Back Surgery and Neck Surgery

Source:
Spine-Health Original article

By: Peter F. Ullrich, Jr., MD


Spine surgery introduction
The primary purpose of back surgery or neck surgery is to correct an anatomical lesion in individuals who fail to show improvement with conservative treatment. For those patients who have pain, but no anatomical lesion can be identified that accounts for their pain, surgery is not an option. Surgery is useful only to change a patient’s anatomy (e.g. remove a disc herniation). There is almost never any reason to consider exploratory surgery to “look” for a cause of pain.
Advancements in spine surgery
Modern spine surgery has made major advancements in both technique and spinal instrumentation/implants over the past couple of decades, but by far the most significant advancement in spine surgery has been better preoperative imaging techniques. Specifically, magnetic resonance imaging (MRI scan) has revolutionized spine surgery. It is most often the best test to identify an anatomical lesion responsible for the patient’s problem. The most important factor in the determination of the success in spine surgery is proper preoperative diagnosis. Without an accurate preoperative diagnosis, even the most technically successful surgery has little chance for a successful outcome.
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Although spine surgery is performed by either orthopedic surgeons or neurosurgeons, it is increasingly becoming a field unto itself. Many surgeons are doing additional specialized training in the field after their residency training (fellowship training). Given the precision required for these more demanding surgical techniques, many orthopaedic or neurosurgeons with fellowship training are choosing to focus more of their practice on spine surgery. Some believe that the increased level of specialty training and focus on the spine has contributed to enhancements in surgical technique, which in turn has led to overall improved success rates and reduced morbidity (e.g. reduced post-operative discomfort) with many types of spine surgery.

Reasons for spine surgery
Top Back Surgery Topics:
Microdiscectomy
Lumbar Laminectomy
Cervical Spine Surgery
Lumbar Spinal Fusion
Spine surgery is typically an “elective” undertaking, meaning that it is considered as a possible approach to enhance a patient’s ability to function and decrease pain. Just because it is elective does not mean it is not covered by insurance. Elective surgery can be medically necessary. It just means that surgery of the spine is rarely an absolute necessity. Only in rare instances, such as for patients who have a progressive neurological loss of function or sudden onset of bowel or bladder incontinence, is spinal surgery actually necessary on an emergency basis.
Spine surgery can basically accomplish three tasks:
It can decompress a nerve root or the spinal cord.
It can stabilize an unstable or painful segment with fusion surgery.
It can reduce a deformity (e.g. scoliosis surgery in the thoracic spine).
Spine surgery is not done for exploration. The cause of a patient’s pain is not readily apparent with opening and exploring the spine. The preoperative evaluation and imaging results are what identify the problem and guide the design of the procedure.

Back Pain Health Center

Source: here is the original article

What is sciatica?
Sciatica is pain, tingling, or numbness produced by an irritation of the nerve roots that lead to the sciatic nerve. The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. Branches of the sciatic nerve extend through the buttocks and down the back of each leg to the ankle and foot.
What causes sciatica?
The most common cause of sciatica is a bulging or ruptured disc (herniated disc) in the spine pressing against the nerve roots that lead to the sciatic nerve. But sciatica also can be a symptom of other conditions that affect the spine, such as narrowing of the spinal canal (spinal stenosis), bone spurs (small, bony growths that form along joints) caused by arthritis, or nerve root compression (pinched nerve) caused by injury. In rare cases, sciatica can also be caused by conditions that do not involve the spine, such as tumors or pregnancy.
What are the symptoms?
Symptoms of sciatica include pain that begins in your back or buttocks and moves down your leg and may move into your foot. Weakness, tingling, or numbness in the leg may also occur.
Sitting, standing for a long time, and movements that cause the spine to flex (such as knee-to-chest exercises) may make symptoms worse.
Walking, lying down, and movements that extend the spine (such as shoulder lifts) may relieve symptoms.
How is sciatica diagnosed?
Sciatica is diagnosed with a medical history and physical exam. Your doctor will ask you questions about your symptoms. And your doctor may be able to tell just by asking you these questions that you have sciatica, but X-rays and tests such as magnetic resonance imaging (MRI) are sometimes done to help find the cause of the sciatica.
How is it treated?
In many cases, sciatica will improve and go away with time. Initial treatment usually focuses on medicines and exercises to relieve pain. You can help relieve pain by:
Avoiding sitting (unless it is more comfortable than standing).
Alternating lying down with short walks. Increase your walking distance as you are able to without pain.
Taking acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).
Using a heating pad on a low or medium setting, or a warm shower, for 15 to 20 minutes every 2 to 3 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help, but you can try them to see if they help you.
Additional treatment for sciatica depends on what is causing the nerve irritation. If your symptoms do not improve, your doctor may suggest physical therapy, injections of medicines such as steroids, or even surgery for severe cases.