Surgical Treatment Options for Back and Neck Pain with Dr Robert Feldman

Surgical Treatment Options for Back and Neck Pain with Dr  Robert Feldman


– Okay, so let’s say you’ve been through the conservative options, you’ve seen your primary care doctor, you’re just not getting better
or you’re getting worse, you’re having trouble
working, you’re having trouble taking care of things around the house, you eventually get to see
someone like me, a neurosurgeon. My job is to actually fix the problem. So, I’m usually assuming by
the time you get to see me you’ve tried all the other things that I would have recommended
you try before you see me, so now it’s time to talk
about surgical options. So before we get into the
actual surgeries themselves, you should probably
understand the concepts of spine surgery, what do they involve. Well, there’s really two basic concepts of fixing problems with the spine. One is decompression, basically unpinching the pinched spot, and that typically takes
care of arm and leg symptoms. The nerves are pinched, that’s why you get something running down the arm or the leg, pain,
numbness, tingling, and weakness. So, the first concept is
to unpinch that tight spot, assuming that’s what’s going on. The second concept is stabilization. Remember, the primary reason
that things get pinched is initially they become slightly unstable and in an effort to compensate
for that instability they’re growing bone spurs,
they’re thickening ligaments, and eventually pinching things. Well, you can unpinch something, but you might not fix
the stability problem. So the other half of the surgical
concept is stabilization. So typically for the neck or the back, what I’m gonna have to do is
I’m gonna have to figure out where is the spot causing the trouble? Is it the number five nerve or is it the number six nerve in the neck, is it the number three nerve or is it the number
four nerve in the back? And then once I figure out where
the problem is in the body, I have to also correlate
that with the pictures, and one of the biggest chances of success from surgical procedures in the spine is matching up the pictures with the clinical history
and the clinical exam. So, does the patient limp into the office describing back, buttock, and leg pain down the right leg, in the
back and side of the thigh, the side of the shin, I’m sorry the side of the
calf, front of the shin, into the big toe? Well, that’s right out of the textbooks for the number five nerve. If I then go look on the MRI and I see on the right side of the picture a pinched number five
nerve from a big bone spur or a herniated disc,
that’s the perfect patient to feel better after surgery. I know where the problem is,
I know what needs to be fixed, and I can go in with a
relatively small surgery and unpinch that nerve and
the patient will wake up in the recovery room, feeling better. Now, let’s say the patient comes in and they don’t hae any leg
pain, it’s all back pain. Well, that typically implies
there’s not a pinched nerve going on, but there’s some
kind of mechanical problem with the bones and the joints, and that’s usually a stability problem. Then I examine the patient, I kind of get a general
idea of where the pain is, where the muscles are in spasm. Then I look at the pictures and I see that the four bone is about
two centimeters forward on the five bone, and when
I get X-rays of the patient bending forward and bending backward I see that those bones are
wiggling all over the place. Well, that matches up beautifully with the patient’s symptoms,
so I’m very confident now that if I stabilize those two bones and stop them from moving around so much, that back pain’s gonna go away. So those are the two concepts of surgery. Decompression, unpinching; stabilization, fusing
or immobilizing things.

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