TREATMENTS
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Spinal Treatments
Conservative Management
Dr. Darwish and Ashley Michelsen PA-C will evaluate you based on your symptoms and physical exam. Based on the severity and longevity of your symptoms, a treatment plan will be outlined. Dr. Darwish believes that most cervical and lumbar symptoms can be treated conservatively. A combination of medications, physical therapy, MRIs, and injections may be warranted to treat your pain or symptoms.
Physical Therapy
Physical therapy is a prescription treatment option that may be prescribed to improve range of motion, decrease pain, and increase strength. Simple exercises and stretches can diminish leg and arm pain after a couple weeks. The physical therapist will first evaluate you prior to initiating treatment. Along with exercises and stretching, physical therapists can also perform ultrasound, e-stim, and massage. A home exercise program is also given.
Pain Management
A referral to a pain management specialist may be warranted to reduce the inflammation and pain associated with radiculopathy. A pain management physician is an anesthesiologist that is fellowship trained in pain management. There are many different treatment options that pain management physicians can execute including epidural steroid injections, facet injections, trigger point injections, median branch blocks, and radiofrequency ablations. Dr. Darwish may recommend one of the above treatment options depending on your history, physical exam, and diagnostic testing.
Surgeries
Endoscopic Discectomy
Endoscopic discectomy is the least invasive spine surgery option. The incision is the size of an eraser tip. No bone is removed like in the typical laminectomy and discectomy. This also creates the least amount of tissue damage. This is an outpatient procedure and leave the surgery center within hours of completing the surgery.
Laminectomy/Discectomy
The laminectomy and discectomy removes a very small amount of bone, lamina, to be able to reach the herniated disk. Dr. Darwish only removes the disk that is herniated into the canal or foramen. No disk is removed between the vertebral bodies. The incision is one to two inches with minimal recovery time. Restriction are put in place for six weeks to allow the disk to heal and reduce the patient’s chance of a reherniation.
TLIF
A transforaminal lumbar interbody fusion with posterior instrumentation is a minimally invasive spine surgery option. Two incisions are utilized to work between the muscles instead of a traditional large midline incision. A small amount of bone is removed, the facet, to access the disk space. The disk is removed and donor bone material along with a spacer is placed to open the disk space. The spacer is also called a cage, interbody, prosthesis, or device. It is made of PEEK, a medical-grade plastic.
The goal of the surgery is to correct any structural issues and decompression the nerve in a 360 degree fashion. Bone will form in between the vertebral bones where the disk was prior: this is the fusion. Due to the removal of the facet joint which contributes to the stability of the lumbar spine, screws and rods need to be placed while the fusion is healing.
XLIF
A lateral lumbar interbody fusion is a minimally invasive spine surgery option. This is especially effective in patients with a prior history of a lumbar fusion or needing a correction of spinal alignment. A small incision on the patient’s side is made. The disk is removed and donor bone material along with a spacer is placed to open the disk space. The spacer is also called a cage, interbody, prosthesis, or device. It is made of PEEK, a medical-grade plastic. Depending on the patient, a plate or screws and rods may be placed to stabilize the spine while the fusion is healing.
ACDF
An anterior cervical discectomy and fusion is a minimally invasive cervical surgery to relieve symptoms of radiculopathy in the cervical spine. A small incision in the front of the neck is used to access the disk space. The herniated or arthritic disk is removed along with any bony spurs also contributing to radicular symptoms. Once the disk is removed, donor bone material along with a spacer is placed to open the disk space. The spacer is also called a cage, interbody, prosthesis, or device. It is made of PEEK, a medical-grade plastic. The fusion will take place between the vertebral bodies. A plate and screws are placed to support the healing fusion.
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