Severe pain can be very debilitating, however, it is extremely rare that the
cause can lead to either death or paralysis. Even though most spinal problems
will never become emergencies, there are some complaints that require immediate
attention. The following is a list of symptoms that can require immediate
- Any change in bowel and/ or bladder control
- Inability to urinate
- Increased weakness in the arms and legs (most commonly foot drop)
- Numbness in the genital or/and anal area
- Pain that increases at night or while laying down
- History of any type of cancer
- Fevers, chills, or unplanned weight loss
- Any recent infection ,including dental work, steroid use, or IV drug abuse.
Frequently Asked Questions
Why should a neurosurgeon do my spine surgery?
Neurosurgeons train in surgery of the spine including microdiscectomy, laminectomy, cervical and lumbar fusion and instrumentation during their entire residency training. Their experience is not limited to a one year fellowship or a few weekend courses as with other specialties that sometimes operate on the spine, or who claim expertise in spinal surgery.
Approximately 80% of a neurosurgeon’s training is dedicated to the spine. Our practice is devoted to assessing the needs of our spinal patients as individuals and designing the safest, most precise procedure that will accomplish our goals of pain relief and neurologic recovery in those patients who ultimately require a surgical repair. Our knowledge of neurologic function and microsurgical techniques are invaluable tools in the pursuit of a functional recovery for our spinal patients.
How do I know if my back pain is serious?
Most of us suffer from back pain at one time or another. But persistent back or leg pain, possibly associated with weakness or numbness may represent a more serious condition such as a torn disc (herniated disc) or spinal stenosis -- an arthritic condition. Your physician should consider an MRI or other appropriate study in these cases.
Who needs surgery?
A small number of patients who have suffered from a herniated disc will not respond to conservative measures such as massage, exercise, or steroid injections. These usually have gone for several weeks and have just not tolerated the pain from the nerve root compression. A very small number of patients have a huge tear (herniation) and become bedbound, with weakness in the muscles supplied by the compressed nerve, requiring early surgery (in the first week or so). In essence, it is the large herniations with clear signs of nerve root compression (leg pain, weakness in the leg muscles) and/or numbness that benefit from a disc procedure.
I have painful disc herniation, now what?
For patients not responding to rest, massage, therapy, etc., the choice of a microdiscectomy may be offered. A skilled neurosurgeon who performs this procedure should be sought out. Microdiscectomy is a modernization of the standard laminectomy procedure that is designed to be done through a small incision, with minimal muscle and boney trauma, thus limiting the postoperative discomfort. Most patients can go home the same day and be back at work in a few days.
My doctor says that I need a fusion. What's that all about?
The specific indications for lumbar fusion are spinal instability, i.e. a slippage of angulation of the vertebral bodies. It is rare to prescribe a fusion for a simple disc herniation. Unfortunately, there are a lot of more vague indications being marketed today for fusions, resulting in a lot of procedures that we feel are unnecessary, and possibly very harmful for these patients. While modern medicine is making vast improvements in the ability to perform fusions in the lumbar spine, the indications remain controversial. Seek out several opinions if a lumbar fusion is recommended.
Spinal stenosis, what's that?
Arthritis, (boney overgrowth) that occurs in the facet joints can compress single or multiple nerve roots causing spinal claudication, which is the feeling of leg weakness with activity. Essentially, the boney growth blocks blood flow to the nerves, causing heaviness in the legs, ultimately causing the patient to sit down to recover. This can also lead to spinal instability due to the facet joint compromise from the arthritis. These patients may require a more extensive decompressive laminectomy. Some may be unstable, benefiting from a fusion.
Unfortunately, the condition often mimics the pain of arthritis (such as night pain at rest, morning stiffness, and central back pain). The success rate for the procedure runs around 65 - 70%. Many of the patients still suffer postoperatively form their persistent arthritic pain. We try very carefully to select patients with true nerve compression symptoms for this surgery.
What about chiropractors?
Our practice maintains an excellent relationship with several of the chiropractors in the area. We will gladly work with your chiropractor and suggest chiropractic treatment in appropriate situations. Since the treatment for these conditions is often non-surgical, the chiropractor, physical therapist, and other non-surgical professionals can be an integral part of your treatment and recovery from lumbar disc problems.
Do I need a fusion?
Although our physicians are trained and experienced in these techniques, a fusion is not a procedure to be taken lightly. The success rate in cervical fusion for disc herniation approaches 95% when patient selection is appropriate, and most of these patients resume normal activities within a few months of their procedure.
In the lumbar spine, however, the success rate is fairly low, and the complication rates clearly seem to outweigh the benefits for most patients. Simple disc herniations that require surgery do not need to be fused in the vast majority of cases.
Instability is the commonly accepted indication for fusion; in patients that meet the strict criteria for instability in the lumbar spine, a procedure with or without instrumentation will be discussed.
An inordinate number of lumbar spinal fusions are currently being done in this country, with little agreement on indications and requirements for this procedure. What is known, is that the complication rates and failures in patients chosen with liberal criteria are quite high. Dr. Hope takes these considerations very seriously and recommends lumbar and cervical fusion only when rigid criteria are met.
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