FAQ – Back Institute Neurosurgery

Am I a Candidate?

Can I get a free review of my MRI report and also the actual MRI? Yes !

Patients can fax in their written MRI reports and also send in their actual MRI for a free review by one of our medical staff.

How do I determine if I am a candidate for a Non-Traumatic Discectomy at the Back Institute?

Potential patients can contact us by phone or by filling out the online patient form on our web site. A patient advocate will answer any questions. Back Institute medical staff will determine if you are a candidate for a Non-Traumatic Discectomy or another procedure. Back Institute offers a comprehensive analysis of the spine and our center treats all spine problems. We treat spinal conditions with the best procedure done in the least invasive way possible anywhere in the world.

Am I a candidate for a Non-Traumatic spine procedure if I have already had an open operation that didn’t work?

Yes, many spine problems can still be corrected following a failed surgery or can be redone using a non-traumatic method. Sometimes patients injure discs at different levels than what was treated in a previous operation. Non-Traumatic spine procedures will not create more instability in the spine and will not create more scar tissue, unlike an open revision surgery.

What are the risks of your Non-Traumatic procedures?

Complications are almost non existent at the Back Institute. Higher risk operations, such as laminotomy, foraminotomy, MED, and microdiscectomy are done around the country at other facilities. The description “minimally invasive” that centers are using has lost its significance. These so called minimally invasive procedures are actually very invasive because surgeons are cutting muscle and removing bone to get to the disc. They are just doing it through a smaller opening, so they call it minimally invasive. At the Back Institute, we do Non-Traumatic procedures, where there is no muscle cut, no bone removed, and no stitches.

Why don’t more surgeons around the country perform Non-Traumatic Discectomies?

The advancements in proprietary equipment and totally non-traumatic techniques that the Back Institute has made over the last 20 years make us the leader in performing Non-Traumatic Spine Procedures. Many surgeons around the country, even in the biggest centers, claim to do minimally invasive spine surgery when the fact is they are just beginning to learn how to do it.The problem is that the words “minimally invasive” have lost their meaning from over 20 years ago when the Back Institute pioneered the techniques. Today, surgeons around the country are using smaller openings in their procedures, but they are missing the point to “minimally invasive,” which is not to cut muscle, not to cut and remove bone, not to cause scarring, and not to alter the normal anatomy of the spine to get to the problem disc area.Spine centers around the country rely on clever marketing and catchy words like “laser” to attract patients, but they are missing the experience, expertise, credentials and technology to do a Non-Traumatic Procedure. In fact laser is rarely needed in any of these procedures, whether done at the Back Institute or elsewhere. Back Institute is the only center in the world that can accomplish these truly Non-Traumatic techniques, and that is why our procedure is a “Non-Traumatic Discectomy.”

Frequently Asked Questions

Why are Non-Traumatic spine procedures at the Back Institute better for me than surgical options at other facilities?
At the Back Institute, we perform the most advanced non traumatic procedures available with the most technologically advanced surgery tools and equipment. Some of our technology is only available at the Back Institute. With a Non-Traumatic Discectomy at the Back Institute, there is no cutting, no bleeding and no scarring. Patients are left with only a dot opening that is covered with a band aid. Our surgery center has the highest level of certification. From all aspects of surgery, the Back Institute is the safest and most advanced center for Non-Traumatic Surgery anywhere in the world.

Back institute is a prestigious institution at the highest level, and in fact ahead of the other top institutions (Ivy League, etc.) in the field of spinal non-traumatic access for disc disorders, which is why many doctors from these other top institutions have come to us for their own spine procedures!! The fundamental approaches for non-traumatic access spinal disc removal were invented here. Since 1986, we have developed a lengthy resume of peer reviewed publications (more than 40 in the non-traumatic access field) and have taught our advanced techniques around the world.

The fundamental approaches of non-traumatic access spinal disc removal procedures were invented here. We have developed a lengthy resume of peer reviewed publications and have taught our advanced techniques around the world.

Why is Back Institute Surgery Center of Beverly Hills the best and safest surgery center to have my procedure performed at?
Our surgery center has the highest level of certification available. From all aspects, the Back Institute is the safest and most advanced center for Spine Procedures anywhere in the world. All of the equipment is specific to Non-Traumatic spine care and doing more procedures in the least traumatic way possible.

What are the risks of your Non-Traumatic procedures?
Complications are almost non existent at the Back Institute. Higher risk operations, such as laminotomy, foraminotomy, MED, and microdiscectomy are done around the country at other facilities. The description “minimally invasive” that centers are using has lost its significance. These so called minimally invasive procedures are actually very invasive because surgeons are cutting muscle and removing bone to get to the disc. They are just doing it through a smaller opening, so they call it minimally invasive. At the Back Institute, we do Non-Traumatic procedures, where there is no muscle cut, no bone removed, and no stitches.

What type of anesthesia is used for Lumbar Non-Traumatic procedures?
Patients are given IV sedation and a local anesthetic. Conscious sedation and a local anesthetic are the ideal and safest way to anesthetize a patient for a Non-Traumatic Discectomy. Patients are very comfortable and are able to become fully conscious very quickly after the procedure

Can spinal stenosis or foraminal stenosis be treated?
The procedures done at our center can treat these conditions removing impingements to the spinal or foraminal canal and freeing the nerve. Pain and symptoms can be relieved.

How many spine procedures will I require to solve my back pain?
One procedure is usually sufficient to treat a patient’s spine problems. However, some patients need treatment at multiple levels and this can also usually be treated during the same operation. Very rarely a patient needs to return for a second surgery. There are rare cases where patients re-injure themselves and need to return for another procedure.

Am I a candidate for a Non-Traumatic spine procedure if I have already had an open operation that didn’t work?
Yes, many spine problems can still be corrected following a failed surgery or can be redone using a non-traumatic method. Sometimes patients injure discs at different levels than what was treated in a previous operation. Non-Traumatic spine procedures will not create more instability in the spine and will not create more scar tissue, unlike an open revision surgery.

Are there any medications that I should avoid before having a Non-Traumatic Discectomy at the Back Institute?
Patients should avoid any type of blood thinning medication whether over the counter or prescribed.

If a patient is taking a prescribed medication, such as Coumadin, please consult your doctor before discontinuing its use as a medication prior to surgery. If you are taking any other medications, please inform us at the time you schedule your procedure so we can instruct you on a case by case basis whether to continue them or not.

Can I drive after surgery? When?
Patients cannot drive immediately after a procedure. However, 24 hours after coming out of conscious sedation will be a safe time to start driving again.

I have a protruding or herniated disc. Can it be treated?
Yes. The main purpose for doing a procedure is to remove the offending disc material while not causing trauma to the surrounding tissues. Some centers feel that cutting the bone and freeing up some space around the problem is enough. Our position is that there is no need to dissect and traumatize the surrounding tissues instead of treating the disc herniation/protrusion itself.

How do I determine if I am a candidate for a Non-Traumatic Discectomy at the Back Institute?
Potential patients can contact us by phone or by filling out the online patient form on our web site. A patient advocate will answer any questions. Patients can fax in their written MRI reports for a free review by one of our medical staff. Back Institute medical staff will determine if you are a candidate for a Non-Traumatic Discectomy or another procedure. Back Institute offers a comprehensive analysis of the spine and our center treats all spine problems. We treat spinal conditions with the best procedure done in the least invasive way possible anywhere in the world

How long will I have to stay in Los Angeles if I am coming from out of town?
3 nights in Los Angeles is the typical stay for patients from out of town. We have a 2 day program in some cases as well. Patients do not need to stay overnight in the surgery center since the procedure is outpatient, however patients will get to enjoy 3 nights in a nearby Los Angeles or Beverly Hills Hotel.

What will my limitations be after having a Non-Traumatic Discectomy and will I have to miss any work?
Patients begin with passive therapy after the procedure (massage, ice, heat). After 2 weeks patients move on to pool therapy, and then at 4 weeks, patients begin active physical therapy. Most patients can return to work a couple of days after having the procedure. If a patient’s job is strenuous, then we recommend waiting 6 weeks or starting with light restricted duties such as desk work.

What arrangements do I need to make before having my procedure at the Back Institute?
Due to sedation, patients cannot drive themselves after a procedure. Patients need to bring all medications they are currently taking.

Why don’t more surgeons around the country perform Non-Traumatic Discectomies?

Because they are not able to actually do it, they just describe their work as the same thing, which it is not.

The advancements in proprietary equipment and totally non-traumatic techniques that the Back Institute has made over the last 20 years make us the leader in performing Non-Traumatic Spine Procedures. (Shown in over 40 peer accepted publications.) Many surgeons around the country, even in the biggest centers, claim to do “minimally invasive” spine surgery when the fact is their surgery is very invasive. The problem is that the words “minimally invasive” have no defined meaning. Today, surgeons around the country are not able to provide what is TRULY “minimally invasive,” which is not to cut muscle, not to cut and remove bone, not to cause scarring, and not to alter the normal anatomy of the spine to get to the problem disc area. Spine centers around the country rely on clever marketing and catchy words like “laser” to attract patients, but they are missing the experience, expertise, credentials and technology to do a Non-Traumatic Procedure. Back Institute is the only center in the world that can truly accomplish these actually Non-Traumatic techniques, and that is why our procedure is a “Non-Traumatic Discectomy”, with NO access damage.

What is the best way to learn about my treatment options if I think I have a herniated disc?
An MRI is the best way to tell what is going on in the spine. Your local doctor can prescribe one for you. You can then fax in the written report and mail the actual films or CD to the Back Institute for a free evaluation.

What causes a herniated disc?
There are many things that can cause herniations including falling, having an accident, aging, and working.

What should I do first to relieve the pain and symptoms of my herniated disc?
Many patients first try physical therapy, injections, pain management, or chiropractic care to relieve pain and symptoms. Sometimes these treatments may relieve pain temporarily, however they cannot cure a herniated disc. A Non-Traumatic Discectomy is the next safest option for treating a herniated disc.

Is it possible to have a herniated disc and not have the symptoms?
Yes, occasionally people have a herniation and don’t realize it. Symptoms can include pain, numbness, tingling or weakness.

If I already have hardware in my back, will it affect my procedure?
We will have to review your MRI results in order to determine this. Sometimes the hardware can be removed and sometimes we will be working at a different disc level, so the impact will be minimal.

How long is the rehabilitation period?
Patients walk out of the surgery center the same day and some fly back home the next day after their procedure. Many return to work within a couple of days. Desk work or non-impact work is required for 6 weeks. Physical therapy also lasts 6 weeks.

What is the difference between a bulge and herniation?
A bulge is when the interior part of the disc becomes irritated and begins to push on the outer wall of the disc. This can cause the wall to bulge and possibly put pressure on the spinal cord or the nerves exiting the spinal cord
A herniation is a more extreme bulge, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out. This tear in the disc ring can put pressure on the spinal cord or the nerves exiting the spinal cord.

I only want my mri reviewed by back institute. What do i do?
Please contact our office at 310.551.0690. A Patient Coordinator can assist you.

Is my insurance accepted?
Please call us at 310.551.0690 and provide us with your insurance information. We will be able to verify your benefits and tell you what services your insurance covers.

Questions to ask your doctor

Before you have a traumatic operation, please ask your doctor these questions

Is surgery recommended?
If surgery is recommended, what kind?
How big is the opening? Are stitches ever used?
Is general anesthetic used or can the surgery be done with local/IV?
Is bone/joint removed during the opening process of the operation?
Is Surgery outpatient?
How long is rehab?
Expected return to work date.
If you consult with a medical group, ask for the name of the doctor who will treat you and for his credentials. Then check these credentials on the medical licensing web site.

Conditions

Back Pain

Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.

The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be in the upper back, and might radiate into the arm and hand or or in the lower back, and might radiate into the leg or foot. Back pain may be accompanied by other symptoms other than pain, such as weakness, numbness or tingling.

Back pain is one of humanity’s most frequent complaints. In the U.S., acute low back pain is the fifth most common reason for physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.

Bone Spurs

Bone spurs, also known as Osteophytes, are bony projections that usually form along joints. Bone spurs form due to the increase in a damaged joint’s surface area. Most commonly it happens from the onset of arthritis. Bone spurs usually limit joint movement and typically cause pain.

Bone spurs grow naturally on the back of the spine as a person ages and are a sign of degeneration in the spine. In this case the spurs are not the source of back pains, but instead are the common symptom of a deeper problem. However, bone spurs on the spine can impinge on nerves that leave the spine for other parts of the body. This impingement can cause pain in both upper and lower limbs and a numbness or tingling sensations in the hands and feet due to the nerves supplying sensation to their dermatomes.

Spurs can also appear on the feet, either along toes or the heel, as well as on the hands. In extreme cases bone spurs have grown along a person’s entire skeletal structure: along the knees, hips, shoulders, ribs, arms and ankles.

Osteophytes on the fingers or toes are known as Heberden’s nodes (if on the DIP joint) or Bouchard’s nodes (if on the PIP joints).

Bone spurs may also be the end result of certain disease processes, such as osteomyelitis, charcot foot and some others.

Bulging Disc

A spinal disc herniation (prolapsus disci intervertebralis), informally and misleadingly called a “slipped disc”, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. Tears are almost always posterior-ipsilateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of nerve root compression. This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear.

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure.

Degenerative Disc Disease

Degeneration of the intervertebral disc, often called “degenerative disc disease” (DDD) of the spine, is a condition that can be painful and can greatly affect the quality of one’s life. While disc degeneration is a normal part of aging and for most people is not a problem, for certain individuals a degenerated disc can cause severe constant chronic pain.

With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, or there is pain in the buttocks or thighs while walking; sporadic tingling or weakness through the knees may also be evident. Similar pain may be felt or may increase while sitting, bending, lifting, and twisting. Chronic neck pain can also be caused in the upper spine, with pain radiating to the shoulders, arms and hands.

Failed Back Surgery Syndrome

Failed back syndrome or post-laminectomy syndrome is a condition characterized by persistent pain following back surgeries.

Failed back syndrome (FBS), also called “failed back surgery syndrome” (FBSS), refers to chronic back and/or leg pain that occurs after back (spinal) surgery. It is characterized as a chronic pain syndrome. Multiple factors can contribute to the onset or development of FBS. Contributing factors include but are not limited to residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and spinal muscular deconditioning. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is a risk for poor recovery.

Common symptoms associated with FBS include diffuse, dull and aching pain involving the back and/or legs. Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities. The term “post-laminectomy syndrome” is used by some doctors to indicate the same condition as failed back syndrome.

The treatments of post-laminectomy syndrome include physical therapy, minor nerve blocks, transcutaneous electrical nerve stimulation (TENS), behavioral medicine, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, spinal cord stimulation, and intracathecal morphine pump. Use of epidural steroid injections may be minimally helpful in some cases. The targeted anatomic use of a potent anti-inflammatory anti-TNF therapeutics is being investigated.

The amount of spinal surgery varies around the world. The most is performed in the United States and Holland. The least in the United Kingdom and Sweden. Recently, there have been calls for more aggressive surgical treatment in Europe (see infra). Success rates of spinal surgery vary for many reasons.

Treatment – It depends on the cause. If there is nerve root compression, then we can treat it directly. If there is just scarring, then it is treatable with pain management

Herniated Disc

A spinal disc herniation (prolapsus disci intervertebralis), informally called a “slipped disc”, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. Tears are frequently posterior-ipsilateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. It is normally a further development of a previously existing disc protrusion.

Pinched Nerve

Radiculopathy is not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly (a neuropathy). The emphasis is on the nerve root. This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.

In a radiculopathy, the problem is at or near the root of the nerve, along the spine. However, the pain or other symptoms may manifest in an extremity through a process called referred pain. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot. Polyradiculopathy is the name of the term for describing when more than one spinal nerve roots are affected.

Prolapsed Disc

Radiculopathy

Slipped Disc

A spinal disc herniation (prolapsus disci intervertebralis), informally and misleadingly called a “slipped disc”, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. This tear in the disc ring may result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of nerve root compression. This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear.

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosis are still intact, but can bulge when the disc is under pressure.

Sciatica

Sciatica (or sciatic neuritis) is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.

Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.

Spinal Stenosis

Word stenosis means narrowing. Stenosis means narrowing of the blood vessels. The same as vascular. Spinal stenosis means the main spinal canal is narrowed.

The term Spinal Stenosis does not reflect, which element of the spinal structures causes this narrowing. Many times bone growth creates it, something ligament tissue growth provides for it.

Most of the spinal Spinal stenosis cases, though, ave due to a significant disc bulge, prolapse, herniation or any other disk component which causes the symptoms. Any of these disk components are treatable which our non-traumatic access approach.

Spondylolisthesis

Spondylolisthesis describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. These “slips” occur most commonly in the lumbar spine.

Usually this condition is found on the films, especially flexion-extension X-rays. On these films it is easy to see that shift our relative to another when the person changes position.

A hangman’s fracture is a specific type of spondylolisthesis where the C1 vertebra is displaced anteriorly relative to the C2 vertebra due to fractures of the C2 vertebra’s pedicles.This condition usually does not need treatment. In very severe cases when the movement of the spine impinges on the nerves roots, fusion is recommended to stabilize the spine.