Laminectomy, The Surgical Response to Sciatica

Laminectomy, the surgical response to sciatica

Sciatica is a symptom of spine damage that can usually be remedied at home. There are a myriad of steps you can take in tending to sciatica without needing surgery. However, in some cases patients need to undergo surgery to alleviate their symptoms. This procedure removes the lamina (a small vertebra in the spine), it may also remove bone spurs in your spine and takes anywhere between 1 and 3 hours. This process has the aim of reducing pressure in your spinal column; in turn lessening the symptoms of sciatica. 

The procedure is often done to treat spinal stenosis. It removes damaged bones or discs. As we explored in last week’s blog, sciatica is a symptom, and not a cause – and the best way to cure sciatica is to tackle the underlying problem. 

It is important to have an x-ray or MRI of your spine before making any decisions to undergo surgery. You must divulge any medication you are taking to your health provider.

Before you leave your home, ensure you leave it prepared for when you return. You must refrain from smoking in the days leading up to your surgery. It is imperative you do not smoke after the surgery is complete. You must speak with your doctor if you have been drinking lots of alcohol, especially if your consumption could be considered alcohol abuse. 

You will likely be asked to not drink or eat anything for 6 – 12 hours before the procedure. With everything prepared, you are ready undergo your Laminectomy. 

Laminectomy opens your spinal column with the aim of giving spinal nerves more space to move. You will be asleep and feel no pain. The procedure begins with you lying face down on the operating table. Once the anaesthetic kicks in, the surgeon makes an incision in your back.

The skin, muscles, and ligaments are moved to the side. Depending on the cause of sciatica, part or all of the lamina bones may be removed on both sides of your spine. Your surgeon may then remove small disc fragments, bone spurs, or other soft tissues. The muscles and other tissues are back in place. The skin is sewn together.

After waking, you will be encouraged to get up and walk around as soon as the anaesthesia wears off. You will be allowed to go home around 1 to 3 days after their surgery.

You will be able to drive within a week and resume light work after around 4 weeks. The surgery should relieve the patient of all symptoms of sciatica due to addressing the root cause of the problem.

As we have stressed in previous blogs, surgical procedure is not recommended as a treatment for sciatica – it should be a last resort and not a go-to when the symptoms of sciatica kick in. Before thinking about surgery, you should consult your physician and discuss options. Alternatively, you can read our blogs on living with sciatica found here.

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

How to Deal With Sciatica, The Do’s and Don’ts

How to deal with sciatica, the do’s and don’ts

This week, we are going to look at ways of managing sciatica. In our previous blog we looked at what sciatica is, and suggested some causes of the problem. To quickly recap, sciatica is the compression of the sciatic nerve – which in turn causes pain down the lower back, through the hamstring all the way to the foot. What is most important to remember when dealing with sciatica, is that is a symptom, and not the underlying problem itself.

The first step when dealing with sciatica is diagnosing the underlying issue. The root of the problem can be anything from a slipped disc in the spine, to a spinal stenosis, or in more serious cases, a tumor. It could even come from a small fracture in the hip. Although we can treat sciatica without dealing with the genesis of the problem, you are more likely to experience a reoccurrence of sciatic pain if we do not.

We recommend that if you suffer from sciatica, get a diagnosis on what caused it. That way we can deal with the pain alongside remedying the original problem, and reduces the chances of it reoccurring.

For now, let’s look at some of Mount Sinai’s recommendations for dealing with sciatica at home.

Conservative (non-surgical) treatment is best in most cases. When you are suffering from sciatica, or begin suffering due to some other cause, apply heat or ice to the painful area. Try the ice first (48-72hrs); then use heat on the pain. Over the counter pain relievers such as ibuprofen or acetaminophen can also help with inflammation and general pain relief.

Surprisingly to a lot of patients, bed rest is not recommended. Although short term bed rest may be needed for patients in extreme pain, staying inactive and reclined for long periods of time weakens the body and extend the life of agonizing symptoms.

Upon first suffering the symptoms of sciatica, it is recommended to tone down your physical activity for the first few days, and gradually work your way back to your daily routine.

You should reduce your activity in the first couple of days – and gradually adjust your body to your usual activities. This will ensure you do not overstress any of the damaged components, and give your body time to adapt.

Patients are recommended to start exercising again after around 2-3 weeks. You should include exercises to strengthen your abdominal muscles and improve flexibility in your spine.

If weightlifting or contact (collision) sports such as American Football are part of your usual exercise routine, you should not return to your sport/hobby for at least 6 weeks since the pain began. Do not lift heavy objects or twist your back. Your physician can help identify good exercises to remedy sciatica.

More serious complications depend on the causes of sciatica, such as slipped discs or spinal stenosis. Call a provider immediately if you have:

·        Unexplained fever with back pain

·        Back pain after a severe blow or fall

·        Redness or swelling on the back or spine

·        Pain traveling down your legs below the knee

·        Weakness or numbness in your buttocks, thigh, leg, or pelvis

·        Burning with urination or blood in your urine

·        Pain that is worse when you lie down, or awakens you at night

·        Severe pain and you cannot get comfortable

·        Loss of control of urine or stool (incontinence)

Also call if:

·        You have been losing weight unintentionally (not on purpose)

·        You use steroids or intravenous drugs

·        You have had back pain before, but this episode is different and feels worse

·        This episode of back pain has lasted longer than 4 weeks

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

Causes and manifestations of sciatica

Sciatica is the name given to any sort of pain caused by irritation or compression of the sciatic nerve. The sciatic nerve stems from the back of your pelvis, and runs through your buttocks, down the legs, and ends at your feet. It is the longest and widest nerve in the human body. It supplies sensation to most of the muscles and ligaments in the lower body – this ranges from the hamstring all the way to the sole of the foot.

When the sciatic nerve is compressed or irritated it can cause pain, numbness, or a tingling sensation that radiates from your lower back and travels down one of your legs to your foot and toes. Some sufferers also report a weakness in the calf muscles or the muscles that move the foot and ankle. Sciatica can range from being extremely painful to a mild annoyance, usually exaggerated by sneezing, coughing – or any involuntary or sudden movements. The pain of sciatica is localised in the lower body region, stemming from the top of your buttock downward, people also report suffering from back pain. Although this is most likely related to the problem, it will not be the sciatic nerve causing the pain.

Most cases of sciatica stem from a slipped disc. Injury or weakness can cause the inner portion of the disk to protrude through the outer ring. This is known as a slipped, herniated, or prolapsed disc. If the slipped disc compresses the sciatic nerve then we have sciatica. Most people with sciatica experience unrelated back pain. But a slipped disc is an injury in its own right; we should see sciatica as a result of this injury. We can summarise this as: Sciatica often occurs from a slipped disc; however, not all cases of sciatica are from slipped discs; and you can get sciatica without having a slipped disc. There are a myriad of ways a disc can slip. 

You can help prevent sciatica by adopting better posture and lifting techniques at work, stretching before and after exercises, and exercising regularly.

Although most cases of sciatica pass within 6 weeks, sciatica can become extremely dangerous. If you are experiencing a tingling or numbness between your legs and around your buttocks, and have recently lost bowel/bladder control, and have sciatica in both your legs – you must contact a physician immediately. Our physicians can confirm a diagnosis of sciatica based on your symptoms and recommend appropriate treatment.

If you are suffering from any of the symptoms listed, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 241-6321

How we can help diagnose Carpal Tunnel Syndrome

The carpal tunnel is the space between a group of eight small bones in the wrist joint, and the ligament that links them to the lower neck. Carpal Tunnel Syndrome (CTS) is a medical condition which compresses the median nerve as it travels through the wrist at the carpal tunnel. The median nerve starts at C5 to T1 (the middle lower part of your neck), and travels down the front of the elbow, and into your hand. The nerve gives feeling to parts of your hand. Symptoms materialise as pain, numbness, and tingling in the thumb, index finger, middle finger, and the thumb side of the ring fingers. Due to this, sufferers tend to lose grip strength and if the problem persists, muscles at the base of the thumb may begin to waste away. 

Chances of suffering from CTS increase with obesity, repetitive wrist work, pregnancy, and arthritis. Diabetes has also been shown to have a weak correlation with CTS. There are some things you can do at home to help with CTS. But how can you know if you have CTS?

It has been suggested that there are exercises you can do at home to trigger the median nerve to exaggerate the symptoms. By placing our hands together as if one were praying, and ensure our forearms to our elbows are in a horizontal line, people suffering from CTS are said to feel their symptoms exaggerate. However, this is not a full diagnostic – and will not suffice to tell you if you are suffering from CTS.

We offer full a diagnostic test. An electrodiagnostic supplies us with objective evidence that will tell us if you are suffering from CTS or another medical condition. This helps rule out other medical conditions that mimic the symptoms of CTS, such as cervical radiculopathy.

The symptoms of CTS are equivalent in many ways to cervical radiculopathy (a neurological condition characterized by dysfunction of cervical spinal cords). With home tests, it is easy to conflate the two. Both issues result in numbness pain and weakness in the hand. With an electromyography, physicians can identify not only if you are suffering from CTS, but also – exactly where along the median nerve the problem lies. The root of the problem could be proximal to your lower neck, the median nerve itself, or the three fingers. Our diagnosis will precisely pinpoint the genesis of the condition.

The electrodiagnostic also identifies if patients are suffering from what is called double crush syndrome, where patients suffer from both CTS and cervical radiculopathy – which is increasingly common.

It is important that if you are experiencing the symptoms, you contact us immediately to discuss options. CTS is most easily treatable in the early days, the longer it is left, the higher chance of irreparable damage being caused. Get an accurate diagnosis.  

Mount Sinai specialize in CTS and pain management. If you experience any of the symptoms listed, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 659-8551 or (212) 590-3300

Introducing Parag Sheth

Introducing Parag Sheth – Mount Sinai’s Carpal Syndrome Tunnel Expert

This month, with our continued aim of ensuring our patients know and trust our physicians, Mount Sinai presents to you our long-standing Assistant Professor of rehabilitation medicine, Dr Parag Sheth. Dr Sheth holds a certification in Physical Medicine and Rehabilitation; his specialisation lies in Carpal Tunnel Syndrome (CTS).

Dr Sheth’s expertise is grounded in his rich and varied academic career. Beginning his studies receiving honors at Johns Hopkins University, Dr Sheth moved on to study at Stony Brook School of Medicine, and subsequently held the position of Chief Resident at St. Vincent’s Medical Center’s Rehabilitation Residency Program. Dr Sheth is now a fellow of The Mayo Clinic, where he specialised in Musculoskeletal Rehabilitation; and he has been with us at Mount Sinai for over 20 years. During his time practicing with us, Dr Sheth has always gone beyond the call-of-duty to ensure patient satisfaction.

CTS, Dr Sheth’s specialization, manifest itself as a tingling, numbness and sometimes pain in the hand and fingers. This is caused by a compression of the median nerve, which controls sensation and movement in the hand. It can sometimes be hard to identify as the symptoms are common and often go unchecked. Dr Sheth is renowned for his ability to exercise expert judgement on patient’s symptoms, but always communicates in way understandable to the patient; we believe this to be paramount to a patient’s happiness. Dr Sheth has often been praised for his ability to listen carefully, and explain the process of treatment and aftercare in a concise and easy to follow way; this has made him a patient favorite. 

His clinical focus also extends to: back pain, electrodiagnostic testing, epidural steroid injections, herniated disk, knee pain, low back pain, shoulder pain, neck pain, and spine stimulation.

Outside of his professional career with us, Dr Sheth also teaches a yearly cadaveric dissection and weekly musculoskeletal lectures where he has been awarded the Avital Fast Award and the Department Teacher of the Year award. His research has been published in Nature, Lancet, and The American Journal of Sports Medicine. 

Dr Sheth is “Board Certified” and accepts insurance plans. For more details on appointment availabilities and plan coverages, please contact our call center at: (212) 241-6321.

What Causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is the compression – and sometimes squashing – of the median nerve that passes through the wrist. Its symptoms can include numbness, tingling and pain in the thumbs, fingers and wrists, which can travel as far as to the arms and even to the shoulder. Modern medicine has a firm grip on what CTS is; what causes it is quite a different story.

Diagnosing CTS can be done through a relatively simple physical examination. One test is called the ‘flick signal’, for which the patient is asked, ‘what do you do when your symptoms are worse?’ If the patient responds with a hand movement that resembles the shaking of a thermometer, there is good reason to suspect CTS. There are plenty of other tests such as Phalen’s Test and Tinel’s Sign – yet, despite the relative wealth of ways to diagnose CTS, there actually isn’t any kind of test to identify the precise cause CTS, and – except for patients suffering from underlying diseases – the biological mechanisms that create this inflammatory disorder remain unknown. 

It is a common story that CTS is caused through repetitive and often high-stress tasks that involve the wrists and hands – typing, using a computer mouse, manual labour to even playing the piano. While the correlation between CTS and tasks of this nature is undoubted, there is minimal evidence to suggest any clear causality.

In fact, most studies today indicate that CTS’ causes go above and beyond mere so-called ‘workplace factors’ and that they are rather linked to ailments that cause swelling in the wrist (osteoarthritis and rheumatoid arthritis) and others that obstruct blood flow (hypothyroidism and diabetes). We also see CTS pop up in clusters within a family, which suggests that something genetic is at play. Lifestyle also appears to play a significant factor, as those who smoke, drink alcohol excessively, consume excessive salt and who are obese all show increased risk of developing CTS. Women are also three times more likely to develop CTS than men, particularly after childbirth and during menopause.

Despite the range of medical, physical, genetic and life-style related items that are linked to an increased risk in developing CTS, their relationship is that of a correlation and not one of cause and effect. A modicum of clarity might be achieved, however, by overlapping both ends of the spectrum – the ‘workplace effect’ with medical/genetic/lifestyle factors. When somebody is susceptible to CTS – whether it be through genetics, a medical condition or an unhealthy or stressful lifestyle – and they also subject their hands and wrist to frequent, repetitive task, the likelihood of suffering from CTS will be at its greatest.

If you believe you are at risk of developing CTS, we would like to encourage you to seek medical advice on how to prevent it; if you believe you might already be suffering from it, we suggest you speak to one of our specialists for a suitable treatment. The earlier CTS is treated, the more likely – and easier – a full recovery will become.

Neuroplasticity – The Brain's Repairing Mechanism

 Injuries to the head can result in long term damage to areas of the brain, varying depending on where on the head the injury was sustained. While a variety of therapeutic services can be employed to regain a certain level of functionality the brain also has a unique response to regional damage – neuroplasticity.

Neuroplasticity is the brain's ability to reorganize itself through lifetime creation of new neuron pathways. From birth developmental plasticity begins, as neuron branches and synapses form to process new sensory information. At the age of two or three, a child's brain has around 15,000 synapses per neuron. This is around twice as many as in the adult brain as neurons strengthen, weaken, and are eliminated with age. While this process slows down, the brain retains the ability to grow new neurons throughout life in response to new stimuli. One such circumstance under which the brain may begin to regenerate in this way is when a certain area of it is damaged.

Known as functional plasticity, in response to an area of the brain loosing functionality, often the surrounding healthy areas will take over those processes, restoring former abilities. Neurons which remain undamaged will grow new nerve endings to create new connections where the original links were broken due to injury. As well as restoring connections, undamaged neuron axons can create entirely new pathways, developing nerve endings that connect with other undamaged neurons, to carry out necessary functions. Especially in children, when damage is sustained in one hemisphere of the brain, the corresponding area in the other half of the brain may take on functions traditionally performed in the initial hemisphere.

One example of when natural adult neurogenesis (formation of new neuron endings) can occur is following a stroke. Strokes are caused either when a blood clot prevents sufficient oxygen flow to the brain or when a blood vessel bursts leading to internal bleeding in the head. If left untreated, a stroke can cause certain areas of the brain to cease to function. Strokes can cause long-lasting physical and psychological problems, however, the brain may attempt to compensate for permanent localized damage by re-routing function pathways.

Head injuries can cause debilitating damage that leave the patient with reduced functionality. Therapeutic rehabilitation, such as physiotherapy, occupational therapy, and speech therapy can go some way to recovering a patient's abilities, however, the body's natural propensity to repair itself, many also contribute to patient recovery following a localized head injury.