Are You a Candidate? Surgery for Back Pain with Dr. Dean Karahalioshttp://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=116Trying to live and cope with your back pain? Afraid surgery could make your pain worse? Dean Karahalios, MD, Neurosurgery at NorthShore, will take questions on minimally invasive surgical options for treating chronic back pain. Are you a good candidate? How long will it take to recover? Submit your questions early.Copyright 2014 NorthShore University HealthSystemPost at 2:54 PMBrenna: Our chat will begin in approximately 10 minutes. For more information on back pain and treatment options, explore our <a href="http://www.northshore.org/neurological-institute/centers-and-programs/back-pain-spine-center/"> NorthShore Spine Center</a> webpage.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1162:54 PMPost at 3:01 PMMohd: I am a tarlov cyst patient and it's asymptomatic. It was finally found when i had an MRI scan and it's around L1 to L2. i still continue to pain even after receiving a physio therapy. My doctor hasn't explained much but he said that I have no need to be worried with the cyst that i have. Will the pain get worse?<br/><br/>Dr. Dean Karahalios (NorthShore): These cysts are common, and usually asymptomatic. We only rarely treat them. Your pain may be from some other problem in the spine.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:01 PMPost at 3:03 PMTammy: How bad does pain/discomfort have to be to be a candidate for surgery?<br/><br/>Dr. Dean Karahalios (NorthShore): Everyone responds to pain in different ways. Only you can judge how bad it is. I would say that if it starts to affect your activities of daily living, or the things you like to do recreationally, it may be time to think about treatment.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:03 PMPost at 3:05 PMM: Do you brace your patients after L4-5 spinal fusion?<br/><br/>Dr. Dean Karahalios (NorthShore): It depends on strength of your bone during surgery. If someones bone is soft, then I do tend to prescribe a brace for a period of time.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:05 PMPost at 3:06 PMBetty: How long does it take to recover from minimally invasive surgery compared to normal back surgery?<br/><br/>Dr. Dean Karahalios (NorthShore): It depends on the condition and what is done, but typically recovery times are cut in half.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:06 PMPost at 3:08 PMDorothy: I have lower back pain that affects my lower limbs, especially my left leg. I had the shot in my back next to my spine and it did not work, infact the pain in my left leg got worse. After I had physical therapy and it helped a great deal, however, I still experience some stiffness and I still cannot walk up the stairs normally. It could be my RA that cause the stiffness. You did my partners neck, and he's doing great. So, what do you recommend for me? Thank You.<br/><br/>Dr. Dean Karahalios (NorthShore): I would have to see your imaging studies any examine you to see if surgery may be right for you.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:08 PMPost at 3:10 PMEileen: Have spinal stenosis,s pondelethesis, arthritic spine, have had numerous injections some last awhile others do not...causes numbness in right thigh and extreme burning, stabbing pain in lower back and hip...anything else that u have done other than surgery?<br/><br/>Dr. Dean Karahalios (NorthShore): It sounds like you may have tried all the things we would typically try before offering surgery. This is usually a mechanical problem that requiresa mechanical solution (surgery). It can sometimes be done minimally invasively.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:10 PMPost at 3:14 PMSonja: I have a buldging disc at my L5-C1; I have had sciatica pain in the past and it has always gone back in. However this past summer I did something and since then the buldge has not gone in. I have pain in my left calf and depending on how I move or sit, it does not subside. I did go through physical therapy when this 1st occured and it helped me to be able to walk and get back to work. However, I love to ride horses and do things and I am afraid to do anything that will cause it to flare up. What are my options?<br/><br/>Dr. Dean Karahalios (NorthShore): You should first be evaluated by your primary care physician. If you have any weakness, numbness or bowel/bladder changes you should seek immediate consultation ith a neurosurgeon. If not, your physician will then refer you to a physiatrist (pain management physician) for further conservative treatment such as; physical therapy, injections and /or medication. If you have no improvement with that, then you may need to have a microdiscectomy.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:14 PMPost at 3:23 PMHeather: Why is it that no doctor will say a spinal that was done for your c section messed up your back? They tell me to loose weight but I never had spasms and severe back pain after natural birth of 7lb baby.<br/><br/>Dr. Dean Karahalios (NorthShore): Spinal injections do not typically injure the spine. Pregnancy and chidbirth can damage the spine and cause pain.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:23 PMPost at 3:25 PMAnnette: Have one herniated and some degenerate disc in lower back.It cause for legs to have weakbess and crampy feeling. Right knee doesnot bend completely. Did phsyical therapy for over 10 weeks After Spinal injections. Can anything else be done besides surgery ?<br/><br/>Dr. Dean Karahalios (NorthShore): It sounds like you have done the usually conservative treatments we would prescribe before doing surgery. Assuming you are a surgical candidate (we would need to evaluate your imaging studies and examine you), surgery can sometimes be done minimally invasively.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:25 PMPost at 3:27 PMIke: How long do you continue to recover and improve after surgery? When can you expect to be at your "best" after having back surgery?<br/><br/>Dr. Dean Karahalios (NorthShore): I depends on your condition, and what you have had done. A simple microdiscectomy can take a few days to a few weeks. A fusion can take several weeks to months.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:27 PMPost at 3:29 PMAnonymous: I am a candidate for a decompression and fusion of L4-L5. I am 61 and have lead a very active lifestyle. I would love to return to some active sports such as golf, tennis, and Nordic skiing. I hope that I would not have to "baby" by back after surgery. How realistic is it to expect that I can participate in such activities as I have in the past<br/><br/>Dr. Dean Karahalios (NorthShore): You should expect to be able to return to your usual activites, including strenuous athletics, especially if the surgery is done using a minimally invasive approach.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:29 PMPost at 3:32 PMRobert: I was told I have Cervical Spine Spondylosis a few years ago after testing. It is causing pain and stiffness in the neck.Also hissing in ear and unbalance . I am 76 years old.Was told surgery may not help. Would it?<br/><br/>Dr. Dean Karahalios (NorthShore): It may be causing balance problems. Doubt the hissing in ears is related.We would need to see your iaging studies and examine you to give you a more precise answer.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:32 PMPost at 3:35 PMNikki: Is there a difference in treatment if a surgery is done by a neurosurgeon or a orthopedic surgeon?<br/><br/>Dr. Dean Karahalios (NorthShore): All Neurosurgeons are trained to do spine surgery. Some Orthopedic surgeons receive additional training in order to specialize in spine. Both Neurosurgeons and Orthopedic surgeons who are fellowship trained have advance skills in dealing with the more complicated spinal conditions.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:35 PMPost at 3:40 PMKen: My dad has suffered with lower back pain for as long as I can remember. What can I do to prevent the same problems from develping in my back?<br/><br/>Dr. Dean Karahalios (NorthShore): There is probably some genetic component (that you can't do anyting about). However, your general health and lifestyle are probably more important. Eat healthy meals, excercise regularly, keep your weight down, and don't smoke. This will lead to benefits in other areas as well. Do low impact exercises. Avoid running on hard surfaces and heavy lifting. Swimming and riding a bicycle are best.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:40 PMPost at 3:44 PMPaul: Assuming I have reached the point where conservative treatment (i.e. PT, Epidural) have not provided an acceptable level of pain and function, and my patience has been exhausted, what are the best things a patient can do prior to surgery? Do you see an increased level of successful outcomes with pre-surgical programs of weight loss, abdominal strengthening, etc. Would you recommend a patient delay surgery to accomplish these goals?<br/><br/>Dr. Dean Karahalios (NorthShore): It depends. If you have neurological deficits you shouldn't wait. If you feel that you can effectively excercise and lose weight, despite your pain, do so. If you smoke, stop.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:44 PMPost at 3:46 PMKyla: How much range of motion is lost after a fusion @ L3-L4?<br/><br/>Dr. Dean Karahalios (NorthShore): Probally none that you would notice, because the motion segments that are unfused above and below will compensate.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:46 PMPost at 3:49 PMRicky: Pain in back and legs have had 6 surgerys and have spinal stimulator in now to control pain. What else can I do?<br/><br/>Dr. Dean Karahalios (NorthShore): This is a very hard question to answer without seeing your imaging studies or examining you. That said, in general, more surgery is probably not the answer.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:49 PMPost at 3:50 PMBrenna: There are 10 minutes left in this chat. Please submit your final questions.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:50 PMPost at 3:51 PMHenry: What does rehab after back surgery involve? How long does it take?<br/><br/>Dr. Dean Karahalios (NorthShore): This depends on yoru condition, and what you have had done surgically. In general it involves exercises to restore flexibility and improve core strength. It usually takes 2-3 sessions per week for 4-6 weeks.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:51 PMPost at 3:53 PMJoe: Can spine "instability" be treated non surgically?<br/><br/>Dr. Dean Karahalios (NorthShore): It depends upon how much instability there is. However, this term is typiclly used to describe a mechanical condition that usually warrants a mechanical solution for stabilization (surgery/fusion).http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:53 PMPost at 3:55 PMPaul: I assume that you are enthusiastic about the use of an Aspen devise for MIS L4-L5 fusion. Are there some people for which it is inappropriate? Do you feel it has been used enough to warrant long-term confidence? What is the source of graft material in most people? Is it autograft? Do you ever use allograft? Which is the most effective? Does the graft ever fracture after it matures?<br/><br/>Dr. Dean Karahalios (NorthShore): MIS proceudres require fixation to promote fusion, and can be done using a number of technologies. Spinous process fixation can be used for some midline MIS procedures (also facet screws, translaminal facet screws, and cortical screws). The list of contraindications is long. That said, there are many clinical scenrios in which it is appropriate. I am confident of its long-term efficacy. I use local autograft and allograft. I dont recall seing any fractures throught a mature graft.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1163:55 PMPost at 4:01 PMBrenna: This was a popular chat, so we apologize if we were unable to answer all your questions. For more information or to request an appointment with Dr. Karahalios, visit his <a href="http://www.northshore.org/apps/findadoctor/physicians/dean-g.-karahalios?oqs=doctor%3dKarahalios"> Find a Doctor page</a>.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1164:01 PMPost at 4:03 PMBrenna: Thank you everyone for your participation in today's chat. Please check our online medical chat schedule regularly for upcoming chats. We also welcome topic suggestions.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1164:03 PM