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, MD
Dermatologic Surgeon
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With time, the bones and disks of our neck may change shape and the delicate architecture that leaves space for the spinal cord and the nerves changes as well. The rings of the vertebrae of our neck must line up perfectly to create space for the spinal cord. If the space is limited, one may start to have spinal cord disease or myelopathy.

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MyelopathyMyelopathy is spinal cord dysfunction related to abnormal pressure placed on the spinal cord. Unlike conditions that cause pressure on individual nerve roots, this type of damage can result in loss of nerve function anywhere along the spinal cord below the damaged area. The effects of myelopathy can range from mild to severe, and can worsen over time.

Myelopathy, begins with neck pain that shoots to shoulders, arms, forearms and hands. Patients may notice issues with balance and coordination, difficulty handling small objects such as buttons and coins and finally neck pain.

The progression of myelopathy occurs in a “step wise” patterns. Patients notice a deterioration in balance and hand coordination and then learn to function within the limits of their tight spinal canal. About a third of patients get better with time. About two thirds stay the same or deteriorate. Some patients may only feel hand numbness, others may loose hand strength and function altogether. When urinary incontinence starts or when patients become dependent on a wheel chair for long period of time, the chance that surgery will help decreases. However, if spinal cord compression is caught early and surgically corrected, the progression of myelopathy is halted.

Physical therapy and injections may help, but do not usually provide lasting relief from myelopathy. A short course of steroids can be tried to relieve some of the swelling that is associated with spinal cord compression. A steroid injection can help decrease swelling of the spinal cord as well as help with the inflammation of the nerves.

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Cervical Epidural steroid injectionThis injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs, spinal stenosis, or radiculopathy can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.

When spinal cord compression causes balance and coordination issues, a steroid injection may actually create more pressure on the spinal cord and worsen the symptoms. It is important to critically evaluate the MRI with your spine surgeon.

There are a number of minimally invasive surgical options if the patient does not get better with conservative means:

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Cervical LaminaplastyThis surgical procedure creates more space for the spinal cord and nerve roots to relieve the painful pressure of spinal stenosis, a narrowing of the spinal canal that can result from arthritis.

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Anterior Cervical Decompression and Fusion (Intervertebral Spacer)This surgery removes a herniated or diseased disc and relieves neck and radiating arm pain caused by parts of the disc pressing on nerve roots.

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Artificial Cervical Disc Replacement (PCM)(Caution: Investigational Device) A goal of this procedure is to relieve the pain caused by pinched nerves due to a damaged disc in the cervical spine. The diseased or damaged disc will be replaced with a specialized implant.

The rehabilitation after neck surgery takes about 6 weeks. Patients usually complain that their neck feels heavy and tired after a long day. However, when motion that was causing pain before surgery is stopped, pain improves, and hence patients feel better. Furthermore, when compression on the nerves is removed, patients often feel dramatic relief in the arms, forearms and hands. There are numerous approaches to treat spinal cord disease and it is important to tailor the approach to each patient individually to minimize risk and allow the best chance for a fast recovery.

• Myelopathy Article 1 [ Download PDF ]
• Myelopathy Article 2 [ Download PDF ]

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