MDNews - Long Island

develop new symptoms that you may be able to treat conservatively — which is always recommended first. However, if they have a true abnormality that develops secondarily, and their symptoms don't respond to conservative management, then they need to have revision surgery." In another scenario for revision surgery, a patient who had a herniated disc removed may experience another disc herniation at the same level. That patient may also be a candidate for revision surgery. Revision surgery can be more compli- cated than the primary surgery. However, many revision procedures involve spinal cord decompression, something NSPC's neurosurgeons have deep experience in performing. "It makes things more complex, and you have to know how to work around that scar and develop the proper tissue plains in order to success- fully decompress the spinal canal, which is what you're doing most of the time," Dr. Sonstein says. " That 's one of the things I specia lize in — taking arthritic, degenerative mate- r ia l of f t he spina l m e m b r a n e a n d doi n g it sa fely so we get successf u l d e c o m p r e s s i o n without having any complications such a s a s pi n a l f lu i d leak. When you have revisions or scarring, that ma kes the tactical incidence of getting a spinal fluid leak higher, so that's why you need to be careful and have good visualization of what you are doing." As well as correcting the patient's com- plaint, a surgeon performing a revision aims to make all efforts to reduce the risk that the patient has another issue in the future. For instance, if a patient received a prior discectomy or microdiscectomy and then experienced a new herniation at the same level, the surgeon — in addition to removing the new herniation — may fuse that section of the spine, ensuring the patient doesn't have any more abnormal motion at that segment to re-herniate the disc. Sometimes the natural course of events that occur are out of the surgeon's con- trol. A surgeon cannot always prevent patients who have had a spina l fusion from developing a next-segment problem in the future. For that reason, researchers are explor- ing ways to prevent the need for second operations — an avenue of study NSPC surgeons are following avidly in order to benefit their patients. Some of this research includes avoiding spinal fusion to prevent creating a stiff spina l segment by replacing the disc. Dr. Sonstein uses cervical disc replace- ment as an example. "The problem with a disc replacement in the neck — if you look at the literature on this — is that the results in the end are no different than actually performing a traditional fusion in the neck to remove a one-level or two-level disc," he says. "The spine is so much more complex than any other structure in the body — even the brain — because the spine has so many moving parts, so many issues, so many more things going on than other parts of the body. Here we have nerves around the joint, so it is so much more complicated." However, NSPC 's spi ne su rgeon s love this complexity and welcome the opportunity to help patients live with maximum ease and functionality. With NSPC available on Long Island, patients need not travel to a large urban center for excellent spine care. "I just enjoy what I do," Dr. Sonstein says. "As long as my hands can still work, I'll do it." ■ Please visit nspc.com to learn more about services and providers. For nearly 20 years, Dr. Sonstein's secretary Teresa Sorian (left) has made it possible for him to balance a busy surgical schedule with weekly in-office appointments and, now, NSPC Mobile Unit visits. A board-certified Diplomate of the American Board of Neurosurgery, Dr. Sonstein is an expert in complex spine surgery and has been with NSPC since 1998. " A lot of patients who come to see us at NSPC Mobile have no idea where to turn. We're a valuable resource to patients in an area of medicine that can feel scary to a lot of people." — WILLIAM SONSTEIN, MD, FACS, ATTENDING NEUROSURGEON AND PRESIDENT AT NSPC M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 2 2 0 9

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