Endoscopic Treatment of Cervical Foraminal Stenosis

In this insightful episode of the Back Pain Talk podcast, host Dr. Tony Mork, MD a renowned endoscopic spinal surgeon, discusses the challenges and solutions related to annular tear surgery. He shares a real-life case study of a patient who suffered from chronic low back pain after a motor vehicle accident and was unable to find relief through conventional treatment methods like physical therapy and chiropractic care.

Dr. Mork delves into the diagnostic process, explaining the use of MRI scans and CT discograms to identify annular tears. He highlights the importance of accurate diagnosis, especially for patients experiencing axial low back pain without radicular symptoms, as it helps determine the most appropriate treatment plan.

The episode further explores the controversial nature of annular tear treatment and emphasizes Dr. Mork's belief in minimal intervention. He shares his successful experience using a trimedyne laser with a 1.6 mm side-cutting tip to treat the patient, resulting in significant pain relief and recovery within two months post-surgery.

Tune in to this episode of "Back Pain Talk" to learn more about the innovative and minimally invasive treatment options for annular tears, as well as Dr. Tony Mork's commitment to providing patients with the best possible outcomes.

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

An episode about annular tear surgery and treatment options as well as a comprehensive guide on annular tears themselves.

The episode begins by explaining that an annular tear is a condition where the ligament featuring a strong ring of cartilaginous fibers that connects your vertebrae to your discs is torn. The outer annulus fibrosus ring is chock-full of nerves, which means a tear is going to result in substantial pain if these nerves are damaged.

Annular tears typically develop over time in the lumbar spine or lower back, which means the main cause is simply getting older. As we age, our bodies become weaker, and the disc in our back takes a lot of punishment during that time. If you live an active lifestyle or take part in regular heavy weightlifting, especially lifts involving twisting motions, your chance of damaging the annular fibers increases. Other common causes of annular tears include car crashes and other physically taxing accidents, excessive body weight, degenerative disc disease (DDD), and bone spurs.

There are three types of annular tears: transverse, radial, and concentric. Transverse tears extend from the outer rim of the disc to the nucleus, which means individuals with this type of tear almost always experience significant lower back pain. Radial tears occur along the innermost portion of the annulus, while concentric tears form in the ring around the nucleus of the disc. They are oftentimes the product of torsional injuries caused by excessive twisting.

The pain that accompanies an annular tear can vary, but it typically falls into one of several categories. Lower back pain that starts bad and gets worse during exercise, stretching, etc. The back goes out suddenly after months without issue, leaving one sidelined for days or weeks. Sitting upright for extended periods of time causes agonizing pain. Groin or testicular pain. Pain that persists after taking pain pills. Sporadic pain, numbness, or burning in the feet, legs, or buttocks. An individual could experience no pain at all if the annular tear is minor.

YouTube: https://www.youtube.com/watch?v=VUOY6ZrUq0c

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

Welcome to the Bulging Disc Symptoms and Disc Herniation Treatment episode, where we discuss chronic neck and back pain and its resolution. Our host is Dr. Tony Mork, an endoscopic spine specialist and certified North big surgeon with over 13 years of experience in the field. Today's episode is all about bulging discs and their different protrusions and bulges, so that when you read your MRI report, you have a better understanding of what's going on.

Dr. Mork explains that a bulging disc is a common spinal condition that occurs when the soft cushion between the vertebrae bulges outwards, putting pressure on the surrounding nerves. This can cause a range of symptoms, including:

• Pain in the neck, back, arms, or legs
• Numbness or tingling in the arms, hands, legs, or feet
• Weakness in the arms, hands, legs, or feet
• Difficulty standing or sitting for long periods of time
• Difficulty lifting objects or performing everyday activities

He goes on to explain that there are different types of bulging disc protrusions, including contained and non-contained herniations and sequestered fragments. While the symptoms can vary depending on the severity and location of the bulging disc, it's important to seek medical attention if you're experiencing any of these symptoms.

Dr. Mork also discusses the different treatment options for bulging discs, including physical therapy, pain management, and in some cases, surgery. He emphasizes the importance of seeking treatment early on to prevent further damage to the spine and to improve quality of life.

Thanks for listening to this episode on bulging disc symptoms. If you have any questions or concerns about your own spinal health, please contact Dr. Mork at drtonymork.com. Stay tuned for more episodes on spinal health and chronic pain management.

Bulging Disc Video

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

Welcome to this informative podcast episode with Dr. Tony Mork, a board-certified orthopedic surgeon. Today, Dr. Mork will discuss adjacent segment disease (ASD) following spinal fusion surgery. He will share the story of a patient who underwent a successful fusion 10 years ago but has recently experienced increasing back, buttock, and leg pain, which has significantly impacted his active lifestyle and forced him to give up racquetball.

Dr. Mork will walk listeners through the patient's MRI scans, explaining the various findings such as the darkening and narrowing of the disc, disc bulging, and overgrowth of bone tissue above the fusion level. He will also highlight the significant enlargement of the facet joints, a common pathological occurrence in ASD, and the resulting compression of the spinal cord.

In this comprehensive episode, Dr. Mork will delve into the long-term studies on ASD, discussing the potential consequences of spinal fusion in different populations. While fusion has been proven to be an effective treatment for degenerative spondylolisthesis, its use in younger patients and for an expanding range of indications raises questions about the possible long-term effects on certain cases and populations.

Dr. Mork will review the existing literature on fusion and decompression outcomes, highlighting both the satisfactory results and the challenges faced by some patients. He will also explore the factors contributing to ASD, such as increased mechanical stress on adjacent segments and the accelerated degeneration of adjacent discs and facet joints. He will discuss various considerations for preventing or mitigating the risk of ASD, including patient selection, surgical techniques, and the role of motion preservation technologies in potentially reducing ASD incidence.

Moreover, we'll examine the options for managing ASD, ranging from conservative treatments like physical therapy and pain management to surgical interventions.

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

Welcome to this podcast episode featuring Dr. Tony Mork, an esteemed endoscopic spinal surgeon, speaker, and inventor. In this episode, Dr. Mork will discuss an intriguing article presented at the American Academy of Surgeons meeting in New Orleans. The article sheds light on the treatment of chronic low back pain in individuals aged 65 and older, a significant issue that affects 1.5 million people in the United States. Among this age group, chronic low back pain is considered the second most disabling condition, trailing only arthritis.

Dr. Mork delves deeper into a well-designed study that investigated the effectiveness of TENS (Transcutaneous Electrical Nerve Stimulation) units in treating low back pain. He provides a comprehensive explanation of how these devices function by delivering light electrical stimulation to superficial nerves, consequently blocking the deeper pain sensations.

The study, led by Michael Minshall, Master of Public Health, compared the outcomes of statistically matched groups of individuals using TENS units and those who did not. The results revealed that the group using TENS units experienced less back pain, had fewer visits to clinics, required less diagnostic studies, and had reduced hospitalizations and surgeries. This study suggests that TENS units may be a promising non-invasive treatment option for managing chronic low back pain in older adults.

Throughout the episode, Dr. Mork also discusses the findings of past studies on TENS units, which have demonstrated mixed results. Some studies have shown benefits, while others have reported limited effects or poor-quality evidence. He elaborates on the factors that may contribute to these discrepancies, such as study design, participant selection, and variations in the application of TENS units.

Dr. Mork will also explore the potential reasons behind the effectiveness of TENS units in treating chronic low back pain, such as the gate control theory of pain. This theory suggests that non-painful input, like the electrical stimulation provided by TENS units, can close the "gates" to painful input, preventing pain sensation from traveling to the central nervous system. This mechanism could explain the pain relief experienced by older adults using TENS units in the study.

TENS Unit Video

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

Introduction: Hi, I'm Dr. Tony Mork, an author, speaker, inventor, and board-certified surgeon. As an endoscopic spine specialist, I've dedicated my practice over the past 13 years exclusively to the treatment of painful neck and back conditions without the use of fusion. In this podcast, I will discuss endoscopic laser spine surgery, its differences from other types of spinal surgery, and how it can help those suffering from chronic pain.

The Problem: Chronic neck or back pain can be debilitating, and it's not uncommon for individuals to experience pain that radiates down the arm or leg. Often, the cause of the pain is unknown, and traditional treatments like chiropractic care, physical therapy, and massage therapy may not provide relief. Many people try medications, but these only take the edge off and don't solve the underlying problem.

Confusion About Surgical Options: If you're considering surgery for your pain but are unsure about what your MRI results mean or what surgical options are available, you're not alone. Years ago, when I was a knee and shoulder surgeon, I asked my senior partner, a highly experienced spine surgeon, to explain the difference between various types of back surgery. He offered a simple, yet profound answer, saying that there are only two things you can do to a spine: fuse it or decompress it.

In the past 20 years, a few additions have been made to the surgical options, including disc replacements and neural ablation using RF generators. However, the basic components of spine surgery remain the same—fusion and decompression.

Spinal Fusion vs Decompression: The choice between spinal fusion and decompression is, in many ways, a philosophical consideration. Endoscopic laser spine surgery is a form of decompression that offers a less invasive alternative to traditional spinal surgery. By understanding the differences between these two approaches and discussing your options with a qualified medical professional, you can make an informed decision about the best treatment for your chronic neck or back pain.

Blog Post: https://drtonymork.com/back-surgery/alternatives-to-spinal-fusion/

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

Hi, I'm Dr. Tony Mork, an endoscopic spine specialist. Today, I'd like to talk a little bit about lumbar foraminal stenosis. Whether it's in the cervical spine or the lumbar spine, the foraminal canals can become stenosed, or narrowed. The problem is essentially the same: if there is anything inside the foraminal canal, other than the nerve that's supposed to pass through it, the nerve becomes obstructed. This could be a deposit of bone, soft tissue, or a disc. These deposits compete for space with the nerve and often result in pain in the buttock, leg, or foot.

Let's review the anatomy of the lumbar spine briefly. You can see the vertebrae, the facet joints, and the yellow spinal cord going down the center. This is the central canal, the larger canal that allows passage of the spinal cord or the nerves in the lower lumbar spine (called the cauda equina) at each level. By level, I mean the space between two discs, for example, L1 and L2, or L2 and L3. Each level has a nerve root that passes through a foraminal canal, a short tunnel.

The foraminal canal can become narrowed for several reasons. For example, if the disc is gone, and one vertebrae is on top of another, the bone would be closer, causing some narrowing. Another cause of narrowing is overgrowth of bone or osteophytes (spurs) in the facet joint. If these dig into the nerve root, it's referred to as foraminal stenosis. Additionally, if the disc pushes out into the foraminal canal, it can also compete for space with the nerve root.

View on YouTube

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

Hi, I'm Dr. Tony Mork, an endoscopic spine specialist and orthopedic surgeon. Today, I'd like to talk about a term that's commonly discussed and that you may see in your radiology reports. It's a term I don't like very much because it doesn't have much meaning and is not very specific. That term is "spondylosis."

Spondylosis refers to general  osteoarthritic changes of the spine, whether it be cervical, thoracic, or lumbar, but it doesn't really have anything to do with where you hurt, which is the main reason people are getting X-rays, CT scans, or MRI scans. It really only has to do with the radiology report and gives a general reflection of wear and tear. Osteoarthritis essentially means wear and tear changes, just like parts in our cars wear out with time. That's the basic concept of spondylosis. It's a very non-specific term that means things are wearing out.

Let's talk a little bit about what it means more specifically. In this picture, spondylosis can mean that there's narrowing of a disk space. Here is an example of a disk space that's still intact. We've got some space here, it's a little narrow in the back, but not too bad. As we move up to these other levels, we have a significant loss or complete loss of the joint space or the disk space. Not only that, there's also calcification of what used to be the soft tissues, and we can even see some subluxation or even vertebrates moving backward on this one. We've even got some spurring. This does not tell us anything about pain; it really just tells us that we've got some osteoarthritic changes, which may or may not be a problem or even contribute to a problem.

View on YouTube

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

Hi I'm Dr Tony Mork endoscopic spine specialist. Today I'd like to talk about spondylolisthesis and although there are five types of spondylosis as described by Newman and McNabb, I'd like to talk about the most common one I get to see in my practice which is Degenerative Spondylolisthesis. Well first off, what a Spondylolisthesis? “Spondylo” means spine and listhesis means to slip.

So there's some slipping of one vertebrae on the other, in this case usually in the elderly population although not always, and six times more commonly at the L4-5 and is the facets joints. As the joints of the facets narrow the vertebrae can actually slip forward. So let's take a look on this model about what I'm trying to explain. Well in this model here we can see that we're looking at the spine from the back and this is a Facet Joint. here if I turn that a little bit obleakly you see that normally there’d be a  joint here with several millimeters of cartilage between the 2 facet joints. So If I take them apart you can see that bone from the facet joints are going to meet. Each of the joints are covered by cartilage and if a product if there is wear and tear in the cartilage is gone you can see that the actual vertebrate could slip forward. So in the picture here what I've drawn is the facet joints in the back wearing out and as a result this vertebrate, let's just say four five can slip forward as a result the disc oftentimes will narrow. The Joint will become arthritic lose its joint space and the body in response to this whole thing will often times try to form osteophytes and calcify spinal ligaments in order to reduce the motion particularly at the level where the most motion occurs which is L4-5...

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I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...

Transcription:

Hi Im Dr Tony Mork, endoscopic spinal surgeon and today I'd like to take a few minutes to just show you what is possible endoscopically for the treatment of symptomatic cervical foraminal stenosis. 

So the problem being tight framinal canals and that nerves getting compressed or pinched either from some bony problem like an overgrowth of Facet Joint the uncle vertebral joint getting enlarged or some disc herniation into canal. In any event the foraminal canal is too tight and the nerve is getting pinched giving rise to shoulder arm and hand pain. So this is the Richard wolf endoscopic cervical set and I just like to just give you a brief demonstration of how this goes. This the cervical spine and if we go ahead and put this I'm going to just aim at a little bit toward you we can get a sense that these are the cervical facets as they overlap at various levels on both sides. But the cervical facet joints lead into the foraminal canal where the nerve actually passes out so this procedure is one of opening a portion of the foraminal canal and i will try to go through that process right here. To do the following first we utilize a small guide in like this to establish where the Facet Joint that we're interested in. So for example in this case at the 5 6 highlighted in red here this pin goes right on top of the area of interest and on top of that is followed by a cannula this is the size of the cane between three and four millimeters and through a very small incision this is past over the guide wire. Once this is passed over the guide wire I have a small obturator that goes down to the facet or the level of Interest. This establishes the initial port through the soft tissues down to the areas and it is followed by a cannula which goes over the operator down to the area of interest and then at this point the initial operator can be removed and a little Rubber seal placed. This allows the port to be established and then at this point the vertebra scope or the arthroscope which is this and can be inserted then down the cannula to the area of interest. 

 Video More on YouTube
Blog Post here: https://drtonymork.com/back-pain/foraminal-stenosis/cervical-foraminal-stenosis/

I'm Dr. Tony Mork and I run an Endoscopic Spine Surgery practice in Irvine, California and Naples, FL. I avoid a fusion when possible (which is most situations) and provide treatments that actually address the pain without taking an invasive approach.

Some of the conditions I treat:

• Disc Herniation
• Bulging Discs
• Spinal Stenosis
• Annular Tears
• Sciatica
• Facet Syndrome
• Foraminal Stenosis
• And more

Dr. Tony Mork, MD
2102 Business Center Dr #127, Irvine, CA 92612
(949) 640-6675
Get Directions

Links:

Podcast
Website
Spine Surgeon Irvine, CA
Tony Mork Reviews
Business Site...