Sciatica or sciatic neuralgia is a commoncondition in which one of the spinal nerve roots of the sciatic nerve is compressed resultingin lower back, buttock and leg pain. Sciatic nerve is a large nerve derived from 5 spinalnerve roots: L4, L5, S1, S2 and S3. It runs from the lumbar spine through the buttockdown the leg and the foot on the posterior aspect. There is one sciatic nerve on eachside of the body. Typically, only one side of the body is affected.A typical sciatica pain is described as a sharp shooting pain in the lower back, downthe buttock, thigh and leg on one side of the body. There may also be numbness, burningand tingling sensations. The pain can get
worse with sitting, moving, sneezing, or coughing.The patterns of pain depend on which nerve root is compressed, and follow the dermatomedistribution. The most common cause of sciatica is a herniatedspinal disc. The spinal disc is a soft elastic cushion that sits in between the vertebraeof the spine. With age, the discs become rigid and may crack, the gellike center of thedisc may protrude out and become a herniation outside the normal boundaries of the disc.Disc herniation presses on the nerve root as it exits the spine.In majority of the cases the condition resolves by itself after a few weeks of rest and conservativetreatment. Pain relief, nonsteroidal antiinflammatory
drugs and muscle relaxants may be prescribed.Stretching exercises and physical therapy may be recommended.Surgery may be needed if the pain doesn't go away after 3 months or more of conservativetreatments. The herniated disc may be removed in a procedure called discectomy. Or, in anotherprocedure called laminotomy, part of the bone of the vertebrae may be cut to make room forthe nerve.
L5 S1 Fusion TLIF Back Surgery Tutorial O Arm CT Vail Colorado
this is corenman and we're going totalk about a transforaminal lumbar interbody fusion using minimally invasive micro surgical technique stealth and the O Arm this is a typical picture of a verydegenerative L5 S1 disc the disc has collapsed and you can seeblack vacuum phenomenon this is the MRI finding where you cansee the lowest disc
is much collapsed compared to theones above with bone signal changes indicatingstress fracturing this is a discogram where the twodiscs above the degenerative disk obviously normal with a cotton ballappearance and the L5 S1 disc is quite degenerative this is the technique of the pedicle screw insertion we start first
by putting a small frame on the spinousprocess which you can see protruding out of the blue sheets there we cover it with a clear sheet in order to protectthe sterility of the field this device is an O Arm it's an introoperative CT scanner and this device can lend us images not only front toback and side to side but top to down which
makes surgery much safer and much easier for insertion of the screws we're going to watch how this CT worksthe light on top comes on and you'll see this image spin around and this is the actual CT scan and howlong it takes this CT is onethird the typicalexposure of a standard CT performed in a
here are the tools that we use in orderto identify the levels the incisision has alread been made that device that is protrudingout is attached to the spinous process the device I am and holding identifies thelevel that we are at after identify where the screw is going to be inserted I use a small burr to create a starting hole once that starting holes is created
then i use a tool called a pedicle finder or pedicle to find the pedicle and this is done under direct visualizationyou'll see here that this device that i have has these ballsattached and these balls reflect off of a frameand is very similar to a GPS device you can actually insert
Cervical Foraminal Stenosis and Nerve Compression Neck Pain Colorado Spine Surgeon
a part of the cervical spine or neck that is important is the uncovertebral joint and that is this little triangularoutcropping of bone right here this point as we get older starts toenlarge and push against this point and that creates a spur the spur can live right in this areaand of course that spur is right where the nerve root exits and thereforethat spur can compress a nerve root and it's quite a common problem
for patients with neck shoulder and arm pain these are actual cervical vertebra these are out of people who've had degenerative arthritis and you can see here significant bone spur formation and right here i was talking about theuncovertebral joint you can see the nerve hole right here is quite narrowedbecause of those bone spurs growing into that area compressing the nerve
that is the bone spur from theuncovertebral joint that causes the nerve root compression.