Treatment options range from basic rest, ice or heat and gradually resuming activity to medication, exercise, physical therapy, chiropractic treatment, acupuncture and surgery. Dr. Rezaian will make recommendations for the treatment of your specific back pain. Make sure to educate yourself on the cause of your back pain, and look into the pros and cons of available treatment options, so you and your doctor can choose what's best for you.

The three main procedures performed by us are the following:

• Rezaian Spinal Fixator for management of fractures of the thoracolumbar spine
• Herniated Disc Surgery
• Spine Fusion

The Rezaian Spinal Fixator
What is a spinal fixator?
The Rezaian Spinal Fixator (RSF) is a simple turn-buckle appliance with a fixation mechanism on two extremities. It simply replaces the compressed, burst, or damaged body of the vertebra. It corrects kyphotic deformity, completely relieves neural pressure anteriorly, and stabilizes the spine for early rehabilitation. Hospitalization period is 7 to 14 days. No external support is required.

The Rezaian Spinal Fixator (RSF) has been invented to replace only the broken failed body of the vertebrae. It fully allows anterior decompression of the cord for a better neurological recovery, restores the failed body of the vertebrae, and corrects the kyphotic deformity for normal weight-bearing. It produces a secure stable spine for early rehabilitation. The need to include two or three vertebrae above and below the fracture site in mass fusion and the need for external support (e.g., cast, brace, jacket) are completely eliminated.

The RSF is a form of a turnbuckle with a flat plate on each end, with four sharp spikes on each flat plate. Following the decompression of the cord, this appliance is imbedded between the two adjacent intact vertebral endplates. At the same time, the height of the collapsed vertebral body is restored by turning the turnbuckle mechanism; concomitantly, the kyphotic deformity is corrected. Based on a distraction compression mechanism, the fixator securely fixes and stabilizes the broken and unstable spine. It occupies approximately one-third of the body of the vertebra; two-thirds of the space is filled with bone graft when it is used for long-lasting fusion.

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Herniated Disc Surgery

What is a herniated disc?
A herniated disc is also referred to as a "slipped disc." The disc contains nucleus tissue that may be forced from the center of the disc as a result of too much pressure, when this happens, it can cause the disc to rupture against one or more of the spinal nerves. Pressure on the spinal nerves can cause severe pain, numbness, or weakness in the lower back as well as the legs and feet. Other names used for herniated discs are "prolapsed", "bulging", or "ruptured".

What is Endoscopic Discectomy?
Endoscopic Discectomy is a surgical procedure that removes herniated disc material.
The procedure usually is performed on an outpatient basis under local anesthesia, consisting of an injection of anesthetic in the muscle (not a spinal block). The procedure may be performed in the operating room or special procedures room at the hospital.

After local anesthesia has been given, a small-guided probe is inserted into the disc using X-ray control. The Nucleotome probe, a specially designed probe, is inserted into the skin of the back between the vertebrae and the ruptured disc and a 1/8 inch opening is made into the disc itself. The Nucleotome probe is used to remove small pieces of the nucleus tissue using a suction device. The probe can sometimes be used to push the bulging disc back into place and can be used for the removal of disc fragments and small bone spurs.

The procedure takes about an hour and has minimal exposure to X-rays. You will feel little, if any pain or discomfort. After completing the surgery, the probe is removed and the incision is ceiled with a Band-Aid, no stitches required. The entrance route to the disc consists of the probe's small puncture site, usually the size of a freckle.

Clinical results with Endoscopic Discectomy, as compared to alternative surgical procedures, have proven:

• No stitches
  
• No serious complications
  
• No blood loss (i.e., no risk from blood transfusion)
  
• Less risk of infections
  
• Little, if any hospitalization required
  
• Faster return rate to work and normal activity
  

Postoperative Course
Most patients feel immediate relief from pain following the procedure. Walking is permitted the same day and patients can be discharged from the hospital that evening. While the Endoscopic Discectomy procedure is frequently performed on an outpatient basis, your physician may recommend an overnight hospital stay. Some patients experience low back muscle spasms that may last a few days following the procedure. This pain can be relieved with muscle relaxants if needed.

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Spinal Fusion

What is spinal fusion?
Spinal fusion involves the use of bone graft to cause two opposing vertebrae to grow, or "fuse" together. To ensure position and rigid alignment while the fusion takes place, surgeons apply spinal instrumentation, or implants, such as screws and rods. These implants are connected together to maintain spinal stability and are rarely removed. Spinal fusion and internal fixation is performed to restore stability to the spine, correct deformity and bridge spaces created by the removal of damaged spinal elements, such as vertebral discs.

Surgeons have traditionally used an open approach to perform spinal fusion procedures, which involves making an incision along the middle of the back, stripping large bands of back muscles free from the spine, and pulling (retracting) the muscles to each side of the opening so that the surgeons can view the spine and easily access the vertebrae for instrument implantation.

The main benefit of traditional open spinal surgery is the degree of exposure (i.e., view of the spine) and accessibility that it affords the surgeon. Several studies have shown, however, that extensive surgical exposure and prolonged periods of retraction can seriously injure the major muscles of the back and, in turn, cause considerable post-surgical pain.

How is the surgery done?
A small incision is made to one side of the neck at the collar line. The trachea (windpipe) and the esophagus (food pipe) are pulled to one side. This gives clear access to the front of the vertebral bodies and to the discs so that discs and bone spurs can be removed easily.

A small piece of bone is put into the space where the disc was removed. The bone used for the fusion will either be your own, harvested from your hip or from the bank bone. Holes are drilled into the disc, overlapping into the vertebral bodies above and below. A "cage" device is inserted into the disc space. Bone or material to enhance bone growth is inserted into the cage. When the bone grows through the holes in the cages uniting with the vertebral bodies, the fusion will be "solid." The advantage of this method is that it provides instant stability-it will not slip. Your doctor will discuss which method is best for you.

After the procedure is complete, the windpipe and the food pipe are returned to their usual place and the incision is closed. After a few months, the site of the incision is barely visible.

Your doctor may want you to wear a brace for a while. He will discuss that with you.

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