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I n f a c t , l a m i nopl a s t y pre s er ve s between 30 and 50 percent of motion at the repaired levels, according to the A merica n Academy of Or thopaedic Surgeons. During laminoplasty, sur- geons hinge open the lamina but do not completely remove the vertebrae. This provides more space in the spinal canal and provides surgeons space to repair other affected levels. The Lumbar Spine When an overweight patient exhibit- ing poor posture complains of back pain radiating down the leg, disc herniation is often the cause. Although genetic variables can play a role, most patients who suffer from disc herniations do so as a result of bad lifting techniques combined with bad posture. "Many people develop the condition when the discs are ground between two bones and break," Dr. Vaynman explains. "Discs don't have a mechanism for repair, and they are pushed backward, squeezing the nerve roots against bones or ligaments in the spinal canal. When that happens, patients go to their primary care provider complaining of pain in the leg." Disc herniation should be suspected if a physical exam reveals no strength deficit but patients are in a great deal of pain. MRI scans confirm the condition. At this point, either conservative or surgical interventions can be used. Conservative measures, such as physical therapy or epidural injections, can be effec- tive — 80 percent of patients resorb the herniated disc in three months, according to Dr. Vaynman. This option is particularly suited for patients who don't have labor- intensive professions and can stay home while the body heals. "Spine surgery is a considerable endeavor. However, when necessary, it should be considered sooner rather than later. There is a much better prognosis if patients are treated before they develop significant disability and muscle weakness from severe pain and lack of motion." — Artem Y. Vaynman, MD, FAANS, partner and neurosurgeon at Neurological Surgery, P.C. Other patients require discectomy. "There's a 30 percent chance of reherniat- ing another piece of the same disc in the six months following discectomy," Dr. Vaynman says. "After that, the risk decreases because scar tissue forms. It's imperative that after discectomy, patients adjust their lifestyle to reduce risk of herniation. If they don't lose weight and they continue smoking, the risks of reherniation increase." Minimally Invasive Fusion When disc herniations occur in areas where the nerve root exits the spine, repair requires dissecting the joint connecting the two vertebrae and fusing the spine to maintain its structural integrity and prevent the likelihood of recurrent stenosis. Dr. Vaynman performs minimally invasive transforaminal lumbar interbody fusion through small incisions using tubular retractors. "Instead of lifting the muscles, you spread the muscle fibers using retractors," he says. "We introduce instruments through a small tube and then remove the joint and disc, alleviating the pressure on the nerve root. Through the same incision, we place bone graft and lock the two bones in place with screws and rods." Measured Care Even though surgeons at NSPC have access to the latest technological break- throughs, the most important part of their practice is knowing the most effective conservative treatments and optimal time for surgical intervention. "Patients certainly benefit from early referral," Dr. Vaynman says. "Surgical repair is much more challenging when the condition has persisted for three or four years. But not every patient needs surgery. I operate on 15 to 18 percent of my patients, which is around the national average. There's not always a reason to rush someone to the operating room, but when patients make no progress after three months of conservative treatments, it's time to treat the underlying cause instead of the symptoms." For more information about NSPC, visit www.nspc.com. ■ Artem Y. Vaynman, MD, FAANS, is ready to greet his next patient in his Lake Success office. COV ER FE AT UR E 1 0 | Long Island MD NEWS ■ M D N E W S . CO M

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