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Back - Thoracic and Lumbar Spine

Five percent of the United States population experiences back pain each year (1). Over your lifetime, you have a 60-80% chance of experiencing at least one episode of back pain. Most episodes are not severe and resolve without medical care. Some, however, are severe and disabling. But even the more severe cases which cause patients to seek medical or chiropractic care are usually transient. It has been estimated that 90% of patients who seek professional treatment for back pain will be pain free within 1-3 months. In this group of patients, after ruling out an underlying systemic cause such as a malignancy or infection, appropriate care consists of providing conservative treatment.

The gold standard of conservative treatment consists of management with NSAIDS (Non Steroidal Anti Inflammatory Drugs) and exercise therapy (chiropractic or physical therapy). If these modalities fail after a 3-6 week trial, referral to a specialist (neurosurgeon or orthopedic surgeon) is appropriate. Often, we as specialists will continue conservative measures. When this fails, surgery can be extremely effective. Surgery is only performed when conservative measures fail and diagnostic tests demonstrate abnormalities.

In our practice, the most frequently encountered causes of nerve impingement in the lumbar spine are herniated disk, spinal stenosis and painful mechanical instability with degenerated disk.

Microdiskectomy - Herniated Lumbar Disk

The lumbar intervertebral disk is made up of a fibrous outer ring called the annulus and a gelatinous inner portion called the nucleus. The disk acts as a cushion between the vertebral bodies. When herniation occurs, the nucleus pushes through the annulus of the disk producing pressure on the nerve root and/or cauda equina.

Nearly all patients complain of leg pain (sciatica) in the distribution of one or more nerve roots. Some have back pain as well. Frequently, patients can be treated conservatively with success. However, when their ability to perform normal day to day functions is degraded for a substantial period of time (4-6 weeks), or in the presence of progressing neurological deficit (i.e. foot drop, loss of control of bowel and bladder, cauda equina syndrome), lumbar microdiskectomy is the most effective treatment. During microdiskectomy, the offending disk fragment and much of the loose nucleus are removed through a small, one to two inch incision.

The success rate is very high for this procedure and patients are able to return to work and full activity in an average of about 10 weeks. Our group has the most extensive experience in Western New York performing outpatient microdiskectomy.  Patients prefer this to overnight stay in the hospital.

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