The Flex-Bar Retractor Kit The set, except for the table attachment (black handle), is sterilized. At the appropriate time during micro-diskectomy, the large, solid retractor bar, is passed through a small slit in the drapes to a non-sterile nurse, who affixes it to the table attachment and tightens it into the position held by the … Continue reading Microdiskectomy for Lumbar HNP, Part 4
A Periosteal Elevator - its width is the length of the incision. With the patient asleep and turned prone, a metal marker is placed over the intended level and a portable X-ray is taken to verify. The small vertical midline skin incision is deepened to the tops of the spinous processes above and below the … Continue reading Microsurgery for Lumbar HNP – Part 1
When you need not wait for lumbar HNP surgery
Left - X-ray showing balance line created by lordosis. Right - MRI scan of normal lumbar spine; T = thoracic (w 12 pairs of ribs not shown). L = lumbar, S= sacral (a solid bone w rudimentary disc spaces) The intervertebral discs have three components that enable them to flex and twist while bearing lots … Continue reading What are the Lumbar Discs?
English National Institute for Health and Care Excellence (NICE) offered clinical guidelines for managing low back pain (LBP) in primary care. But guidelines were deemed just one of many aides to clinical decision-making. Physicians draw on personal experience, inter-professional networks and are constrained by organizational factors when deciding which treatment to prescribe, refer for, or … Continue reading Usefulness of Guidelines
The rate of ambulatory surgery for lumbar intervertebral disc disorders and spinal stenosis increased dramatically between 1994 and 2006 based upon a National Survey of Ambulatory Surgery. That's progress, due to the use of minimally invasive, same-day lumbar disc operations. However, another study has shown that the rate of lumbar disc operations that were combined … Continue reading Outpatient Spine Surgery?
The Laser Spine Institute, a startup in many large U.S. cities, folded in March of last year declaring bankruptcy, according to the Tampa Bay Times. As a neurosurgeon who taught laser neurosurgery for several years, I can say first-hand that the laser has no place in HNP surgery, Often a spine surgeon needs to tease … Continue reading Laser Spine Surgery
. IF pain nerves emanate from a spot in the center of a vertebra (?), a way to "kill" those nerves could relieve chronic back pain. A surgical procedure has recently been given FDA Clearance to do just that. It involves inserting a large needle under X-ray guidance, usually under anesthesia, into the center of … Continue reading NEW INVASIVE TREATMENT FOR CHRONIC BACK PAIN and FDA CLEARANCE vs APPROVAL
During this pandemic trips to the doctor are difficult to impossible, so consulting a doctor by video from home has become more common and now many insurance plans are helping patients to pay for these online sessions of "telemedicine". I think this makes the use of the LOBAK app more valuable, by letting you know … Continue reading Telemedicine
The Predictive Value Curves I developed in the 1980's for herniated disc diagnoses in LOBAK are now called ROC (Receiver Operating Characteristics) Curves, as shown. These curves have been used to gauge the value of tests for Coronavirus. Turns out that a positive test is quite predictive, but a negative test can be a false-negative … Continue reading Testing for HNP or Coronavirus
When an intervertebral disc extrudes through the capsule, it won't go back and often surgery is the only way to relieve the pain. Some extruded fragments go into the "armpit" (the axilla) of a nerve root. In those cases straight leg raising of the "well leg" (A), as illustrated, increases pain in the painful leg … Continue reading An Ominous Sign of a Lumbar HNP
Health Care Executives recently held a symposium on Intelligence in Surgery. They named three components; smart instrument systems, human understanding, and digital insights. Surgeons already have a lot of understanding about what they do, particularly in the O.R. My App LOBAK is an example combining human understanding with digital insight. It's a way of coding … Continue reading Future Surgery Will Be “Intelligent”
This is a rare kind of nerve disorder that can begin with numbness or weakness in the legs, or even one leg, and may have associated reflex losses. It could simulate nerve irritation from changes in the lower back, such as disc protrusion or spinal stenosis. I didn't include it in my list of other … Continue reading CIDP
You can get your report emailed, faxed, via the doctor's web site or sent by regular "snail" mail. This website (LOKAKAPP.com), under FAQ's describes when to get an imaging study for low back pain and how to evaluate the result. A full description of a report is at http://www.RadiologyInfo.org. The report should say what you … Continue reading Reading Your Radiology Report