Bulging disc or herniated disc causes back pain, weakness or numbness by stressing the spinal cord or radiating nerves. Removal of bulging disc that presses on a nerve root or the spinal cord is called discectomy. This spine surgery is commonly performed as an outpatient procedure in a spine surgeon's office. Discectomy has a high success rate, especially in relieving sciatica pain and lower back pain.
There are two types of discectomy – microdiscectomy and endoscopic (or percutaneous) discectomy. When performing microdiscectomy, the surgeon makes a small, about one inch incision and spreads the muscles and ligaments instead of cutting them to minimize post-operative recovery time, pain and tissue damage. Another common type of discectomy is an Anterior Cervical Discectomy and Fusion (ACDF) which corrects herniations in the cervical spine.
A discectomy is indicated under the following circumstances:
Trouble standing and walking
Pain traveling into extremities that is not manageable via pain medications
Weakness in the extremities
Numbness and tingling in the extremities or groin
Loss of bladder or bowel control
Age-related arthritis in the spine generally leads to bone spurs (outgrowths) within the spinal canal narrowing the space and causing pressure on the spinal cord or the nerves.
Laminectomy involves removing a part of the vertebrae called the lamina, bone spurs and tissue to create space and enlarge the spinal canal which relieves pressure on the spinal cord and nerves. Laminectomy is often done as part of a decompression surgery.
Laminectomy is recommended when medication, physical therapy or injections fail to relieve symptoms and the symptoms keep getting worse. Although laminectomy relieves pressure by widening the spinal canal, it does not relieve back pain or cure the underlying arthritis.
Loss of bowel or bladder control
At each level in the spine, there is a disc space in the front and paired facet joints in the back. Working together, these structures define a motion segment and permit multiple degrees of motion. Due to disc degeneration, aging and other reasons, abnormal and excessive motion at a vertebral segment results in severe pain and inability to function.
Spinal fusion, also called spondylodesis, involves joining two or more vertebrae into one structure to prevent any movement between the fused vertebrae. Fusing stops movement in painful vertebrae and hence relieves pain. Spinal fusion is performed at any part of the spine.
Other conditions that may be treated by a spinal fusion surgery include a weak or unstable spine caused by infections or tumors, fractures, scoliosis, or deformity. A spine fusion surgery involves using bone graft to cause two vertebral bodies to grow together into one long bone. Bone graft can be taken from the patient's hip (autograft bone) during the spine fusion surgery, harvested from cadaver bone (allograft bone), or manufactured (synthetic bone graft substitute).
There are several types of spinal fusion surgery options. The most commonly employed surgical techniques include:
Posterolateral gutter fusion
Posterior lumbar interbody fusion (PLIF)
Anterior lumbar interbody fusion (ALIF)
Anterior/posterior spinal fusion
Transforaminal lumbar interbody fusion (TLIF)
Extreme Lateral Interbody Fusion (XLIF)
Oblique lateral lumbar interbody fusion (OLLIF)
Dr. Samadani is among the first surgeons in the country to perform navigated single-position prone OLLIF, which reduces blood loss and is muscle-sparing. Two of her first 6 patients were even discharged from the hospital on the day of surgery.Make an Appointment
The human body senses pain through nerve signals transmitted from the body to the brain. When nerves are damaged, they can send pain signals to the brain even without an injury. A pinched nerve in the back, uncontrolled diabetes, traumatic injury and chronic pain syndromes are a few things that can result in nerve pain.
Spinal cord stimulation interrupts pain signals before they reach the brain alleviating the pain. A small device, similar to a pacemaker, known as spinal cord stimulator (SCS) is implanted under the skin in the lower back. SCS delivers mild electrical pulses to the spinal cord interrupting the pain signals from reaching the brain. A hand-held remote control turns the device on and off and adjusts the settings.
Some SCS devices use a low frequency current to replace the pain sensation with a mild tingling feeling called paresthesia. Other SCS devices use high frequency or burst pulses to mask the pain with no tingling feeling. A paresthesia free setting is an option on most devices.
Spinal Cord Stimulation could be a good option when physical therapy, medications, and spinal injections fail to relieve neck or back pain. Spinal cord stimulation can relieve chronic back pain, amputated stump pain, and complex regional pain syndrome.
Stimulation does not eliminate the source of pain. It simply changes the way brain perceives it. As a result, the amount of pain relief varies for each person.
Stimulation does not work for everyone. Some people may find the sensation unpleasant. Other people may not get relief over the entire pain area. Your overall physical condition, medicines that you take, your pain history and source of pain are considered while determining if SCS is appropriate for you.
SCS might be appropriate, if you meet the following criteria:
Debilitating pain lasting more than 3 months and response to medicines is poor
Alternative pain remedies and medicines failed to produce relief
Your overall health permits an implant
Persistent pain caused by arthritis, spinal stenosis, or by nerve damage.
Failed back surgery syndrome
Complex regional pain syndrome
Angina or peripheral vascular disease
Spinal cord injury
Dr. Samadani is a national leader in the effort to use SCS to help spinal cord injured patients recover lost function below the level of injury.Make an Appointment
Subdural hematoma (SDH) means pooling of blood in the brain between the skull and the surface of the brain, mostly caused by severe injury to head, like being in an accident or a hard fall. During a severe head injury, the blood vessels burst and leak blood. The bleeding occurs within the skull but outside the actual brain tissue. If not treated, it can lead to death or permanent disability and is a medical emergency requiring an ER visit.
The brian is covered by three membrane layers called meninges that protect the brain. They lie between the skull and brain tissue. These layers are called pia, arachnoid, and dura. The outermost layer is dura. When a vein in the brain bursts and leaks blood into the space below the dura, it is called sub-dural hemorrhage. Broadly, SDH falls under traumatic brain injury (TBI).
Older adults, athletes who play contact sports and people on blood thinners, alcoholics, hemophiliacs and babies are at higher risk of developing SDH.
Subdural Hematoma Evacuation refers to a surgical procedure to drain the pooled blood. The Subdural Evacuation is a minimally invasive removal of blood through a small burr hole. This procedure does not require irrigation, aspiration, or a catheter and can be done under local anesthetic at the patient’s bedside.
The symptoms of a subdural haematoma can develop soon after a severe head injury, or gradually over days or weeks after a more minor head injury. Symptoms of a subdural haematoma can include:
a headache that keeps getting worse
feeling and being sick
confusion and personality changes
drowsiness and difficulty keeping eyes open
paralysis on one side of the body
loss of consciousness
Your physician will examine you for physical signs of an injury to your head and assess symptoms. The Glasgow Coma Scale (GCS) may be used to check your level of consciousness to determine the severity of brain injury. A brain scan (CT, X-Ray or MRI) is generally required to diagnose hematoma.
Surgery is the most common treatment for subdural haematomas. Depending on the size and severity, either a craniotomy will be performed or a burr hole is drilled to drain the blood. However, small amount of pooling may not need surgery - the blood may be absorbed and the condition may disappear over time.Make an Appointment
The posterior fossa refers to the compartmentalized space in the lower back of the skull. It includes brain structures such as the brainstem and cerebellum. The cerebellum is the part of the brain responsible for balance and coordinated movements. The brainstem is responsible for controlling vital body functions, such as breathing.
Because this part of the brain is compartmentalized by meninges, it is sensitive to pressure changes with even minimal disturbance. Space-occupying lesions such as tumors, swelling or blood can compress structures in the posterior fossa leading to tonsillar herniation. Posterior fossa decompression involves the removal a small portion of the skull (suboccipital craniotomy) and spine (cervical laminectomy) to relieve pressure on the brain and spinal cord. The procedure involves making about three inch incision at the back of the head and the top of the neck, where a small section of bone (around an inch in diameter) at the base of the skull is removed.
The aim of Posterior fossa decompression is to halt the progression of damage to the brain and spinal cord by providing room for the cerebellum outside of the spinal canal and restoring the natural flow of spinal fluid while also alleviating some of the symptoms experienced by the patient.
Contact Dr.Samadani for posterior fossa decompression surgery.Make an Appointment