Free Conquer Back and Neck Pain - Walk It Off! by Mark Brown Page B

susceptible to infection, so I ask my patients to stop smoking before they have an epidural. The risk of infection from an epidural is very low. In order to prevent this complication, I do not recommend that a patient with an active infection, such as acne around the site of injection, have an epidural steroid injection until the infection is treated first. If you have had a recent urinary tract infection, fever, earache, toothache, periodontal disease, foot ulcer, or other source of infection in your body, you should not have an epidural. Active infections somewhere in your body must be treated before having an epidural steroid injection because of the risk of the infection spreading to your spine as the result of the procedure. You should warn your doctor of any active or recent infections that you have experienced, even a common cold, before allowing yourself to have an epidural steroid injection.
    Increased nerve damage may result from an epidural injection if the needle penetrates the nerve. A skillful doctor who performs the injection will take precautions while performing the procedure to prevent this from happening.
    When appropriate precautions are taken, I have found that epidural steroid injections are a safe and effective way of relieving pain caused by a herniated disc. Many of my patients have been satisfied with the pain relief experienced from an epidural steroid for a painful herniated disc.
Band-aid surgery, micro-surgery, laminectomy: Which is best for me?
    If your disc herniation causes weakness of a major muscle in your arm or leg along with the pain, if you have changes in your bowel and bladder function, or if you experience loss of balance, you need surgery as soon as possible. If the pain is unrelenting and you are having difficulty walking and sleeping, you should have surgery. If you have had the pain for more than three months and it has not been relieved by one or more epidural steroid injections and you need narcotics to function, you should seriously consider surgery.

    The top figure illustrates a spine cross section showing a compressed nerve from a herniated disc. The lower figure shows that a portion of the disc has been removed to decompress the nerve.
    The standard surgical procedure for a disc herniation in your low back is called a laminectomy (removing part of the roof of the spinal canal in order to see the herniated disc) and disc excision (removing that part of the disc that is pressing on the nerve). The incision is between two and four inches long, depending on how large you are, and the surgeon wears magnifying glasses to perform the procedure. The procedure takes between 45 minutes and an hour and a half, depending on how adherent the herniated disc is to the nerve. Most patients are able to walk the same day of surgery and leave the hospital the following day. You can expect to be able to get out of bed by yourself and walk without pain before you leave the hospital. The procedure is not very painful, and most of my patients take narcotics for no more than a day or two following surgery. You can expect to be back at work within 10 days.
    I once removed a herniated disc in the low back on a bone fisherman. Bone fishermen are the ones who stand on an elevated platform in the back of a skiff and push the boat through the water with a long pole. The surgery was on a Monday, and he returned to the Florida Keys the following morning. He never came back to see me in the clinic, so I contacted his wife and she told me that he was out fishing and had been since two days following his surgery! It was bone fishing season and he wasn’t going to miss any more time than was necessary. He was pushing his boat with his clients around the salt-water flats of the Florida Keys in hot pursuit of bonefish.
    Though I would not advocate that you try to do what he did two days following disc surgery, this story illustrates that recovery from a standard open disc excision in the low back can be that