Online Health Chat with Scott Robertson, MD

Tuesday, July 21, 2015


Description

Back pain affects an estimated 80% of Americans at one time or another throughout their lifetime. While some may find relief in medication or physical therapy, more than 500,000 people a year decide to undergo surgery to alleviate their symptoms. While many people suffer from back pain, every case is different and not everyone will need surgery. Spine surgery will likely be recommended if your condition has not responded favorably to conventional treatment approaches for back pain.

Most of the time when surgery is needed, it is due to:

  • Spinal fracture from an injury
  • Infection in the spine
  • Tumor
  • Spinal stenosis
  • Loss of feeling or sensation in the back or legs
  • Herniated disc or damaged nerve

Whether someone is a candidate for surgery is usually decided following a thorough evaluation of their symptoms and medical history. During that evaluation, the neurosurgeon will determine which type of procedure is right for the patient. These procedures can include discectomy, percutaneous discectomy, laminectomy for spinal stenosis, kyphoplasty for tumors and infection, and spinal fusion. Following back surgery, a rehabilitation program is recommended in order to regain and strengthen muscles and movement.

Cleveland Clinic Florida’s Medical, Interventional and Surgical Spine Care Center treat complex spine disorders in adults and adolescents. Our goal is to improve patient’s condition and quality of life with the most appropriate, most advanced and least invasive treatment available.


About the Speaker

Scott Robertson, MD is a Neurosurgeon in the Department of Neurological Surgery at Cleveland Clinic Florida. Dr. Robertson received his medical degree from the University of Iowa Carver College of Medicine in Iowa City, Iowa. He completed his residency in neurosurgery at the University of Iowa Hospitals and Clinics and was the Director of Neurosurgery in Oklahoma for 17 years. Dr. Robertson is part of the World Federation of Neurological Societies, teaching and training both nationally and internationally.


Let’s Chat About Surgical Options for Back Pain

Welcome to our Online Health Chat "Surgical Options for Back Pain?" with Scott Robertson, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.


Surgical Treatment Options

sinaihospital: I have spinal stenosis and degenerative disc disease since 2008, it is getting worse not better. I’ve tried shots, physical therapy and back braces. I had an MRI that found the problems. Can surgery help doctor in this case, yes or no? Thank you for help.

Scott_Robertson,_MD: Yes surgery can be helpful for spinal stenosis and DDD. There are several types of surgery depending on the number of levels and degree of stenosis and compounding factors.

GNT: I need your help. I was diagnosed with Degenerative Disc Disease at the age of 23 (I will be 50 in October.) After two "minimally invasive" back surgeries to repair L4-L5; the first in 2006, the second in 2009, I ended up with severe neuropathy in both legs and still have 3 herniated discs in my lower back (L1-L2, L2-L3, L5-S1.) I ended up with a fusion to repair L4-L5. L5-S1 has no disc left and the sac is completely dehydrated, so as my back surgeon told me, my spine is like a house with a severely damaged foundation that must be repaired.  1) Is neuropathy permanent? The pain is unbearable most days and the toe cramps and leg jerking uncontrollably at times just adds to the misery.  2) When I had my surgeries, artificial disc replacements on adjoining disc levels wasn't an option. The Charite Artificial Disc wasn't even FDA approved then. Is this still true, and if not what options are there for me?

Scott_Robertson,_MD: 1) Neuropathies can be permanent, an EMG/NCV study may help determine the severity and likelihood of recovery. 2) Artificial discs were being used in Europe, but not approved in the US until about the 2005-2006 time frame. There are several lumbar artificial discs approved now in the US, but usually not indicated for multi-level disease like yours.

BrianB: I consulted with a surgeon who reviewed my MRI and recommended a TLIF at L3/L4. After researching TLIF surgery, I find that it is a well-established procedure with many experienced surgeons providing this procedure. Given this, and limiting my choices to experienced surgeons with years of experience, how do I decide on a surgeon to perform this surgery? Is there a significant degree of difference in successful outcomes among experienced surgeons?

Scott_Robertson,_MD: I recommend you research your surgeon and make sure they have done a significant number of the TLIF approach fusion and have had the proper training. This procedure does have a certain learning curve and there is a significant risk of nerve injury during this approach.

msugal: I've dealt with RSD since 2004 knee replacement and have severe spinal stenosis. I've been told I'm not a candidate for back surgery due to the RSD. Is this true...or can surgery be done with nerve blocks?

Scott_Robertson,_MD: The RSD may influence your recovery and outcome slightly, but is not a true contraindication to surgery. I would recommend seeing a qualified spine surgeon to review for individual case.

smithrh: The Laser Spine Institute reviewed my MRI's and CT scan and found that I have Degenerative Disc Disease, Bulge/Herniation, Spinal Stenosis, Foraminal Narrowing and Facet Disease. They propose to do minimally invasive procedures for repair. Is this a reasonable option for me? What are the pros and cons? Are there facilities closer to home in Northern Michigan who are capable and offer the same service?

Scott_Robertson,_MD: Most spine surgeons and facilities dealing with spinal conditions can provide the same type of procedures they are recommending. I am sure you can find a qualified program in Michigan who can do the same minimally invasive procedures.


Surgical Outcomes and Recovery

BrianB: If I have one spinal joint fused (L3/L4) with TLIF surgery, even if it heals optimally, with no pain after surgery, what is the likelihood that I will injure the joint above or below the fused joint when I return to normal activity? To what degree would I need to modify my daily activity? Specifically, I am a yoga teacher, and tend to engage in vigorous flexion and extension of the spine on a nearly daily basis.

Scott_Robertson,_MD: Historically after a fusion there is a 10-20% chance of developing adjacent segmental disease over the life time of the patient. Typically, after 9-12 months you should be able to resume most normal activities and exercises.

MrJones05213: What is the normal recovery time following spinal fusion surgery? How long will it take to return to my normal routine?

Scott_Robertson,_MD: Most people are recovered by 3-6 months depending on age, physical condition, and type of surgery. It may take up to a full year for the fusion mass to be complete.


Spinal Conditions

Julz: How would one get an infection in the spine?

Scott_Robertson,_MD: There are a number ways a patient can get infections. We are all carriers of bacteria on our skin and any break in skin, which acts as a barrier to the bacteria getting into our body, can allow bacteria to get into a surgical wound and cause an infection. Also, any infections in other parts of our body can spread usually through the blood stream and seed into the spine and cause an infection.

smithrh: I had fusion surgery on my vertebra at the neck level, which slowed the progression. I have been told I have "permanent" spinal cord damage, and it prevents me from walking correctly. This has taken a huge toll on my quality of life. Someone along the way suggested stem cell research could offer me repair. Is this a real possibility for me, and if so, where would I start my research to explore this possibility.

Scott_Robertson,_MD: This is a very complex question. Not all stem cell therapy is the same! In theory for stem cell therapy to work in repairing the spinal cord, the cells need to be co-cultured with neural cells and treated with factors to help them differentiate into the proper neurons and supportive glial structures prior to injection and then still receive the proper signals for the repair process to occur. It is a lot more complex than going to some of these outpatient clinics who offer to inject your own stem cells into the spine the same day. I would recommend looking for a reputable clinical research program offering this service. Most of these procedures are not covered by insurance.

Kcarlyle: Can degenerative disc disease be non-symptomatic, and with an injury become symptomatic? Does it then require surgical treatment?

Scott_Robertson,_MD: Yes, DDD often is asymptomatic only becoming symptomatic with an injury. Most of the time DDD can initially be treated conservatively and not require surgery.


For Appointments

To make an appointment with Scott Robertson, MD, Neurosurgeon or any of the other specialists in the Department of Neurological Surgery at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at my.clevelandclinic.org/florida.

For More Information

On Cleveland Clinic Florida

Cleveland Clinic Florida, located in Weston, West Palm Beach, Atlantis, Palm Beach Gardens and Parkland, is a not-for-profit, multi-specialty, academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic Florida has 240 physicians with expertise in 35 specialties. The medical campus is fully integrated and includes diagnostic centers, outpatient surgery and a 24-hour emergency department located in the state-of-the-art hospital. Cleveland Clinic Florida ranked third among the 66 best hospitals in the Miami-Fort Lauderdale metro area and ninth in Florida in US News & World Report’s 2015-2016 ranking of Best Hospitals metro area rankings. Cleveland Clinic Florida is an integral part of Cleveland Clinic Ohio, where providing outstanding patient care is based upon the principles of cooperation, compassion and innovation. Physicians at Cleveland Clinic are experts in the treatment of complex conditions that are difficult to diagnose.

For more information about Cleveland Clinic Florida, visit my.clevelandclinic.org/florida.


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