All posts by Legacy Neurosurgery

Sciatica

Sciatica is a painful condition of the nerves in the lower back that is associated with a variable degree of pain, numbness, tingling and weakness of one or both legs. Often it is self limited and resolves on its on. However, it can be persistent and need treatment. It is usually due to a ruptured or herniated or bulging disc. Discs are the cushions between our vertebrae of the spine. Normally these function as shock absorbers of the spine but over time the normal covering of the disc- the annulus- can become weak and allow the central part of the disc- the nucleus- to become displaced outside its normal location. If this displacement is adjacent to one of the nerves that run from the lower back into the legs it can produce sciatic pain.

Non-operative Treatment can consist of any or all of these options for those cases that do not spontaneously resolve:

* Spinal Exercises, Traction and other forms of spinal therapy

* NSAIDS

* Neuropathic medications such as Gabapentin

* Course of oral steroid medications

* Spinal Epidural injections In refractory cases minimally invasive microsurgical decompression and/or discectomy is a very safe and effective treatment.

 

At Legacy we offer this surgery for most patients at the outpatient surgery center through a MIS (minimally invasive) 1 inch or less incision. The success rate in terms of pain relief, return to work, return to ones sports or other activities of life are outstanding. Usually within 4-6 weeks most patients are able to resume normal activities. Patients with sedentary type work can usually return to their job in 2-5 days.

 

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Cell Phones and Neck Pain

Cell phones and neck pain

A new catchphrase in the health care world is Text Neck. It is a term that describes neck pain and damage sustained from looking down at a cell phone, tablet, or other electronic device for too long. In today’s society the cell phone is very much a necessity to most people and as a result, individuals begin to experience pain from overuse of these handy little devices.

 

Symptoms of Text Neck

  • Upper back pain (nagging pain to sharp, with or without muscle spasms)
  • Shoulder pain
  • Radiating pain in the arms or hands due to poor postural alignment

Treatment of Text Neck

  • Use handheld devices at eye level as much as possible
  • Take frequent breaks every 20-30 minutes
  • Physical Therapy
    • Core strengthening/stabilization exercises
    • Cervical musculature stretching
    • Soft Tissue Mobilization
    • Modalities for pain

 

The link below does an excellent job of explaining cervical spine anatomy and how it relates with neck pain, including “text neck”: https://www.spine-health.com/conditions/spine-anatomy/cervical-spine-anatomy-and-neck-pain

 

Image courtesy of: Always Connected. How Smartphones and Social Keep US Engaged\

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Cervical Radiculopathy

See below for some common symptoms and treatments for cervical radiculopathy.

  • Radiating arm pain and/or numbness and tingling
  • Usually due to a ruptured or herniated disc in the cervical spine or narrowing of the exit hole for the nerve also called neural foramen stenosis
  • May be also associated with cervical spinal stenosis which can lead to spinal cord damage or cervical myelopathy
  • If not associated with spinal cord compression can be initially treated with conservative care
  • Conservative options include: Neuropathic medications, physical therapy and manipulation therapy, Cervical Epidural Injections
  • Surgery is usually via an ACDF or anterior cervical discectomy and fusion from the front of the neck for refractory cases and/or those with severe neurological issues including spinal canal stenosis.
  • When indicated surgery is usually very successful and the benefits far outweigh the risks
  • Other causes less common of this type of pain may include shoulder disease, neuropathy, CTS, brachial plexopathy, vascular disease

Images obtained via google

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Medication Pitfalls

Medications are an incredible medical resource for the management and treatment of many neurological conditions. However, all medications have side effects and interactions. This is the case for every prescription, over the counter medication, or supplement a patient takes. For most commonly used medications, side effects and significant interactions are rare. The more medications a patient requires, the higher the likelihood interactions or side effects can occur.

Elderly patients are especially susceptible to medication side effects and interactions. When there is concern for dementia or memory and cognitive defects, medication-induced memory problems must be ruled out first. A number of meds for pain control, depression, allergies, incontinence problems, and a host of other issues can cause confusion in older patients. If the underlying cause is not addressed, patients can then be placed on additional meds for mood issues or agitation that further compound the problem.

Patients requiring multiple medications for pain control are also at high risk of side effects and interactions. Medications used to treat headaches, from prescription meds to OTC ibuprofen or acetaminophen, can cause rebound headaches. Long-term use of narcotic pain meds such as hydrocodone, oxycodone, and tramadol, can increase pain receptors in the body leading to more severe withdrawal and rebound pain symptoms.

It is important to recognize the risks associated with any medication, to make sure your physician is aware of the medications and dosages you are taking, and to be open to idea of reducing medications if your physician recommends it. Bring all of your active meds and supplements to all of your office appointments. Ask questions about the meds you are prescribed. Be cautious of overusing medications. Ask your physician if medications could be contributing to your current symptoms and if reducing those medications is a safe and reasonable option

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Sacroiliac Joint Pain

 

There are many causes for low back pain that are treated here at Legacy. One common condition that can often be overlooked originates at the sacroiliac (SI) joints. They are located where the ilium of the pelvis meets the sacrum—the left and right sides of the sacrum.  Strong ligaments and muscles hold the SI joints in place and allow only a few millimeters of movement when the body bears weight or flexes forward. Arthritic and certain age-related degenerative disorders may gradually erode protective joint cartilage, which can subsequently lead to instability and pain that can mimic some of the symptoms of lumbar pathologies.

How Do You Know If You Have an SI Joint Dysfunction?

Pain is a primary symptom of a SI joint problem.  Some patients experience difficulty sitting, standing, walking, bending, and lifting.  The pain and symptoms may mimic other types of lumbar spine (lower back) disorders.

Possible areas where pain may be felt:

  • Lower back
  • Hips
  • Buttocks
  • Groin
  • Thighs and legs (usually stops at the knee)

SI Joint Pain Treatments

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Medication to relax muscle spasms
  • Ice and/or heat
  • Sacroiliac joint brace
  • Physical therapy (to reduce pain and strengthen SI musculature)
  • Corticosteroid joint injections

 

Sources:

https://www.spineuniverse.com/conditions/sacroiliac-joint-pain/sacroiliac-joint-animation

https://www.medindia.net/patients/patientinfo/sacroiliac-joint-dysfunction.htm

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Brachial Plexitis (Parsonage-Turner Syndrome)

There are many causes of neck, shoulder and arm pain. Often the cause can be found in the neck where the nerves leave the spinal cord to innervate the arms. However, these nerves can also be affected by other compression syndromes, inflammation or injury as they course from the neck to the arm.

Parsonage-Turner Syndrome or Brachial Plexitis can cause symptoms such as shoulder pain, arm pain, loss of sensation, paresthesias and/or weakness in the affected arm. These symptoms are very similar to symptoms patients experience with neck pathology. However, the problem arises in the proximal shoulder where the brachial plexus is located, not in the cervical spine. The brachial plexus is a complex network of nerves that innervate the arm to provide movement and sensation. It is located in the lateral neck and proximal part of the shoulder. 

Many times there is no known associated injury or illness that causes brachial plexitis. Other times it can be triggered by a viral illness or an autoimmune response to a vaccination.

Fortunately, most patients will make a very good recovery with only supportive treatment. Treatments may include steroids, neuropathic medications such as Gabapentin and physical therapy. The diagnosis can be difficult and is often made by a neurosurgeon or neurologist. MRIs, EMG/NCV and physical exam are most commonly used to help confirm the diagnosis.

Picture from www.familydoctor.org

 

 

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Restless Legs Syndrome

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them for relief. Individuals affected with the disorder often describe the sensations as throbbing, polling, or creeping. The sensations range in severity from uncomfortable to irritating to painful.

Treatment

For those with mild to moderate symptoms, many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients. Physicians also may suggest a variety of medications to treat RLS, including dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. The drugs ropinirole, pramipexole, gabapentin enacarbil, and rotigotine have been approved by the U.S. Food and Drug Administration for treating  moderate to severe RLS. The Relaxis pad, which the person can place at the site of discomfort when in bed and provides 30 minutes of vibrations (counterstimulation) that ramp off after 30 minutes, also has been approved by the FDA.

Prognosis

RLS is generally a life-long condition for which there is no cure. Symptoms may gradually worsen with age. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. In addition, some individuals have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear.

 

For more information:

American Academy of Neurology www.aan.com

and

Restless Legs Syndrome Foundation

Provides educational materials on restless legs syndrome and related disorders to individuals, their families, physicians, healthcare providers and supports medical research into the cause and cure for restless legs syndrome.

3006 Bee Caves Road Suite D206

Austin, TX 78746

info@willis-ekbom.org

http://www.rls.org

Tel: 512-366-9109

 

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Laser’s in Spine – The Big Sting!

Learn more about the truth and fiction of Lasers in Spine procedures! Always get a second opinion if you feel like you are dealing with a Mr. Haney, The Sting, or the ole time “Snake Oil” salesmen.

Scott Schlesinger MD

Legacy Neuro

 

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Bell’s Palsy

Definition

Bell’s palsy refers to facial paralysis caused by a lesion or inflammation of the facial nerve. Symptoms resemble a stroke, with unilateral facial weakness. However, most facial weakness from strokes spares the forehead muscles. These are weakened with Bell’s palsy. Patients will have unilateral facial weakness that often causes difficulty with eyelid closure, dropping of the affected side of the mouth and reduced ability to wrinkle the forehead or the nose.

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Legacy MIS Fusion Surgery vs. Traditional MIS Surgery vs. Open Back Surgery Incisions

Legacy Surgery Center, and the surgeons at Legacy Spine and Neurological Specialists offer the state-of-the-art most minimally invasive fusion possible. The patient pictured in the first image below, underwent a lumbar fusion, an outpatient procedure,  using our special MIS (Minimally Invasive Surgery) technique. The patient returned today for a six week post-operative appointment, completely free of sciatica pain and with marked improvement in their quality of life. By using minimally invasive surgery, after conservative care failed, this patient was able to return to her normal activities very quickly after her surgery, short of any heavy lifting.    

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