scarring is also very minor, typically only the 1 inch incision marks. This procedure minimizes recovery, but can be quite effective. We use local anesthetic and intravenous sedation and can often perform the procedure in our own outpatient surgical center.

This minimally invasive surgery takes about 90 minutes per disc with about an hour of recovery time in our offices. After the procedure you will need to spend some time on bed rest while your body heals and recovers. We will schedule appointments with you to monitor your progress. Many of our patients notice immediate pain relief, while others take a little more time to notice the results. The ultimate goal of this surgery is to provide long lasting back, neck, leg or spine pain relief.

Interbody Fusion and Facet Fixation

Conditions treated: degenerative disc disease, facet joint disease, spinal stenosis, bulging/herniated disc, pinched nerves, bone spurs, sciatica, arthritis of the spine, foraminal stenosis, .

We use the facet screw to stabilize the spine and to make fusion procedures more effective. The facet fixation procedure can provide pain relief for those with a variety of conditions including Degenerative Disc Disease (DDD). Basically this procedure helps provide stabilization to the back and spine when intervertebral disc degenerates and no longer can provide stability and support and/or when facet joints degenerate. When this happens, the adjacent vertebras collapse and the spinal nerves get compressed. This procedure is like fixing a broken bone; its intent is to join one vertebra to another.

Stabilization of the spine is done by using facet screws and an intervertebral implant.Depending on patient condition, facet fixation can be done on its own or combined with the intervertebral implant.

Unlike many of our procedures, this one typically brings relief, but cannot make your back as good as new. We hope to bring significant improvement, but complete pain relief is not typically possible. It will take between 6 months and 2 years for the bones to fuse together and during this time you will need to be careful to avoid injury. We find that this procedure can improve quality of life and help you feel better while slowly returning to your regular activities. Yet majority of our patients report great satisfaction with this minimally invasive lumbar fusion surgery.

These are just a few of the many surgeries we offer at the Spine Institute Northwest. Many of these procedures are very complex and need a skilled surgeon. Our doctors are experts in the pain management field and will help you find the right procedure for your problem. Contact us today and improve your quality of life. We bring quality spine care, skilled surgeons and friendly staff to those in Seattle and the surrounding areas. Be sure to watch the blog for part two of the series where we will cover radio frequency neurotomy and endoscopic nerve excision and part three covering the pain pump and spinal cord stimulators.

Many people have heard of the epidural as a pain relief option for women during childbirth, but that isn’t its only purpose. An epidural can also be an effective pain management and treatment option for those experiencing back pain. Let’s learn more about this procedure by exploring 10 facts about the epidural.

Fact #1- Epidurals for Labor and Delivery are Different from Epidurals for Back Pain

While the procedure is very similar when administering a labor and delivery epidural and a back pain epidural, the types of medication used will vary quite a bit. Epidurals for back pain often contain a corticosteroid (a powerful anti-inflammatory) to reduce swelling and discomfort. Epidural steroid injections are also commonly guided by fluoroscopy to ensure that the treatment is placed at the exact point of the problem.

Fact #2- Epidural Steroid Injects Use Two Different Pain Relief Medicines

Epidural steroid injects often use two different medications to treat back pain. The first is usually a numbing agent like Lidocaine to provide immediate pain relief. The second medication is a steroid that will work to reduce inflammation and discomfort. Steroids don’t reduce pain as quickly as the numbing agent, but provide a longer lasting effect.

Fact #3- Back Pain, Nausea and Headache Are Potential Side Effects of an Epidural Steroid Injection

Side effects from an epidural injection are rare and when they do occur they are often minor. Side effects can include back pain or tenderness at the injection site, feeling sick to your stomach or vomiting, dizziness and headache. Serious side effects happen very rarely and include bleeding, infection, nerve root injury and meningitis. Various physical and mental conditions can impact your risk for side effects. Talk with your doctor about any concerns you may have regarding side effects and the risks of this treatment.

Fact #4- Epidural Injections Are a Short Term Pain Relief Solution

Epidural injections can be an effective pain relief solution, but the effects typically only last 2-3 weeks. Epidural injections are a treatment option, but are not a cure for spinal stenosis or other conditions.

Fact #5- Can Be An Effective Treatment for Spinal Stenosis and Other Conditions

Epidural steroid injections can be used to provide temporary pain relief for a variety of different conditions including spinal stenosis, herniated discs and degenerative disc disease.

Fact #6- The Length of Pain Relief Varies from Patient to Patient

The effectiveness of this treatment can vary from patient to patient. Pain relief if present can be few days to few weeks. There is a wide range reported by patients regarding the duration of benefit.

Fact #7- Epidural Injections Can Increase Discomfort in Patients with Some Congenital Problems

If spinal stenosis is caused by a congenital problem like a small spinal column the epidural injection may actually increase pain and discomfort. This treatment is more effective for those suffering from the spinal stenosis due to osteoarthritis and other degenerative diseases.

Fact #8- Imaging Scans or Fluoroscopy Are Often Used to Guide the Needle in this Procedure

During the procedure your doctor will probably use a fluoroscope (live x-ray) to guide the needle to the correct location. This helps to ensure that the medication will be able to treat the nerves that are causing the discomfort.

Fact #9- Epidural Injections Can Be Completed on an Outpatient Basis

You don’t have to spend time in the hospital to get an epidural injection. We can typically complete this procedure in our offices. We do ask that you bring someone along to drive you home since you won’t be able to drive for a short time after your procedure.

Fact #10- Your Doctor Can Determine if an Epidural Can Help You with Your Back Pain

Your doctor will be the best judge of if this procedure is right for you. Talk with them and ask any questions that you may have.

An epidural steroid injection is just one of many pain relief options for those experiencing back pain. If you have back pain there are things that we can do. Contact us at the Spine Institute Northwest and let us help you manage your back and spine pain.

Many back pain treatments and procedures must be completed in our offices, but there is something that you can do at home that may provide back pain relief: stretching. Talk to your doctor and find out if this could be an effective option for your condition.

How Does Stretching Help Combat Back Pain?

Stronger bodies are better able to withstand stress. Physical therapy, stretching and an active lifestyle may promote healing and rehabilitation. The spinal column is a complex combination of muscles, bones, ligaments and other tissues. Stretching can increase the range of motion in this area. In many cases this can have a positive effect on back pain.

If you are already experiencing back pain it can take several weeks or even months before the pain relieving effects of stretching are felt. It takes time to get the spine moving again and restoring a proper range of motion will not happen overnight.

Stretching Tips

• Dress Appropriately- Stretching is easiest when you wear loose, comfortable clothing. Try to avoid clothing that binds the body or constricts your movement.
• Don’t Force It- Stretching shouldn’t hurt. Do not force yourself into positions that are painful or overly difficult.
• Don’t Bounce- Move into stretches slowly and carefully. Avoid bouncing since this can tear your muscles and cause injury.
• Consult Your Doctor- Talk with your doctor before starting a stretching program. They will be able to let you know which stretches can help your condition and which stretches to avoid during your treatment process. At The Spine Institute Northwest may utilize MedX medical machines as a part of your treatment.

What Are MedX Machines?

MedX machines are similar to the exercise machines you will find at the gym, but they are specifically designed for physical therapy purposes. We often use the spine machines to treat and diagnose various spinal problems including strains, sprains, herniated discs, degenerative disc disease, spondylolisthesis and spinal stenosis. Research indicates that stretching and strengthening the spine may help patients to avoid spinal surgery.

Every case of spine and back pain is different. Some of our patients find great results from medications while others require surgery. Contact us at The Spine Institute Northwest and let us help you find the best treatment method for your situation. If you don’t currently have back or spine pain, start stretching now. A strong spinal column will be better able to deal with the stresses of daily life and is less likely to experience spine pain.

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Overview

Sciatica means painful sensation along the large sciatic nerve that runs from the lower back down through the buttocks and along the back of each leg. It is a relatively common form of back pain.

Sciatica is usually caused by pressure on the sciatic nerve from a herniated disc (also referred to as a bulging disc, ruptured disc or pinched nerve). The problem is often diagnosed as a “radiculopathy”, meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root).

For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse. Usually, sciatica only affects one side, and the pain often radiates through the buttock and/or leg.

One or more of the following sensations may occur:

• Pain in the buttocks and/or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness or difficulty moving the leg or foot
• A constant pain on one side of the buttocks
• A shooting pain that makes it difficult to stand up

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While sciatica can be very painful, it is rare that permanent nerve damage (tissue damage) will result. Most pain syndromes result from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis.

Symptoms that may constitute a medical emergency include progressive weakness in the legs or bladder/bowel incontinence. Patients with these symptoms may have cauda equina syndrome and should seek immediate medical attention.

Any condition that causes irritation or impingement on the sciatic nerve can cause the pain associated with sciatica. The most common cause is lumbar herniated disc. Other common causes include lumbar spinal stenosis, degenerative disc disease, or isthmic spondylolisthesis.

Nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both of these conditions. Treatments include:

• Manual treatments (including physical therapy and osteopathic or chiropractic treatments) to help relieve the pressure.
• Medical treatments (such as NSAIDs, oral steroids, or epidural steroid injections) to help relieve the inflammation.
• Surgery (such as microdiscectomy or lumbar laminectomy) to help relieve both the pressure and inflammation may be warranted if the pain is severe and has not been relieved with appropriate manual or medical treatments.

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What causes sciatica?

The sciatic nerve is the largest nerve in the body. It starts in the low back at lumbar segment 3 (L3). The nerve roots run through the bony canal, and at each level a pair of nerve roots exits from the spine.

The nerve is named for the upper vertebral body that it runs between (for example, the nerve that exits at L4-L5 is named L4). The nerve passing to the next level runs over a weak spot in the disc space, which is the reason discs tend to herniate (extrude) right under the nerve root and can cause leg pain.

The sciatica symptoms (pain, numbness, tingling, weakness) are different depending on where the pressure on the nerve occurs. For example, a lumbar segment 5 (L5) nerve impingement can cause weakness in extension of the big toe and potentially in the ankle (foot drop) (See Figure 1).

Common conditions that can cause sciatica, or pain along the sciatic nerve include:

• Lumbar herniated disc
  A herniated disc can occur when the soft inner core of the disc (nucleus pulposus) extrudes through the fibrous outer core (annulus) and the bulge places pressure on the contiguous nerve root. In general, it is thought that a sudden twisting motion or injury can lead to an eventual disc herniation. A herniated disc is sometimes referred to as a slipped, ruptured, bulging, or protruding disc, or a pinched nerve.
• Lumbar spinal stenosis
  This condition involves a narrowing of the spinal canal. It is more common in adults over age 60, and typically results from enlarged facet joints placing pressure on the nerve roots as they exit the spine.
• Degenerative disc disease
  While disc degeneration is a natural process that occurs with aging, in some cases it can also lead to pain along the sciatic nerve. The condition is diagnosed when a weakened disc results in excessive micro-motion at the corresponding vertebral level and inflammatory proteins from inside the disc can become exposed and irritate the area.
• Isthmic spondylolisthesis
  Relatively common in adults (approximately 5% to 7% of adults), this condition rarely causes pain. It occurs when a small stress fracture, often at the fifth segment, allows the L5 vertebral body to slip forward on the S1 vertebral body. Caused by a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the L5 nerve can get pinched as it exits the spine.
  See also Isthmic spondylosthesis
• Piriformis syndrome
  The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttocks, leading to sciatica.
  See also Piriformis syndrome - another irritation to the sciatic nerve
• Sacroiliac joint dysfunction
  Irritation of the sacroiliac joint can also irritate the L5 nerve, which lies on top of it, and cause sciatica.

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How is sciatica treated?

The good news is that if pain along the sciatic nerve is going to get better on its own it will usually do so within a couple of days or weeks. In fact, the vast majority of sciatica episodes usually heal on their own within six to twelve weeks.

• Conservative care:
  During an episode of sciatic pain there are a number of conservative care options available to help alleviate the pain and discomfort.
• Heat/ice
  For acute sciatica pain, heat and/or ice packs are most readily available and can help alleviate the pain, especially in the acute phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated.

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Common causes of muscle strain of the large back muscles include:

• A sudden movement
• An awkward fall
• Lifting a heavy object (using the back muscles
• A sports injury

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While it sounds like a simple injury, a muscle strain can create a surprising amount of pain. In fact, this type of injury is one of the most common reasons people go to the emergency room. However, not much can be done for a strained back muscle except for rest (e.g. for up to two days), pain relief medications, and ice and/or heat application. This article discusses how and to apply ice for quick relief of back pain caused by muscle strain.

How ice provides pain relief

Ice can help provide relief for back pain in a number of ways, including:

• Ice application slows the inflammation and swelling that occurs after injury. Most back pain is accompanied by some type of inflammation, and addressing the inflammation helps reduce the pain.
• Numbs sore tissues (providing pain relief like a local anesthetic)
• Slows the nerve impulses in the area, which interrupts the pain-spasm reaction between the nerves
• Decreases tissue damage

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Ice is most effective if it is applied soon after the injury occurs. The cold makes the veins in the tissue contract, reducing circulation. Once the cold is removed, the veins overcompensate and dilate and blood rushes into the area. The blood brings with it the necessary nutrients to allow the injured back muscles, ligaments and tendons to heal.

As with all pain relief treatments, there are some cautions with ice. Never apply ice directly to the skin. Instead, be sure that there is a protective barrier between the ice and skin, such as a towel. Additionally, ice should also not be used for patients who have rheumatoid arthritis, Raynaud’s Syndrome, cold allergic conditions, paralysis, or areas of impaired sensation.

Medications

Over-the-counter or prescription medications may also be helpful in relieving sciatica. Non-steroidal anti-inflammatory drugs (NSAIDs) or oral steroids can be helpful in reducing the inflammation and pain.

Non-steroidal anti-inflammatory drugs (NSAID’s)

Because most episodes of back pain have an inflammatory component, anti-inflammatory medication is often an effective treatment option. NSAID’s work like aspirin by limiting the formation of inflammation, but have fewer gastrointestinal side effects (such as gastritis or ulcers) than aspirin.

NSAID’s comprise a large class of drugs with many different options. Ibuprofen (e.g. Advil, Nuprin, Motrin) was one of the original non-steroidal anti-inflammatory drugs and is now available without a prescription. The recommended dose is 400 mg every eight hours, although prescription doses can be as high as 800 mg every eight hours. Another type of NSAID is naproxen (e.g. Naprosyn, Aleve).

It is better to use NSAID’s continuously to build up an anti-inflammatory blood level, and the efficacy is markedly lower if taken only when experiencing pain. Since NSAID’s and acetaminophen work differently, the two medications may be taken at the same time.

NSAID’s are cleared from the blood stream by the kidney, so it is very important that patients over 65 years of age or patients with kidney disease consult a physician prior to taking the medication. If patients take an NSAID for an extended period of time (six months or more), a blood test needs to be performed to check for early signs of kidney damage. NSAID’s may also cause stomach upset or possibly ulcers. Patients with stomach ulcers or a history of stomach ulcers should first consult with their physician.

A new class of NSAID’s, COX-2 inhibitors, just became available (e.g. Bextra, Vioxx, Celebrex). The primary difference between these drugs and the older NSAID’s is that they selectively inhibit the chemical reaction that leads to inflammation in the body, and do not inhibit the chemical production of the protective stomach lining. Since the major side effect of NSAID’s is ulcer formation in the stomach, these new drugs have a lower complication rate and do not tend to produce ulcers. Celebrex and Vioxx were the first COX-2 inhibitors on the market, and Bextra has just been released.

Oral Steroids

Oral steroids, a non-narcotic type of prescription medication, are very powerful anti-inflammatory medications that are sometimes an effective treatment for low back pain. Like narcotics agents, oral steroids are intended for use for short periods of time (one to two weeks). Oral steroids come in many forms, but are usually ordered as a Medrol Dose Pack in which patients starts with a high dose for initial low back pain relief and then taper down to a lower dose over five or six days.

When used on a short-term basis, there are generally few complications associated with oral steroids. There are, however, a number of potential complications associated with long-term usage of oral steroids. Adverse side effects can include weight gain, stomach ulcers, osteoporosis, collapse of the hip joint, as well as other complications.

It is important to note that diabetics should not use oral steroids since the medication increases blood sugar. Steroids should also not be taken by patients with an active infection (e.g. sinus infection, urinary tract infection) because they can make the infection worse.

Epidural steroid injections

If the pain is severe, an epidural injection can be performed to reduce the inflammation. An epidural is different from oral medications because it injects steroids directly to the painful area around the sciatic nerve to help decrease the inflammation that may be causing the pain. While the effects tend to be temporary (providing pain relief for as little as one week up to a year), an epidural can be very effective in providing relief from an acute episode of sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning program.

Conservative care specialists

A visit to a physical therapist, osteopathic physician, chiropractor, physiatrist or M.I.S.S spine specialist can be helpful both to alleviate the painful symptoms and to help prevent future recurrences of sciatica. These conservative care professionals can assist in providing pain relief and developing a program to condition the back.

Surgical treatments:

If the pain is severe and has not gotten better within six to twelve weeks, it is reasonable to consider minimally invasive spine surgery (MISS specialist) or traditional open spine surgery. Depending on the cause and the duration of the sciatic pain, one of two surgical procedures may be considered: an arthroscopic microdecompression (microdiscectomy) or an open decompression (lumbar laminectomy).

• Arthroscopic Microdiscectomy (microdecompression)
  In cases where the pain is due to a disc herniation, a microdiscectomy may be considered after 4 to 6 weeks if the pain is not relieved by conservative means. Urgent surgery is only necessary if there is progressive weakness in the legs, or sudden loss of bowel of bladder control. A microdiscectomy is typically an elective procedure, and the decision to have surgery is based on the amount of pain and dysfunction the patient is experiencing, and the length of time that the pain persists. Approximately 80% to 95% of patients will experience relief from their pain after this type of surgery.
  This procedure can be performed for cervical, thoracic and lumbar disc herniations.
• Lumbar laminectomy (open decompression)
  Lumbar spinal stenosis often causes pain that waxes and wanes over many years. Surgery may be offered as an option if the patient’s activity tolerance falls to an unacceptable level. Again, surgery is elective and need only be considered for those patients who have not gotten better after conservative treatments. After a lumbar laminectomy (open decompression), approximately 70% to 80% of patients experience relief from their pain.