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- Today's patients want to remain active.
They don't want a big surgery that's going to
cause them to be out of work for a long time.
Minimally invasive surgery allows them
to get back doing those things
such as return to work early,
getting back so they can go on vacation,
and really start enjoying their life again.
The traditional open procedures often had
more pain, more bleeding, and longer hospitalizations.
No patient wants that.
Patients come and see me for a lot of reasons.
Back and neck pain can be debilitating.
Sometimes this is accompanied with arm or leg pain.
That can really affect the activities
of daily living by a patient.
They can't perform their job.
They can't do the things that they like to do.
It's usually when their pain affects
their activities of daily living,
or their ability to go to work,
or just do the things that they want to do.
It may affect their sleeping habits,
so they're sleep deprived.
They can't go to the grocery store
because they can't walk far distances.
It can be very debilitating.
All new patients get a comprehensive
physical exam where we will assess
your gait, your strength, and your sensation.
Just take a few steps for me across the room.
The reason I assess the patient's
gait or walking pattern is I want to make sure
they don't have a limp or an antalgic gait.
I want to make sure they have no obvious signs of weakness,
or what we would call a pathologic gait
that might indicate compression of the spinal cord.
Very good. Get up on your tiptoes,
and on your heels. Excellent.
How far can you bend over?
And now lean back for me.
Very good. And now to me, and away.
Excellent. Go ahead and have a seat.
The reason I check range of motion
is I want to assess the patient's flexibility,
or where they have pain.
Is there more pain in flexion, or more pain in extension,
which might indicate to me where the source
of her disability is coming from.
Let's first assess the range of motion of your neck.
Look straight in the air,
chin down to your chest,
chin over to this shoulder,
chin over to that shoulder.
Very good.
Now I want to test how strong you are.
Arms up like this.
Don't let me push you down.
The strength confirms maybe
what the MRI is telling us.
Does she have weakness in her bicep?
That might be a C6 nerve problem.
Is there weakness in the triceps?
That might be a C7 nerve problem.
Or with her ankle dorsiflexors,
when her ankle moves up like this,
that might be an L4 or an L5 problem.
This is an MRI of the lumbar spine.
You can see we're looking directly from the side.
These are building blocks we talked about before.
The lumbar vertebrae.
This is L5, L4, L3.
In between them are the cushions
that we talked about before.
Those are the spongy parts that allow for motion.
In the back of the spine is a tube,
and that tube is full of nerves and fluid.
In this particular example, the tube is wide open.
We see no bone spurs.
We see no herniated discs.
There's lots of room for these nerves.
I wouldn't expect this patient
to have a whole lot of leg pain.
I also want to point out how healthy these discs look.
They're big and healthy looking discs.
This is an unhealthy spine.
Rather than having the big disc space,
you can see we have a lot of collapse
and degenerative changes of these discs.
There's some bone spurs out here in the front.
Then we look at the canal,
the tube where all the nerves are.
Rather than having a big canal
with lots of room for the nerves,
you can see, the nerves are pinched here and here.
This is what stenosis looks like on an MRI.
Here's an example of another MRI.
Again, this is the front of the spine.
This is the back of the spine.
Here's the tube with all the nerves.
Here are the vertebrae.
This is L4 and L5, and you can see these are the discs.
In this particular situation,
if we go down to L5 and the first sacral vertebra,
you can see that some of this disc material
is no longer in the shock absorber.
It's in fact in the canal, touching one of the nerves.
This is going to cause this patient
significant pain and disability.
I like to look at MRIs that are usually within 6 months.
Sometimes, as time goes on,
there can be changes in the spine
that require an updated MRI.
Perhaps the patient's pain pattern has changed,
and that would be another reason for an MRI.
The MRI is a road map for what the surgeon
might need to see when they're performing an operation.
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