Best Practice Health TV
As an emergency room nurse Christina knew right away what was happening; that didn’t make it hurt any less. "I could not sleep. I could not position myself at night to where my right arm wasn't just flaming. I had to wear a sling to work." Watch the whole interview here ER Nurse w/ SEVERE [...]
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When should I get an MRI of my neck? It depends on whether you have arthritis, a torn or herniated disc, or cervical stenosis. MRI (Magnetic resonance imaging) plays an especially vital role in helping your doctor know how to deal with problems in your neck. However, studies show getting an MRI too soon can [...]
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If you are reading this article, I am going to assume you have neck pain. That is a pain starting in your neck and radiating into the base of your neck and shoulders. There are a lot of different causes of neck pain, but people with neck pain can be sorted into two buckets. What […]
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Jon Rogers and his wife moved to Phoenix to start a new life. Trained as an aerospace engineer, Jon worked on some of the largest military projects in America. For example, Jon was on the team that developed the Top Gun missile for the US Air Force. When it came time to retire, he moved […]
read moreThink of the spinal canal as a room. The floor is made out of the disc space, the walls are the facet joints, the ceiling is the yellow ligament, and the roof is the lamina bone. With age, our spinal canal naturally becomes smaller due to thickening of the yellow ligament, bulging discs, and enlargement of the facet joints. In other words, our spinal room gets smaller because the floor is coming up, and the ceiling lower. The best way to make the room bigger is to raise the roof, or remove the lamina bone. In medicine, removing something is called an –ectomy. So removal of the lamina bone is called laminectomy. If you live long enough, your spinal canal will become so narrow your nerve roots will be pinched. As a result, laminectomy is one of the most common operations in the United States. A surgeon will operate through a microscope down a tube. This technology enables a fast recovery, while preserving as much normal tissue as possible, leading to a spectacular long term result.
It is best practice to undergo laminectomy for severe spinal stenosis. Back in the day surgeons recommended fusion along with laminectomy. That is no longer best practice. Today, there are 3 primary reasons that doctors, surgeons, professional guidelines, commercial insurance panels, and Medicare all recognize you may need a fusion: spondylolisthesis, scoliosis, or instability. Pain to palpation on your surgeon’s examination is not an indication for fusion. You do not have spondylolisthesis, scoliosis, or instability. Therefore, you do not need spinal fusion.
And that’s good news. Spinal fusion is a life saver if you need it. But there are some real downsides as well. Spinal fusion is more invasive than laminectomy. It involves hardware, so you have a foreign body in your body. And we know from history that 16% of people who have a spinal fusion need another one within five years. No thanks!
You do need a laminectomy. Severe spinal stenosis crushes your nerve roots and can lead to permanent bladder dysfunction, weakness, and numbness. In fact, a recent study showed a horrible increased in death within one year for those who declined laminectomy for severe spinal stenosis when offered by a spine surgeon.
On the bright side, minimally invasive laminectomy is a highly effective surgery to relieve the severe spinal stenosis shown on your MRI (Magnetic Resonance Imaging). You can expect an incision less than an inch, outpatient surgery, and to be mostly recovered after 1 week, walking a mile a day for exercise in 3.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. They will do a medial branch block and radiofrequency ablation as appropriate. Don’t let anyone talk you into epidural injection; that is not what you need.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI. We can help you find a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management who doesn’t over-prescribe dangerous narcotics.
They will offer you medial branch block and epidural injection. Those don’t really work for this problem. Your options are (off label) intradiscal injection of stem cell-derived growth factors, denervation with the relevant procedure, and then referral to a spine surgeon for interbody fusion if those fail.
You need an MRI now and referral to a spine surgeon for possible laminectomy decompression surgery. We can help you find one who is board-certified and specializes in minimally invasive surgery.
You need an MRI now and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. Don’t go to one that prescribes a lot of narcotics, they may get you killed. If you’re not better after 3 epidural injection you will be referred at 12 weeks to a spine surgeon to consider microdiscectomy. Note that you DO NOT need radiofrequency ablation; so, don’t let anyone talk you into a medial branch block.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your MRI came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the MRI has a copy as well. Find the section labeled Impression. First, under the impression, look for the word normal. If you see something like “Normal MRI of the hip then you are done. You do not need to check anything.
Next, search the impression section for the words osteonecrosis or avascular necrosis. If you see either one in the report, then ignore the rest of the report and check the osteonecrosis box. If neither of those is in the report, ignore the rest for now and continue.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your x-ray came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the x-ray has a copy as well. Find the section labeled Impression.
First, under the impression, look for the word normal. If you see something like “Normal x-ray of the hip then you are done. Check the box normal. Next, search the impression section for the word hypoplasia. If you see hypoplasia in the report then ignore the rest, and check the hypoplasia box.
If you are still going, then look for the word arthritis. The radiologist should have given the arthritis a grade from 1 to 4. If you see arthritis in the impression section but there is no grade, then look at the rest of the report for a grade 1,2,3 or 4 and check the appropriate box. If there’s no grade then you have every right to call the imaging center and ask them to have the radiologist to do their job and redo the report with a grade.
Not all orthopedic surgeons are the same. You deserve the best. That means a surgeon who is
In my experience less than 10% of orthopedic surgeons meet all five of these criteria. That means if you go to the surgeon you’ve been seeing, or the one recommended by friends or family, there’s a 90% chance you will not be getting the best.
At Phoenix Spine and Joint we make it our business to know the best. Call us for help finding the best surgeon near you who takes your insurance and is accepting new patients.
If you have any of the following red flags you need to see a doctor NOW!
Radiculopathy. This condition is most often due to herniated disc, but can also be caused by bone spurs, or compression of nerve roots as they leave the spinal canal. The traditional treatment is to confirm the herniation or compression by MRI, followed by a trial of epidural injection, with microdiscectomy or laminectomy surgery if all else fails.
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Facet syndrome. Your low back pain is most consistent with arthritis. Look for confirmation on your x-ray and MRI reports with discussion about “arthritis.” The traditional treatment is radiofrequency ablation done by a pain management physician.
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Discogenic low back pain due to an annular tear. Sorry, this is the least common and the hardest to treat. Traditionally, the recommended procedure is fusion; however, that does not always work and causes adjacent level issues. More recently a denervation procedure was approved called the Intercept procedure from Relievant. Some doctors recommend injection, The two options are stem cell-derived growth factors, and ozone.
Enter below and we will email or text you more information about how to get rid of your discogenic low back pain.
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