Disk Surgery

Disk Surgery

Disk Surgery

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Have you been told you need Disk Surgery?   Unfortunately, that is a common situation faced by many patients that suffer from back pain with radiating,  shooting leg pain.

In extreme situations,  such as severe weakness, or loss of control of bowel and bladder function,  assuming the disk is the cause of the problem,  you will need urgent disk surgery.

But, in most cases,  you should at least try some non-surgical treatments.

Treatments usually include rest for a few days ( not more than 2), medications, physical therapy, and/or chiropractic care.  Usually,  by 6 weeks,  many patients are feeling better.

If there is still pain,  before disk surgery,  some physicians will offer steroid injections, either locally,  or in the epidural space.  There are plenty of articles on the efficacy of all these non-surgical treatments.  For the most part,  you should try at least 6 weeks of something before you consider disk surgery.  The reason is that a large percentage of patients can improve without disk surgery.

But,  if you  are considering disk surgery,  there are factors associated with better outcome.

1.   The disk herniation causes reproducible leg pain,  and certain leg movements cause a shooting sensation to the foot.  In this scenario,  the disk is definitely pressing on the nerve, and as you move your leg,  you are pulling on the nerve,  causing pain.   This is what physician’s call a straight leg raise sign.  It usually is associated with good leg pain relief by  disk surgery.

2.  The disk herniations are localized to one or two levels, with the  pain  findings corresponding to the distribution of the nerves at the disk level.   Nerves typically provides electrical signals to corresponding area of skin for sensation,  a certain reflex, and a certain pattern of muscle movement.  This distribution of sensation is call the dermatomes. 

To give an example,  the S1 nerve, typically irritated by a L5-S1 disk herniation, will cause numbness to the outside of the foot, weakness of the gastronemius muscle, and weakness of the ankle reflex.

Patterns of leg pain, weakness and numbness that follow the distributions of the affected nerves predict good success with disk surgery.

3.  There are patient factors that increase the likelihood of successful disk surgery.  Fit individuals that was in good physical shape before the operation typically recover faster from disk surgery.  Factors that increase the likelihood of complications or prolonged recovery includes obesity,  smoking,  diabetes and cardiac disease.  I am not judging anyone.  But,  it is possible to control some of these factors.  If you want a better success rate of disk surgery,  consider these negative factors.

4.  Proper attitude is important to disk surgery.  While patients must be informed of the risks,  once it is decided to have surgery,  the attitude must be a positive one.  A patient’s motivation to be active, and do the right exercises and rehabilitation is a very important factor for a sucessful disk surgery.

5.  Adequate preparation of the home and family for disk surgery is necessary.  You must plan ahead on who will care for your day to day needs immediately after disk surgery.  Financial concerns must be handled.  Families and friends must be willing to help in the post-operative few weeks after the disk surgery.

To summarize,  the results of the properly selected patient for disk surgery is excellent.  In fact,  the SPORT (Spine Patient Outcomes Research Trial) data is very encouraging, and demonstrated that for an equally matched set of patients,  the surgically treated patients had slightly better outcomes than the non-operatively treated patients.  But the results must be closely  scrutinized.  The patients that chose surgery had failed non-surgical treatments as outlined above.

In my opinion,  you should always try non-operative treatments if you can.  But, if you fail, and have the good factors outlined above,  the chances of a successful disk surgery is excellent.

Citations

  • Soliman J, Harvey A, Howes G, Seibly J, Dossey J, Nardone E. Limited microdiscectomy for lumbar disk herniation: a retrospective long-term outcome analysis. J Spinal Disord Tech. 2014 Feb;27(1):E8-E13. PubMed PMID: 23563332

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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