JOIMAX, a world leader in minimally invasive spinal surgery technology will be launching a new endoscopic system for neck surgery on April 3rd to 5th at the International Society of the Advancement of Spine Surgery (ISASS) meeting in Vancouver, BC. This advanced surgical system called CESSYS (Cervical Endoscopic Surgical System) will provide an alternative to traditional open neck surgery and will change how neck surgery is done in the future!

Cervical disk herniation is a common cause of pain, stiffness, numbness and weakness. Traditional neck surgery involves a large incision, retraction of the voice box and food tube, removal of the entire disk, and fusion that may produce ugly scars, hoarse voice, swallowing difficulty and stiffness at the fused level. Cervical fusion also may involve future neck pain and surgery because the remaining disks must compensate for the fused level and may become damaged from excessive movement. An enormous amount of research has been focused on this adjacent level disease.

The artificial cervical disk was developed to avoid fusion and prevent adjacent level disease and future surgeries. Even though the artificial disk was welcomed with great enthusiasm, long-term results are unknown, and there is concern for the longevity of these man-made disks. Minimally invasive posterior cervical discectomy was another approach developed to avoid fusion and subsequent adjacent level disease, although unfortunately, most disks are not approachable through the back of the neck. This has led to development of an endoscopic discectomy through the front of the neck, similar to, but less invasive than the traditional open neck surgery.

Endoscopic spine surgery has become a popular alternative to traditional spine surgery. The endoscope is a pen-sized, high-definition video camera that is inserted into the spine under x-ray guidance. The endoscope allows the surgeon to find and remove the herniated portion of the disk under direct visualization with very tiny instruments, relieving pain and suffering. Advantages of endoscopic surgery include a tiny skin incision, minimal tissue damage and pain, quicker recovery and same-day discharge.

JOIMAX designed the CESSYS cervical endoscopic surgery system to minimize tissue damage and be versatile enough to remove most disk herniation without the need of fusion, with the objective of decreasing the need for future surgery. The CESSYS cervical endoscopic surgical system will be available in the United States in the fall of 2013 to select JOIMAX instructors and faculty, including Dr. Carl Spivak.

August 23, 2014

Yoga can be an excellent way to improve flexibility and mobility of the spine, as well as core strength. It is also an excellent tool for opening up the chest and relieving an over-stretched back and shoulders, as well as strengthening the core. Core strength is an important part of a healthy back. A strong core supports the spine from the front.

Over-stretched muscles are weak muscles. Working on a computer, driving, texting and many other aspects of the modern lifestyle all cause the shoulders to come forward by shortening the muscles of the chest. This leads to the muscles of the back becoming over-stretched and weak. Many yoga poses focus on opening the shoulders and chest, which relieves the over-stretched back and can allow the muscles to begin to return to their normal position.

Since yoga is full of isometric exercises, it can also strengthen weakened back muscles, which can often be a problem for people who have had chronic back issues. Building strength in back muscles help support the spine, which can sometimes improve lingering back issues that persist after surgery. Sometimes these issues come from muscular imbalances due to compensating for the injured spine. Yoga can help to reverse these imbalances and restore muscle tone.

Nonetheless, some yoga poses could cause injury after surgery, depending on the type of surgery and the area affected. It is important to speak to your surgeon or physical therapist about movements or positions you should avoid before taking a yoga class. When you take a class, make sure to arrive early so that you can speak to the instructor and inform him or her about your condition and your specific needs. Restorative yoga is probably a good place for most spine patients to start, especially if they have never done yoga before. It is important to defer to your physician or physical therapist’s advice.

August 10, 2014

Many of my patients ask me if they can receive a massage after the spine surgery. I always encourage them to see a licensed massage therapist after their incision site or sites have healed fully. It is important for the spine patient to tell the massage therapist where and what kind of spine surgery they received. Some massage therapists may ask for a doctor’s note or clearance before massaging a client who has received spine surgery recently.

I am happy to clear my patients for massage, as it can help improve circulation to ischemic muscles and help muscles that are both too tight and overstretched. Chronic back pain can lead to postural compensation patterns which can continue even after the back injury is repaired. When paired with physical therapy or exercise, regular massage can help stimulate the muscles to return to their proper postural alignment. Massage therapists can also sometimes help patients stretch and work on improving patients’ active and passive ranges of motion.

Massage also relaxes the patient, which allows the body to rest and heal. A relaxed patient has a better overall prognosis than a stressed patient. Massage is becoming a part of a more integrated, holistic way of looking at modern medicine. Though I work principally on the spine, I make sure that my patients also try to take care of their muscle. It is unfortunately quite common that patients experience back pain after spine surgery. This is often caused by tight or overstretched muscles rather than a dysfunction of the spine. Unfortunately muscles don’t just snap right back into place on their own after spine surgery, but through a combination of physical therapy and massage, the spine patient can restore his or her body to a strong, healthy, comfortable postural alignment.

August 6, 2014

The spine is supported by many muscles in the back, but it is also protected and supported by the muscles of the abdomen or core. Many people do not realize how important it is for the spine to be supported in both the front and back. It is especially important for those with a weakened spine or back muscles to develop strength in the abdominal muscles.

Core strength can be built with exercises that do not strain the back. Many people find that standard crunches, sit-ups and other abdominal exercises are painful, especially if they have a tight or injured lower back. Instead of doing these back straining workouts, which could ultimately do more harm than good, simply increasing one’s time in the plank and side plank positions is very beneficial for strengthening the core. If you have trouble with the standard plank at first, you can modify it by lowering your knees and work up to standard form. Both of these exercises are simple ways to build core strength without hurting or straining the back. Many back patients are found to have a weak core, which can increase their pain and suffering, as their spine lacks frontal support.

Plank Pose for Core Strength

Plank Pose

Side Plank for Core Strength

Side Plank

If you can hold both plank and side plank poses for at least a minute each, work on increasing to three minutes. Once your core is strong enough to hold both poses for at least three minutes, you might want to ask your doctor or physical therapist if pilates or yoga might be good methods for continuing to build core strength.

Images courtesy of YogaOutlet.com

July 9, 2014
Several of my patients have asked me if losing weight could help take pressure off of their spine and help ease their back pain. The answer is slightly more complex than a simple yes or no. Simply losing weight through the alteration of diet could diminish muscle mass, which could actually lessen the support that the spine is receiving.

On the other hand, a healthy diet when combined with a mixture of strength training and low impact cardio can help build new muscle and support the existing muscle while losing fat. As muscle is higher density than fat, the scale might not accurately predict the changes occurring in your body. It is important to track measurements with a tape measure as well as weighing in on the scale.

Resistance training is very important to helping minimize back pain. Strengthening the muscles of both the back and abdomen help to support the spine and decrease back pain. Strong muscles in the torso can do quite a lot to help support a compromised spine. Mobility training such as yoga or pilates can help increase flexibility and range of motion in those who have back pain or who have had back surgery. Exercise that is too fast or high impact should be avoided, as well as activities that involve twisting the torso.

As every patient is different, it is important to consult your doctor or physical therapist before you begin a new exercise routine. They should be able to tell you specific exercises that could help, as well as those you should avoid.

Can Zumba Hurt My Back?

by Carl Spivak

July 7, 2014
Recently I have had a couple patients ask me if they could participate in Zumba classes without putting their backs at risk. Unfortunately, I cannot recommend this low-impact dance aerobics class for those with a bad bad or those who have undergone back surgery. Even though it is low impact, it is fast paced and often performed on a hard surface. The quick movements, many of which twist the spine, combined with a hard surface can do much to throw off the alignment of the spine and exacerbate existent back problems. Zumba can also damage the back by increasing the pressure of existent muscle, skeletal or postural imbalances. For these reasons, I generally do not recommend that my patients take Zumba classes unless they already had a vigorous fitness routine that would help their body adapt to the movements of Zumba.

Other exercises I recommend to my patients who have undergone spine surgery or who are receiving treatment for back pain include Pilates, Soul Cycle, Restorative Yoga, swimming, walking, and resistance training with weights or bands. Low impact exercise is generally best for those with back problems, but low impact is not the only thing to consider, as we can see with Zumba. High speed twisting of the torso is not advisable for a spine patient. Pilates often involves twisting, but at a slower speed and more control. If you have any doubts about whether an exercise or workout is appropriate for you, it is best to check with your doctor to be sure. While a good workout can help your back pain, choosing the wrong one can do significant damage.

June 22, 2014

I see many patients who suffer from sciatica. These shooting pains in the lower back and legs can be debilitating. Sometimes surgical treatment is necessary to relieve this pain, but sometimes it can be brought under control or even eliminated with the proper exercises. Sometimes patients can be treated non-surgically with anti-inflammatory medications and pain relievers or steroids. These non-surgical treatments for sciatica are often paired with physical therapy so that the body can be trained to support the spine and protect the back from further damage or recurrence of sciatica. A program of gentle stretching and strengthening can often be paired with massage to help restore muscles that often stiffen or spasm due to back injury. A combination of pain and inflammation relief with physical therapy and massage or other soft tissue relief is ideal for returning the sciatica sufferer to normal daily activities and restoring range of motion.

While each physical therapy program is tailored to the individual patient, they often have many elements in common. People with back problems often have weakened abdominal muscles and tight back muscles. The hamstrings are also often tight in sciatica patients, so both massage or TENS treatment as well as stretching can be used. Strengthening the back and abdomen helps to support the spine and keep it in proper alignment. Weight training is often combined with stretching, Pilates, and low or no impact exercise to rehabilitate the body gently while medication controls the pain and inflammation. Ideally this treatment can postpone or prevent the need for surgery. Often this kind of conservative treatment brings the patient a good deal of relief from his or her symptoms and surgery is not necessary.

If the patient does need surgery, a minimally invasive approach combined with the above rehabilitative treatment can effectively treat the pain of sciatica. Depending on the cause of sciatica, a surgical patient often needs either a microdiscectomy or discectomy, or a laminectomy or laminotomy. All of these procedures can be performed using minimally invasive techniques, which allow for less anesthesia, little to no hospital stay, and a much faster healing time than traditional open surgery. Minimally invasive procedures do much less damage to the soft tissue surrounding the damaged disc or discs causing the symptoms, so physical therapy can begin soon after the surgery, which greatly increases a positive outcome.

June 11, 2014

When a patient undergoes endoscopic spinal fusion surgery, he or she must stay in the hospital for at least two days after surgery. The first day, someone from the hospital’s physical therapy staff (PT) will come to get the patient up and walking. It will be determined whether the patient needs a walker. Walking may be painful at first, especially if a bone graft was taken from the hip for the fusion surgery. PT will also show the patient how to perform basic daily tasks, such as getting out of bed, and discuss how to avoid putting stress on the spine after surgery.

On the second day, PT makes sure that the patient is walking independently and makes sure that he or she will be able to function at home. In order for the patient to be discharged, it is important that the patient be able to walk, go up and down stairs, and get in and out of bed independently. Some patients need a cane or walker for a couple weeks after surgery. This will be determined before the patient leaves the hospital.

Patients who have had endoscopic spinal fusion surgery, rather than traditional open spinal fusion surgery, can usually go home on the second day after surgery. Sometimes older or more frail patients have trouble walking or functioning independently after surgery and need extra rehabilitation. Usually the spine surgeon will be able to tell the patient ahead of time if he or she should expect extra rehabilitation after endoscopic spinal fusion surgery. After the surgery, the patient’s doctor, physical therapist, and occupational therapist will work together to determine whether the patient needs extra rehabilitation. Extra rehab can be done either at the patient’s home or at an inpatient rehab facility.

What Causes A Back Spasm?

by Carl Spivak

A back spasm is a sudden, painful muscle contraction in the back near the spine. It often occurs while lifting, pushing, or pulling a heavy object or performing some other action that would strain the back. The patient’s pain often increases within the next two or three hours after the injury, and any movement of the back usually causes severe pain. Sitting, standing and bending usually cause the patient great pain, and for many lying on one side in a fetal position offers the only relief from pain.

Spasms are more likely to occur if the muscle is already swollen or strained. If force is added, previously damaged muscles and tendons can tear. Any sport or job that requires twisting, pushing or pulling can cause a back spasm. Those with a weakened back from conditions like spondylolysis, spondylolisthesis, disc rupture, spinal stenosis, arthritis, are more likely to have back spasms. Similarly those with anterior pelvic tilt, tight hamstrings, weak muscles along the spine or in the abdomen are also more likely to suffer from back spasms.

The patient should rest as much as possible and treat the site of the injury with ice and compression. Muscle relaxants and anti-inflammatory medication and sometimes even local anesthetic injections can be used to treat the injury during first few days after the injury. Four or five days after injury, these treatments can be supplemented with massage or chiropractic care. As the severe pain of the injury begins to clear, the cause of the injury should be determined by the physician so that further treatment, such as strength training, physical therapy, or even in rare cases surgery, can be considered, depending on the reason behind the muscle spasm.

As people age the spine starts to wear out. The spine undergoes wear and tear from daily living, work, sports and accidents. This damage weakens the discs and facet joints, producing instability or abnormal movements of the spine. If this process continues, the spine may fall apart and one vertebra may slip forward relative to another vertebrae. This process is called spondylolithesis. Instability puts stress on the discs, ligaments, tendons and bones, which stimulates new bone formation to strengthen the spine and hold it together. This new bone formation is called bone spurs or osteophytes.

Bone spurs may pinch nerves inside the spinal canal. The spinal canal may be compressed in the center, outer gutters, exiting hole or just outside of the spine. Central compression is called central spinal stenosis. Gutter compression is referred to as lateral recess stenosis. If the nerve is compressed in the foramen or hole exiting between the vertebrae this is called foraminal stenosis. Lastly, if the nerve is compressed outside of the spine it is called far lateral stenosis. This may cause neck, arm, back and leg pain depending on the location of the bone spur. The pain may be associated with numbness, tingling and weakness.

Bone spurs may be seen on X-rays, CT and MRI. X-rays show irregular white areas in the spine. CT scan shows the size, shape and location of bone spurs best. MRI scan is good at showing if the bone spurs are pinching the nerves. EMG (electromyography) nerve studies can help confirm nerve irritation and injury.

Spinal injections may be used to determine if the bone spur is causing pain. This is called pain mapping. A spinal needle is placed where the bone spur is pinching the nerve under x-ray guidance. Numbing medicine is injected on the bone spur and nerve. If the bone spur is the cause of the pain, the pain will temporarily improve or stop.

Patients who do not benefit from conservative treatment may benefit from surgical treatment. Traditional surgery involved removal of the facet joint to take pressure off the nerve combined with spinal fusion and instrumentation to hold the spine together. Today back and leg pain may be treated with endoscopic foraminotomy.

Endoscopic foraminotomy a micro video camera is inserted through a very small incision onto the bone spur pinching the nerve. The camera projects the images onto a video screen so the surgeon can easily visualize the compression. Tiny instruments are inserted through the camera to decompress the nerve relieving pain and suffering. Advantages of endoscopic spine surgery include twilight sedation (usually avoid general anesthesia), very small incision (size of a finger nail), minimal postoperative pain and much shorter recovery then traditional fusion surgery.

Osteoporosis Spine Fractures: Cause & Treatment

May 12, 2014

The spine is made up of many bones called vertebrae. The front of each vertebrae is made up of a square shaped vertebral body, disc, and ligaments. The discs act to cushion the vertebrae, but if the vertebral body weakens or is injured by excessive force, it may break and flatten like a pancake, which […]

Read the full article →