Spinal surgery aims to stop spinal degeneration and improve your overall health. The process has a low infection rate, less blood loss, and shorter hospital stays. Typically, the minimally invasive surgical procedure leads to a seamless recovery process. Nevertheless, not every patient is an ideal candidate for Los Angeles back surgery, and you must consult with a qualified doctor. Dr. George Rappard is a certified surgeon and one of the top spine surgeons in Los Angeles. He can examine your medical history and explain different types of spinal surgery and their benefits and disadvantages. This information can assist you in making informed decisions that suit your physical activity level and lifestyle.
Myelopathy, Radiculopathy, and Importance of Surgical Procedure
An average individual is born with 33 bones (vertebrae) that interact and connect. By the time most people are adults, they have 24 bones. Your spinal column combines flexible tendons, ligaments, muscles, sensitive nerves, joints, and bones. While many people take the benefits of a healthy spine for granted, spinal pain is a reminder of how humans depend on their spine daily.
Damage to your spine makes enclosed nerves vulnerable to injury. Please note that this article focuses on the interventions required when a structural change to your spine affects the nervous system. Your spine is susceptible to degenerative aging changes like osteophyte changes and wear and tear.
The rationale for surgery is:
- Improving life quality for radiculopathy patients with signs and symptoms that they cannot medically manage, and
- Preventing further worsening of any myelopathic symptoms
Nevertheless, the choice to conduct surgery depends on the patient. You and your doctor should make it in the understanding of the benefits and potential risks and through informed consent.
Myelopathy is damage to your spinal cord, which can happen for many reasons. The most prevalent cause is when your spinal cord is squeezed or compressed. Typically, the compression disputes nerve transmission. You can compress your spinal cord due to spondylosis (age-related or degenerative changes in your spine) or arthritis of the spine.
The condition’s symptoms depend on the involved levels of your spinal cord and the involvement pattern. The symptoms can include:
- The clumsiness of your hands
- Numbness of your hands
- Hand and arm weakness
- Urinary urgency
- Neck pain
- Leg stiffness
The time of the manifestation of symptoms and progression varies with patients. Also, the progression rate changes over time. Symptoms can progress rapidly for a while before entering stability. Alternatively, your symptoms can progress gradually but steadily.
Since cervical myelopathy can have identical symptoms to other health conditions and you could have numerous symptoms, diagnosis of myelopathy can be challenging. Typically, top spine surgeons in Southern California evaluate their patients’ history before performing an exam. The surgeons can also order diagnostic tests like:
- Post-myelography computed tomography — Involves x-rays taken following injection of contrast material into the spinal fluid through a lumbar puncture. The procedure can offer images of your spinal cord interior and show spinal fluid sac indentation caused by bone spurs or bulging discs.
- Magnetic resonance imaging gives high-resolution spinal cord and cervical spinal canal images.
The spine consists of vertebrae. The spinal cord runs through the canal in the center of the bones. The nerve roots separate from the cord and run through the vertebrae to different body parts. When the nerve roots become pinched or damaged, the resulting symptoms are known as radiculopathy. The condition can affect any person.
Since nerves travel from your spinal cord to various body parts, patients experience different symptoms depending on the compressed nerve root.
Common types of radiculopathy include:
- Lumbar radiculopathy — Also known as sciatica, lumbar radiculopathy happens in your lower back. Patients will experience sensation changes, numbness, and pain in their lower back, foot, leg, buttock, or leg. Generally, the nerve roots making up the sciatic nerve are involved. If the nerves affecting your bladder and bowel are compressed, you will experience bladder or bowel incontinence.
- Thoracic radiculopathy happens when nerve root irritation or compression happens in your mid-back. Its symptoms include tingling and numbness, band-like pain, and burning pain in your abdomen, side, or rib. Since it is an uncommon condition, it can be misdiagnosed as gallbladder, abdominal, shingles, or heart complications.
- Cervical radiculopathy — It happens when the nerve root in your upper back or neck is compressed. Its symptoms include radiating pain, muscle weakness, and pain in your arm, neck, upper back, or shoulder.
Typically, radiculopathy happens with aging. As your body ages, your spine discs begin to degenerate and bulge. Additionally, the spine disc starts drying out and stiffening. Your body responds to the change by creating bone spurs to reinforce your discs. Regrettably, this narrows your nerve root exit, pitching your nerve.
Before diagnosing radiculopathy, a proficient spine surgeon in Los Angeles should review your medical history and conduct a physical examination. Depending on your symptoms, the medical practitioner can examine your hands, arms, shoulders, and neck.
The physician will check:
- Muscle reflexes
- Muscle strength
- Your posture
- For loss of feeling or numbness
Other diagnostic tests your surgeon can recommend include:
- Spine MRI
- X-rays to show bone alignment along the neck and determine any damage or narrowing to your discs.
- Electromyogram to determine the exact affected nerve root
Cervical Disc Surgery
The surgical procedure involves the removal of the disc pressing on your spinal cord or pinching your nerve. Depending on the location of your disc, your physician can remove it via an incision either at your neck’s back or front.
Then a procedure is carried out to close the space left after the physician removes the disc and restores your spinal cord to its original length. Typically, patients have the following options:
- Cervical fusion
- Artificial cervical disc replacement
The U.S. Food and Drugs Administration approved the first artificial disc that moves and looks like your real one in 2007. Since then, the FDA has approved many artificial discs. An artificial disc allows a range of motion and improves arm and neck pain as effectively and safely as a cervical fusion. Patients who receive artificial discs return to their daily activities quickly.
However, not every patient qualifies for the artificial disc. People with infection, joint disease, osteoporosis, inflammation at their surgical site, or allergic to steel are not ideal candidates for the procedure.
Regarding a cervical fusion surgical procedure, your surgeon will remove your injured disc and place a bone graft between your vertebrae. They can screw a metallic plate into your vertebrae below and above your graft to hold your bone as it heals. Your bone will finally fuse to your vertebrae below and above it.
While the surgical procedure is safe, it has risks like:
- Excessive bleeding
- Chronic neck pain
- Reaction to anesthesia
- Damage to your blood vessels, esophagus, vocal cords, nerves, or spinal cord
Typically, fusion can take between three (3) months to twelve (12) months before becoming solid, and you can experience some symptoms. Your skilled Los Angeles back surgery expert can recommend wearing a cervical collar that supports the neck. You can also accelerate your recovery by exercising, eating healthy diets, practicing good posture, and avoiding smoking. Before beginning any exercise following your surgery, please check with a doctor to see the activity level that suits you best.
Lumbar Decompression Surgery
Lumbar decompression surgery treats a compressed nerve in your lower spine (lumbar). Seasoned medical doctors recommend it when alternative non-surgical treatments fail.
The surgical procedure aims to relieve symptoms like numbness and persistent pain in your legs due to pressure on the nerves in your spine.
If the procedure is recommended, you will undergo at least one of the below:
- Spinal fusion — Where at least two vertebrae are joined together with a bone to strengthen and stabilize your spine
- Laminectomy — Where the surgeon removes a bone from one of the vertebrae to relieve pressure on your affected nerve
- Discectomy — Where the physician removes the damaged disc to relieve pressure on your nerve
Your surgeon can integrate these techniques.
The surgery is performed under general anesthesia. Generally, the procedure takes one hour but can take longer depending primarily on its complexity.
Many patients who have undergone the surgery experience significant pain relief. People who experience challenges walking due to leg weakness or pain can often walk with ease and further after surgery.
While the surgical procedure is safe, it has the risk of the following complications:
- Blood clot in the leg veins
- Infection at the surgery site
- Damage to your cord or spinal nerves leading to continuing symptoms or numbness in your leg(s)
Preparing For Your Surgical Procedure
If your spine surgeon in Los Angeles has determined that surgery can rectify your spinal challenge, there are numerous steps you can take to prepare for the surgical procedure. They include:
Depending on your overall health and age, your skilled surgeon can require you to have a checkup with your primary physician.
If you are a smoker, you should quit many months before surgery. Smokers are more vulnerable to severe complications following surgery like delayed recovery and wound infections.
Ensure you inform the medical practitioner about your smoking habit before the surgery to develop a quitting plan together.
Typically, it is unnecessary to donate blood for your surgery. Nevertheless, blood loss will likely happen during the surgery. Your Los Angeles back surgery expert should tell you the pros and cons of donating your blood versus using another person’s blood. If you decide to donate your blood, the surgeon can prescribe iron supplements to build up the blood before the procedure.
While you can walk following your surgery, you might require help with activities like shopping, laundry, cleaning, washing, and grooming. Therefore, make arrangements to receive assistance with the activities before the procedure.
Even after minor surgery, your surgeon can recommend you stop driving for a while. Consequently, you should arrange for transportation to and from the hospital in advance.
Pharmaceutical Care Following a Spinal Surgery
A patient undergoing either lumbar or cervical decompressive procedure can be admitted and discharged within twenty-four hours of the surgical procedure. Typically, you will require an assessment from top spine surgeons in Southern California to ensure you can be discharged safely.
Besides analgesia for surgical site pain, many patients do not experience substantial changes to the prescribed drugs.
Anticoagulants and antiplatelet drugs like aspirin, warfarin, and clopidogrel are stopped before the operation and bridged according to local guidelines. The pharmaceutical care ensures strategies to reintroduce the drugs after spinal surgery with monitoring, and the patient understands the plan during discharge.
Your surgeon can manage your postoperative nausea and vomiting using local guidelines.
You are also likely to experience spasms of the back muscles. The doctor can treat it with short courses like three (3) days of benzodiazepine. Typically, the surgeon should query the prescription and regularly review the need.
You can manage pain at the surgical site using paracetamol.
You are likely to experience neuropathic pain after radiculopathy. When relieving the pain, your surgeon should consider the withdrawal of anti-neuropathic pain agents. While no guidelines exist on withdrawal, the surgeon should do it gradually.
Dysphagia is a common complication in cervical spinal surgery. It results from interruption of swallowing nerves caused by neck manipulation and surgical area swelling. You may need the insertion of a nasogastric tube for the administration of medication and nutrition.
You should keep your spine properly aligned after the surgery. Your surgeon should teach you how to move properly, sit, stand, walk, and reposition. While in your bed, you should turn constantly using a log rolling technique. The technique allows your body to move as a unit, avoiding twisting your spine.
Find a Skilled Neurointerventional Surgeon Near Me
Degenerative aging changes like osteophyte changes and osteophyte changes and wear and tear can injure your spine, resulting in back pain, leg pain, and leg numbness or weakness. As a result, spine pain requires medical doctors to diagnose and treat. Before settling on spinal surgery, consider receiving the services from Dr. George Rappard, the best spine surgeon in Los Angeles.
When you consult us, we recommend you get an evaluation with your primary physician. Additionally, we can watch you over time and encourage you to maintain healthy physical activity and diet to see if your condition resolves. If the problem persists, we can perform spinal surgery. Please contact us at 424-777-7463 to learn how we can help you.