GtgtLori Casey Coming up on being well neurosurgeon Emilio Nardone stops by to talk to us about minimally invasive spine surgeries for those who suffer from disc herniation and spinal stenosis. We’ve got a lot of great information ahead so don’t go away. music gtgtLori Casey We’ll I’m so here with Dr. Emilio Nardone did I say that right. gtgtDr. Nardone Correct gtgtLori Casey Neurosurgeon has come by being well today. First we should explain your practice in central Illinois Neuro health science and you’re located in Bloomington Illinois correct gtgtDr. Nardone That’s correct yeah we’ve been in Bloomington.
For over 13 years now and December over last year approximately we started clinic in Sara Bush because of a need for neurosurgical services here and that has been quite well. gtgtLori Casey Okay so you’re a neurosurgeon for people who aren’t real sure what that is why don’t you tell us about what are the kind of things that you treat in your practice. gtgtDr. Nardone From the word you can say that we treat brain and spine. Typically the brain and spine and quite often also do we perform nerve like carpal tunnel, nerve release. The large majority.
Of neuro is spine surgery, approximately 20 is brain mostly tumors, vascular malformation of the brain and so forth. The large majority is spine as a number of cases. gtgtLori Casey So when does someone a patient typically come to see you at what point in their prognosis or there would they come see a specialist such like a neurosurgeon. gtgtDr. Nardone Yeah I think typically they are referred by primary physician or regular specialist or we have a good number of patients that come directly as referrals. If you have a brain.
Being Well 409 Minimally invasive Spinal Surgery
Tumor or any problem some strokes we see them regularly of course if you have a spine problem like a disc herniation in the spine or the lumber spine, a stenosis or many conditions usually generated to the generation of the spine you see then more referrals. It a a variety of cases we see and that we do include before assessing the compression of nerves like carpal tunnel in the nerves. Most common cases are disc herniation. gtgtLori Casey So tell us specifically what kinds of things you’re doing at Sara Bush in Charleston gtgtDr. Nardone.
Being a primary place where I operate so we don’t do complex cases here but majority are spine minimal invasive micro examination for disc herniation in the neck or back, lumber stenosis, one or two level fusion we cannot keep the patient more than two days. That’s why more complex cases are down in Bloomington. gtgtLori Casey Well let’s talk about one of your specials is minimally invasive surgery for disc herniation and stenosis can you kind of talk about how that’s different than the more traditional surgeries for those elements gtgtDr. Nardone.
Over the years we have seen an improvement into the approach to spinal surgeries by minimizing the soft tissue trauma that the surgery itself creates in order to achieve the goal of relieving the patients pains. Over the last years it’s clear that minimal invasive surgery what we call key hole approach and incision that’s less than an inch in your back we are able to achieve the goals and the most important factor is the patients satisfaction much less pain in the surgery and that they can return to work easy. That can be done in outpatient.
Basis. gtgtLori Casey So what you know we talk about we have a picture that shows what the scarring is like after how did that these two holes basically prior to that how big was the incision. gtgtDr. Nardone Well it varies a typically opening incision can sometimes be even several inches and several inches incision in the back means an opening several inches of muscle in your back. That’s why spas and pain come from so by minimizing the approach you see it better with much less pain in the use of pain medications.
GtgtLori Casey So is it kind of like arthroscopic surgery what they do on knees and stuff like that gtgtDr. Nardone It’s not arthroscopic because the spine or brain their going to have real cavity in there it’s just a minimally access surgery where the opening is very small some people place tubes I place a small blade to access it. Once the opening is confirmed then down goes the microscope. On microscope we perform the surgery, remove the disc herniation or relieving the narrowing stenosis. gtgtLori Casey Okay let’s talk about disc herniation and I’m going to grab hang on here. I’m going.
To grab the model of the spine and I want you to explain to the viewers what happens when you herniate a disc and I’ve had it before why does it hurt so much gtgtDr. Nardone This is a plastic model of your spine, this is the interior portion, this is the back portion of the spine. What we see that are grayish looking are the disc that allows the spine to move and like any structure in the body it can break. Do to wear and tear of the disc or if you have an accident this break.
And this is the back part of the disc when it breaks it protrudes out pinches the nerve that passes by into the canal. That’s why not only do they have back pain so they have a lot of leg pain. That goes to form the sciatic that goes into the leg. gtgtLori Casey What does this disc stuff made out of cartilage or what is it gtgtDr. Nardone It’s made of a fibrous ring of cartilage material and in the core called nucleosis from a Latin word that means it’s a shock absorber the center of the disc.
GtgtLori Casey So if the term herniated disc, bulging disc, lip disc are those all the same things or are they different gtgtDr. Nardone Well it’s kind of somatic. Bulging disc just means just barley bulging out, it means that the disc membrane has lost elasticity and protrudes out. Herniation means actually broken and it’s more fragment from inside out that pinches the nerve. gtgtLori Casey Okay so actually I’m just going to turn this up one more time. Is actually this whole thing that comes out or gtgtDr. Nardone It’s more breakage in the back side here where the membrane breaks and a small fragment typically.
Comes out because it’s very unclear dialog space even a small fragment causes a lot of damage. The patient will not only have pain they can have neurological deficit they can have weakness in the foot or leg numbness, tingling and so forth. gtgtLori Casey So I know a couple of my friends have herniated discs that needed surgery what do you know as a neurosurgeon when someone needs surgery to correct the problem gtgtDr. Nardone Fortunately a large majority of disc herniation cures themselves without an aggressive surgery. It is not that discs can reabsorb can shrink away from the nerve and the symptoms get better.
When do we need to have surgery the medication is persistent, severe pain and does not improve with conservative treatment and presence of neurological deficit, foot weakness, numbness, spinal cord compression and so forth gtgtLori Casey So why is it, it’s weird when herniated disc your back doesn’t really hurt it’s your leg and your hip and sometimes your foot. That’s just all the nerves connect to those areas in your back is that why it hurts so much. gtgtDr. Nardone Symptoms of disc herniation is back pain or neck pain because they ruptured the disc causes.
Irritation of the nerve fibers around the brain or the disk for the back pain. After a few days the back pain subsides and leaves you with a lack pain due to the nerve that the disc herniation has created or has caused. gtgtLori Casey So what long term can happen other than being in constant pain when you don’t have that surgery Can you suffer from permanent nerve damage if you don’t get that herniation taking care of gtgtDr. Nardone Definitely you know it depends where the herniation is and what nerve is affected it could leave.
You with a foot drop, leave you even with paralysis if it’s lumber spine. So sometimes if it’s a central disc herniation it can leave you with problem with bowel or bladder and sex. gtgtLori Casey Are there certain vertebrae’s or disc’s that are more susceptible to herniating in this spine are there certain ones that herniate more than others. gtgtDr. Nardone The two segments that move the most is the cervical spine and the lumbar spine. For this reason the unclear dialog spine has little movement because the presence of the rib cage. So the cervical and lumbar are more prone.
To rupture and in the cervical and lumbar area that one that moves the most respectively c four five six seven c four five c five six and seven disc tend to rupture the cervical spine and then the L four five the bottom two discs in the lumbar spine are prone to rupture. gtLori Casey So basically the top and the bottom not so much the middle. gtgtDr. Nardone That’s the bottom line yes. gtgtLori Casey So when you have patients that come in what’s kind of common causes of herniation that you hear What’s the story or is there one thing.
That kind of seems to resurface. gtgtDr. Nardone Actually it could be multiple. Its daily activity that causes it, even a sudden movement, lifting up a bag, lifting up luggage, but essentially it is never one specific injury that happens across the border. It can be any movement that causes it cause sometimes the wear and tear throw the years and then all of the sudden even a little sudden movement can cause a rupture. gtgtLori Casey So if you have a disc herniates and you know does it mean that you have less disc material.
Than or can it regrow itself or regenerate itself. gtgtDr. Nardone Well there’s a small piece that comes out but the piece is small a lot of the disc is still left for the movement of that segment. The disc does not regenerate and that’s why the symptoms persist because of degeneration but we are not at the level of technology where we can regenerate disc. gtgtLori Casey So let’s talk about another element that people suffer from and that’s spinal stenosis. Explain what is it and what are the symptoms.
Dr. Nardone Stenosis means narrowing if nothing else it’s the narrowing of the canal where the nerve comes through. It mostly common in the lumbar spine but it also possible in the cervical spine. What causes it is aging. Typical spinal stenosis is common in the early population about 60 years of age and it’s due to a combination of degenerative processes that’s involve the facet’s the joints of the spine get thicker in medical terms called hypertrophic. It’s thicket facet’s also the ligaments in the back of the spine called limentiflaol or yellow ligament it gets thicker with time and with.
Aging so the combination of this process is caused by remarkable narrowing on the spine. gtgtLori Casey Okay so what does that feel like if you have stenosis gtgtDr. Nardone So in a sense with back pain most important with what we call big word neurogenic allocation. What does it mean The people feel good when they lay down, when they sit, but when they stand up it’s the walking they sense it i the legs the pain, tingling, numbness, weakness in the legs. Quite often they have a fixed amount they can walk they say I can walk half.
A block. Then I get all the symptoms to bend over to relieve some of the symptoms then I have to sit down. I sit for five ten minutes then I can walk again. That’s what we call neurogenic allocation. gtgtLori Casey So when you say spinal calm that’s actually inside of here. gtgtDr. Nardone That’s right what we see yellow inside is our older nerves. Now being as this spine is a plastic model we don’t show the ligaments so this bone gets thicker there’s a facet and then there’s a ligament in between the.
Yellow ligament before that gets thicker and causes narrowing around the yellow nerves in the back. So what do we do in these cases gtgtLori Casey Yeah let’s talk about the surgery for that. gtgtDr. Nardone When again the cervical treatment and symptoms are quite advanced stenosis remarkable with a small incision approximately inch incision in the back where to get down to the level we localize it with xrays where the stenosis is and we make a key incision right there in bone where theres window with the drill and some other instruments move the bone and.
The ligament that’s causing the tightness of the canal. gtgtLori Casey So what’s the recovery time for someone who has late evasive version of stenosis gtDr. Nardone Yeah it depends on the levels you have to relieve the stenosis but people with one level they stay one night and go home the next day and within a few weeks they should be back to normal and should feel relieved immediately from the pain and be able ambulate the same day and go home walking on their own feet the next day.
GtgtLori Casey That sounds like a nice alternative to gtgtDr. Nardone Actually I want to mention also that there’s a special technique that I wouldn’t say I developed but I refined in doing the minimal invasive compression. The large majority of compression area is done through a typically minimal approach the bone in the back side of the vertebrae and the ligaments is removed. We modify the technique with an oblique approach a small incision, instead of going the unclear dialog we go from the side and making the key incision and the hole into the vertebrae.
From the side approach and itching not only the same side but also the opposite side. So we are able to completely decompression the spine but at the same time avoiding the injury of all important ligaments. From the structure of the spine their important for stability. gtgtLori Casey So while you have that let’s explain how you have surgery if someone has disc herniation How does that one work gtgtDr. Nardone Again an incision on this unclear dialog down to the level that is localized on xrays and you see this is called lamina part of the vertebrae with a little drill unclear.
Dialog a special instrument we bite off the bone and we access the canal where the disc is herniated. The disc is herniated under the nerve so the nerve gets moved gently, we retrieve the fragment from underneath the nerve, we make sure theres no bleeding then we close of the incision with a couple of seuters. gtgtLori Casey Does some of that a majority of neuro surgeons are doing or is this something that’s fairly new that just your practice is doing or is this kind of trend of treating back surgeries or performing back surgeries.
GtgtDr. Nardone The importance of minimal invasive surgery is spreading and it’s been spreading over the last year so more and more neurosurgeons and spinal surgeons adopted. The large majority are still doing traditional surgery it all depends on your training and attitude but theres more and more of the new generation that gets converted into the minimal invasive approaches they have a little bit steeper curvature to learn. But once you learn them and adopt them as a technique they’re rewarding. gtgtLori Casey Did this surgery evolve because of technology.
Of instruments like that or just surgeons like you just developing a new technique What made it possible to be able to do surgeries in this way gtgtDr. Nardone Typical explanation of factors definitely gave an understanding of the autonomy and technology of the spine and how the patients respond. Also guided by patient satisfaction becomes more and more of an important factor in overall healthcare as well as advancing in the technology allow included visualization with the microscope and light sources that progress through time. They’ve allowed us to move forward with this technique. gtgtLori Casey.
Now you mentioned that you do do some fusions do you do that here at Sarah Bush or not gtgtDr. Nardone Yes we do. gtgtLori Casey Fusion always sounds like someone says oh I have to have my disc that sounds like a last resort gtgtDr. Nardone It should be. gtgtLori Casey It should be okay let’s explain what is that when you fuse the discs together gtgtDr. Nardone What that indication for fusion first of all. If you have a slippage called in medical terms spondylolisthesis it means that the disc is failing instead of the bone lined up the bones.
Slipping. So that can cause a lot of back pain and eventually can pinch the nerve if there is a lot of slippage that’s an indication to fuse it. We cannot give you a new spine we cannot produce the stability of the spine so that when the disc failing it needs to be stabilized with screws, rods and eventually the nerves will be compressed. Another indication for fusion severe degenerative disc disease can create a lot of pain from a mechanical point of view it can unclear dialog. If those patients failed to improve the conservative.
Management indication for fusion or artificial disc is there. gtgtLori Casey So what’s the recovery time for something like a fusion is it longer than the disc herniation surgery or some of the other surgeries gtgtDr. Nardone It’s definitely more of an invasive approach and it is a longer one. We can do minimal invasive one level fusion with small incision one of each side. Despite that fusion is definitely more that a microunclear dialog than disc herniation. Depends how many levels is done typically the hospital stay is one to two.
Days still relatively short hospital stay. It requires six weeks to be completely fully recovered. People are able to ambulate well then it’s a progressive approach to the next few months how to lift weights, how to twist we want to make sure fusion takes. So it takes several months before restrictions are lifted. gtgtLori Casey So let’s talk about some of those restrictions people have. You can set that guy down if you want to. If people have that surgery you know do they have to spend the rest of their.
Life oh I might I don’t want to ruin my surgery or do you recommend that you need to be active. Are there things that people should avoid if they’ve had these types of surgeries or can you go back to a very active life gtgtDr. Nardone Definitely the approach to mobilization surgery for spine is completely changed. When I was in training twenty years ago many people were mobilized in bed, staying in bed for long time which is completely different mobilization in the key for recovery. Of course the minimal.
Invasive approach the patient being mobilized because they have less pain. Actually we get them up right away as soon as they wake from surgery and their able to walk because many of the surgeries as I mentioned to you before they are done on outpatient basis. So people go home and able to continue with their routine right away. gtgtLori Casey So have you seen in the time you’ve been a neurosurgeon that back surgeries and back pain is increasing Seems like everybody has back pain. gtgtDr. Nardone They’re conscious of that. Before many many years ago people are supposed to live with.
The pain. gtgtLori Casey Yeah you were supposed to live with it gtgtDr. Nardone Now people to have a high quality of life evading we do. Of course technology has improved and the understanding of the basic process improved and add to the remarkable changing of spine care. gtgtLori Casey Okay so if someone is dealing with some back pain issues how do they know maybe this is something more than just a little bit of pain maybes there’s a little more severe I should see my doctor which may lead to seeing a neurosurgeon. How do you know if your pain is a little more.
Than just, some people talk tolerate pain better than others, but how do you know when something a little more severe should be looked at gtgtDr. Nardone Well as general information almost one hundred percent of human beings in their life suffer a major emphasis of back pain so it’s quite common. So your question is quite pertinent so one we need to seek more attention, well if back pain is associated to what we call reticular pain, pain into the arm or the leg. If it’s a little tingling or numbness or sensational weakness any other changes in neurological.
Status that’s promotes immediate evaluation or if it’s just pain if it’s rather persistent. If its weeks or months that it’s being going on and not improving then this would be looked into it. gtgtLori Casey So if you I’ll ask you back doctor. If you say you go out and landscape your whole yard and you know it’s a lot of work and your back hurts. Something that typically how long should that take to recover from that from just sort of back strain and gtgtDr. Nardone Typically a couple weeks the sensation should.
Be remarkably improved. gtgtLori Casey So then my question is is there a certain time period that something that pain persists beyond two week mark then gtgtDr. Nardone Sometimes it can last longer but as long as there’s a trend of improvement in the next few weeks that’s satisfactory to an approach. gtgtLori Casey Okay. I always like to ask this question not that we want to put you out of business or anything in the back surgery department but are there things that we should be doing to take care of our backs To make sure that we are healthier and aren’t suffering from.
Back pain gtgtDr. Nardone I think the two important things that we can do is be as thin as possible so fight obesity and eat well probably and exercise. Exercise to have good core muscle strength. If we do that then we do what we can to avoid back issues they’re going to come anyway they’re going to be present anyway but at least that’s what we can do to improve it. gtgtLori Casey Okay and if you if you’re not seeing improvement then see someone like a qualified neurosurgeon who can hopefully get you back on the road.
To health. gtgtDr. Nardone We’ll be glad to do so. gtgtLori Casey Thank you so much for coming by Being Well we hope to have you again. gtgtDr. Nardone You’re welcome it was my pleasure. gtgtLori Casey Thank you music gtgtMonica Becker A man named Kevin Lue was triathlete who developed a rare disease that caused his heart to fail. In a matter of months he went from intense competition to barely being able to walk. He needed a heart transplant. In addition to his new heart, he got a whole lot more.
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