Spine damage can cause pain, numbness and muscle weakness that can make everyday tasks difficult.
The Spine Program at Corona Regional Medical Center offers non-surgical and surgical treatment options to help you return to an active life.
Surgeons at Corona Regional Medical Center can evaluate your condition and recommend a treatment plan that may include rehabilitation, exercise or other therapies to help relieve your pain and increase your function. If surgery is required, minimally invasive procedures are available that can offer a shorter hospital stay and a quicker recovery with fewer complications.
Listen as Dr. Richard Lin discusses the indications for spine surgery and what you can expect if you have to go through a procedure.
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Do You Need Spine Surgery?
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Learn more about Dr. Richard Lin
Richard Y. Lin, DO
Dr. Richard Lin is a Spine Surgeon and a member of the Medical Staff at Cornona Regional Medical Center.Learn more about Dr. Richard Lin
Transcription:
Do You Need Spine Surgery?
Melanie Cole (Host): Spine damage can cause pain, numbness, and muscle weakness that can make everyday tasks difficult. The spine program at Corona Regional Medical Center offers non-surgical and surgical treatment options to help you return to an active life. My guest today is Dr. Richard Lin. He is a spine surgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Lin. What are some of the most common spinal issues that you encounter every day?
Dr. Richard Lin (Guest): I think that some of the most common spine issues that I encounter on a daily basis is primarily due to normal wear and tear of the spine, referring specifically to osteoarthritis which causes the space to collapse and overgrown growth joints to develop that causes impingement on a certain neural element within the spinal canals, such as either the spinal cord or the nerves that are branching off directly from the cord, or from the thecal sac. Typically, when this happens patients will present primarily with symptoms descriptive of low back pain that radiates down to the legs and sometimes into the toes. In addition to that, sometimes it could also present with numbness and weakness depending on how far along in their disease that they are.
Melanie: When someone comes to you, what's the first line of defense that you do for them?
Dr. Lin: The first thing you do is you get a good history, and you talk to them and say, “Hey, do you have any weakness? Tell me more about the pain. How far down the leg does it go?” It then gives you the idea exactly of where the issue is in the spine. You start with some x-rays. X-rays can't see nerves, it can't see muscles, it can't see ligaments, it can't see much at all. The only thing you're able to see is anything that's calcified and, specifically, what you're looking at is the spinal column as a bulk. One of the most useful things in the x-rays is that you're able to evaluate for stability of the spine. What I like to do is, I like to get three views, and I shoot a view from anterior to posterior, which is basically front on, and then another one from the side with the patient flexed forward and then another one with them extended backwards. What that does is, it tells me if any vertebral bodies that are out of the alignment. That’s a condition called “spondylolisthesis” which, most of the time, it occurs in arthritis. The joints get worn out and so the vertebral segments lose their stability. Then what happens is that when that bone slides out of alignment, it causes problems to the nerves.
Melanie: So then, when do you tell the patient that it's time to consider some sort of a surgical intervention?
Dr. Lin: Really, it depends on if the issues are in the neck or if the issue is in the low back. In the case of patients who are presenting with leg pain, which is usually it's the low back, then I typically like to exhaust all conservative measures before indicating the patient for surgery, meaning have they tried anti-inflammatories? Have they been through physical therapy? Have they tried to modify their daily activities? And, the last thing is that, what I do is, if they tried all that and they still have this pain down their leg that they consider intolerable, then what I do is, I send them to a pain consult to the pain doctor, for an injection of lidocaine and steroids targeting the nerve and see if that is able to temper down their pain. In some cases, patients get injection and then, I never see them again for years. In other cases, the injection works for six months, they go for another one, that lasts for two months, and they go for a third one and then that lasts for about a week or two. At that point, you tell yourself that the injections are presenting with diminishing returns and, at which point, you tell the patient, "Listen, we've already tried everything. If you don't want to continue to live with this pain, then I would recommend surgical intervention." Now, if they're presenting with weakness, then you present to them the option that, “Hey. This weakness may get worse. If I do surgery on you, the main purpose of the procedure is to prevent further decline of your motor strength. If the surgery is successful, you may get some strength back, you may not, because nerves are a little bit hard to predict." Weakness will be an indication for surgery in the case where they have progressive weakness. Where it's day one and they're having a little bit of weakness when they are lifting their feet off the ground when they walk and day two, they're not walking any more then that's an indication for immediate surgical intervention. In the case of the neck, usually when there's a nerve being pinched in the neck, it could be, given the location, it could be more dangerous because of the spinal cord is there and because it's very high, it affects everything downstream. So, if a nerve is being pinched in the neck. It can, theoretically, affect the leg, and, in that case, your threshold to pull the trigger and bring this patient to the OR for decompression is a little bit lower.
Melanie: Can these surgical interventions be done minimally invasively?
Dr. Lin: Absolutely. Absolutely. There are some new approaches. Traditionally, for the lumbar spine of the low back, we have to instrument patients and fuse them, either going up in the back or going up in the front, both of which involves a pretty reasonable healthy-sized incision and a significant amount of blood loss. With a new procedure called “XLIF,” which stands for “extreme lateral interbody fusion” which we go in from the side, and we make two small incisions, probably about maybe an inch and a half each, and we dock down off the spine from the side. There's not a whole lot of tissue dissection, and we go through the muscle called the “psoas.” We slide the nerves out of the way and we go in and we take out the disk at a specific level, put in a cage. Some surgeons will even put a plate on and put a couple of screws in and that's their fusion, right there.
Melanie: How fascinating. Now, the XLIF cannot be used for all types of lumbar conditions, correct? For ones that are a little bit lower down?
Dr. Lin: Correct. Absolutely. You're right on that. It depends on where in the country you're serving, but a lot of people that do XLIF, they won't go down to L-4, L-5 because that is considered a more dangerous level because it's difficult. The reason what makes it difficult is that, the iliac crest is there and sometimes that blocks to the entrance to the L-4, L-5 disc space, and, in addition to that, the nerves of the lumber plexus are more at risk at L-4, L5 level. However, there are a lot of guys who are very experienced in this procedure that can do an L-4, L-5 and get it done in twenty minutes and, really, there are no complications.
Melanie: Dr. Lin, we hear the word “stenosis” all the time. It's kind of the catch all term, and so many millions of Americans suffer from lower back stenosis, lumbar spinal stenosis. What do you tell them every day when they come to you for back pain?
Dr. Lin: I tell them that, for whatever reason, and I usually blame it on arthritis, that their spinal canal is smaller than what it needs to be and there's just not enough room for the nerves. And so, there's pressure on the nerves, the nerves are flaring up and that's why they have their pain and sometimes their weakness and numbness down their leg.
Melanie: In just the last few minutes, what should people with spinal issues think about when considering spinal surgery or seeking care?
Dr. Lin: Anyone that suspects that they have issues with their spine, and spine issues primarily present, again, with leg pain. It's not necessarily back, it's leg pain that really causes my ears to perk up when I'm talking to a patient. If they suspect that they have this burning feeling down their leg and it's bothering them, then they should go and see their physician about it and, hopefully, get a referral to a reliable spine surgeon. As far as considering whether or not to have surgery, really, the answer is and that I present to the patient is, “Can you continue living with this pain?” If they say, "It's tolerable. It doesn't really bother me. It flares up every now and then." Then, I say, "You know what? Let's ride it out. Let's try some medications. Let's try some physical therapy and let's see how you do." If, however, they say, "I can't sleep at night. I can't function during the day because I can't concentrate. I'm too tired,” or “I'm in too much pain. I've already tried everything. This pain is driving me crazy." Then, it's time to have surgical intervention. The reason why you want to wait it out to the point where you really don't have any choice is because spine surgery is dangerous. I mean, with it comes a lot of possible bad complications.
Melanie: Why should they come to Corona Regional Medical Center for their care?
Dr. Lin: We have a good staff over at Corona, and I think that's really what counts at the very end. The nursing staff, in my opinion, is second to none, number one; and number two is the OR. The facility is great and they have dedicated rooms set up just for spine and specific instruments, they are available there just for spine. On top of that, there are some great spine surgeons there, and the guys that I work with, they make sure that the cases are truly indicated, and that the patient really has no other option other than to undergo surgery before indicating them.
Melanie: Thank you so much, Dr. Lin, for being with us today. You're listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to www.coronaregional.com. Physicians or independent practitioners who are not employees or agents of Corona Regional Medical Center, the hospital shall not be liable for actions or treatments provided by those physicians. This is Melanie Cole. Thanks so much for listening.
Do You Need Spine Surgery?
Melanie Cole (Host): Spine damage can cause pain, numbness, and muscle weakness that can make everyday tasks difficult. The spine program at Corona Regional Medical Center offers non-surgical and surgical treatment options to help you return to an active life. My guest today is Dr. Richard Lin. He is a spine surgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Lin. What are some of the most common spinal issues that you encounter every day?
Dr. Richard Lin (Guest): I think that some of the most common spine issues that I encounter on a daily basis is primarily due to normal wear and tear of the spine, referring specifically to osteoarthritis which causes the space to collapse and overgrown growth joints to develop that causes impingement on a certain neural element within the spinal canals, such as either the spinal cord or the nerves that are branching off directly from the cord, or from the thecal sac. Typically, when this happens patients will present primarily with symptoms descriptive of low back pain that radiates down to the legs and sometimes into the toes. In addition to that, sometimes it could also present with numbness and weakness depending on how far along in their disease that they are.
Melanie: When someone comes to you, what's the first line of defense that you do for them?
Dr. Lin: The first thing you do is you get a good history, and you talk to them and say, “Hey, do you have any weakness? Tell me more about the pain. How far down the leg does it go?” It then gives you the idea exactly of where the issue is in the spine. You start with some x-rays. X-rays can't see nerves, it can't see muscles, it can't see ligaments, it can't see much at all. The only thing you're able to see is anything that's calcified and, specifically, what you're looking at is the spinal column as a bulk. One of the most useful things in the x-rays is that you're able to evaluate for stability of the spine. What I like to do is, I like to get three views, and I shoot a view from anterior to posterior, which is basically front on, and then another one from the side with the patient flexed forward and then another one with them extended backwards. What that does is, it tells me if any vertebral bodies that are out of the alignment. That’s a condition called “spondylolisthesis” which, most of the time, it occurs in arthritis. The joints get worn out and so the vertebral segments lose their stability. Then what happens is that when that bone slides out of alignment, it causes problems to the nerves.
Melanie: So then, when do you tell the patient that it's time to consider some sort of a surgical intervention?
Dr. Lin: Really, it depends on if the issues are in the neck or if the issue is in the low back. In the case of patients who are presenting with leg pain, which is usually it's the low back, then I typically like to exhaust all conservative measures before indicating the patient for surgery, meaning have they tried anti-inflammatories? Have they been through physical therapy? Have they tried to modify their daily activities? And, the last thing is that, what I do is, if they tried all that and they still have this pain down their leg that they consider intolerable, then what I do is, I send them to a pain consult to the pain doctor, for an injection of lidocaine and steroids targeting the nerve and see if that is able to temper down their pain. In some cases, patients get injection and then, I never see them again for years. In other cases, the injection works for six months, they go for another one, that lasts for two months, and they go for a third one and then that lasts for about a week or two. At that point, you tell yourself that the injections are presenting with diminishing returns and, at which point, you tell the patient, "Listen, we've already tried everything. If you don't want to continue to live with this pain, then I would recommend surgical intervention." Now, if they're presenting with weakness, then you present to them the option that, “Hey. This weakness may get worse. If I do surgery on you, the main purpose of the procedure is to prevent further decline of your motor strength. If the surgery is successful, you may get some strength back, you may not, because nerves are a little bit hard to predict." Weakness will be an indication for surgery in the case where they have progressive weakness. Where it's day one and they're having a little bit of weakness when they are lifting their feet off the ground when they walk and day two, they're not walking any more then that's an indication for immediate surgical intervention. In the case of the neck, usually when there's a nerve being pinched in the neck, it could be, given the location, it could be more dangerous because of the spinal cord is there and because it's very high, it affects everything downstream. So, if a nerve is being pinched in the neck. It can, theoretically, affect the leg, and, in that case, your threshold to pull the trigger and bring this patient to the OR for decompression is a little bit lower.
Melanie: Can these surgical interventions be done minimally invasively?
Dr. Lin: Absolutely. Absolutely. There are some new approaches. Traditionally, for the lumbar spine of the low back, we have to instrument patients and fuse them, either going up in the back or going up in the front, both of which involves a pretty reasonable healthy-sized incision and a significant amount of blood loss. With a new procedure called “XLIF,” which stands for “extreme lateral interbody fusion” which we go in from the side, and we make two small incisions, probably about maybe an inch and a half each, and we dock down off the spine from the side. There's not a whole lot of tissue dissection, and we go through the muscle called the “psoas.” We slide the nerves out of the way and we go in and we take out the disk at a specific level, put in a cage. Some surgeons will even put a plate on and put a couple of screws in and that's their fusion, right there.
Melanie: How fascinating. Now, the XLIF cannot be used for all types of lumbar conditions, correct? For ones that are a little bit lower down?
Dr. Lin: Correct. Absolutely. You're right on that. It depends on where in the country you're serving, but a lot of people that do XLIF, they won't go down to L-4, L-5 because that is considered a more dangerous level because it's difficult. The reason what makes it difficult is that, the iliac crest is there and sometimes that blocks to the entrance to the L-4, L-5 disc space, and, in addition to that, the nerves of the lumber plexus are more at risk at L-4, L5 level. However, there are a lot of guys who are very experienced in this procedure that can do an L-4, L-5 and get it done in twenty minutes and, really, there are no complications.
Melanie: Dr. Lin, we hear the word “stenosis” all the time. It's kind of the catch all term, and so many millions of Americans suffer from lower back stenosis, lumbar spinal stenosis. What do you tell them every day when they come to you for back pain?
Dr. Lin: I tell them that, for whatever reason, and I usually blame it on arthritis, that their spinal canal is smaller than what it needs to be and there's just not enough room for the nerves. And so, there's pressure on the nerves, the nerves are flaring up and that's why they have their pain and sometimes their weakness and numbness down their leg.
Melanie: In just the last few minutes, what should people with spinal issues think about when considering spinal surgery or seeking care?
Dr. Lin: Anyone that suspects that they have issues with their spine, and spine issues primarily present, again, with leg pain. It's not necessarily back, it's leg pain that really causes my ears to perk up when I'm talking to a patient. If they suspect that they have this burning feeling down their leg and it's bothering them, then they should go and see their physician about it and, hopefully, get a referral to a reliable spine surgeon. As far as considering whether or not to have surgery, really, the answer is and that I present to the patient is, “Can you continue living with this pain?” If they say, "It's tolerable. It doesn't really bother me. It flares up every now and then." Then, I say, "You know what? Let's ride it out. Let's try some medications. Let's try some physical therapy and let's see how you do." If, however, they say, "I can't sleep at night. I can't function during the day because I can't concentrate. I'm too tired,” or “I'm in too much pain. I've already tried everything. This pain is driving me crazy." Then, it's time to have surgical intervention. The reason why you want to wait it out to the point where you really don't have any choice is because spine surgery is dangerous. I mean, with it comes a lot of possible bad complications.
Melanie: Why should they come to Corona Regional Medical Center for their care?
Dr. Lin: We have a good staff over at Corona, and I think that's really what counts at the very end. The nursing staff, in my opinion, is second to none, number one; and number two is the OR. The facility is great and they have dedicated rooms set up just for spine and specific instruments, they are available there just for spine. On top of that, there are some great spine surgeons there, and the guys that I work with, they make sure that the cases are truly indicated, and that the patient really has no other option other than to undergo surgery before indicating them.
Melanie: Thank you so much, Dr. Lin, for being with us today. You're listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to www.coronaregional.com. Physicians or independent practitioners who are not employees or agents of Corona Regional Medical Center, the hospital shall not be liable for actions or treatments provided by those physicians. This is Melanie Cole. Thanks so much for listening.