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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.

Percutaneous Diskectomy

A lumbar percutaneous diskectomy is performed for the removal of offending disk fragments in a minimally invasive manner. The procedure has a number of benefits including a quicker return to normal activities, less post-op pain, less damage to muscle tissue and skin, an easier rehab, smaller scars and less blood loss.

With the patient asleep, the surgeon is guided by an x-ray fluoroscopic view, and a guide wire is placed in the appropriate location over the herniated disk. Dilators are then placed over the inserted guide wire in progressively larger sizes. A tube is placed over the dilator, which is then removed with fluoroscopy used to confirm the appropriate positioning. The offending disk fragments are then removed through the tube. The tube is then removed and the skin incision is neatly closed.

This description is a general overview. Your Buffalo Neurosurgery Group doctor will provide the details of the correct procedure for you. He will also explain the health benefits, risks and special pre and post-op care instructions.

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