Traditional disc herniation surgery requires stripping away back muscles in order to expose the spine, which can cause extreme scarring and bleeding. At the Minimally Invasive Spine Institute, we are able to treat the herniation with just a laser and without stripping muscle at all. Because we do not use expandable retractors, like many others who claim to do minimally invasive surgery, we avoid cutting muscle altogether. And instead, we insert a tiny camera through a 3 or 7 mm incision, treating the disc with only a laser, so you can heal and get back to life as quickly as possible.

Definition:
A herniated disc is sometimes referred to as a slipped disc or a ruptured disc. It is often the result of an injury or trauma to the spine.

Your spinal column is made up of bones (vertebrae) that are cushioned by small discs consisting of a tough outer layer (annulus) and a soft, jelly-like inner layer (nucleus). These discs act as shock absorbers, protecting the spine and nerves from the stress of everyday tasks – as well as strenuous work such as heavy lifting.

When a disc “herniates,” a tear or weakness in the annulus allows the jelly-like nucleus to push out into the spinal canal. If it puts pressure on a spinal nerve, the herniated disc can cause pain, numbness or weakness in the back, legs or arms – depending on where the disc is located. Herniated discs are most common in the lower spine, but about 10% occur in the neck.

You can have a herniated disc without knowing it – herniated or bulging discs sometimes show up on spinal images of people who have no symptoms of a disc problem. But some herniated discs can be painful.

Symptoms:

• Sciatica – a radiating, aching pain, sometimes with tingling and numbness, that starts in the buttock and extends down the back of one leg.
• Pain, numbness or weakness in the lower back and one leg, or in the neck, shoulder, chest or arm.
• Lower back pain that worsens when you sit, cough or sneeze.

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Many things can cause a pinched nerve. Whether it’s facet disease and bone spurs, disc bulges or herniations, or thickened ligaments due to arthritis, the Minimally Invasive Spine Institute can treat the source minimally invasively with a tiny laser through a 7 or 15 mm incision to free the nerve and rid you of your pain. And because we do not use expandable retractors, like many others who claim to do minimally invasive surgery, we avoid cutting muscle altogether, so you can get back to life as quickly as possible.

Definition:
A pinched nerve occurs when too much pressure is applied to a nerve by surrounding tissues such as bone spurs, disc herniation and ligaments. This pressure (compression) disrupts the nerve’s function – causing pain, tingling, numbness or weakness in the affected area, and in many cases causing permanent damage.

A pinched nerve can occur anywhere in your body. For example, a herniated disc in your spine (neck, thoracic or lumbar) may put pressure on a nerve root, causing pain that radiates down the back of your leg (sciatica), or down your arms or hands. Another common type of pinched nerve is the median nerve in the carpal tunnel in your wrist; compression of that nerve can lead to pain and numbness in your hand and fingers (carpal tunnel syndrome). These are just two common examples of pinched nerves; many other nerves can be pinched including those in your neck, shoulder, elbow and other areas.

With rest and other conservative treatments, most people recover from a pinched nerve within a few days or weeks. In some cases, however, surgery is necessary.

Symptoms:

• Numbness or decreased sensation in the area supplied by the nerve.
• Sharp or burning pain, which may radiate outward. When the pinched nerve comes from the spinal cord, coughing or sneezing may aggravate the pain.
• Tingling, “pins and needles” sensations (paresthesia).
• Muscle weakness or twitching in the affected area.
• Frequent feeling that a foot or hand has “fallen asleep.”

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1. Evaluate your habits. Take a moment and think about how you spend most of your day. Do you work on your feet or sit in a chair all day long? After a day of work do you come home and crash on the couch? Perhaps there is something in your daily routine that is causing your back pain.
2. Correct your posture. Spending a lot of time in a car or working on a computer can lead to a tremendous amount of stress on your lower back and neck. Try some active sitting and learn about correct desk ergonomics.
3. Try alternative methods of exercise. Getting active doesn’t mean you have to join a gym, there are many other alternative methods of exercise. For example, Yoga offers many poses that can help ease back pain. You could also try riding a bike or swimming.
4. Stay active. The old remedy of bed rest for back pain is no longer a wise option. Bed rest can actually make pain worse because without exercises and daily movement, back muscles and the spine weaken and become even less able to support the body properly overall.
5. Change your diet. Your diet can directly affect your health. For example, foods that are more acidic like beef, chicken, dairy, and fish promote inflammation, however foods that come from plants are anti-inflammatory. A diet that is high in animal fats and proteins can cause weight gain, which leads to chronic inflammation of the joints in the spine. This can trigger a pain response.
6. Alter your sleeping position. While your body is resting, your spine may be under a great deal of stress. Some sleeping positions are actually healthier for your spine than others. Try changing your sleeping position.
7. Track your back pain progression. Keep a journal or make a note of the day you first started feeling back pain. If the pain lasts longer than two weeks it may be considered chronic pain. Know the difference between chronic and acute back pain.

The most important point to remember is that you should not ignore the symptoms of back pain. It’s best to know the source of the back or neck pain and have an evaluation to determine whether it is something that will improve, or if the condition could deteriorate if not treated. Many times, people try and ignore the pain or mask its symptoms with over-the-counter medication, and end up hurting themselves even more. Consider an evaluation a check-up for your health.

Spinal stenosis may affect the cervical, thoracic or lumbar spine. In some cases, it may be present in all three places in the same patient. Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs, thighs, feet or buttocks, or loss of bladder and bowel control.

Our minimally invasive techniques are highly successful in diminishing the pain caused by this common disorder. We can enter through a 7 or 15 mm incision and enlarge the spinal canal by shaving off the matter causing the narrowing and the resulting pain. And because we do not use expandable retractors, like many others who claim to do minimally invasive surgery, we avoid cutting muscle altogether, so you can get back to life as quickly as possible.

Symptoms of spinal stenosis:
Spinal narrowing doesn’t always cause problems. But if the narrowed areas compress the spinal cord or spinal nerves, you’re likely to develop signs and symptoms. These often start gradually and grow worse over time. The most common spinal stenosis symptoms include:

• Pain or cramping in your legs, arms, hands or feet.
• Numbness, weakness or tingling in your leg, arms or feet. For some people, the radiating pain is a minor annoyance, but for others, it can be debilitating.
• Pain in your neck and shoulders. This is likely to occur when the nerves in your neck (cervical spine) are compressed.
• Loss of balance. Pressure on the cervical spinal cord can affect the nerves that control your balance, resulting in clumsiness or a tendency to fall.

Loss of bowel or bladder function (cauda equina syndrome). In severe cases, nerves to your bladder or bowel may be affected, leading to partial or complete urinary or fecal incontinence. If you experience either of these problems, seek medical care right away. Visit us at zerospinepain.com

All of our doctors, Dr. Douglas Won, Dr. Michael Rimlawi, and Richard Rhim, are uniquely fellowship trained in both orthopedic surgery and neurosurgery. This dual-fellowship training is considered the highest level in spine surgery training.

The spine-health article then goes on to stress that beyond the training, the most important questions you can ask your surgeon is to describe the specific surgeries that he specializes in, or more precisely “how many of these specific surgeries do you do each year?”

All types of spine surgery have a steep learning curve, and as a general rule, surgeons with more experience in the surgery will have better results. via spine-health.com

For a full list of questions to ask your doctor, check out our blog post on How to Choose a Spine Doctor.

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Minimally Invasive Discectomy

A minimally invasive discectomy is used to relieve pressure on a nerve root caused by a herniated disc or a bone spur. Because we use a small camera to view the patient’s pinched nerve we only have to use an incision of about 3 millimeters. There is no muscle cutting and typically no bleeding at all. As a testament to the precision of the procedure, it is often done with the patient awake and the only bandage needed is a simple band-aid and they are going back home in just an hour after surgery!

But don’t believe everything you read on the internet… You can hear it straight from Dr. Michael Rimlawi’s mouth via this recently uploaded YouTube video.

What is the most widely used surgery that you perform?

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The medical publication reaches an audience of more than 15,000 key orthopedic and spine practice decision makers including orthopedic and sports medicine physicians and surgeons and spine practice administrators. We are very happy that they chose to feature Dr. Rimlawi. Below is an excerpt of the Orthopedic & Spine Q&A with Dr. Michael Rimlawi.

Q: The Dallas Business Journal award honors physicians who show exemplary performance in their field. To what do you attribute your success?

Dr. Michael Rimlawi: I am very fortunate to work in the field that is my passion. Because of this, I approach each day with a positive outlook and attitude. I also love new challenges. As new technologies are developed that can benefit my patients, I seek them out and undergo the training needed to always offer the most advanced treatments available.

Q: What are your professional goals this year and for the next few years?

MR: As you know, there is quite a bit of friendly competition between surgeons. Everyone wants to be the first to perform a particular procedure or to develop a new technique. This quest is part of what drives us all to continuously learn new ways to treat the wide variety of back and neck ailments. Therefore, I always explore all new technologies and procedures and add them to my practice if they provide a real benefit to my patients.

Q: What do you see as the biggest opportunities for spine medicine and the Minimally Invasive Spine Institute over the next few years?

MR: For years, if you mentioned spine procedures to someone, they would turn and run in fear because they had heard terrible stories from someone they knew who underwent traditional spine surgery. However, through the continuing advancements in minimally invasive spine procedures, more and more people are having positive outcomes and getting back to living a full and active life. I believe this will only continue and even grow over the next several years. For The Minimally Invasive Spine Institute, the biggest opportunity is to continue to stay at the forefront of the industry and be recognized as one of the preeminent destinations worldwide for advanced minimally invasive spine treatment.

You can read the entire interview on the Becker’s Orthopedic and Spine website.

Pictured above is a press image of the U3-X personal mobility prototype from Honda. It’s basically the segway office chair. The U3-X uses a balance-control system to guide its passenger in a multidirectional path. It’s a lot easier to understand how it works when you see it in action, so take a look at this demonstration video embedded below.

The riders don’t seem to know what to do with their hands and the lack of back support rules out this method of transportation for many of our readers, but as with the segway, this personal mobility prototype could offer office workers an alternative to the traditional office chair. The posture reminds me of the active sitting exercises and the exercise ball chair. It is very difficult to maintain a rigid posture without any back support for long period of time, but this new method of transportation is like watching a science fiction movie, except it’s real. Perhaps something like this prototype could be a method to help those suffering from severe back pain to move around more easily.

Laparoscopic surgery is a minimally invasive procedure that allows the surgeon to gain access to the inside of the body without the need to create a large surgical wound. There are a number of benefits associated with laparoscopic surgery and this has led to it being favored not only by surgeons but also by the patient. At the moment it is mostly gynecological and gastroenterology procedures that see the most uses for this minimally invasive surgery. This procedure is also commonly used by surgeons as a diagnostic tool.

The number of procedures that can now be performed by laparoscopic surgery has greatly increased over the last couple of decades. The reason for this is connected to the benefits that this technique has over other types of surgery including:

• Shorter hospital stays
• Less risky for people who are not well enough for open surgery
• Reduced risk of operation infection
• Less post-operative pain
• Smaller or no scars at all

The benefits of laparoscopic surgery also mean that patients feel less fearful when approaching surgery. This is important because it encourages people to undergo important elective surgery that they would otherwise seek to avoid.

This procedure is minimally invasive and involves creating one or more small incisions rather than one large one. The surgeon uses small flexible tubes called laparoscopes to help them perform the procedure. This laparoscope contains a camera and light source so that the surgeon can see inside the body without the need to create a big wound. It is also possible to pass small surgical instruments down the laparoscopes so that different procedures can be performed such as cutting or cauterization. Laparoscopic treatments demand a high level of skill and dexterity from the surgeon as he has to do his work by manipulating the laparoscopes while staring at a TV screen.

It seems highly probably that even more procedures will be performed in the future using minimally invasive surgery. Some experts predict that in a few years it will be quite rare for a surgeon to need to open up the body with large surgical wounds. This should mean shorter stays in hospital and less risk of complications arising following surgery.

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An annular disc tear occurs when the substance of the annulus fibrosus (circled in red above) rips and allows that highly pressurized nucleus pulposus to escape outward toward the periphery of the disc. When the tear reaches the outer layer of the annulus the resulting contact between the nerves and nucleus pulposus can cause pain and irritation. At this point in the tear it is now called a herniated disc.

If the nucleus pulposus is still contained by some of the outer annular or capsular fibers then it is referred to as a bulging disc. A herniated disc, also known as a slipped or ruptured disc is a protrusion that has ruptured through the annulus. At the Minimally Invasive Spine Institute we are able to treat the herniation with just a laser and without stripping muscle at all. Because we do not use expandable retractors, like many others who claim to do minimally invasive surgery, we avoid cutting muscle altogether. And instead, we insert a tiny camera through a 3 or 7 mm incision, treating the disc with only a laser, so you can heal and get back to life as quickly as possible.

In summary, an annular tear is not in itself a problem, but it can lead to pain and discomfort if the contained material inside the annular disc reaches the surrounding nerves. You can have a herniated or bulging disc without knowing it. They sometimes show up on spinal images of people who have no symptoms of a disc problem. If you are experiencing aching pain, tingling, or numbness, especially if it extends down the leg, we would strongly encourage you to schedule an appointment with a spine specialist.