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Back Spinal Stenosis

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PATIENT TESTIMONIAL

I’m a 77 year old retired physician. For 1 year I had severe sciatic pain radiating from my right lower back to my right lower leg. I couldn’t walk more than 50 feet before the pain became severe. Dr. Georgiy Brusovanik performed surgery at Doctors hospital in Coral Gables replacing all the disk in my lumbar spine because the degeneration was severe.Procedure was done in two stages.The surgery was very successful.My recovery each time was shorter than i expected.I am now able to walk my dogs up to 12 city blocks per day.I am very pleased with the care i received and feel that Dr. Brusovanik expertise and kind manor helped me to achieve the success i had.

Dr. Burton Silver
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ABOUT Back Spinal Stenosis

Spinal stenosis is a degenerative condition in which the spinal canal is narrowed and the nerves inside the canal are compressed. Usually, the canal is narrowed because of bone spurs, ligament, and disc material that occupy the spinal canal. People with spinal stenosis, experience numbness, tingling, and sometimes weakness, heaviness, and discomfort in the buttocks, hips, and legs. Most often, patients will complain of leg and back pain that makes walking long distances very difficult. In most cases, the problem is slowly progressive and does not improve over time.

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Spinal Stenosis Spinal stenosis results from new bone and soft tissue growth on the vertebrae, which reduces the space in the spinal canal. When the nerve roots are pinched, a painful burning, tingling and/or numbing sensation is felt from the lower back down to the legs and sometimes all the way to the feet.

Conservative treatment including epidural steroid injections, pain medications, and activity modification can provide temporary symptom relief but will not “cure” the disease.

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Lumbar Transforaminal Epidural Steroid InjectionThis injection procedure is performed to relieve low back and radiating leg pain. The steroid medication can reduce the swelling and inflammation caused by spinal conditions such as spinal stenosis, radiculopathy, sciatica and herniated discs.

Steroid medication is usually beneficial for people suffering from pain shooting from their back to their hips, thighs and legs. Epidural steroid injections can be helpful for the short term if the pain is severe. The medication helps by reducing inflammation and swelling, thereby decreasing pain. The steroid medication does not correct the underlying nerve compression. If the underlying problem remains, the pain will return after the steroid medication “wears off.” Epidural steroid injections can be safely repeated as long as there are clinical indications that make the treatment necessary and depending on therapeutic response to previous injections. However, if pain repeatedly returns following the injections, it becomes clear that the treatment will not be a permanent solution to the problem.

Surgery to decompress the spinal canal, i.e. to remove the bone spurs, ligament, and possibly disc that is pinching the nerves, is the only way to “cure” spinal stenosis. If the spine is also fused (bones surgically joined together), the “cure” should be permanent. Patients who undergo spinal fusion usually do not notice any loss of their ability to move or bend. If the spine is not fused, the degeneration will continue and the problem can return over time. Surgical decompression without fusion is usually effective in relieving leg symptoms for the short term, but problems sometimes return over 2-5 years, sometimes requiring repeat surgery.

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Minimally Invasive Lumbar MicrodecompressionThis minimally invasive procedure is used to remove overgrown vertebral bone and soft tissue to relieve the compression of nerve roots in the lumbar spine. It is performed through a small incision on the back.

When spinal instability (abnormal movement of the bones) or severe degeneration of the discs and/or joints exists, it is generally felt that surgical fusion is needed to treat the underlying problem. The main advantage of fusing the spine is that further degeneration, bone spur formation, disc herniations, and instability problems should not arise once the segment of the spine is fused. Furthermore, stopping the abnormal motion is generally helpful in reducing pain. Fusion of the spine usually does not create any significant problems with stiffness or lack of mobility as patients get motion from hip joints and other non fused segments of the spine. Theoretically, fusion of the spine places increased stress on the unfused levels; this could possibly lead to more rapid degeneration of the remaining, unfused levels and create a need for further surgery in the future. This theoretical concern, however, has never been proven to be worse than the normal aging process, which will also progress over time and also may create a need for further surgery.

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Minimally-Invasive TLIF (Transforaminal Lumbar Interbody Fusion)This minimally invasive procedure is used to remove a degenerated disc to relieve the compression of nerve roots in the lumbar spine. It is performed through a small incision on the back.
XLIF: Lateral Lumbar Interbody FusionUnlike traditional back surgery, XLIF is performed through the patient’s side. By entering this way, major muscles of the back are avoided. This minimally-invasive procedure is generally used to treat leg or back pain caused by degenerative disc disease. It can be performed on an outpatient basis.
Lumbar pedicle screw fixation (CD HORIZONS Sextant)This minimally-invasive procedure uses special guides and fluoroscopic imaging to allow a surgeon to precisely implant stabilizing screws and rods in the spine while minimizing damage to muscles, tendons and other soft tissue in the back.

Risks of lumbar spine surgery include bleeding, infection, anesthesia-related risks, numbness, tingling, and weakness after surgery. Problems such as tingling and weakness are usually temporary and improve over time. Paralysis is generally not a significant risk with lumbar surgery as the spinal canal in the lower back contains the cauda equina (nerve roots) and not the spinal cord. Injury to large blood vessels is theoretically possible but very unlikely to occur.

Patients are usually in the hospital for 3-5 days following spinal stenosis surgery. Initially, pain medication is given through the intravenous line as a PCA (patient controlled analgesia – the patient has the button); a Foley catheter (bladder catheter) is in place from surgery as well. After the first or second post surgical day, the PCA and catheter are removed. Initially, pain medications, anesthetics, and surgery can cause significant nausea; this resolves after one or two days. When the nausea resolves, regular eating and drinking can resume. Physical therapy works with the patient daily for mobility and exercise training. When patients are able to get in and out of bed, walk, and get to the bathroom independently, eat and drink normally, and tolerate pain with oral medications, they can be discharged from the hospital. Patients notice ease with walking right away, however for about 3 months, patients tend to feel tired. This improved quickly as well. Please see the attached scientific articles that were written by people who do their best to abstain from bias and financial incentive. Thank you for your attention and feel free to call us for a consultation.

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