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January 31, 2013 at 4:01 pm

Posted in Laser Back Surgery, laser spine procedures, Laser Spine Surgery, Low back pain, Lumbar and Cervical Radiofrequency, Lumbar Microdiscectomy, M.D., Mayo Clinic, Mayo Clinic Spine Surgeon, Mayo Clinic Trained Surgeons, Medical Education, MINIMALLY INVASIVE, minimally invasive disc healing, Minimally Invasive Laser Spine Surgery | Spine Surgeons | Dallas, minimally invasive procedures, Minimally Invasive Spine, minimally invasive spine procedures, Minimally Invasive Spine Surgery, Minimally Invasive Stabilization, Minimally Invasive Surgery, MIS, Myofascial pain syndrome, Neck pain, Neck Pain Treatment Texas, Neuropathic Pain, non-invasive procedures, North American Spine Society, Open Surgery and Minimally Invasive Surgery, Overuse Injuries, Pain, pain disorders, Pain Doctor, Pain Doctor Dallas, Pain Doctor Fort Worth, Pain Doctor Irving, Pain Doctor Plano, Pain Doctor Texas, Pain Doctors, Pain Dr, pain management, Pain Medicine, Painful nerve injuries, Painful osteoarthritis, patients’ own stem cells, Pelvic pain/Genital pain, Pinnacle Pain, Pinnacle Pain Group, Positive Side Effects, posterior spinal fusion, Presbaterian Pain, Proven Results, PRP, Radicular Syndrome, Radiofrequency Ablation and Lesioning, Regenerative Medicine, Robotic Guided Spine Surgery, Robotic Spine Surgery, Rockwall Back Doctor, spinal cases from children, Spinal cord injury spasticity and pain, Spinal Cord Stimulator Trial, Spinal Fusion, Spinal Stenosis, Spine Microdiscectomy, Spine Pain Plano, Spine Surgery, Spine Surgery Addison, Spine Surgery Coppell, Spine Surgery Dallas, Spine Surgery Doctor, Spine Surgery Houston, Spine Surgery McKinney, Spine Surgery Mesquite, Spine Surgery Plano, Spine Surgery Robot, sports injuries, Stem Cell Therapy, stem cells, surgical treatment of spinal disorders, Texas, Texas Back Institute, Texas Health Pain, Texas Spine Consultants, Transforaminal Endoscopic Discectomy, True minimally invasive procedures, Work Comp Injury, Workers Compensation Injury

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Minimally Invasive Spine Surgery

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Minimally Invasive Surgery:

Recent surgical advancements have focused on performing surgery through smaller incisions, with less disruption to surrounding soft-tissues. The idea behind minimally invasive surgery is to perform the same treatment without damage to normal surrounding tissues. The drawback of minimally invasive surgery is that sometimes the underlying problem may not be adequately addressed because of an inability to get to the problem. Whenever a new minimally invasive procedure is introduced, there is almost always controversy as to whether or not the procedure is as good as traditional surgery.

Endoscopic Spine Surgery:

Endoscopic spine surgery uses specialized video equipment inserted through small incisions to see the structures of the spine. Similar to arthroscopic surgery of a joint, endoscopic surgery has advanced over the past decade from merely being able to look to the area of interest, to the ability to repair and reconstruct a variety of complex problems.The benefit of endoscopic spine surgery is the potential to address problems through very small incisions. By not damaging the muscles around the spine, recovery can often be much faster than with a larger surgical exposure.

Microdiscectomy, Microlaminectomy and Microforamenotomy:

All of these micro-surgeries are variations of standard surgeries used to take pressure off of the nerves around the spinal cord. Traditionally done through larger incisions, the micro procedures use smaller incisions and specialized surgical instruments to accomplish the same goals of traditional surgery.There is no rule on where the line between traditional surgery and micro surgery is drawn. To some doctors this means a smaller incision, to others it means the use of special surgical instruments. Many variations of a procedure could be considered micro surgery.

Laser Spine Surgery:

Laser spine surgery is a technique that uses a laser to remove damaged tissues. Because a laser can be inserted through small incisions, it can be used to cut away damaged tissues (such as disc fragments) without having to make a large incision.There is significant controversy about laser spine surgery as this technique has not been shown to have significant benefits, despite advertising that may make you think otherwise. Often marketed in magazines and the Internet, laser spine surgery has become the focus of some lawsuits formisleading patients about expected results from surgery.

Is It Better?:

Is minimally invasive surgery better? There are many ways to answer this question. The bottom line is that we simply do not know. There are theoretic advantages, and there are possible downsides. But there are very few studies that compare the possible risks with the potential benefits of minimally invasive surgery.The bottom line I suggest is to find a surgeon who, above all, is interested in fixing your problem, not someone who is selling you on a smaller incision. If the same benefit can be achieved without damage to normal tissues, then minimally invasive surgery may be a good option.

Sources:

Mathews HH and Long BH “Minimally Invasive Techniques for the Treatment of Intervertebral Disk Herniation” J. Am. Acad. Orthop. Surg., March/April 2002; 10: 80 – 85.

Become Pain Free | Pain Specialist in Texas

Kyphoplasty Surgery, Kyphoplasty, Kypho, Vertebroplasty, Back Surgery, Spine Surgery

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What is Vertebroplasty & Kyphoplasty?

Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of vertebral compression fractures (VCF), which are fractures involving the vertebral bodies that make up the spinal column.

When a vertebral body fractures, the usual rectangular shape of the bone becomes compressed, causing pain. These compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous, and vulnerable to breaking. Vertebrae may also become weakened by cancer.

In vertebroplasty, physicians use image guidance to inject a cement mixture into the fractured bone through a hollow needle. In kyphohplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed.

Performing Kyphoplasty Surgery

  1. During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.
  2. Using X-ray images, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.
  3. The balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA). After being injected, the pasty material hardens quickly, stabilizing the bone.

Kyphoplasty surgery to treat a fracture from osteoporosis is performed at a hospital under local or general anesthesia. Other logistics for a typical kyphoplasty procedure are:

  • The kyphoplasty procedure takes about one hour for each vertebra involved
  • Patients will be observed closely in the recovery room immediately following the kyphoplasty procedure
  • Patients may spend one day in the hospital after the kyphoplasty procedure

Patients should not drive until they are given approval by their doctor. If they are released the day of the kyphoplasty surgery, they will need to arrange for transportation home from the hospital.

Recovery from Kyphoplasty

Pain relief will be immediate for some patients. In others, elimination or reduction of pain is reported within two days. At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.

Candidates for Kyphoplasty

Kyphoplasty cannot correct an established deformity of the spine, and certain patients with osteoporosis are not candidates for this treatment. Patients experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures are likely candidates for kyphoplasty. The procedure should be completed within 8 weeks of when the fracture occurs for the highest probability of restoring height.

It is not known whether kyphoplasty or vertebroplasty will increase the number of fractures at adjacent levels of the spine. Bench studies on treated bone have shown that inserting PMMA does not change the stiffness of the bone, but human studies have not been done. Osteoporosis is a chronic, progressive disease. As stated earlier, patients who have sustained fractures from osteoporosis are at an increased risk for additional fractures due to the loss of bone strength caused by osteoporosis.

Come visit one of our doctors in our group today!

Become Pain Free | Pain Specialist in Texas

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Central Cord Syndrome

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Central Cord Syndrome (CCS) is an incomplete injury to the cervical cord resulting in more extensive motor weakness in the upper extremities than the lower extremities. The mechanism of injury occurs from a hyperextension injury with pre-existent osteophytic (abnormal bony outgrowth) spurs, without damage to the vertebral column.

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Mechanism and Causes of Injury

CCS occurs typically in patients with hyperextension injuries where the spinal cord is squeezed or pinched between anterior cervical spondylotic bone spurs and the posterior intraspinal canal ligament, the ligamentum flavum. The ligamentum flavum is a strong ligament that connects the laminae of the vertebrae. It serves to protect the neural elements and the spinal cord and stabilize the spine so that excessive motion between the vertebral bodies does not occur.

The injury occurs as a result of anterior and posterior compression of the spinal cord, leading to edema, hemorrhage or ischemia to the central portion of the spinal cord. The site of most injuries is in the mid-to-lower cervical cord. Due to the anatomical lamination of the corticospinal tract with the arm fibers medially, and the leg fibers laterally, the arms are affected more so than the legs, resulting in a disproportionate motor impairment.

Symptoms

Patients are typically left with motor weakness of the upper extremities and lesser involvement of the lower extremities. A varying degree of sensory loss below the level of the lesion and bladder symptoms (urinary retention) may both occur.

Incidence

This syndrome more commonly affects patients age 50 and older who have sustained a cervical hyperextension injury.

CCS may occur in patients of any age and is seen in athletes who present with not only hyperextension injuries to their neck but associated ruptured disc(s) with anterior cord compression.

CCS affects males more frequently than females.

Diagnosis

Evaluation of the patient includes a complete history, a thorough neurological exam, MRI and CT of the cervical spine, and cervical spine x-rays including supervised flexion and extension x-rays.

    • Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show direct evidence of spinal cord impingement from bone, disc, or hematoma.
    • Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents, and the structures around it.
    • X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine delineate fractures and dislocations, as well as the degree and extent of spondylitic changes. Flexion/extension views assist in evaluation of ligamentous stability.

 

Surgical Treatment

Acute surgical intervention is not usually necessary unless there is significant cord compression. Prior to the CT-MRI era, surgical intervention was thought to be more harmful because of the risk of injuring a swollen cervical cord and worsening the deficit. However, with advanced imaging technology such as CT and MRI, patients with compression of the spinal cord secondary to traumatic herniated discs and other lesions can be quickly diagnosed and surgically decompressed. In cases with anterior bony ridges and spinal canal narrowing secondary to ligamentous thickening and or stenosis, acute surgery is usually not performed until the patient has made maximum recovery. Reassessment at that time may lead to surgery depending on the underlying cause. If there is significant motor weakness after a period of recovery, or neurological deterioration or spinal instability, then surgical intervention may be considered.

Nonsurgical Treatment

Nonsurgical treatment consists of immobilization of the neck with a cervical orthosis, steroids unless contraindicated, and rehabilitation with physical and occupational therapy.

Outcome

Many patients with CCS make spontaneous recovery of motor function while others experience considerable recovery in the first six weeks post injury.

If the underlying cause is edema, recovery may occur relatively soon after an initial phase of motor paralysis or pareses. Leg function usually returns first, followed by bladder control and then arm function. Hand movement and finger dexterity improves last. If the central lesion is caused by hemorrhage or ischemia, then recovery is less likely and the prognosis is more devastating.

The prognosis for CCS in younger patients is favorable. Within a short time, a majority of younger patients recover and regain the ability to ambulate and perform daily living activities. However, in elderly patients the prognosis is not as favorable, with or without surgical intervention.

 

Become Pain Free | Pain Specialist in Texas

Carpal Tunnel Syndrome, CTS

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Carpal tunnel syndrome is a common problem that affects the use of your hand, and is caused by compression of the median nerve at the wrist. It most often occurs when the median nerve in the wrist becomes inflamed after being aggravated by repetitive movements such as typing on a computer keyboard or playing the piano. It also seems to affect professional artists fairly commonly – in particular, sculptors and printmakers.

carpal-tunnel-syndrome

The “carpal tunnel” is formed by the bones, tendons and ligaments that surround the median nerve. Since the median nerve supplies sensation to the thumb, index and middle finger, and part of the ring finger, and provides motion to the muscles of the thumb and hand, you might notice numbness and weakness in these areas.

Common Symptoms

Thesesymptoms are often exaggerated when the wrist is bent forward. This numbness or pain may be worse at night, and may actually keep you awake. During the day, it may occur more often when you are participating in activities that involve bending of your wrist.

Common Causes of Carpal Tunnel Syndrome

Diseases or conditions that may increase your chances of developing carpal tunnel syndrome include pregnancy, diabetes, menopause, broken or dislocated bones in the wrist, and obesity. Additional causes include repetitive and forceful grasping with the hands, bending of the wrist, and arthritis.

Any repetitive motions that cause significant swelling, thickening or irritation of membranes around the tendons in the carpal tunnel can result in pressure on the median nerve, disrupting transmission of sensations from the hand up to the arm and to the central nervous system.

Diagnosing Carpal Tunnel Syndrome

It is important to seek medical assistance when you first notice persistent symptoms. Do not wait for the pain to become intolerable.

Before your doctor can recommend a course of treatment, he or she will perform a thorough evaluation of your condition, including a medical history, physical examination and diagnostic tests. Your doctor will document your symptoms and ask about the extent to which these symptoms affect your daily living. The physical examination will include an assessment of sensation, strength and reflexes in your hand.

If conservative treatment such as medication or physical therapy does not provide sufficient relief, your doctor may perform diagnostic studies to determine if surgery is an effective option. These diagnostic studies may include:

Conservative (Nonsurgical) Treatments

The main purpose of conservative treatment is to reduce or eliminate repetitive injury to the median nerve. In some cases, carpal tunnel syndrome can be treated by immobilizing the wrist in a splint to minimize or stop pressure on the nerves. If that does not work, patients are sometimes prescribed anti-inflammatory medications or cortisone injections in the wrist to reduce swelling. Your doctor may suggest specific types of hand and wrist exercises, which may be helpful. Treatment for carpal tunnel syndrome may include rest, the use of a wrist splint during sleep, or physical therapy. Conservative treatment methods may continue for up to eight weeks.

When Surgery is Necessary

Only a small percentage of patients require surgery. Factors leading to surgery include the presence of persistent neurological symptoms and lack of response to conservative treatment.

If you experience severe pain that cannot be relieved through rest, rehabilitation or nonsurgical treatment, you may be a candidate for one of several surgical procedures that can be performed to relieve pressure on the median nerve. The most common procedure is called carpal tunnel release, which can be performed using an open incision or endoscopic techniques.

The open incision procedure or carpal tunnel release, involves the doctor opening your wrist and cutting the ligament at the bottom of the wrist to relieve pressure. The endoscopic carpal tunnel release procedure involves making a smaller incision and using a miniaturized camera to assist the neurosurgeon in viewing the carpal tunnel. The possibility of nerve injury is slightly higher with endoscopic surgery, but the patient’s recovery and return to work is quicker.

Recovery After Surgery

After surgery, a dressing will be applied to your hand. You should leave this secured in place until your first office visit following surgery. You may need bandages on one or both wrists depending on your surgery. If this is the case, you may require extra assistance at home with everyday activities. Your stitches can be removed about 10-14 days after surgery. Make sure you avoid repetitive use of the hand for four weeks after surgery and avoid getting the stitches wet. You will notice that the pain and numbness begins to improve after surgery, but you may have tenderness in the area of the incision for several months.

Recurrence of symptoms after surgery for carpal tunnel syndrome is rare, occurring in less than 5 percent of patients. A majority of patients recover completely. To avoid injuring yourself again, it may help to change the way you perform repetitive movements, the frequency with which you perform the movements, and the amount of time you rest between periods when you must perform these movements.

Become Pain Free | Pain Specialist in Texas

OVERUSE INJURIES, Workers Compensation Injury, Workers Comp Injury, Work Accident, Job Injury

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Have you been diagnosed with carpal tunnel syndrome, tendonitis, repetitive strain injury or are you having hand or wrist pain? Here is a roadmap to treating these conditions. The first step in healing is recognizing that you have a problem. Some questions you will want to ask yourself are:

  • Do your hands hurt after using the computer?
  • Do you find yourself dropping more items?
  • Are you constantly re-tying your shoelaces?
  • Do your hands hurt when you floss your teeth?
  • Are your hands or wrist hurting when you wake up, after driving, after playing videogames or using your smartphone?

Each of these problems often falls into what we call overuse injuries. Overuse injuries are slowly debilitating conditions that are the product of years of repetitive actions that eventually take a toll of your body. Studies have shown that there is no silver bullet or quick fix for these conditions.

The first step to recovery from these types of injuries is to find a competent hand surgeon, osteopathic physician or neurosurgeon to get a proper diagnosis.  Once you have a diagnosis from your physician, make sure you get a prescription for hand therapy.  Pain medications can have adverse effects, so take these with caution and only as prescribed by your physician. Surgery is a last resort and may only give temporary relief. From hand therapists, occupational therapists and physical therapists you will learn techniques including hot and cold transition baths, paraffin wax treatments, icing, wearing braces, wearing gloves, strengthening exercises, and ergonomics. These are far more useful than creating a dependence on medications. Keeping a log book or diary, documenting your pain and what activities you participated in that day that caused pain or lessened the pain is a helpful step to take. Hand message and relaxing activities come into play to help further your recovery process. Every therapist has a different approach, and some may work better than others for you, so do not hesitate to try a different hand therapist if the one you are using is not helping.  Education is key in treating these overuse injuries. Reading up on carpal tunnel and repetitive strain type injuries can give you the tools to help combat and eliminate your pain on a daily basis. An educated patient will recover quicker. Carpal tunnel syndrome and hand pain recovery will require changes in your life such as how you drive, bike, or even carry handbags or groceries. Any use of your hands will need to be examined and optimized to your new normal. Work changes such as computer ergonomics, different keyboards, input devices, chairs, desks, and other elements that require attention are important to prevent further damage. Electronic devises such as smartphones, iPods, gaming consoles, and computers can contribute to your hand pain. Touchscreens with their swiping gestures can cause undue hardship. Ergonomics and usage reduction are a must. Physician care, hand therapy, lifestyle, and work station changes are a collaborative approach to overuse injuries. All areas must be considered to have successful recovery without reoccurrence. Experts at The BecomePainFree.com medical group can help!

Become Pain Free | Pain Specialist in Texas

Regenerative Medicine

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Administering undifferentiated stem cells to an injured disc has made adult stem cell regenerative medicine in spine a reality. Adult stem cell regenerative medicine holds the promise of stabilizing or even reversing the degenerative changes associated with aging or following traumatic injury. Current clinical use of stem cells is very limited, in part by the cumbersome approval process. The use of concentrated bone marrow aspirate (BMC) as a “stem cell” preparation is currently the simplest and safest way of utilizing the regenerative potential for mesenchymal stem cells (MSCs) to promote tissue regeneration. In fact, stem cells concentrated from bone marrow have been shown to stimulate the formation of bone, cartilage, ligament and tendon, and dermal tissues.

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Conservative treatment options for lumbar and cervical pain associated with discogenic disc disease (Pfirrmann Grades 3-6) are limited. Treatment options include pain medication, steroids, physical therapy, and chiropractic care. Reversal of disc pathology has not been achieved with current available treatment modalities. Failure of these nonoperative treatments may leave surgical intervention as a treatment option.

The goal of utilizing MSCs is to not only potentially provide pain relief from the painful degenerative disc, but to reverse the degenerative process. There are three methods for placing MSCs into the painful nucleus pulposus.

The use of allogeneic mesenchymal precursor cells (MPCs) is currently being evaluated as a part of an FDA Phase I clinical trial. Extracted from donors and expanded in number by tissue culture, this process isolates and grows the stem cells into pure MPCs which are injected into the nucleus pulposus. This technology does not have FDA approval.

Utilizing expanded, autologous MSCs for injection into the painful disc is the second method. Federal regulations require the approval of an Investigational New Drug application supported by prospective, randomized clinical trials for the use of expanded autologous MSCs. The FDA has not approved this technology.

The third method involves autologous point of care therapy. This technology does not require FDA approval. The patient’s own MSCs are directly injected into the nucleus pulposus of the symptomatic degenerated disc(s) using standardized two needle discography technique. This requires fluoroscopic visualization and 2-3cc of MSCs are slowly injected into the symptomatic nucleus pulposus.

Early analysis of the research data reveals the average lumbar pre-treatment Oswestry Disability Index (ODI) was 56.5% and improved to 22.4% at three-month follow-up (P=0.0001). The average lumbar pre-treatment Visual Analogue Scale (VAS) for pain was 7.9 (on a scale of 1-10) and improved to 4.2 at three months (P=0.0005).

There have been no complications associated with the iliac crest aspiration or disc injection. Thus far no patient in the study has undergone spine surgery following treatment. Results obtained with this technique suggest its potential clinical efficacy in the treatment of moderate to severe degenerative disc disease. These results require verification with longer follow-up and randomized prospective studies.

For more information regarding treatment options please visit our websites at http://www.becomepainfree.com

Become Pain Free | Pain Specialist in Texas

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