Back Surgery & Laser Ablation

This is a transcript of a Dr. Jay Show broadcast on 1560TheGame in Houston, TX. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained

T1 weighted sagittal cervical spine MRI showing degenerative disc disease, osteophytes, and osteoarthritis of C5-C6 (Photo credit: Wikipedia)

Sports Medicine Physician serving patients from Katy, Fort Bend County, Metro Houston and Southeast Texas from offices in Richmond and Sugar Land, TX. Dr Bennett is will begin to see patients at a new office in Houston on May 3, 2012. Call 281-633-8600 for an appointment.

Our special guest for the show was Dr. Benoy Benny. He is a physical medicine rehabilitation physician, and he is board certified for pain and spine as well as for minimally invasive procedures in spine. He’s also a professor at Baylor College of Medicine. Bob Lewis of 1560TheGame is also a guest on the show.

Here’s the transcript of the seventh section of the Show:

BENNETT:  But going back to Dr. Benny and some things I want you to clarify quickly because we don’t have a lot of time. Disc replacement and nerve ablation, where you burn the nerves. That sounds horrible, but you can actually explain what that is.

BENNY:  Let me explain one thing.  What we in the medical world call axial back pain, that’s actually back pain or neck pain, not shooting pain going down your arm, it’s not easy to treat with whatever you do.  Physical therapy, injections, surgery – it’s not the best thing that we have.  Physical therapy is probably the best that we have for that.  Going towards disc replacements, if you purely have degenerative disc disease or in one specific level, disc replacements can be an option.  It’s definitely something you need to talk to your surgeon about.  But it really needs to be limited to one level and unfortunately about two or three years ago this was the biggest hype:  “I have a disc problem, let me get a disc replacement.” Unfortunately, like a lot of things in medicine, when the data is done, the evidence behind it is not that good.  Cervical disc replacements have actually done better than lumbar disc replacements.  So people that have one level cervical disc disease where you can remove one disc and put in an artificial disc, they’ve done relatively okay.  Lumbar disc replacements have not done that well.  You don’t want to go into a disc replacement or a fusion without having tried other things because the data even on fusions is not very good.  One-third of people get better, one-third get worse and one-third it doesn’t affect it.  So if you don’t really absolutely need it, that’s not the way to go.  Let me talk quickly about these alternatives, these minimally-invasive procedures.  If you have facetagenic pain, pain from these joints in the back that are causing your back to just really hurt and it’s worse when you bend backwards, these joints are supplied by nerves.  Those nerves can actually be ablated or lasered or removed to where the sensation that you feel is not there anymore.  Are you still having arthritis in those joints?  Yes.  But it’s not limiting you because you don’t feel the pain anymore.  One of the biggest things I try to do is diagnose exactly what’s going on.  Most people that come in have been having pain for awhile and they’re like, “Doc, help me.  Nobody knows what’s going on.”  So let’s diagnose what’s going on.  And that part of it is crucial, to be able to come up with a correct diagnosis.  Is it your facet joints?  Is it your disc?  And then we have diagnostic tests that actually confirm if it’s from that joint or not.  Now there’s a lot of controversy on that and a lot of insurance companies don’t cover for that but again you’re looking at what options you have out there.  These are things you need to be able to come into your physician and talk about.  What are the options that you have?

LEWIS:  What’s the downside of lasering them or burning them?

BENNY:  The laser ablation of these nerves has been done for about 25 years.  They do supply, for example, the nerves that supply the facet joints also do supply the deeper muscles in your back, but they’ve actually tracked patients who’ve been having these 15 years down the line and they haven’t shown any atrophy of the muscles.  We really don’t know any downside.  There are risks when we do any of these procedures, but besides the minimal risks if you have proven before you do the procedures that that’s where the pain is coming from, I think it’s a great option.

If you have questions about orthopedics or sports medicine, please call our office at 281-633-8600 for an appointment with Dr. Bennett.

Dr. J. Michael Bennett

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