MicroSpine
Low Back Pain or LBP is probably the most common complaint in our society. Some say that over 50% of all people will have some degree of severe LBP at some point in their lives. Most of these cases resolve on their own but a small group of around 5 to 10% develop chronic pain or pain so severe that it requires surgery. The most common reason for LBP is discogenic issues. The discs are the small cushions between the bones and they degenerate with time and cause severe and deep achy type pain. A less common reason is facet joint pain which occurs more in the older population. Of course, a certain group of people have a combination of the two issues. Discogenic LBP is commonly described as a stiffness and deep ache that continues all day long while facet joint pain tends to be worst in the mornings and evenings but improves with motion during the day. Usually MRI’s are used to determine the degree of disc and joint issues. Injections such as facet joint injections or discograms can be helpful in also determining the exact cause of the pain as well. Treatment varies significantly and should always start with conservative therapies such as physical therapy or minor injections and medications. Surgery should always be a last resort. At MicroSpine, we offer minimally invasive spinal surgeries for facet syndrome and discogenic low back pain. Our facet surgery and endoscopic discectomy surgeries are performed through incisions less than one inch and offer permanent relief for around 70% of patients.
Spine Surgery Success Rates – What do they mean?
Many spinal surgeries offer some kind of success rate but do you the patient really understand what is meant by “success”? Obviously success means that you had a positive outcome, but to what degree. Usually conventional spinal surgeries offer a good to excellent outcome in 50 to70% of patients. Usually, but not always, good to excellent corresponds to a improvement level of 50 to 100%. Thus, good to excellent may not mean a cure but implies usually at least 50% improvement. Some scientific papers use 25% or greater as a level of success or even any statistically significant change as evidence for success. Thus, it is important for you the patient to understand what is meant by a successful outcome. It is also important to realize that few studies offer improvement much above 80% for spinal surgeries of any type. What does all this mean? It means three things. 1. spinal surgery of any type, including endoscopic spinal surgery, is successful around 75% of time, give or take a few points and the improvement averages 75% reduction in pain for those people. 2. around 25% of the people don’t get better or have less than a 50% improvement level. This is important since with conventional surgery, those 25% may actually be worse after surgery! 3. No spine surgery is perfect in every patient and this is due to the complexity of the spine itself. Be very wary of a surgeon who says they have perfect results and if he does, ask if he can prove it. The reality is spine surgery isn’t perfect, but we at MicroSpine try to offer a minimally invasive approach that creates an incision of less than one inch with results similar or better to conventional surgery but with fewer outcomes. Honest answers from honest people.
Spinal surgery works around 70 to 80% of the time, thus 30% of the people don’t get better. This is for first time surgery patients. Repeat surgery patients have success rates of around 50%. It is always important to realize that most people will get better but some will not. In fact, if your surgeon guarantees you a successful outcome, Get it in writing! Spine surgery is tricky and Laser or endoscopic spine surgery is even trickier. It is important for people to realize that over half of our patients had prior spinal surgery and were told that nothing could be done for them! Thus, the fact that we have success rates in the 70% plus range is amazing. Sure, some people don’t get better but they didn’t get better with regular surgery either. We try to help people and we offer hope not false promises. Do we do the most advanced endoscopic spine suregry? You betcha. Our working portal is only 14mm in diameter. That means an incision of less than one inch. Our competition uses portals over 18mm in size. That may not seem like mush but for every increase in diameter the incision size increases almost 3-fold! Thus, A 18mm incision is nearly a two inch cut and thus twice the trauma and scar tissue. I have seen people do endoscopic surgery through a 26mm portal which amounted to a three inch cut. That’s the same as regular surgery. Size is important. Keep that in mind
Discogenic or disc related pain
Believe it or not, up until the late 1980′s, it was thought that the discs themselves didn’t cause pain. It was known that a herniated disc could press on a nerve and cause pain but it was assumed that the disc didn’t have any innervation and thus couldn’t cause pain in and of itself. Studies revealled that the discs do have innervation but only on the outer annulus or the surface of the disc. This annulus get damaged due to forces that cause tears in its lining. these tears cause pain stimulation via the small nerves that innervate the surface of the disc. Thus we refer to this as annular pain or pain from the annular fibers of the disc. Since the 1990′s, discectomies have been the gold standard for disc related pain and usually have success rates of around 70%. Fusions surgeries have also been utilized for this type of pain but with success rates of 50 to 70%. Why do the discs cause pain? The tought is that the small tears in the annulus of the disc stretch the nerves that innervate the annulus and thus cause pain. The discectomy reduces the pressures in the disc and thus reduce the pain while the fusion solidifies the spine and thus no motion should equate with no pain. Obviously, neither of these surgeries are 100% effective, endoscopic disectomies offer a good success rate with low complications.
Sacroilitis or Sacro-iliac joint pain
Sacroiliac joint pain or SIJ pain is a common disorder that is seen in females much more than males. The SIJ is comprised of the surface between the sacrum and the iliac bones. The two iliac bones comprise the pelvis. The joint is essentially non-mobile in the vast majority of patients and although some believe the pain is from a hyper mobile joint, we believe that the pain originates from the tissues overlying the joint surface. The region of the SIJ is where many of the ligaments and tendons adhere to the sacrum that supports the spine. These tendons get damaged and torn and this leads to a chronic tendonitis type of picture which causes localized pain that is tender to the touch. The pain is usually contained to the region of the SIJ but in some people the pain can radiate into the buttock and even into the leg. Nonetheless, the common presentation is unilateral low back to buttock pain. Often a “knot” of tissue is felt under the skin where the pain is present. This “knot” of tissue represents the torn tissues and since the tendon tissues heal poorly, the pain tends to be persistent. Probably the wider and shallower pelvis of the female leads to the greater prevalence of the disease in women. Also, childbirth may lead to some the tissues overlying the pelvis to become damaged. The SIJ syndrome is also seen in males but less frequently. The diagnosis of the disorder includes tenderness over the joint region and elimination of the pain with a selective SIJ injection. There are other tests, such as Patrick’s test but if a SIJ injection doesn’t eliminate the pain then think of other causes. The treatment of SIJ pain can be as simple as rest or a back brace with anti-inflammatory medications. Injections of a corticosteroid into the joint can lead to pain relief for several weeks or months. This can be a long term treatment option if the relief lasts at least two to three months. If the relief of the SIJ injection is of short-term benefit then one could consider a SIJ debridement surgery which was pioneered by the doctors at MicroSpine. The SIJ surgery removes the damaged ligamental tissues surrounding the SIJ. This leads to permanent relief of the pain is 60% of the people and involves an incision of less than one inch. Other options include SIJ fusion surgery which involves fusing the joint with metal hardware to reduce motion in the joint. This has a success rate of around 50% and involves a 6 inch incision. There are also treatments that use a needle that burns the tissues around the joint. This is called radiofrequency lesioning and uses electrical energy to create heat to burn the tissues. This works less than 50% of the time and lasts around 6 months. The important thing to remember is that SIJ pain is not always from a hyper mobile joint and that fusion of the joint works only 50% of the time. Thus, minimally invasive procedures offer better outcomes with less trauma and should be considered when appropriate.