Miami Back Specialists based in South Florida is a team of pain specialists, doctors, and orthopedic surgeons who specialize in back pain. We offer urgent spine care and have same day or next day appointments available for new patients.

 

REQUEST A CONSULTATION

OUR TREATMENTS | ORTHOPEDIC SPECIALISTS

Our team of Doctors and Physician Assistants will work towards getting you a diagnosis and treatment plan within the same day or next day.




DR. GEORGIY BRUSOVANIK, MD
MINIMALLY INVASIVE SPINE SURGERY SPECIALIST
Learn More About Dr. Brusovanik

When conservative care fails to help and the patient continues to suffer, minimally invasive procedures may be an option. Dr. Georgiy Brusovanik MD, specializes in minimally invasive surgery, robotic and computer assisted surgery and motion preservation. He trained at Duke University department of neurosurgery and orthopedic spine surgery. He is the doctor for the Miami Dolphins, Miami Heat and Sony Open Tennis as well as the United States Kick boxing association. He is also the chief of spine committee at the Miami Medical Center. He has privileges in every major Miami hospital as well Jackson Memorial and the new, luxurious Miami Medical Center (as seen on the HBO hit series Ballers).




DR. SETH KAUFMAN, MD
BACK PAIN TREATMENT SPECIALIST
Learn More About Dr. Kaufman

Dr. Seth Kaufman has worked with some of the best spine injury surgeons in the world including those from John Hopkins Hospital and Mayo Clinic. With more ten years of experience, Dr. Kaufman offers non-operative, minimally invasive treatments and technology-guided procedures, such as the regenerative technology to induce therapeutic angiogenesis, for the treatment of several conditions, such as hip, knee, and shoulder arthritis, affecting the spine.



https://youtu.be/#
https://youtu.be/#

Treatment of Sciatica

Sciatica, or lumbar radiculopathy, is pain that is created when the sciatic nerve becomes compressed or otherwise irritated. Sciatic nerves run from each side of the lower back through the buttock and back of the thigh all the way to each foot. The sciatic nerve is the largest nerve in the body. It serves a major role in the connection of the spinal cord to the leg and foot muscles.

Sciatic pain may be felt in the lower back, hips, legs, and feet. It usually only affects one side of the body. The pain can feel like sharp stabbing, a dull ache, or numbness and tingling. Severity has a wide range. Some patients experience mild to moderate pain that comes and goes. Others have severe pain and weakness that interferes with daily activities. All types of sciatica are treatable.

Causes
Sciatica is not a diagnosis. It is usually a symptom of another condition or injury. Understanding the underlying cause can be useful in finding the right treatment. There are many possible causes of sciatica. Emergent cases that occur suddenly are usually related to a fall or a car accident. Gradual onset of sciatica may occur due to a bone spur, bulging or herniated disc, or inflammation caused by a medical condition. Common conditions that cause sciatic pain include:

  • Herniated disc – This condition occurs when the outer shell of the cushion between vertebrae breaks allowing the soft center to ooze onto surrounding tissue and nerves including sciatic nerves.
  • Bone spur – When a knobby outgrowth of extra bone forms on a vertebra, the sciatic nerve may become compressed.
  • Isthmic spondylolisthesis – When a small stress fracture occurs in the spine, one disc can slip forward on another. The result can pinch the sciatic nerve.
  • Spinal stenosis – Narrowing of the spine is common with age. This condition is seen most often in patients over 60.
  • Piriformis Syndrome – When the piriformis muscle in the buttock spasms and affects the sciatic nerve, hip and leg pain may be similar to sciatica. However, piriformis pain is not clinically diagnosed as sciatica.
  • Pregnancy – Weight gain and a shift of the center of gravity during pregnancy may cause temporary sciatica.
  • Muscle strain – Strained muscles in the lower back can cause inflammation which compresses the sciatic nerve.

Conservative Treatment
Most people who experience sciatica do not require surgery. Although pain may be severe and debilitating, the condition can usually be resolved over time. When the nerve is no longer compressed, the pain is relieved. There are many conservative treatments for sciatica.

  • Bed rest – A few days off your feet can relieve inflammation and pressure from the sciatic nerve. Bed rest should be limited to a few days and a firm mattress is necessary.
  • Ice and heat – Alternate ice and heat can improve sciatic symptoms. Begin with ice then switch to heat.
  • Physical therapy – After determining the cause of your sciatica, your doctor may prescribe physical therapy. Targeted exercise can improve most back conditions.
  • Stretching – Lower back stretches can relieve pressure.
  • Light exercise – Exercise can reduce inflammation, so short walks are advised.
  • Medication – Over-the-counter pain relievers or anti-inflammatories are usually effective in reducing sciatic back pain. If pain persists or is particularly severe, your doctor may prescribe muscle relaxers or stronger anti-inflammatories.
  • Spinal injections – If other conservative measures are not effective, your doctor may recommend steroid injections that bring relief directly to the affected nerve. The treatment is temporary but may relieve pain to allow you to participate in physical therapy for recovery.

Surgical Treatment
Sometimes, surgery is necessary to relieve the pain of sciatica. If conservative treatment has been ineffective, your condition is too advanced to allow you to participate in physical therapy, or you are suffering vital nerve damage, your doctor might recommend surgery. If your bowels or bladder are affected or you suffer extreme leg weakness, surgery is often required to prevent permanent damage.

There are two types of surgery usually recommended for sciatica pain. The best option may depend on the cause of your sciatica.

  • Discectomy – During this surgery, the surgeon removes whatever is pressing on the sciatic nerve. The goal is to only remove the portion of disc or bone spur causing pain. You may be able to return home a few hours after surgery.
  • Laminectomy – This surgery requires a surgeon to remove part of the lamina (a portion of a ring of bone that surrounds the spinal cord). The lamina and any tissue pressing the nerve is removed. You may return home the same day or the day after surgery.

If you are suffering from ongoing sciatic pain, it is important to understand the cause. A Miami spine doctor can help you understand your condition. Finding the right treatment can finally provide you the relief you have been hoping for.

Lumbar Microdiscectomy Could Solve Your Back Pain

It is estimated that as many as 80 percent of people will experience back pain during their lifetime. Often these issues are caused by muscle strain or poor posture and will be resolved without treatment within a few days. However, sometimes the pain is caused by a more serious condition. Certain symptoms will help you determine whether you should seek help.

  • Pain that interferes with everyday activities – If you are unable to go to work, get dressed, or perform regular daily errands, you might have a severe herniation that is best treated with surgery.
  • Pain or numbness that extends to one or both legs – if your pain is more severe in your leg than your back, a nerve is most likely compressed. Leg weakness is often observed with this condition as well. Your surgeon might recommend surgery to avoid long-term nerve damage. (When herniation is located in the upper back, arm pain and numbness may occur.)
  • Severe pain that keeps you from sleeping at night – If the pain is so severe it limits your sleep, your herniation may be too severe to benefit from physical therapy.
  • Constant unbearable pain – if you are unable to stand for more than a few minutes, you are likely not able to participate in physical therapy to improve your condition.
  • Loss of bladder or bowel control – If this occurs, tell your doctor immediately. Emergency surgery is necessary to prevent permanent damage.

These symptoms might indicate a serious injury called a disc herniation. Discs are soft tissue that sits between vertebrae to keep the bones from rubbing together and absorb shock from activity. A herniated disc occurs when the soft inside of the disc erupts through a tear in the disc’s rough outer exterior. The resulting pain, caused when disc material presses against a nerve, is often excruciating. A herniated disc is usually diagnosed through magnetic resonance imaging (MRI).

Sometimes a disc herniation is minor and can be treated through non-surgical techniques. Your doctor may suggest some non-invasive treatments before considering surgery.

  • Anti-inflammatory and muscle relaxing medications – Relieving inflammation and muscle pain can help relieve pressure from the affected nerve.
  • Physical therapy – When exercise is performed under the care of a doctor, the right techniques can help to heal the disc without surgery.
  • Cortisone injections – These injections can immediately block pain to the affected nerve allowing you to participate in physical therapy for long-term improvement.

Have you Experienced Little or no Improvement with Therapy?
If you have been under a doctor’s care, and traditional medication or physical therapy isn’t yielding the desired results, you might be a candidate for surgery. Your spine doctor will likely order imaging in the form of an x-ray or MRI. The imaging results combined with the severity of your symptoms will determine if you should proceed with surgery. Some severe symptoms indicate when surgery will be the best option.

  • Therapy shows little to no improvement – If you have participated in a therapy program for weeks with little to no change, you might be ready for surgery.
  • Leg weakness does not improve or gets worse – Relieving pressure from the nerve early is most likely to prevent permanent weakness.
  • MRI results show a large herniation – A large herniation takes longer to heal and is less likely to respond to therapy.

Lumbar Microdiscectomy
If you have been avoiding surgery because you have heard worrisome stories about large incisions and slow recovery time, you might not have up-to-date information. Today’s advanced tools allow surgeons to work with much smaller incisions, resulting in quicker surgeries and speedy recoveries.

Lumbar microdiscectomy surgery takes around a half-hour. The surgeon makes a small (1 – 1 ½ inch) incision. With the use of special tools, the surgeon removes the damaged portion of the disc. This relieves pressure from the affected nerve. The procedure is often outpatient surgery, and you will likely be allowed to return home the same day.

Benefits

  • Immediate relief of leg pain – Relieving pressure from the affected nerve means patients often feel no sciatica or leg pain immediately after surgery.
  • Short recovery time – Patients are able to leave the hospital a few hours after surgery and only require minimal restrictions, usually regarding lifting and twisting.
  • Lower chance of long-term damage – A nerve compressed over a longer period of time is less likely to fully heal.
  • Ability to return to regular activities – Physical therapy might take months to be effective. If your condition severely impacts your life, surgery can help you heal faster.

The decision to have surgery is never one to be taken lightly. However, with the help of a Miami back specialist, you may realize it is the best way to finally relieve your pain.

Compression of the Spine: Do You Have It?

Compression of the Spine: Do You Have It?
Your spinal cord sends signals between your brain and your body. When a spinal cord compression happens, a mass presses down on the cord. What your Miami spine doctor will call a mass can be anything from a tumor to a bone fragment. Compressions can occur anywhere on your spine. The symptoms of this condition can vary widely. The symptoms you experience can vary depending on the severity of the compressions, as well as its location on your spine. Many people with a spinal cord compression experience pain or stiffness in their neck or back. They can also develop numbness in the arms, legs, and hands. If the compression takes place in the lumbar area, this condition gets called cauda equina. The symptoms of cauda equina include weakness in your legs, a loss of bladder control, and numbness in your inner thighs or in the back of your legs. There are many causes of spinal cord compression. In some cases, the condition can come on suddenly. In other circumstances, the condition can come on slowly over time. For example, arthritis can lead to spinal cord compression. Ruptured disks, a pre-existing spinal injury, bone spurs, and tumors can also cause the condition. Any person can develop spinal cord compression. Using improper lifting technique when picking up heavy objects can cause spinal injuries. Those patients who have osteoarthritis can also find themselves at a higher risk for developing compression on the spine.

How Does a Doctor Diagnose Spinal Cord Compression?
Your doctor will perform a medical history and an exam, as well as a spinal x-ray and either a CT scan or an MRI test. The MRI test and the CT scan can give the doctor an image of your spine and can give them an idea of what is causing your back pain. Your doctor might request a test called a myelogram. In a myelogram, dye gets injected into the area of your spine, after which a CT scan will get taken of that space. The treatment you will get for a spinal cord compression will largely depend on the severity and cause of the compression. Your doctor might assign you to bed rest or to take time off of work to treat the condition. Some other treatment plans can include medications, steroid injections, and physical therapy. Some people choose to treat their compression with home health treatments such as over-the-counter medications, ice packs, and heating pads. Others choose to seek treatment with alternative medicine practitioners to get acupuncture services. Other treatment options include radiation or chemotherapy. These options may get put on the table in order to shrink a tumor or mass on your spine. When your compression gets treated as soon as possible, before your nerves get destroyed, treatment can keep your spinal cord from getting damaged. After treatment, you usually recover most, if not all, of your former function. Much of the time, you will need surgery to properly treat the compression on your spine. Your doctor might also need to perform surgery to insert steel rods, screws, or pins to keep your spine straight. If you have a tumor or other type of blunt injury, your doctor might give you corticosteroids intravenously. Corticosteroids keep down the swelling in the spinal cord area. This treatment is important as the swelling could contribute to your spinal compression. Once your doctor gives you corticosteroids intravenously, your surgeon will either remove the tumor or treat the mass with radiation therapy.

If you have an abscess that causes spinal dysfunction such as loss of bladder control or paralysis, a surgeon will remove the abscess quickly. You will also get antibiotics. For those patients who have not developed any symptoms of spinal dysfunction, the only thing that your doctor may have to do is give you antibiotics, draw out the pus of the abscess with a needle, or provide both treatments to treat the abscess. If a hematoma acts as the cause of your compression, the blood that accumulates will get drawn out immediately. If you have a bleeding disorder or are taking an anticoagulant, your doctor will give your injections of plasma and vitamin K to reduce any bleeding that may occur.

Can You Prevent Spinal Cord Compression?
The cause and severity of your compression will largely determine your outlook. However, we find that many of our patients respond well to treatment. Because of this condition’s many causes, it is probably not possible to prevent every single case of spinal cord compression. However, there are some things that you can do to make getting a compression on your spineless likely. By exercising regularly and maintaining a healthy weight and BMI can reduce the pressure on your back. You can also decrease your chances of getting this painful issue by learning how to lift heavy objects properly.

Red Flags of Back Pain

Back pain is very common. Most of the time, back pain is muscular and gets better on its own; but sometimes it does not. As a spine surgeon, I will always be on the aggressive side with regards to diagnostic modalities. I believe that in 2018, we have an opportunity to know instead of just think. With the use of advanced imaging and other diagnostic tools, one can be certain that back pain is not a sign of something scary. Something scary is rare but when it happens, it needs to be addressed as quickly and efficiently as possible.

Some things to look out for include:
Recent Unwanted Weight Loss: I always ask this question of my patients and 99% of the times, the answer is laughingly, “I wish”; but if you are not trying to lose weight and you find that your pants are becoming loose or that your face is changing in the mirror, I would seek medical advice.

Nighttime Pain:
Nighttime pain is generally a sign of inflammation, but so can cancer. I would perform advanced imaging on any patient who complains of nighttime pain.

Fevers and Chills:
This is a common sign of infection and when it occurs in conjunction with back pain, I would have it further evaluated.

Incontinence is a very common finding and it is important to note that at most times, incontinence is not associated with spinal pathology. However, when incontinence is associated with groin numbness or when incontinence occurs suddenly in association with back pain, that is a big red flag that should be evaluated right away.

Red flags in association with back pain are rare but when they are there they should not be ignored. This includes again, recent unwanted weight loss, fevers and chills, incontinence and nighttime pain.

Georgiy Brusovanik, M.D.
GB/st

A to Z about Spondylolisthesis Condition

Studies show that up to 4-6% of the U.S. population suffers from either spondylolisthesis or spondylolysis. This translates to a staggering 12,463,676 – 18,695,515 Americans. Further, recent studies show that up to 90% of isthmic Spondylolisthesis is from grade 1 to 2, while 10% of the slips are high grade from grade 3 and above.

What is Spondylolisthesis?
Spondylolisthesis is a condition whereby one of the spine bones, also referred to as vertebrae, slips forward (anterolisthesis) or backwards (retrolisthesis) onto the vertebra below it.  When this spine bone slips too much, it is likely to compress on a nerve that exits the canal (foraminal stenosis) or narrowing of the canal of nerves (central stenosis) and in turn the subject experiences too much pain. Spondylolisthesis comes from a Greek word spondylos that means the spine. It also means the ‘vertebra’. Listhesis is also a Greek word that means to slide. There are up to three types of Spondylolisthesis.

There is the congenital Spondylolisthesis, whereby congenital stands for ‘present at birth.’ This condition is as a result of an abnormal formation of born. Here, the disorderly arrangement of vertebrae puts the bones at a great risk of sliding into the vertebra. There is also the Isthmic Spondylolisthesis that occurs due to spondylolysis. Spondylolysis is a condition whereby the vertebrae experience breaks or fractures. These fractures are responsible for the bone weakening that in turn makes it slip out of place.  The third type of Spondylolisthesis is called degenerative Spondylolisthesis which is thought to be the most common type of disorder. When a patient ages, their discs, these are cushions that are found between the vertebral bones, lose water and become less spongy and therefore not able to resist the vertebrae movement.

There are also some forms of Spondylolisthesis which are considered to be less common, and these comprise of traumatic Spondylolisthesis, which is essentially an injury that leads to the fracture of the spinal feature or at times a slip. The other less common type of Spondylolisthesis is known as pathological Spondylolisthesis. Here, the spine is often weakened by a disease like osteoporosis or an infection and at times a tumor. Then we have the third type of a less common Spondylolisthesis which is Post-surgical Spondylolisthesis. It is the spillage that occurs after a spinal surgery; at times the spinal surgery may worsen the condition.

Signs of Spondylolisthesis
Before we delve into the symptoms, it’s vital to know the risk factors of Spondylolisthesis. Common risk factors include certain sports that entail hyperextension and rotation, Spinal Bifida Occulta, generalized mobility, Inuit population, facet joint morphology and genetic susceptibility. Females have 2 to 3 times chances of having this condition, and so are men but seldom experience slips. Also, degenerative Spondylolisthesis is likely to affect expectant black women.

Black people are more prevalent to get Spondylolisthesis. This condition is one of a kind, which does not immediately show the symptoms when the slippage occurs. However, a person who has this condition may often present with excruciating low back pain. The pain may extend to the buttocks or often complain of leg pain. You will often have your back aching and have an intense sway back. Also, many people have tight hamstrings, up to 80% of patients presenting with severe tight hamstrings have Spondylolisthesis. Also, the pain may have you limping when walking.

Spondylolisthesis in its severe case may make one to produce neurological signs such as a feeling of numbness or tingling pain. Here, your leg muscles may weaken and experience diminished reflexes. When the spine tries to stabilize the unstable part of the back, facet joints enlarges hence intense pressure on your nerve roots that causes lumbar spinal stenosis and also recess stenosis. When a bone slips forward, there is often a narrowing of the intervertebral foramen this is called foraminal stenosis. Doctors measure the degree of slippage in grade by obtaining and classifying the width of your vertebral body as follows;

  • 1st grade 0-25%
  • 2nd grade 25- 50%
  • 3rd grade 50-75%
  • 4th grade 75-100%
  • 5th grade 100% plus

Since Spondylolisthesis seldom presents symptoms, a trained spine doctor may always observe it through X-rays or CT scans. These are obtained while the patient lays flat. Mostly though, a slip may be detected when the patient bends forward or stands straight. Spinal surgeon and neurosurgeons obtain flexion standing X-rays or extensions and sometimes the CT myelogram.

Treatment of Spondylolisthesis
The symptoms of Spondylolisthesis can be treated several different ways.  One way, is oral steroids to reduce inflammation and irritation. The second is to consider an epidural steroid injection (ESI).  An ESI is a method to deliver a steroid medication directly to the segment of your back that is causing your painful symptoms.  Physical therapy, is another option to assist is some pain relief for patient with minor symptoms.  A physical therapist can assist the patient in hamstrings stretching, lumbar stretching and abdominal strengthening.  Although, physical therapy is not recommended if the patient has moderate to severe radiculopathy, or pain radiating to their legs, because it can make the symptoms worse.  One is recommended to stretch at least twice every day to ease the pain on the lower back. The exercise program should start gradually and increase as time goes by. The last and final form of treatment that a Miami doctor would recommend would be a fusion surgery.  Lumbar fusion could be an option for patients that suffer from back pain radiating to the lower extremities caused by spondylolisthesis.  Fusion surgery immobilizes a painful mobile vertebral segment.  After fusion surgery to correct spondylolisthesis, the expectations are to walk immediately after surgery with no need for physical therapy or back braces.  Patients should go back to their normal life, pain free.

Scoliosis – Symptoms, Causes, and Treatment

Scoliosis is an abnormal curve of the spine. The curve can vary in location and severity. The causes of scoliosis are unknown. While most common in young women ages 9 to 15, presenting as an S-shaped curve of the spine, there are many types of scoliosis that can affect others age groups as well.
+ Scoliosis before birth: Congenital Scoliosis
+ Scoliosis in young children: Early Onset Scoliosis
+ Scoliosis in older children/teenagers: Adolescent/Idiopathic Scoliosis
+ Scoliosis in Adults: Degenerative Scoliosis

There are different types of scoliosis curvatures such as kyphoscoliosis (outward and lateral spine curvature), dextroscoliosis (curvature of the spine to the right), rotoscoliosis (curvature of the vertebral column on the axis), levoconvex (curvature of the spine to the left), and thoracolumbar (curvature in both thoracic and lumbar regions).

Some patients with scoliosis may be asymptomatic (no painful symptoms), and others may have chronic back pain and/or symptoms such as leg pain or numbness due to nerve compression as a result of the scoliosis. These symptoms can affect your activities of daily living.

Treatment depends on the type, severity and location of the curve and can range from observation and/or brace to surgery. Patients with Degenerative Scoliosis in the thoracolumbar region with pain radiating to their legs may be a candidate for lumbar fusion (an operation that results in vertebrae in the lower back to grow together, reducing pressure on nerves). Given the intricacies of the surgery, it may be performed by an orthopedic spine surgeon or a neurosurgeon. While there is no cure for scoliosis, treatment can reduce symptoms and prognosis is good, particularly if diagnosed and treated early.

Interested in learning more or seeking treatment for back pain, a spine doctor at Miami Back and Neck Specialists can support you in taking next steps in protecting your back and minimizing any pain. Contact us at 305-901-1511 or BackDoctorMiami.com today for a free evaluation with a board-certified specialist and develop your individualized plan.

Read More News