Understanding the Symptoms

Back pain
Back pain is one of the leading reasons Americans visit a physician. Although back pain may occur throughout the back, it is generally experienced at the lower back, which supports most of the body’s weight. Low back pain occurs below the waist and can be sharp or dull, sudden or persistent, and is most commonly caused by muscle strain associated with extreme physical exertion, heavy lifting, bending, twisting, awkward positions and prolonged standing. Other causes of lower back pain:

• Injuries
• Small spinal fractures
• Ruptured (herniated) disc
• Inflamed or pinched sciatic nerve (sciatica)
• Misaligned or deteriorated vertebrae joints
• Narrowed spinal canal (stenosis)

Leg pain (hip, thigh, knee)
Conditions such as herniated disks and sciatica often cause pain in the legs. Sometimes this pain is not accompanied by back pain, making it difficult for the patient to identify the source of pain and making medical intervention all the more crucial.

Numbness, weakness, pain in neck, arms or legs
A variety of conditions of the spine, especially herniated disks, can lead to numbness, weakness or pain in the neck, arms or legs. Because these symptoms are often unaccompanied by back pain, it is difficult for the patient to identify the source of numbness, weakness or pain, and crucial that the patient seek medical intervention.

 

Possible non-surgical Interventions

Diagnostic

CT
CT (computed tomography), uses X-rays to provide images of the body. In contrast to conventional X-ray procedures, CT scans provide highly detailed 3-D images of the body by sending a beam of X-rays beam all around the patient, scanning from hundreds of different angles.

EMG & Nerve conduction studies
EMG (electromyography) measures the electrical impulses of muscles at rest and during contraction. EMG is used to detect damaged muscle tissue, nerves, and neuromuscular joints and diagnose disorders such as herniated discs, amyotrophic lateral sclerosis (ALS) or myasthenia gravis (MG).

Nerve conduction studies measure how well individual nerves can transmit electrical signals. Nerve conduction studies are used to detect damage to the peripheral nervous system, to help diagnose disorders such as carpal tunnel syndrome, and to pinpoint the location of sensations such as numbness, tingling or pain.

MRI
MRI (magnetic resonance imaging) uses powerful magnets and radio waves to generate images of the body. The level of detail provided by an MRI scan, unparalleled among other imaging techniques, makes it uniquely appropriate for studying the complexities of the spine.

X-ray
A spinal X-ray, like a typical X-ray, uses a focused beam of radiation to generate images of the body’s bones and organs. Spinal X-rays tend to focus on specific sections of the spine—neck (cervical), mid back (thoracic) and lower back (lumbar).

 

Therapeutic

Back bracing
By limiting the motion of the spine, or directing its growth and development, back bracing can often enhance the treatment and recovery process following spinal fractures, postoperative fusions and the diagnosis of scoliosis or other diseases that cause curvature of the spine. Braces can be either elastic or rigid and form fitting.

Medication
For the most part, medication only treats the symptoms of spine and back trouble, specifically back, leg, neck and arm pain. Pain management plays an important role in the treatment and recovery process for most back and spine patients. A number of non-prescription drugs, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), can alleviate pain associated with spine and back trouble. Prescription drugs commonly used to treat back, leg, neck and arm pain include narcotics and muscle relaxants. These drugs can be very effective, but carry the risk of physical dependence.

Physical therapy
Physical therapy targeting back pain, beyond decreasing the pain, is generally used to increase function and provide the patient with the knowledge and regimen to prevent further recurrences.

Physical therapy can include passive therapies such as the application of heat or ice packs, the use of electrical stimulation to target nerves, and ultrasound to penetrate and soothe soft tissue with sound waves.

Active physical therapy should involve stretching, strengthening exercises and low-impact aerobic conditioning. Routine stretching targeting a specific muscle group in response to a specific problem area—stretching the hamstring muscles for low back pain, for example—is perhaps the most important form of physical therapy for back and spine problems. A physician can prescribe specific strengthening exercises, such as dynamic lumbar stabilization. Regular low impact aerobic conditioning–walking, bicycling—should be performed in conjunction with both stretching and exercise.

SURGERY AT GRMC

The GRMC Spinal Surgery team is staffed by dedicated, experienced professionals. The minimally invasive surgery techniques are supported by the latest advancements in spinal surgery technologies, including a Carl Zeiss OPMI NC4 Surgical Operating Microscope and a state-of-the-art spine table. Patients that require overnight medical centerization will be able to take advantage of newly remodeled surgical floor rooms, including patient suites featuring a spacious room complemented by a large private bath, kitchenette, vanity, family sitting room, comfortable overnight accommodations for guests–even a flat screen television and gourmet room service.

If you suffer from pain, weakness or numbness associated with the spine or have other reasons to believe you might benefit from a visitation to the GRMC Spinal Surgery department, call Dr. Irvin Sahni at (830) 379-8800.

Surgeon
A native Texan, Dr. Irvin Sahni earned his medical degree and completed his residency in orthopedic surgery at Baylor College of Medicine in Houston. In 2003, he completed his fellowship in spinal surgery at Baylor. Upon completion of his education, Dr. Sahni established a home and practice in Seguin, where he’s developed a reputation as a skilled and knowledgeable spinal surgeon.

Types of Surgery

Anterior cervical fusion
Anterior cervical fusion addresses herniated cervical disks. Typically, a candidate for anterior cervical fusion experiences pain in the neck and arm.
Specifically, anterior cervical fusion involves a small incision in the neck, through which the soft tissues of the neck are gently moved aside, and the herniated intervertebral disc and bone spurs are removed. The space remaining between the vertebrae may be filled with a small piece of bone from a donor or from the patient’s hip—because it contains no blood cells, rejection of this bone graft is unlikely. Eventually, the vertebrae fuse together.

Anterior cervical fusion patients typically spend 3-4 nights in the medical center.

Kyphoplasty
Kyphoplasty addresses progressive vertebral body collapse/fracture (VCF) caused by osteoporosis or cancer. Typically, candidates for kyphoplasty experience debilitating back pain and, in the worst cases, loss of height due to spinal compression.

Specifically, kyphoplasty refers to the use of an orthopedic balloon and bone cement or other material to restore bone height and shape. The balloon is inserted through a small incision in the back and inflated to fill and expand the space left in the vertebra by the collapse or fracture. The balloon is deflated and removed and replaced with bone cement or other material.

Kyphoplasty patients typically spend 1 night or less in the medical center.

Lumbar fusion: anterior, posterior
Lumbar fusion addresses instability of the spine caused by fractures and other trauma and disorders such as degenerative disc disease. Typically, candidates for lumbar fusion experience low back pain and limited range of motion and are only considered for surgery following the unsuccessful completion of an extensive physician-directed non-surgical therapy regime.

Specifically, lumbar fusion refers to the practice of augmenting and replacing deteriorated bone material to trigger growth and fusion between the vertebrae to provide a greater degree of stability.

In posterior lumbar fusion, through a small incision in the patient’s back, the lower back muscles are gently peeled away to expose the bony covering of the nerve root, or lamina. Following a lumbar laminectomy, the nerve roots are gently moved aside, and the disc space is cleaned of deteriorated disc material before it is filled with an implant or bone graft—because it contains no blood cells, rejection of this bone graft is unlikely.

Anterior lumbar fusion is similar to posterior lumbar fusion, but the disc space is accessed through a small incision in the abdomen.

Anterior lumbar fusion provides greater access to the disk space, and allows a better opportunity to clean out deteriorated disc material, increasing the surface area available for fusion. The greater access also allows for the implanting of a larger implant or bone graft, providing greater stability and offering a more corrective fusion. Physicians often opt to perform both anterior and posterior lumbar fusion as part of the same surgery session.

Lumbar fusion patients typically spend 2-3 nights in the medical center.

Lumbar decompression
Lumbar decompression addresses pinched nerves, or neural impingement, caused by conditions such as a narrowed spinal canal (stenosis) or herniated disc. Candidates for lumbar decompression may experience lower back pain, limited range of motion, and numbness or weakness of the legs.

Specifically, lumbar decompression refers to the removal, through a small incision, of materials causing pain or pressure. Specific types of lumbar decompression include lumbar discectomy and lumbar laminectomy.

Typically, lumbar decompression patients spend 1-3 nights in the medical center.

Lumbar discectomy 
Lumbar discectomy, a type of lumbar decompression, addresses herniated lumbar disks and is the most common surgical procedure for low back pain. Typically, a candidate for lumbar discectomy experiences pain radiating from the buttock to below the knee.

Specifically, lumbar discectomy refers to the act of performing a lumbar laminectomy, gently moving aside nerve roots exposed by the laminectomy to remove a portion of or the entire herniated or ruptured disk.

Lumbar discectomy patients typically spend 1-3 nights in the medical center.

Lumbar laminectomy 
Lumbar laminectomy, a type of lumbar decompression, addresses pinched nerves, or neural impingement, caused by conditions such as a narrowed spinal canal (stenosis) or herniated disc. Typically, a candidate for lumbar laminectomy/discectomy experiences pain radiating from the buttock to below the knee.

Specifically, lumbar laminectomy refers to the removal, through a small incision, of a small amount of the bony covering of the nerve root, or lamina.

Lumbar laminectomy patients typically spend 1-3 nights in the medical center.