Dr. Sean McCance, Orthopaedic Spine Surgeon

Most of us have heard the term Sciatica generally used to describe back pain or shooting leg pain. True sciatica occurs when a spinal disc in the Lower back herniates ( pushes out) of the disc space and presses against a nerve in the spinal canal. The pressure from the herniated disc on the nerve causes a shooting pain down the leg and often into the calf or foot. It can also cause numbness, tingling and weakness of the leg. It can be extremely painful! Treatment for h...erniated disc falls into two categories, non-operative and surgical. Non-operative treatment includes oral pain medications, physical therapy, and possibly shots in the back, called epidurals. If those treatments fail, or if the patient has intractable pain or progressive weakness of the leg, we move toward surgery. Surgery for this condition is a micro-surgery done through a small incision to remove the disc fragment from the nerve, and typically takes about an hour. Surgery is very effective for this condition, and the vast majority of patients wake up from the procedure with resolution of the nerve pain, and typically go home 2 to 4 hours after the surgery. There is a small percentage of patients ( less than 5%) who do not get a great response to the surgery if the nerve has become damaged or very inflamed from the chronic pressure of the disc. This is a risk that can increase if the patient waits too long to consider surgery. The MRI image below is a 37 year old recreational tennis player that I treated last month - he had 3 months of severe leg pain, numbness, weakness, and difficulty walking. The MRI shows the fragment of disc pinching the nerve. He had a very nice response of the surgery with resolution of symptoms, and will return to tennis in the near future. The first two images below showed the herniation from the side view and the cross-sectional view ( arrow) - the third image shows what a normal segment looks like.

Today I am presenting a chronic neck pain case to help explain some of the issues we deal with in spine surgery This is the case of a 47-year-old active athletic male who had five years of significant and fairly constant neck pain and two years of worsening arm pain, numbness and weakness in the arm. His symptoms got worse over time despite having tried medications, physical therapy, epidural injections traction and chiropractic treatment. His x-ray and MRI show that he had... 3 discs in the neck that were herniated and pressing on the nerve and spinal cord. This is why he did not respond to the physical therapy and other treatments. About six months ago I performed a three level anterior cervical discectomy and fusion (ACDF) What this means is that we removed the discs that were hitting his nerve and spinal cord and replaced them with disc replacement spacers - which are titanium cages - and then inserted a plate and screws to hold it all in place. This was performed at three discs in his neck, you can see the x-ray below. Since having the surgery he has had nearly complete resolution of the neck and arm pain and has returned to full activity including sports and is very pleased. Typically about 95% of patients who have the surgery have an extremely good response with resolution of neck pain and arm pain. There are some patients who do not respond well to the surgery if they have sustained chronic nerve damage, a pain syndrome, or do not heal well from the surgery. Below you can see the the preoperative MRI with herniated discs and the postoperative x-ray.

In an effort to educate patients and the public with what is happening in Spine Surgery, I will be presenting each week an interesting spine issue and what we do to surgically to correct it. Today we will discuss spinal fusion for chronic back and leg pain. Below is the case of a 53-year-old woman who suffered from chronic lower back pain for over 10 years, and when it began to radiate down her legs she had difficulty walking. She had developed numbness and tingling. She trie...d treatments including physical therapy, medications, and shots in the back called epidurals, all of which is appropriate and done before surgery. When that did not help and she became worse and was in constant pain, she sought out surgery. I performed her surgery about a year ago, and she has had a very nice response, now being able to walk without pain and with resolution of her neurological symptoms. And that is the typical outcome in about 90% of cases. With that said, some patient do not get a good response if they have developed nerve damage or have problems with healing, and some patients have chronic pain syndromes which may not respond well to the surgery. Patient selection is very important for this procedure. This surgery is called a spinal fusion, performed by placing screws and rods in the back to realign and stabilize the spine. Many patients are fearful and think they will lose function with this type of surgery, but in fact the opposite is usually the case. Typically patients become much functional after the back is stabilized, as they can now perform physical functions without the back giving out or becoming painful. Here you can see the pre and post surgery Xrays

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