All posts by Legacy Neurosurgery

Keep Your Pain Under Control While on the GO

Keep Your Pain Under Control While on the GO

Get comfortable
Eliminate any items that could potentially alter your spinal alignment while seated. Remove any objects from your back pocket like a wallet or cell phone. If you are the driver, make sure your seat position is close enough to the steering wheel to avoid reaching.

 

Get out and move around
Sitting for prolonged periods of time will cause your muscles to tighten and can even lead to spasms. If driving, try to stop every 30-45 minutes for a brief stretch. If you will be on a long flight, make a conscious effort to get up every 30 minutes. Below are a few quick stretches you can do on your short break.

 

 

Bring along cold or hot packs
Back pain is often accompanied by inflammation. Ice can help to decrease inflammation and numb any soreness that is a result of prolonged sitting. Some individuals find heat to be more soothing to sore and tight muscles so utilizing heated seats or quick use hot packs can help to ease the ache as well.


 

 

 

 

 

 

 

 

 

 

 

 

Support your back with your feet
Good support for your back can be strongly influence by foot positioning. Your feet should both be positioned on the floor. Ideally you would like your knees to be at a right ankle in relation to your hips. You may have to modify your seat or utilize a foot rest to achieve optimal positioning.

 

 

 

 

 

 

 

Have a Diversion
The mind is a powerful thing, so if you are not the driver then use a book or movie to occupy your time. If you are the driver, try music or an audiobook to keep you mind off any pain that may arise from a long trip.

 

 

 

 

 

 

 

Image credit: https://www.pakwheels.com/forums/t/tips-for-maintaining-pain-free-posture-when-driving-a-car/442532

Image credit: https://wellness-centre.com.au/why-you-should-never-sit-on-your-wallet/

Image credit: https://praktispartners.com.au/latest-news/turn-t-rex-work/

 

 

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Sports Injuries

Well, we are in full swing of the summer! Speaking of swings, I hope most of you are enjoying my favorite game golf! I hope your swing looks as good as my daughters Maci’s after playing for only three months! I wish mine did as well, unfortunately, with the game of golf comes back and neck injuries all too frequently. To learn more about preventative measures stay tuned in the coming weeks we will post important steps to use to attempt to avoid injury.

Common injuries include musculoskeletal back pain and neck pain that can be treated with anti-inflammatories and physical therapy. More significant injuries can cause herniated discs in the neck or back. This can produce severe back and neck pain with or without radicular pain down the leg or arm. If the pain is down the leg or arm this is called sciatica. We can often treat these more significant injuries with the above and often with the addition of epidural steroid injections. These are outpatient procedures often done a couple of weeks apart for 2 to 3 injections. Of course, neural imaging is important to be obtained first. We perform these procedures and potential surgical intervention if needed at our outpatient spine facility- Legacy Surgery Center. Our team has vast experience with the performance of these and other spinal procedures which to be effective requires experience as well as fluoroscopic guidance.

Lastly, if a disc herniation causes intractable radicular (radiating) pain in the arm or leg (sciatica) refractory to the conservative care above then minimally invasive spinal surgery could be needed. At Legacy Spine and Neurological Specialists, we offer the most minimally invasive surgical solutions available anywhere in the world. These solutions range from micro decompression and discectomy surgery to the minimally invasive standalone lumbar fusion operations without the need for pedicle screws. These surgeries are performed through keyhole incisions less than 1 inch completely outpatient when medically appropriate.

To Learn more visit www.LegacyNeuro.com. Stay tuned for upcoming posts on prevention of golf and other sports -related back and neck injuries.

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Effects of Chronic Pain

Effects of Chronic Pain

Anyone that has experienced pain, whether acute or chronic, knows that it can affect multiple aspects of daily living.

The feeling that “I hurt everywhere” or “I have no energy” are common complaints associated with pain scenarios that are treated regularly here at Legacy.

Persistent pain is truly its own disease regardless of its underlying cause.1-3 This type of pain, which is also often characterized as chronic or intractable, has all the ramifications of a disease in that it may have pre-clinical and overt phases.4-6 Many recent and emerging studies clearly document that persistent pain exerts profound impacts on the body’s endocrine, cardiovascular, immune, neurologic and musculo-skeletal systems.7

According to an article on the complications of uncontrolled pain, there are three major classifications of complications associated with chronic pain.8

Deconditioning

“Overuse” of ancillary musculoskeletal tissue with degeneration

Decreased mobility

Obesity

Muscle atrophy

Contractures

Neuropathies

 

Hormonal

1.       Excess catecholamine production with hypertension and tachycardia

2.       Glucocorticoid excess or deficiency

3.       Hypotestosteronemia

4.       Insulin – Lipid abnormalities

5.       Immune suppression

 

Neuropsychiatric

1.       Nerve – Spinal cord degeneration

2.       Cerebral atrophy

3.       Depression/suicide

4.       Insomnia

5.       Attention deficit

6.       Memory loss

7.       Cognitive decline

 

 

Knowledge and understanding of pain complications only aides in better treatment of the entire patient instead of treating just the active pain site. Here at Legacy we always strive to provide comprehensive care by offering services from skilled and experienced healthcare professionals. There are many treatment options offered at our facility that have the ability to encompass multiple body systems that could be affected by chronic pain. Whether the patient’s needs are medication therapies, minimally invasive surgical intervention, spinal injections, diagnostic studies, or physical therapy ▬▬ the Legacy Team is well-equipped to assist their patients back to a better, more functional way of living

 

  1. Brookoff D. Chronic pain: A new disease? Hosp Prac. 2000. 7:1-13.
  2. Murphy K. Chronic pain syndrome: What is it: And how can we help? Am Pain J Management. 1994. 4:129-31.
  3. Carver A and Foley K. Facts and an open mind should guide clinical practice. Curr Neurol Neurosci Rep. 2001. 1:97-8.
  4. Curlje O, Von Kostt M, Simon CE, et al. Persistent pain and well-being: a WHO study in primary care. JAMA. 1998. 280:147-151.
  5. Liebeskind JC. Pain can kill. Pain. 1991. 44:3-4.
  6. Mantyselka BT, Turennen J, Ahonen RS, and Rumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003. 290:2435-2447.
  7. Chapman RC and Gavin J. Suffering: The contributions of persistent pain. Lancet. 1999. 353:2233-7.
  8. https://www.practicalpainmanagement.com/pain/other/co-morbidities/complications-uncontrolled-persistent-pain?page=0,1
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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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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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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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