Lumbar and Cervical Surgery for Spinal Conditions
October 29, 2013
12:00 p.m. – 1:00 p.m. (EST)
Moderator: Welcome to our Online Health Chat "Lumbar and Cervical Surgery for Spinal Conditions" with Graham Mouw, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.
Meurer: At what point should lumbar stenosis be surgically corrected? How does the pain manifest itself? I was offered steroid injections which I refused. Physical therapy helped. I do spinal extension exercises daily. Pain in leg and hip.
Graham_Mouw,_MD: Surgery should be considered when the pain affects daily activities. If the lumbar stenosis is mild or moderate I usually would start off with a steroid injection. However, for "severe spinal stenosis" surgery is usually more effective.
Sharonbarr: I am a 59 year old female with Scoliosis. I had a Harrington rod surgery (rod still in) in my mid 20's. I have recently had an MRI and the results show severe deterioration of my lower spine causing pinched nerves, sciatic pains etc. Three recent epidermal shots have not given me much relief from pain. What options do I have to help with pain relief other than meds? I have always heard surgery is a last resort. Is this true?
Graham_Mouw,_MD: The treatment options include seeing a good pain specialist. There are many other types of procedures besides epidural injections. You should see if you are a candidate for any of those. Surgery is general is only recommended if a problem has developed above or below you have the rod placed.
guyinfla89: Numbness in lower legs & feet + right leg calf muscle weakness, diagnosed as spinal stenosis 2011. Treated by lumbar surgery Aug 2011 including vertebral fusion + following physiotherapy. Not effective, numbness persists and calf muscle continues to shrink. What are treatment options now?
Graham_Mouw,_MD: I would recommend a follow-up MRI to see if there is any remaining narrowing around the nerves. If MRI does not reveal any narrowing around the nerves and the spinal fusion looks good, I would recommend finding a good pain management specialist. They have multiple treatment procedures for people who have had prior spinal fusions without much relief.
jc7: I would like to understand the surgical options available, the risks and recovery time. Would you recommend surgery or another treatment with this MRI report? I have 4 herniated discs, but I don’t have enough room to include everything from the MRI. Here is the worst one from the report. L5-S1: Disc desiccation. Broad-based HNP, central and left paracentral, 10mm in AP dimension effacing the thecal sac and abutting and displacing the descending left S1 nerve root is noted. The more shallow broad-based underlying disc protrusion encroaches into and mildly narrowed.
It has been 6 months and I'm still having pain run down my rear end and lower back. I'm very active (walking, biking, aerobics, weight lifting etc.) and I'm unable to bend over, jump or do the normal things that I used to do. I'm also experiencing lower rib pain and my knees are taking a beating from the compensation from my back. I have tried alternative methods such as physical therapy, acupuncture and a chiropractor.
Graham_Mouw,_MD: You should see a reputable spinal surgeon for evaluation for surgical options. Many times people are told they have disc herniations when in fact it is just spinal stenosis or narrowing. It is essentially unheard of to have 4 disc herniations. However, many people feel that they have been told that they have many disc herniations. It more than likely represents spinal changes that are age related. It can be a contributing factor to spinal stenosis. If the narrowing is significant enough there are decompressive techniques that can be highly effective.
tabialex: Male, age 75, with neck problems for 3 years which physical therapy did not help. Neurosurgeon #1 wrote after MRI "primarily two level disease at C5-C6 and C6-C7. There is a spondylolisthesis of C5 on C6. There is central stenosis, as well as bilateral neural foraminal narrowing at C5-6 and C6-7. Looking at C5 to C7 cervical discectomy and fusion." Orthopedic 2nd opinion surgeon recommended steroid injection for symptoms. Sent to neurosurgeon #2 for injection; he did not do or recommend risky injections. My main complaints are: cannot turn head very far to left and right, pain at top of my right shoulder and stiff entire right shoulder. I don't seem to have much loss of strength or muscle. Would surgery increase flexibility in turning my head, help relieve pain and stiffness? Should I try the injection? Is fusion necessary in my case? Would I be a candidate for minimally invasive surgery? Thank you for your expert comments.
Graham_Mouw,_MD: Generally neck surgery is not recommended for neck pain nor stiffness. No surgery will increase range of motion nor help neck pain. The reason for evaluation for neck surgery is symptoms down the arms and hands. There are motion preservation surgeries available.
sadiegrey: I have chronic low lumbar pain, acute when on feet for 10-15 min. I have Marfans (connective tissue disease) and have the dural ectasia on the spine per MRI's. I have degenerative disc disease, spinal cysts on my low spine per MRI.....not as big as they can get, but also not small. I have degenerative disc disease and osteoporosis and chronic osteoarthritis. All my joints hurt and I've had 3 stem cell injections in foot with torn tendon that I didn't injure and 3 in right knee that was bone on bone and did help and had cortisone in hips, cortisone and synvisc in both knees...just to give you a picture that I'm in a lot of pain. If I stand 15 min at most I get so much back pain I get very nauseated and feel light headed. I was taking 10 mg liquid morphine 2x day and 6-8 Tylenol also, but then put on 15 mg slow release morphine 2x day and Tylenol. It does help take edge off pain, but now I've developed reflux so bad and had pure acid come up in throat and stomach and esophagus in pain so stopped morphine. Is there anything that can be done for my spine to relieve pain? I have afib periodic and on meds. One neurosurgeon said he wouldn't want to do surgery.
Graham_Mouw,_MD: You would need an MRI and further evaluation from a spine specialist. Generall speaking surgery is not performed for low back pain.
sha: What types of surgeries require use of braces post-op?
Do you allow your patients to shower post-op? If prescribed a brace, must the patient wear the brace in the shower?
How do you decide whether to take an anterior vs. posterior approach to a cervical repair? How long post surgery until you remove staples or stitches?
Graham_Mouw,_MD: Generally speaking any surgery that requires a spinal stabilization, braces are used. Braces are not to be work in the shower nor sleeping. In terms of front or back approach to the cervical spine, you should see a surgeon who is competent in performing both types of surgery. That way they can determine which surgery is best for you. The decision to go in the front or the back is based on many factors including age, number of levels involved and spinal condition. Staples or stitches may be removed anywhere from 7 to 14 days depending on type of sutures and type of procedures.
Paula1028: My husband is having sharp, stabbing pains from his neck to his right shoulder only. What could be the cause? He has tried to keep his neck still being in a brace - one you by at a drug store - plus using a heating pad. Had to use pain meds but only helped for a short period of time.
Graham_Mouw,_MD: Generally speaking, your husband should have an MRI and an evaluation of his shoulder by an orthopaedist.
guyinfla89: Symptoms: Numbness in lower legs & feet, weakness in right lower leg including calf muscle atrophy. 2011 diagnosis "lumbar stenosis". Surgery Aug 2011 incl fusion, followed by brace & physiotherapy. Poor results, symptoms persist, getting worse. is further surgery worthwhile?
Graham_Mouw,_MD: Unfortunately spinal fusions can result in narrowing above or below the fusion. So a repeat MRI is likely indicated to evaluate if there have been changes above or below your previous fusion.
Jen2013: I have two herniated discs and am in a lot of pain, would I be a candidate for surgery? I’ve tried therapy and medication with no relief.
Graham_Mouw,_MD: You would need an evaluation by a spine specialist to determine that. It is important to understand the severity of the narrowing of nerves on your imaging study and how it relates to your symptoms.
Dolfan72: My husband suffered an injury at work and now has three bulging discs. He continues to experience numbness in his legs when standing for a long time. What type of treatment should he receive?
Graham_Mouw,_MD: If he had a work related injury it is important that he see a reputable spine specialist that can give him a proper evaluation. Many of these conditions can be treated with physical therapy and pain management.
precioso: I saw your television interview where you talked about the O-Arm used in surgery. Could you provide more details on how it is used? How does it help with outcome?
Graham_Mouw,_MD: The O-arm is an intra-operative CT based scanner. It gives the surgeon 3D images of your spine. It allows for safe and accurate placement of spinal instrumentation if needed. There are many other benefits including the ability to perform less invasive surgery and reduced exposure to radiation.
oanimalsyes: Does the surgeon treating lumbar stenosis L4 L5 area widen the spinal area around the nerves that are being aggravated and is that by removing and widening the spinal area of affected area
Graham_Mouw,_MD: There are very good decompression techniques for spinal stenosis, most do not require a fusion. You should see a surgeon that specializes in less invasive techniques. In most cases, a spinal surgeon can just decompress the nerve and not remove the lamina
CarlaT: I'm a 42 year old female - two years ago I got out of bed and after taking a couple steps, had a sharp pain shoot down my right leg which brought me to the floor - severe back pain left me partially immobile - went to ER and diagnosis was sciatica (no MRI no X-rays) - physical therapy for two months - to this day I still have numbness in my leg and outside of foot - back pain off and on - sharp depending on movement - there are times when laying down that I cannot turn over or get up without help - where do I go from here?!
Graham_Mouw,_MD: It sounds like you need a lumbar MRI to evaluate if there is any root nerve compression. I would recommend you see a reputable spine specialist after acquiring a lumbar MRI.
Moderator: Thank you for joining us today. We appreciate all of your questions. Unfortunately, Dr. Mouw was called away to see a patient. Please join us for our next web chat, "Breast Cancer" on October, 11 at 1:00 pm, with Martin Newman, MD.,