Steve's Spine Surgery Story

From massgeneralbrigham.org

For months, 57-year-old Steve Bricker lived with unrelenting pain.

The source was a synovial cyst located near his spine. This fluid-filled sac was pressing against his lower back nerves, sending pain radiating from the lower back to the feet. Over about 14 months, the pain shooting down his right side got more and more intense.

"At its worst, I'd rate the pain as a 9 or 9.5 on a 10-point scale," said Steve, a resident of York, Maine. "The only way I could find relief was to lie flat on my back. Living my life became very, very difficult. It was terrible."

After several failed attempts to treat the sciatica, Steve set out on his own to find a solution. His research led him to Mass General Brigham Spine Care and spine surgeon Pat Bovonratwet, MD, who specializes in minimally invasive and endoscopic spine surgery.

'This is the guy'

When Steve started experiencing pain, a local doctor sent him to physical therapy. It didn't help. Eventually, he had an MRI, which showed a synovial cyst near his spine.

Sometimes a synovial cyst can be drained or ruptured with a needle. In Steve's case, doctors tried twice without success, as the cyst was in a hard-to-reach location. Meanwhile, steroid injections intended to calm inflammation and pain only brought temporary relief.

"I finally asked one of my local surgeons, 'What's next for me?'" Steve recalled. "He said, 'Probably a spinal fusion.' That's when I decided to take matters into my own hands and look at other options."

Following some research on minimally invasive spine surgical options, Steve called Mass General Brigham and was referred to Dr. Bovonratwet.

"I shared his background and bio with my father, who's a retired endocrinologist," Steve said. "He said, 'Steve, you've got to do whatever it takes to have him take care of you. This is the guy.'"

Removing cyst via minimally invasive tubular decompression

With his father's vote of confidence, Steve scheduled an appointment with Dr. Bovonratwet at Mass General Brigham Healthcare Center (Danvers). At the visit, Dr. Bovonratwet reviewed an MRI scan and proposed an approach for removing the synovial cyst: minimally invasive tubular decompression.

With tubular decompression, the surgeon uses specialized instruments to gently separate the muscles near the spine. A small, thin tube, about the size of a nickel, is then placed to provide access to the spine.

Using a surgical microscope for visualization, the surgeon takes out a small portion of the lamina (part of the vertebral bone) to safely access and remove the cyst. The spine's natural stabilizing structures, including the spinous process and interspinous ligament, are preserved. Unlike in traditional open spine surgery, no muscles are stripped or cut.

"Tubular and endoscopic decompressions are contemporary, minimally invasive spine surgical techniques that allow us to relieve nerve compression with minimal disruption to surrounding tissues," Dr. Bovonratwet said.

After that visit, Steve knew he was in good hands. "I saw that Dr. Bovonratwet was a kind, lovely man and a great communicator who explained everything very thoroughly," Steve said.

Why high-volume experience matters

Dr. Bovonratwet, who is on the faculty of Harvard Medical School, performs tubular and endoscopic decompressions at Massachusetts General Hospital, Mass General Outpatient Surgery Center in Danvers, and Salem Hospital. On average, he conducts these procedures three or four times a day.

"The more you do it, the more efficient you become. At a high-volume center like ours, with dedicated expertise in minimally invasive and endoscopic spine surgery, these procedures can often be completed in around 60 to 90 minutes," he said. "We can consistently achieve the goal of decompressing the nerves, giving patients the same durable outcome as an open procedure."

Steve's surgery was scheduled for three months after his consultation with Dr. Bovonratwet. It could not have come soon enough.

Before heading to Florida for the holiday season, Steve had a third steroid injection to address his worsening pain. It delivered only about 24 hours of relief. He spent the final weeks before surgery taking pain medications and lying on his back as often as possible.

Finally, the day of surgery arrived. It was the first spine surgery performed at the Mass General Outpatient Surgery Center in Danvers — and the first spine case performed in a freestanding outpatient surgery center within the Mass General Brigham system. Steve was nervous but eager to proceed.

When he woke up from surgery, Steve no longer felt the severe nerve pain that had plagued him for so long. He dreaded the prospect of getting up to walk. But once he did, that all-too-familiar pain shooting down his right leg didn't return. He went home the same afternoon.

"I wasn't ready to call it a cure, but I felt there was enough change that this was going to go as projected," he said. "I couldn't wait to see how my recovery went."

Enjoying a pain-free life again

Immediately after the operation, Dr. Bovonratwet had told Steve that his nerve was red and inflamed from having the cyst pressing against it for so long—but that it would heal quickly. Indeed, Steve was completely pain-free within a few months.

The minimally invasive techniques that Dr. Bovonratwet employed have helped speed Steve's recovery. Since no muscle was cut, he hasn't required any pain medications beyond Tylenol. And other than avoiding lifting heavy objects, he is as active as he was a couple years ago.

"Everyone on my care team at Mass General Brigham was top-notch. Just wonderful," Steve said. "I can't say enough about Dr. Bovonratwet, his communication skills, and his expertise. I've passed on his name to as many people with similar needs as me as I could."

While stressing that some cases of sciatica will require open surgery, Dr. Bovonratwet hopes to increase awareness about tubular and endoscopic spine surgery.

"A lot of patients still don't know this may be an option for them," he said. "I would love for people to see Steve's story and learn that they may be a candidate for these modern minimally invasive procedures.

"Spine surgery has advanced dramatically over the years. Operations that once required large incisions and a hospital stay can now, in select patients, be performed through an incision the size of a nickel or pencil tip, often allowing patients to return home the same day."

https://www.massgeneralbrigham.org/en/patient-stories/steve-spine-surgery-story 

How to Relieve Sciatica Pain in Bed

From bensonsforbeds.co.uk 

By Gemma Henry

If we’re being honest, sciatica pain in bed is no joke. That sharp, shooting pain running down your leg is hard to ignore whether you’ve got the comfiest bed in the world or not. And when all you really want is a good night’s sleep, with sciatica pain in the mix, it can feel futile. 

But don’t worry — we’ve got some tips and tricks that might just help you drift off a little easier (without tossing, turning, or muttering expletives under your breath at 3am). 

What is sciatica? 

Sciatica pain happens when your sciatic nerve (the longest nerve in your body) gets pinched, irritated or compressed. It can cause pain, numbness, tingling, or weakness down your bottom, into leg, and even into your foot.

While those who have experienced sciatica pain will assure you that it’s not fun in the slightest, with the right support and sleep setup, sciatica is manageable. 

How to relieve sciatica pain in bed 

Let’s move onto the tips and tricks you can try to help relieve sciatica pain while you’re trying to sleep: 

1. Try sleeping on your side 

Lying on your pain-free side can take pressure off the sciatic nerve. Position a pillow between your knees to keep your hips aligned and prevent your back from twisting uncomfortably during the night. It might feel a little strange at first, but trust us — it can work wonders. 

2. Back sleepers try placing a pillow under the knees 

If you can’t sleep on your side, try lying on your back with a pillow under your knees instead. In elevating your knees slightly, you’ll effectively flatten your lower back against the mattress and reduce the pressure on your sciatic nerve. 

3. Invest in a supportive mattress 

Mattresses need to offer the right firmness level for both your body type, and your preferred sleep position. Too firm, and your hips and shoulders get pushed out of line. Too soft, and your spine sinks into the mattress as though you’re sleeping in a hammock. You want something just right — a medium-firm mattress that supports your back but still cushions your curves. 

4. Heat before bed 

A hot water bottle or heat pad on your lower back before bed can help to loosen tight muscles and soothe nerve pain. Just try to remember to take it off before you fall asleep. Otherwise, you’re likely to wake up sweaty. 

5. Stretch before bed 

Gentle stretching before bed can release tension and help your body relax. knee-to-chest pulls, pelvic tilts, or lying hamstring stretches are all great examples of light stretches that can help to relieve tension that’s built up during the day.  

And remember to keep it light and easy — we’re not at the gym working on those gains, we’re in bed, trying to prepare our bodies for a great night’s sleep. 

Sciatica in bed FAQs 

Before you dash off to try out these 5 techniques to reduce sciatica pain in bed, we took a look at some frequently asked questions relating to the topic. Read on for some additional insights. 

What kind of mattress is best for sciatica? 

A medium-firm mattress is usually the best option for those suffering with sciatica pain. Medium firm mattresses provide enough support to keep your spine aligned, while maintaining a softness that helps to ease pressure on your joints and muscles. 

Can a mattress make sciatica worse? 

Absolutely. If your mattress is too soft or sagging due to age, your spine can dip out of alignment, putting more pressure on the sciatic nerve. 

Should I sleep with a pillow under my lower back? 

It depends. Some people do find relief with a small, rolled towel or cushion under their lower back — others prefer it under their knees. Try both and see what works for you. 

Is it better to sleep on the floor? 

Honestly? Probably not. While a super-firm surface might help some people, most of us need a bit of cushioning to avoid creating additional pressure points. In our experience, it’s best to stick to a supportive mattress over sleeping on the floor. 

How long does sciatica last? 

Mild cases can clear up in a few weeks, especially with rest, stretches and the right sleeping setup. If it’s dragging on for months or getting worse, have a word with your GP. 

How to relieve sciatica pain in bed: final thoughts 

Getting a great night’s sleep while struggling with sciatica can be tough — but the right mattress, sleeping position, and bedtime habits can help to make a big difference.

https://www.bensonsforbeds.co.uk/sleep-hub/how-to-relieve-sciatica-pain-in-bed/?gclsrc=aw.ds&gad_source=1&gad_campaignid=23645696046&gclid=CjwKCAjwn67VBhBnEiwAXUIN1eaeURH8hjRo81FH_jJr0t52EbmwFLS9lQHD6b-7CHUxPdb5NGnm5RoCxjQQAvD_BwE

We Asked Podiatrists to Recommend the Best Shoes for Sciatica—They All Said the Same Thing

From eatingwell.com

By Brierley Horton, M.S., RD

Sciatic pain—commonly called sciatica—refers to pain that occurs when the sciatic nerve becomes irritated, inflamed or compressed. The sciatic nerve is the largest nerve in the body and originates in the lower (lumbar) spine, travels through the pelvis and buttocks and runs down the back of each leg to the foot. 

“What people feel is usually a burning, shooting pain that runs down the leg, but sciatic nerve pain rarely starts where it hurts. The source is often a compressed lumbar disc or a tight piriformis muscle,” says Mikel Daniels, D.P.M., President and Chief Medical Officer at We Treat Feet Podiatry. 

The shoes you wear won’t cure sciatica. But sciatic pain can be affected by how the feet strike the ground, so the right shoes can minimize the kind of motion that irritates the sciatic nerve. “Because sciatic pain can be influenced by how forces travel up from your feet to your hips and lower back during activity, shoes that support alignment and absorb shock can be a useful tool in controlling sciatic pain,” says Anne Sharkey, D.P.M., FACFAS, founder of Solely Podiatry.

Credit:  EatingWell

The Best Shoes for Sciatica, According to Podiatrists 

• Asics Gel-Nimbus 28, $170 at asics.com
• Vionic Walk Max Skyline Sneaker, $175 at vionicshoes.com
• Revitalign Gaia Sneaker, $120 at nordstrom.com
• Brooks Glycerin 23, $175 at brooksrunning.com
• Asics Gel-Kayano 32, $125 (was $165) at zappos.com

So, what should you look for in shoes if you have sciatica? 

Cushioning and shock absorption are important. “The midsole is key—it determines biomechanics, shock absorption and energy return. A shoe with good shock-absorbing capabilities will reduce repetitive stress transmitted up the kinetic chain along the course of the sciatic nerve, thereby decreasing pain,” says Sharkey. “The best midsole materials that are both durable and shock absorbing are EVA, TPU and supercritical foams.” 

Another consideration is heel-to-toe drop. “Look for a medium drop—around 6 to 10 millimetres. A higher heel drop can tilt the pelvis forward and choosing a 0 drop or lower can increase strain through the calf and hamstrings,” says Sharkey. 

Other factors to consider are arch support and stability to lessen pronation and supination and a firm heel counter for stability and alignment. 

When we asked podiatrists which shoes they recommended for sciatic pain, two brands were consistently recommended—Asics and Brooks. But they also gave us other options. Read on for the best shoes to wear for sciatica pain. 

More details are here...

https://www.eatingwell.com/podiatrist-recommended-best-shoes-for-sciatica-12108627

Sciatica myths busted

From mersearoadclinic.co.uk

Sciatica IS common and affects a number of people of all ages and abilities. Yet it is also surrounded by a number of myths

Sciatica is pain or numbness anywhere along the sciatic nerve (which runs from the lower spine, through the buttocks, and down the backs of the legs) caused by compression of the nerve.

 

Myth: We do not know what actually causes Sciatica

 

Fact: Sciatica occurs when the sciatic nerve is pinched or compressed, which is often caused by a bulging or herniated disk between the vertebrae in the lower spine.

 

Other causes include a bone growth on the spine itself or by spinal stenosis, a narrowing of the spinal canal. Thorough examination can typically enable us to determine the cause and therefore the best treatment and recovery path.

 

Myth: Sciatica is a diagnosis or a condition

 

Fact: Sciatica is actually a symptom, indicating that something is irritating a nerve root in the lower back. As Osteopaths, our goal is to determine the cause of that pressure on the nerve and advise on the best treatment plan for each patient.

 

Myth: I should stay in bed and rest if I have Sciatica

 

Fact: As with back pain, we recommend that most of our patients will benefit more by remaining active and avoid bed rest. We see little to no benefit to staying in bed compared with staying active for people with sciatica.

 

Myth: Medication is the only way to provide relief from Sciatica

 

Fact: Reaching for an anti-inflammatory drug is generally most people’s first instinct to help ease the pain of sciatica. However “a systematic review and meta-analysis published in February 2012 in the BMJ (British Medical Journal) found a lack of evidence of the efficacy of drugs including NSAIDs, corticosteroids, antidepressants, and opioid analgesics.”

 

Our Osteopaths are highly trained to identify if you are suffering from sciatica using a number of neurological and orthopaedic tests. However, it is not always possible to relieve true sciatica with just osteopathic treatment and your osteopath will know when to send you for further investigations or a different treatment approach.

 

Myth: All leg pain means I have Sciatica

 

Fact: There could be a number of reasons for your leg pain including muscle trains, vascular issues or another nerve being irritated. The symptoms of Sciatica runs from the mid-buttock down the back of the leg, commonly past the knee and down through the calf.

 

Myth: Sciatica is caused by an injury or event

 

Fact: This is not always the case. In most cases the intervertebral disk has a small defect and is ready to herniate, which means the Sciatica is not necessarily caused from any specific event.

 

Myth: Surgery is the only way to truly address Sciatica

 

In most cases, Sciatica can be resolved within about six weeks and do not need surgery. We may recommend other treatment options if the Sciatica is particularly stubborn to treat.

 

Myth: Sciatica cannot be prevented

 

It is true that not all cases of Sciatica can be prevented, but maintaining an active life, correct posture, strong core and body maintenance will all help towards preventing lower back pain and Sciatica. We highly recommend Pilates as an effective form of exercise to help prevent and address Sciatica as it focuses on strengthening your core.

https://www.mersearoadclinic.co.uk/tips-tricks-and-articles/9-sciatica-myths-busted