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Herniated Disc

When discs are damaged by injury, disease or the normal wear and tear associated with aging, they may bulge or rupture, becoming a herniated disc (sometimes called a slipped or ruptured disc).

  • Introduction

    The bones of the spine are cushioned by small discs, which are round and flat with a tough, outer shell (capsule) that surrounds a jelly-like material (nucleus). When discs are healthy, they act as shock absorbers for the spine, keeping the spine flexible. When discs are damaged by injury, disease or the normal wear and tear associated with aging, they may bulge or rupture, becoming a herniated disc (sometimes called a slipped or ruptured disc).

     

    Although injury to the outer covering of a disc can cause pain, often a herniated disc by itself does not cause any discomfort. Pain occurs when pressure from the herniated disc is put on the nerve roots or spinal cord. Pain or numbness may occur in the area of the body affected by the nerve. For example, a herniated disc that presses on one of the nerve roots of the large nerve that extends from the lower back down the back of the leg may cause pain and numbness in the leg (a condition called sciatica).

     

  • Symptoms

    Many people who have a herniated disc are not aware of it because they have no symptoms of leg or back pain. Symptoms that do appear vary greatly, depending on the position of the herniated disc. If the herniated disc is:

     

    • Not pressing on a nerve, there may be a low backache or no symptoms at all

    • Pressing on a nerve, pain or numbness can occur in the area of the body leading from the nerve

    • Located in the neck, pain or numbness may be felt in the shoulders, arms or chest

    • Located in the lower back, sciatica may occur and cause leg pain and other nerve-related symptoms, such as weakness, numbness or tingling in one leg. Pain from a herniated disc in the lower back (sciatica) may be felt in the buttock and down the back of the leg to the ankle or foot. There may be low back pain, but it is usually not as severe as leg pain

     

    Nerve-related symptoms of a herniated disc include:

     

    • Tingling ("pins and needles" sensation) or numbness in one leg that can begin in the buttock or behind the knee and extend to the ankle or foot

    • Weakness in certain muscles in one or both legs

    • Weakness in both legs and the loss of bladder and/or bowel control, which are symptoms of a specific and severe type of nerve root compression called cauda equina syndrome. This is a serious problem that requires immediate medical help

    • Other symptoms of a herniated disc may include severe deep muscle pain and muscle spasms.

     

    Herniated Disc Causes and Risk Factors

    Herniated discs are caused by aging, degeneration of the disc (disc disease) or injury to the spine. Disc disease may result from tiny tears or cracks in the outer capsule of the disc, called the annulus. The jelly-like material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule. This causes the disc to bulge, break open or break into sections.

     

    Disc disease may develop as part of the normal aging process. After about age 30, the nucleus of a spinal disc begins to lose its fluid content, becoming less springy and more easily injured. Herniated discs can affect people of all ages, but they are most common in people between 35 and 45 years old who perform heavy manual labor or drive motor vehicles for long periods of time. Herniated discs can occur anywhere in the spine, but most occur in the lower back or in the neck region.

     

    Injury to the spine can occur from:

     

    • A sudden heavy strain or increased pressure to the lower back. Sometimes a sudden twisting movement or even a sneeze will force some of the jelly-like material inside the disc out through the disc's outer shell.

    • Activities that are done over and over again that may stress the lower back, including poor lifting habits, prolonged exposure to vibration or sports-related injuries

     

  • Diagnosis

    To diagnose a herniated disc, the consultation begins with a medical history. During a physical exam, the doctor looks for limitations on movement, pain, loss of reflexes or other symptoms when the patient moves his or her spine. Other procedures that can help confirm the diagnosis include:

     

    X-rays, which can help rule out tumors, injuries or abnormalities

    Magnetic resonance imaging (MRI), which can be helpful in detecting damage or disease in the soft tissues, such as the discs between vertebrae or ligaments

    Computerized tomography (CT scan), which can show the shape, size and nearby structures of the spinal canal

    Myelogram, in which an opaque dye is injected into the spinal column followed by an MRI or CT scan, can show pressure on the spinal cord or nerves from herniated discs, bone spurs or tumors

    Bone scan, which can detect fractures, tumors, infections and arthritis

     

     

  • Conservative Non-Surgical Treatment

    Degenerative Disc Disease, ddd, disc cartilage, vertebrae, skeleton, injection, with consrvative treatmentHere at the California Spine Institute we always consider non-surgical treatment first when managing degenerative disc disease and other neck and back ailments. Non-surgical treatment options are effective at treating the majority of neck and back disease. Some common non-surgical treatments include:

     

    Physical therapy – Often the first step in managing back and neck problems caused by osteoarthritis, we prescribe physical therapy, which improves flexibility and mobility and increases strength. Typical physical therapy treatments include exercise, massage, electrical stimulation, heat therapy, hydrotherapy (aquatic therapy) and others. The California Spine Institute has a fully equipped, state of the art physical rehabilitation center onsite.

    Chiropractic – Chiropractors typically adjust the spine in order to treat neck and back pain, deploying such techniques as manual manipulation (adjustment), applied pressure, and massage, of the vertebrae and joints. We provide a range of chiropractic services at our physical rehabilitation center.

    Pain management – Pain management covers a wide range of remedies, such treatments as injections, drugs and medications, spinal bracing and others.

    Alternative medicine – We have found that several non-traditional therapies including acupuncture, acupressure, yoga, biofeedback, and more are sometimes viable solutions for relieving back pain. Although supporting research is limited, many of our patients have reported relief from alternative medicine.

     

    In addition to medical treatment, there are a variety of things you can do to delay onset and lessen the severity of spine arthritis. These include:

     

    • Maintain a healthy weight

    • Maintain proper posture

    • Remain active and avoiding any extended periods of inactivity

    • Quit smoking, as smoking impairs blood flow resulting in nutrient and oxygen loss in spinal tissues

    • Wear comfortable, low-heeled shoes

    • Sleep on a mattress of medium firmness to reduce curvature of the spine

  • Conventional Surgery

    Surgery is recommended only if compressed disc symptoms become overwhelming and lasts for an extended period of time. Until recently, often this was a major operation that required general anesthesia, the dissection of muscle, removal of bone, manipulation of nerve roots, and, at times, bone fusion. Often, these types of procedures require large incisions and the manipulation bones and muscle tissue.

     

    Conventional back surgery attempts to solve this and other back problems with extreme measures—such as removing a spinal disc or fusing parts of the spine together, so that they no longer move independent of one another, significantly decreasing the spine's mobility, or ability to move freely. Too often, considering the risks and sustained trauma, these solutions fail to relieve the patient's pain or make it and the overall spine condition worse.

     

    It hurts just thinking about that. As you can imagine, major alterations like this to your spine (not to mention the huge access wound) take a long time to heal, several weeks or months. Full recovery, or returning to 100 percent original functionality, occurs infrequently. Also, this kind of surgery can require lengthy hospital stays, entails significant blood loss, and renders the patient vulnerable to several possible complications.

  • Minimally Invasive Spine Surgery

    Minimally Invasive Spinal Surgery (MISS) is a procedure for decompressing nerve roots and other tissues affected by a herniated disc, as well as several other types of back conditions. The term minimally invasive, of course, speaks volumes. It defines a category of procedures designed to do as little damage—to be as non-invasive and non-intrusive—as possible. Minimally invasive surgery, then, refers to surgical procedures designed to do as little collateral or malingering damage as possible.

     

     In other words, we perform the procedure with minimal disruption to:

     

    • The offending disc, joint, bone spurs, or facet area itself

    • The entry point and access path

    • The immediate area surrounding the problem area

    • The patient’s overall health.

     

    MISS is performed with micro instruments, fiber optics, lasers and digital imaging, as opposed to conventional highly invasive knives, bone saws and other equally trauma-inducing devices. Compared to conventional open back surgery, which usually entails huge incisions, displacing muscle tissue and nerve roots, and sometimes the removal of bone, MISS is without question much less traumatic. Also, it doesn’t destabilize the spine, unlike many conventional back surgeries. It can also be performed on multiple discs or other offending areas, even at widely spaced levels, during the same surgical session. Working on multiple levels with open back surgery often requires additional destructive entry wounds—far too much traumatic damage for patients to endure or recover from.

     

    Herniated discs—one of the more common back problems—for example, can cause pressure on the nerves in your spine, causing severe pain. Conventional back surgery attempts to solve this and other disc problems with extreme measures—such as removing a spinal disc or fusing parts of the spine together, so that they no longer move independent of one another. Either method significantly decreases the spine’s mobility, or ability to move freely. Too often, considering the risks and sustained trauma, these solutions fail to relieve the patient’s pain or make it and the overall spine condition worse.

     

    As you can imagine, major alterations like this to your spine (not to mention the huge access wound) take a long time to heal, several weeks or months. Full recovery, or returning to 100 percent original functionality, occurs infrequently. Also, this kind of surgery can require lengthy hospital stays, entails significant blood loss, and renders the patient vulnerable to several possible complications.

     

    MISS, on the other hand, is performed with very small “micro” instruments and tiny cameras inserted through a small tube. We also use x-ray, and other types of visualization technology to help guide the instruments, allowing us to “see” what we’re doing without cutting and clearing obstructing vital tissues and structures. We reach the offending disc through a very small incision. Damage to tissues and other vital structures in the immediate vicinity are, in nearly all instances, so minuscule that within a very short time the access point and path are healed, with little to no impact on the patient’s body and overall health.

    Minimally Invasive Spine Surgery viewed from two perspectives: Dr John C. Chiu of the California Spine Institute manipulating the micro probes and graspers, and footage from inside the disc of the instruments in action (including close-ups), cutting away a portion of the bulging disc, .

  • After Surgery

    There  are numerous advantages to MISS compared to open spinal surgery.

     

    (Note: Patients with large free fragments of disc in the spinal canal, as determined by the x-ray, cannot benefit  from the endoscopic procedure, but might benefit  from the arthroscopic procedure. However,  the laser can shrink the bulging disc further for disc decompression.)

     

    Some  advantages are:

     

      •Much less tissue trauma when compared to an open  surgical procedure

      •Hospitalization is not required, MISS is an outpatient  procedure

      •Faster recovery, since MISS is an outpatient procedure

      •Minimal to no scarring in and around the nerves post  operatively

      •Earlier return to work and to daily activities

      •Patients can begin an exercise program the day after  surgery

      •We estimate the cost of endoscopic surgery is 40% less  than conventional spine surgery

     

    Please feel free to contact my staff at (800) 354-8554 or email us at info@spinecenter.com any questions you might have concerning these procedures.

     

    Do you need a second opinion? Click here to fill out our Global Online Consultation form.

  • Advantages of Minimally Invasive Spine Surgery

    There are numerous advantages to MISS compared to open spinal surgery, including:

     

    An outpatient  or  “same day surgery“, no hospitalization

     

    Less traumatic

     

    Faster recovery

     

    Costs less - approximately 40% less than a open spinal  surgery/fusion

     

    Minimal to no scarring in and around the nerves post operatively

     

    Earlier return to work and to daily activities

     

    Patients can begin an exercise program the day after surgery

     

    Multiple level spinal discectomy can be performed at one sitting with minimal risk

     

    Can be done for high risk anaesthesia patients with morbid obesity, emphysema, and cardiac conditions under local anaesthesia/IV sedation at much less risk

     

    Preserves spinal motion

     

    After surgery, most patients require little analgesics

     

    MISS requires no hospitalization, allows for earlier recovery and earlier return to work and return to daily activities, when compared to conventional spine surgery.

     

    Please feel free to contact my staff at (800) 354-8554 or email us at info@spinecenter.com any questions you might have concerning these procedures.

     

    Do you need a second opinion? Click here to fill out our Global Online Consultation form.

     

     

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