Failed Open Back Surgery for Spinal Stenosis - What Next?

While no area in spinal surgery seems to exist without controversy, laminectomies continue to be one of the most controversial. By definition, a laminectomy is a surgical procedure in which a portion of a vertebra is removed to relieve pressure on the spinal cord on the nerve roots that emerge from the spinal canal. The procedure is often used to treat spinal stenosis, a progressive narrowing of the opening in the spinal canal.

According to the spine surgeon in Chennai, there are approximately 200,000 laminectomies performed every year. An estimated 20% -30% are reported to be unsuccessful, with a reoperation rate of 10%-25%. Even though these statistics include surgeries for a wide variety of conditions in addition to stenosis, it is easy to see that the problems of "failed back surgery" are enormous.

There is nothing more distressing to the physician or the patient than to be faced with this unhappy dilemma. There are over l5 billion dollars spent on low back care every year in this country. We can no longer afford anything less than a good outcome. Can the failed back surgery syndrome be avoided? What is going wrong? Why are there so many failed back surgeries? Is it the patient's fault? Is it the surgeon's fault? Or is it just the natural history of the disease? There are biologic variables doctors cannot control such as bone healing, cartilage degeneration, and patient behavior, all of which can affect outcome.

Should patients with stenosis who are experiencing failed open back surgery give up? No. Patients with stenosis should consider the following:

Diagnosis

The physician must determine that the symptoms are caused by spinal stenosis. Conditions that can cause similar symptoms include a slipped (herniated) intervertebral disc, spinal tumors, and disorders of the blood flow (circulatory disorders). Spinal stenosis causes back and leg pain. The leg pain is usually worse when the patient is standing or walking. Some forms of spinal stenosis are less painful when the patient is riding an exercise bike because the forward tilt of the body changes the pressure in the spinal column. 

Doppler scanning can trace the flow of blood to determine whether the pain is caused by circulatory problems. X-ray images, computed tomography scans (CT scans), and magnetic resonance imaging (MRI) scans can reveal any narrowing of the spinal canal. Electromyography, nerve conduction velocity, or evoked potential studies can locate problems in the muscles indicating areas of spinal cord compression.

How Stenosis is Diagnosed

Before making a diagnosis of stenosis, it is important for the doctor to rule out other conditions that may have similar symptoms. In order to do this, most doctors use a combination of tools, including:

History: 

The spine doctor will begin by asking the patient to describe any symptoms he or she is having and how the symptoms have changed over time. The doctor will also need to know how the patient has been treating these symptoms including what medications the patient has tried.

Physical Examination: 

The spine doctor will then examine the patient by checking for any limitations of movement in the spine, problems with balance and signs of pain. The doctor will also look for any loss of extremity reflexes, muscle weakness, sensory loss, or abnormal reflexes which may suggest spinal cord involvement.

Tests

After examining the patient, the doctor can use a variety of tests to look at the inside of the body. Examples of these tests include:

X-rays - these tests can show the structure of the vertebrae and the outlines of joints and can detect calcification.

MRI (magnetic resonance imaging) - this test gives a three-dimensional view of parts of the back and can show the spinal cord, nerve roots, and surrounding spaces, as well as enlargement, degeneration, tumors or infection.

Computerized axial tomography (CAT scan) - this test shows the shape and size of the spinal canal, its contents and structures surrounding it. It shows bone better than nerve tissue.

Myelogram - a liquid dye is injected into the spinal column and appears white against bone on an x-ray film. A myelogram can show pressure on the spinal cord or nerves from herniated discs, bone spurs or tumors.

Bone scan - This test uses injected radioactive material that attaches itself to bone. A bone scan can detect fractures, tumors, infections, and arthritis, but may not tell one disorder from another. Therefore, a bone scan is usually performed along with other tests.

Treatment

Mild cases of spinal stenosis may be treated with rest, nonsteroidal anti-inflammatory drugs (such as aspirin), and muscle relaxants. Spinal stenosis can be a progressive disease, however, and the source of pressure may have to be surgically removed.

Surgical Treatment

In many cases, non-surgical treatments do not treat the conditions that cause spinal stenosis, however they might temporarily relieve pain. Severe cases of stenosis often require surgery. The goal of the surgery is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing, trimming, or realigning involved parts that are contributing to the pressure.

The most common surgery in the lumbar spine to treat stenosis is the laminectomy. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance fusion and support unstable areas of the spine.

A laminectomy is considered open back surgery. Many people have endured the long recovery process of such a procedure, only to learn that the outcome is poor. Not only is this a physically painful experience, it is also very difficult to deal with emotionally.

With advances in science and technology, there are alternatives. A proven alternative for helping to alleviate the pain of a failed laminectomy is The Bonati Procedures(sm).

The Bonati Procedures are advanced spine surgeries developed and perfected by The Bonati Institute(sm). The procedures employ the smallest incision possible to correct problems of the lumbar, cervical and thoracic spine with patented instrumentation and methods. The Bonati Procedures are performed sequentially as outpatient surgeries with the patient under local anesthesia and alert and able to communicate with the surgeon throughout the procedure. The result of this approach is far less trauma to the muscles and tissues, minimal blood loss and faster recovery. The Bonati Procedures are performed only at The Bonati Institute.

Consider all options

Before you agree to undergo any back surgery, consider getting a second opinion from a qualified spine specialist.

Things To Consider Before Getting Surgery For Back Pain

When you visit your doctor to get a diagnosis for the pain you're experiencing in your back, they may recommend that you undergo surgery. In this article I want to go over back surgery and the things you should consider before going through with this procedure.

The first thing you should realize is that if you have doubts about your doctor's advice, or feel that surgery is not necessary for you, it would be wise to get the opinion of another healthcare professional. This doesn't mean you have to switch doctors, it just means you want to get the opinion of somone else.

When you ask another spine surgeons their opinion, it is important to not give them the details of the diagnosis you were given from your doctor. This will insure that you get an honest opinion which is not based on what your own doctor told you.

After this you will want to sit down and learn more about the type of back disorder you have. Look at the different types of treatments available and the pros and cons associated with them. Read some books and visit websites which can give you additional information.

Visit chat rooms online and talk to people who have back disorders similar to yours. Many of them may have had the same treatment you are considering and can tell you their thoughts. It is important to remember that different people react to treatments differently.

It is important to check your local neurosurgeon's credentials before undergoing a surgical operation. The highest level training they can achieve is called a fellowship. A surgeon who has this level of training has spent at least one year working at a medical facility which specializes in spinal operations.

This program is designed and aimed at orthopedic surgeons. The difference between them and neurosurgeons is that while orthopedic surgeons focus on the bones, neurosurgeons focus on the nerves, both of which make up the spine.

Before visiting your doctor for consultation regarding surgery, make up a list of questions to ask them. Don't be afraid to ask any question you want. Once you have your answer, do some additional research to make sure you're comfortable with undergoing the operation.

Getting back surgery is a serious operation that most people take very seriously. If you don't feel confident that your doctor is giving you the right advice, don't be afraid to talk to others and do your own reseach to find out more about your condition.

An Introduction To Laser Disc Surgery

In today's modern era, it is often the case that people are mostly interested in everything done in the most modern way. The laser disc surgery is one example. It is one of the most modern ways to heal those suffering from the spine ache or back ache. However, there are quite a decent number of things that people are better off aware prior to getting introduced to the most modern way of curing spine ache, which is, the laser disc surgery. Lets see little more about laset disc surgery from best neuro specialist in chennai.

Before the laser disc surgery had not even made its way into concept in the medical world, there had already been quite a few kinds of surgeries as well. However, all those former and more conventional surgeries were not capable of offering what a laser surgery can offer. All those conventional surgeries will always leave the patients undergoing them in great pain, even after the patients had completely undergone the entire processes of the surgeries.

Having to experience such a great painful feeling is not likely to be something that the modern patients will want to tolerate, especially when they take into consideration the amount they are required to pay for the surgeries. This is not to mention that the conventional surgeries, in most events, will also leave permanent scars on the body that make them unsuitable for the female patients.

With that being said, it can now clearly be seen why today's spine ache sufferers will prefer to undergo a laser disc surgery instead. With these surgery, the patients are not likely to regret even if they have to pay a large sum of money to get the laser disc surgery. This laser disc surgery is even more suitable for those women patients out there. Women are not usually afraid of losing a large sum of money as long as they get what they want with regards to their beauty. And, since the these surgery can maintain their beauty perfections by not making any surgical cuts, it needs no questioning why women will always opt for this surgery rather than the more conventional ones.

At this point of time, some patients may be wondering what a laser disc surgery actually does to cure them if it does not make any surgical cuts. They may be wondering if it is in fact a surgery after all. Well, in a laser disc surgery, the doctors will try moving a laser fiber needle into the patients' affected inter-vertebral disc. This is the way doctors use in order to treat patients by way of a laser surgery.

Deuk Spine Institute employs a comprehensive continuum of care approach and a world class team of physicians, each the best in their field.