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Lower back pain is a prevalent issue affecting millions of people worldwide. It can range from mild discomfort to debilitating agony, impacting daily activities and overall quality of life. Understanding the causes and available treatment options is crucial for managing and alleviating this common ailment.

Causes of Lower Back Pain:

1. Muscle Strain: Overexertion, improper lifting techniques, or sudden movements can strain the muscles and ligaments in the lower back, leading to pain and stiffness.
2. Poor Posture: Prolonged sitting, slouching, or standing incorrectly can strain the muscles and spine, causing chronic lower back pain over time.
3. Herniated Disc: When the soft, gel-like center of a spinal disc protrudes through the tough outer layer, it can irritate nearby nerves, resulting in sharp pain, numbness, and tingling sensations.
4. Degenerative Disc Disease: With age, the discs in the spine lose hydration and elasticity, leading to reduced cushioning between vertebrae and increased susceptibility to pain and stiffness.
5. Spinal Stenosis: This condition involves the narrowing of the spinal canal, which puts pressure on the spinal cord and nerves, causing pain, weakness, and numbness in the lower back and legs.
6. Arthritis: Osteoarthritis and other forms of arthritis can affect the joints in the lower back, leading to inflammation, stiffness, and pain.
7. Structural Abnormalities: Conditions such as scoliosis, where the spine curves abnormally, or spondylolisthesis, where one vertebra slips forward onto another, can cause lower back pain.

Treatment Options:

1. Rest and Activity Modification: Resting the affected area and avoiding activities that exacerbate pain can provide temporary relief. However, maintaining gentle movement and incorporating low-impact exercises like walking or swimming can promote healing and prevent stiffness.
2. Physical Therapy: A customized physical therapy program can strengthen the muscles supporting the spine, improve flexibility, and correct posture, reducing the risk of future injuries and alleviating chronic lower back pain.
3. Medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help reduce inflammation and alleviate discomfort. In some cases, muscle relaxants or prescription pain medications may be necessary for more severe pain.
4. Heat and Cold Therapy: Applying heat packs or taking warm baths can relax tense muscles and improve blood flow to the affected area, while cold packs can reduce inflammation and numb the pain.
5. Spinal Manipulation: Chiropractic adjustments or osteopathic manipulation can help realign the spine, alleviate pressure on nerves, and improve range of motion, providing relief for acute and chronic lower back pain.
6. Injections: Corticosteroid injections directly into the affected area can reduce inflammation and provide temporary relief from severe lower back pain, particularly in cases of herniated discs or spinal stenosis.
7. Surgery: In rare cases where conservative treatments fail to provide relief, surgery may be considered. Procedures such as discectomy, laminectomy, or spinal fusion aim to alleviate pressure on nerves, stabilize the spine, and improve overall function.

Conclusion:

Lower back pain can stem from various underlying causes, ranging from muscle strain to structural abnormalities. Effective treatment often involves a combination of rest, physical therapy, medication, and other interventions tailored to individual needs. By understanding the causes and available treatment options, individuals can take proactive steps to manage and alleviate lower back pain, restoring mobility and enhancing overall well-being. Remember to consult with a healthcare professional for proper diagnosis and personalized treatment recommendations.

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Relationships are an essential part of being human.  These connections we form with others play a crucial role in shaping our lives and are integral to who we are.  They provide us with a sense of belonging.  We are social creatures, and we thrive when we have a support system in place.  The relationships we develop help us to grow and develop, and improve our overall well-being.  It is vital to nurture these relationships to ensure we can continue to reap the benefits they offer.

Throughout my life I have always appreciated the people I meet and the relationships that develop. Engagement with people from all walks of life is one of the most enjoyable parts of my daily practice as a neurosurgeon.  I enjoy learning something specific about each of my patients outside of why they walked into my clinic.  Further, I am fortunate to have a career where, at times, I can make a significant difference in my patient’s lives.  I appreciate hearing from patients and loved ones where I truly have made a difference.  I would like to share one specific example from a patient I treated a few years back and has since moved away from Denver…………….

Email:

Dr. Robinson

I’m not sure you remember me or not, but I just wanted to reach out to let you again know how grateful I am for the help you gave me. I truly believe you saved my life back in 2017, and there isn’t a day that goes by that I’m not thankful to have met you and to have had my spinal fusion. True story.

My wife and I are still living near Seattle and we absolutely love it out here. We would have Never considered moving before you helped me

Thank you for all you’ve done for me. I feel so blessed,

Tim

Review:

I have a genetic tumor disorder that caused me to have two spinal surgeries with two different doctors (neither was Dr. Robinson). My second surgery began a years-long process of decline that found me on the edge of not being able to carry out some of the basic functions that I took for granted for so many years. I was in pain to the point to where I thought my life was never going to be back to normal.

Then I was fortunate enough to meet Dr. Robinson. Most importantly, he believed me when I said how much pain I was in. After multiple pain management attempts (RFA, etc.), we agreed to schedule my spinal fusion (T9-L3). As crazy as it sounds, I woke up after the surgery and knew I had a chance to have my life back. The recovery was much less difficult than I imagined, and I am now more mobile than I ever dreamed before the surgery. I only wish I had met Dr. Robinson sooner; he is a gifted and kind surgeon. Thank you, Dr. Robinson; truthfully, not a day goes by where I’m not grateful.

You are most welcome Tim!  Thank you for the opportunity to take care of you and make a difference!

Spine surgery is evolving at a lightning fast pace and an integral part of that is robotic surgery.  Robotic spine surgery utilizes navigation technologies which enables surgeons to more accurately and efficiently place instrumentation or “hardware” in the spine. Spine navigation technology has been around for many years and has been helpful in decreasing the amount of radiation exposure for patients and surgeons during surgery. It also helps in the accuracy of placement of spinal instrumentation.  In a sense, it is like GPS for spine surgery. 

Benefits of Spinal Robotic Technology

Robotic spine surgery is taking navigation to the next level by enhancing patient safety and improving efficiency in surgery. This technology allows surgeons to develop a specific surgical plan prior to surgery.  By integrating preoperative imaging into the robotic software platform, a surgeon can see the patient’s anatomy in three dimension.  This allows the surgeon to create a specific surgical plan and obtain spinal alignment parameters without the need to surgically expose a large portion of the spine.  Pedicle screw (spinal hardware) trajectory can be planned prior to surgery and goals of spinal alignment can be met much more easily. Once the surgery begins, the surgeon can employ the plan with more accuracy and efficiency, thus producing a safer and faster surgery for the patient.

Spinal  robotic surgery techniques utilize minimally invasive surgical techniques.  Due to the enhanced accuracy of robotics, smaller incisions are used which result in less blood loss, decreased postoperative pain and a faster recovery for patients.  Simply put, robotic spine surgery allows surgeons to more easily obtain surgical goals, decreases operating time, and improve the care of their patients- all without compromising safety in any way.

Who is a candidate for Robotic Spine Surgery

Currently, any patient with thoracolumbar (mid and low back) spinal pathology may be a candidate for robotic spine surgery.  This technology can be  incorporated into most surgical plans throughout the mid and lower spine based on surgeon preference and recommendation.  

What’s next in Robotic Spine Surgery

The next phase of robotic spine technology will allow surgeons to perform more accurate and directed decompression surgery.  The decompression aspect of a typical spine surgery involves the process of removing bone and ligament that may be pressing on nerves causing pain and numbness.  By providing three dimensional anatomy views, robotic technology will allow the surgeon to create a precise custom surgical plan for the decompression surgery.  Disrupting less tissue and muscle, robotic decompression surgery will help alleviate common symptoms like pain and numbness and  ultimately produce better surgical outcomes. 

What is an Anterior Lumbar Interbody fusion (ALIF)

Anterior Lumbar Interbody Fusion or ALIF is a minimally invasive spine fusion procedure where the spine is accessed through the abdomen.  The anterior approach to the spine can often be performed with smaller incisions.  Surgeons access the anterior lumbar spine by separating muscles in their normal plane which are then put back in place at the conclusion of the surgery.  Conversely, a posterior approach to the spine involves cutting through muscle and bone to access the spine.

A general or vascular surgeon who is well versed in abdominal surgery provides safe access to the anterior lumbar spine during an ALIF procedure.  The approach is performed in a retroperitoneal fashion meaning we are coming around the important abdominal structures thus not interfering with them at all.  Your films are studied prior to surgery to determine if this approach can be performed safely with limited risk.  When the spine procedure is finished, muscle layers are put back together and function as if surgery never happened.

What are the benefits of an ALIF

The anterior approach gives surgeons much better access to the disc space.  We are able to place a bigger implant which allows restoration of height that may have been lost with disc degeneration.  By restoring normal disc height with the implant we are able to take pressure off of the nerves indirectly.  Indirect decompression allows us to treat nerve pain without disrupting the muscle, and bone from a posterior approach.   We can also correct deformities and more easily put your spine in better alignment using the ALIF procedure.  This will protect your spine for years to come.

Who is a candidate for an ALIF

Candidates for Anterior Lumbar Interbody Fusion surgery are typically patients with degenerative disc disease or progressive arthritis of the spine who have back and/or leg pain.  Specific etiologies include patients with severe degenerative disc disease, spondylolisthesis,  instability (inappropriate movement of the spine producing pain) , fractures, scoliosis, severe facet joint disease, and post laminectomy syndrome  are usually good ALIF candidates. Most likely they have participated in conservative, non-surgical treatments but have not seen significant long term relief.  Good bone quality is also a prerequisite for lumbar disc replacement.  Special consideration is needed if patients have had prior abdominal surgery or radiation to the abdomen or pelvis.  We would be happy to discuss your circumstances at a consultation.

In summary, Anterior Lumbar Interbody Fusion (ALIF) is a minimally invasive, powerful spine fusion procedure used to treat many conditions that are refractory to conservative non-surgical treatments.   I’m proud to offer this treatment for the right patients in my practice.  If you would like more information or feel like you have tried many non-surgical options and are still having pain, please don’t hesitate to make an appointment.  I’d be happy to discuss your symptoms and see if ALIF is the right procedure for you.

Lumbar disc replacement, or  lumbar arthroplasty is a surgery of the lower back where a degenerated disc is replaced with a motion preserving mechanical device that mimics the natural motion previously provided by the disc.

Our spine has three sections – cervical (upper spine/neck), thoracic (mid-back) and lumbar (lower back).  The spine consist of a series of bones called vertebrae with a disc located between each vertebra.  These discs serve as a cushion or shock absorbers, absorbing the impact of everyday motion.  They consist of an outer annulus and a softer gelatinous material in the center.  As we age, it is common for the discs to become worn and compressed.  This is called degenerative dis disease (DDD). Estimates suggest that 40% of adults over the age of 40 and 80% of adults over 80 suffer from this degeneration. Low back pain is a very common symptom of DDD and is one of the most common reasons people see their primary care physician.  A variety of non-surgical treatments are available to relieve pain and enhance mobility. However, about 10-20% of adults with lumbar DDD do not obtain long standing relief from non-surgical treatments and in those cases, a surgical treatment can be considered.

Historically, spinal fusion has been the most common and primary surgical treatment for DDD.  Lumbar Disc Replacement (LDR) or lumbar arthroplasty is a procedure that has been around for 30 years continues to evolve with better implants and more widespread acceptance with patients and insurance companies.  Lumbar arthroplasty  involves an anterior approach providing access to the front of the disc space.  The surgeon removes the degenerated disc and replaces it with an artificial disc which preserves natural motion of the spine.  A spine fusion procedure, conversely, replaces the degenerated disc with bone graft or cage that permanently joins two vertebrae together as one solid unit of bone thus reducing movement.  This procedure acts to decrease pain by restricting painful movement of the arthritic spine.

Benefits of Lumbar Disc Replacement

The benefit of Lumbar Disc Replacement is the preservation of the natural motion of your spine. The implanted artificial disc, which is made of two titanium “endplates” with a mobile  composite center replicates the motion of the natural disc.  Spine fusion on the other hand  limits movement across the fused segment.  This transfers motion to the adjacent segment causing added stress and strain.  Added stress and strain can lead to accelerated degeneration of the adjacent level (above or below the fused level), creating the possibility of additional pain and degeneration.

Additional benefits of lumbar disc replacement include much faster recovery time.  Often lumbar disc replacement patients are performing normal activities within weeks of surgery compared to months with a spinal fusion.  No bracing is required with an arthroplasty whereas with a spine fusion a brace is recommended for up to three months.

Candidates for Lumbar Disc Replacement

Candidates for lumbar disc arthroplasty typically are patients with degenerative disc disease  who have participated in conservative, non-surgical treatments but have not seen significant relief.  Not all back pain patients are candidates for lumbar disc replacement surgery.  Patients with instability, fractures, scoliosis, severe facet joint disease, post laminectomy and other etiologies are often not good arthroplasty candidates.   As previously mentioned, motion preservation is a benefit of lumbar disc replacement.  However,  for some patients with instability or other problems mentioned above, a spinal fusion may be the optimal treatment. Good bone quality is also a prerequisite for lumbar disc replacement.

In summary, Lumbar Disc Replacement is often a good alternative to traditional spine fusion for the treatment of degenerative disc disease and/or mechanical back pain.  I’m proud to offer this treatment for the right patients in my practice.  If you would like more information or feel like lumbar disc replacement surgery is right for you, please don’t hesitate to make an appointment.  I’d be honored to discuss your symptoms and see if lumbar disc replacement is right for you.

 1. Medical Advisory Secretariat. Artificial discs for lumbar and cervical degenerative disc disease -update: an evidence-based analysis. Ont Health Technol Assess Ser. 2006;6(10):1-98. Epub 2006 Apr 1. PMID: 23074480; PMCID: PMC3379529.

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