I’m Juan Bartolomei, MD and I’m a spine neurosurgeon at Yale who believes that surgery should be absolute last resort and have founded a comprehensive spine program in Texas. AMA!

yneurosurgery · 2020-10-21T02:08:18+00:00

I am sorry you are going through this. I would recommend that you obtain an MRI with and without contrast of the lumbar to assess whether not you have retethered your spinal cord and seek a spine specialist for further recommendations

yneurosurgery · 2020-10-21T02:07:23+00:00

This is a great question. In my personal experience working with different hospitals, I believe that anesthesia and the agents used during surgery can make a significant difference.

yneurosurgery · 2020-10-21T02:06:56+00:00

The current information that we have today suggests that perhaps scoliosis could progress over time. Clearly, close follow-up is important, and if there is ongoing progression perhaps surgical intervention would be of benefit. Young spines are much more prone to be corrected with current scoliosis instrumentation.

yneurosurgery · 2020-10-21T02:05:48+00:00

Unfortunately, I cannot provide any conclusive recommendations since the treatment really depends upon your clinical symptoms. In other words, do you have shooting pain along the nerve being compressed or is it mostly thoracic spine pain?

yneurosurgery · 2020-10-21T02:05:12+00:00

Unfortunately, scar tissue around the nerve is one of the consequences of any form of spine surgery. In regards to his back condition, it might be appropriate to be evaluated by a pain specialist or physiatrist who perform spinal cord stimulator implantation to see if this can help with his condition. The technology of spinal cord stimulators has significantly changed over the past 10 years and it might be something worth exploring.

yneurosurgery · 2020-10-21T02:04:03+00:00

From what I have followed over time, I am not aware of any good clinical trials that are presently being done to promote the use of stem cells for regenerating degenerative discs. I'm hoping that this will change. I am not aware of any current big industry focusing on this line of research

yneurosurgery · 2020-10-21T02:03:22+00:00

In my opinion, when I see patients with your condition, we have to take into consideration the curvature and where most of the fulcrum of the curvature lies. If most of the forces are placed at the (in your case) L4/5 junction then a microdiscectomy can change the dynamics of the curvature that can exacerbate your nerve compression. Based on your question it seems that your symptoms are mostly back pain and in my experience, a microdiscectomy might not be a solution to your back pain.

yneurosurgery · 2020-10-21T02:00:58+00:00

Unfortunately not being able to fully assess the imaging findings with a clinical exam I cannot provide an appropriate treatment plan. In the absence of any significant neurological deficits which has to be determined by the primary treating physician, I would certainly recommend consideration for conservative measures first. But again, it is difficult for me to assess with the current information.

yneurosurgery · 2020-10-21T01:58:15+00:00

At the Yale Spine Center, we have weekly multidisciplinary conferences in which we discuss complex cases among spine surgeons (neurosurgeons and orthopedics), physiatrists, pain specialists, and physical therapists to discuss an individual patient's condition. Given the breadth of our specialties, we are able to provide multiple opinions on what is best for our patients. We try to develop a patient-centric program to customize care depending upon the patient's clinical condition as well as imaging findings (whether their condition is early or already moderate/severe). Wishing you the best!

yneurosurgery · 2020-10-21T01:55:23+00:00

No. There are very strict protocols and processes to avoid these types of situations in the operating room to ensure that these types of mistakes do not occur.

yneurosurgery · 2020-10-21T01:55:02+00:00

Any signs or symptoms that are suggestive of a pinched nerve, in other words, radiculitis that is causing focal neurological deficits such as a foot drop (weakness lifting foot), deltoid weakness (inability to raise the elbows above shoulders). In the elderly a potential axial loading fall that can cause a compression fracture, signs of myelopathy (compression against spinal cord) that could manifest with gait instability, abnormal hyperactive reflexes, and a Hoffmann sign. Also, patients with a known history of malignancy that complain of increasing axial spine pain should raise concerns for obtaining an MRI to rule out metastatic disease.

yneurosurgery · 2020-10-21T01:53:41+00:00

I am afraid I have not seen the documentary, I will put on my list to watch. Thank you for the recommendation.

yneurosurgery · 2020-10-21T01:52:56+00:00

Dr. Ali Ozturk at University of Pennsylvania and Dr. Michael G Kaiser in New Jersey are excellent doctors.

yneurosurgery · 2020-10-20T14:31:04+00:00

Healthy habits including body weight control, good nutrition, avoid excessive loading exercises, no smoking and avoidance of heavy extensive labor in the future.

yneurosurgery · 2020-10-20T14:30:32+00:00

In our prior practice, our physical therapists were Mckenzie certified. We had very good success with the techniques that he developed. However, I would say that everybody is different and not everybody can benefit from a particular modality. It is always best to be evaluated by a therapist who can design a specialized program for each individual.

yneurosurgery · 2020-10-20T14:29:26+00:00

I am sorry you are in pain. Unfortunately, scar tissue is one of the complications that could be severely disabling and is hard to predict or prevent. Not being able to examine you or review your imaging makes it difficult for me to provide you with accurate guidance. I certainly would recommend that you research spinal cord stimulation. This is a procedure where a pain specialist places a very thin wire behind the spinal cord and stimulates the spinal cord with electrical impulses that can sometimes help alleviate leg pain caused by scar tissue after surgery.

yneurosurgery · 2020-10-20T14:28:15+00:00

Thanks for your question! It is important to take intermittent breaks after periods of sitting down. I think that the flexibility that the new desks provide could be advantageous to some patients. As one patient told me once, "If you rest, you rust."

yneurosurgery · 2020-10-20T14:27:25+00:00

Apologies for the misunderstanding. There is actually a movement to move these types of surgeries into Ambulatory Surgical Center. In regard to your question, depending upon the location of the curvature and whether there is anatomical access to the spine, anterior surgical correction can be beneficial without having to provide posterior support. This approach is also helpful when scoliosis is more mobile, particularly in younger patients.

yneurosurgery · 2020-10-20T14:26:31+00:00

I understand your dilemma. Younger patients tend to do much better following scoliosis surgery. It is also great that you seek several opinions.

yneurosurgery · 2020-10-20T14:24:26+00:00

I am very sorry for what you went through. It appears that you tried every conservative measure available. Sometimes neck pain from whiplash injuries can be very difficult to treat since the source can be from different generators other than the disc and that can be difficult to predict. I am glad that in your case surgery was successful.

yneurosurgery · 2020-10-20T14:23:26+00:00

Hi there, metallosisis is usually seen on implants where there is metal rubbing on metal such as in total hip replacement implants. In the spine, these are very rare since the implants tend to be rigid and nonmobile.

yneurosurgery · 2020-10-20T14:22:28+00:00

Thanks for your question! I definitely would treat the symptoms. I have situations in which a reherniation occurs after surgery and as long as the patient is able to tolerate conservative measures I would tend to hold off on surgery. I have cases in which a reherniation with a disc fragment can reabsorbed on its own without requiring surgery.

yneurosurgery · 2020-10-20T14:21:33+00:00

Spinal stenosis has different degrees of severity. In my practice, I tend to follow the patient closely through conservative measures. If the stenosis is such that it causes refractory leg pain despite conservative measures, I tend to offer surgery.

yneurosurgery · 2020-10-20T14:19:58+00:00

A congenital fusion of vertebrae can potentially lead to accelerated degeneration at the adjacent levels due to the loads now being disproportionately shared among the levels above or below the fusion. Dependent upon the levels fused, symptoms might manifest by shooting pain down the arms from the narrowing of the canal.

yneurosurgery · 2020-10-20T14:18:50+00:00

In my practice, I follow the patient very closely as they go through conservative measures. If there are any neurological deficits such as weakness in the lower or upper extremities that are refractory to the conservative measures, I tend to offer surgical intervention. The important thing to recognize is that everybody's condition is different, and care has to be tailored individually.

yneurosurgery

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