Herbert Cares, M.D.

Frequently Asked Questions

INDICATIONS FOR SURGERY

What is the difference between a ruptured disc and a herniated disc?
A ruptured disc is the same as a herniated disc. Other names are "slipped disc", "protruding disc", "pinched nerve".

What are the indications for surgery?
Surgery is always a last resort. We have no objection to (alphabetically) acupuncture, chiropractic, epidural steroids, faith healing, herbal therapy, or hypnotism. Anything that works is fine! The endpoint that we use is when the patient says "I'm no good this way", "I'm sick of the pain", or "I can't live like this."

QUESTIONS ABOUT THE SURGERY

How long will I be in the hospital?
Most patients for simple disc surgery are in the hospital for either the same day or overnight

What is the recovery period?
Most patients return to work anywhere from a few days to several weeks depending on the nature of the job and personal variables

Do you take the whole disc out?
At surgery we remove only the ruptured(broken) part and everything else that is loose. It is possible to totally remove a cervical disc, but it is difficult, if not impossible, to totally remove a lumbar disc without doing both sides or going through the abdomen.

Will I need blood transfusions?
Blood transfusions are not needed with the microsurgery in our experience. (We have even operated on Jehovah's Witnesses whose religion prohibits the use of blood.)

How about a second opinion?
We welcome second opinions, but make sure that you realize what our first opinion is before seeking a second opinion. In most cases our first opinion consists of leaving it up to the patient, since only the patient decides.

If I don't have the surgery will I hurt myself?
Most people can get by without surgery obviously

How soon can you do the surgery?
In most cases were are able to schedule the surgery within a week or two. If there are danger signs, the surgery would have to be performed as an emergency.

How soon does the nerve root (leg) pain go away after surgery?
Often it is instantaneous. Sometimes it takes a few days or even weeks to slowly fade away. It is very common to experience "numbness" in the distribution of the previous pain. That is very common and to be expected. It has to do with once the pressure on the nerve is relieved, it transmits what is called a paresthesia instead of the pain. True "numbness" is total loss of sensation, and that would be unusual.

What is the success rate?
We never give exact percentages or probabilities. However, (1) we choose our surgical patients very carefully; and (2) obviously we wouldn't do the surgery if we didn't expect it to relieve the pain.

WHAT HAPPENS IF THE NERVE ROOT PAIN DOESN'T GO AWAY AFTER SURGERY?

There is a small number of patients for whom the surgery affords temporary or no relief.What then?
  • A blood test (CBC and sed rate) rules out deep infection (discitis or osteomyelitis).
  • An MRI rules out surprises such as another disc fragment, hemorrhage, or discitis.
  • If 1 & 2 do not explain the persitent pain, we suggest an outside independent second opinion. (We may do a myelogram first).
  • Experience shows the 2nd opinion rarely has anything new to offer, but once established that further surgery is not needed, rehab measures, including pain control, are the last tactic.

Some patients in this category are described as having "a failed back syndrome".

FREQUENTLY ASKED QUESTIONS---CERVICAL
Most of the principles under the lumbar section above apply to the neck.
There are frequent questions that apply specifically to the neck.

What determines whether I will have an operation from in front (anterior cervical discectomy and interbody fusion) or from behind (cervical laminectomy)?
Quite simply, if the disc or spur is pressing on the cord or nerve root from in front, then that is the preferred method of removal. In that way, the spinal cord or nerve root does not have to be retracted or even touched. The anterior route is preferred especially when there is just one level involved.

If there are multiple levels, and/or if the pressure on the neural structures is from behind, then the preferred route is from behind.

Why is a fusion necessary from in front, but not from posteriorly?
Interestingly, it is more likely than not that when, the disc is removed from anteriorly, the vertebral bodies fuse together anyhow. Placing a bone graft where the disc was keeps the foramina open where the nerve roots exit. In my experience, we have never regretted using a graft, but on rare occasions we did regret not using one.

Is it possible to have a bone bank graft instead of using my “hip” (actually iliac crest) as a donor site?
On rare occasions we have used bank bone. However, we prefer to use the patient’s own bone for a variety of reasons; there is less of a chance the bone will be rejected, esthetic considerations notwithstanding.
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