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What can you expect from surgical treatment of a disc herniation? Dr Qureshi Explains
What Do Doctors Think About Before Cervical Spine Surgery? Watch Video Now
Interview with Mark R. McLaughlin, MD, FACS
Interview by Johnny Morris
WIMG Channel 25/Radio
1. What is the difference between a Neurologist and a Neurosurgeon?
A neurologist is a doctor who specializes in the medical treatment of diseases that affect the brain, spine, and peripheral nerves such as multiple sclerosis, Parkinsons disease, migraine headaches, and others. A neurosurgeon is a doctor who specializes in the surgical treatment of diseases that affect the nervous system such as brain tumors, certain kinds of stroke, fluid build up on the brain, and nerve compression problems. Also neurosurgeons treat patients with diseases of spine such as neck and back pain caused by herniated or bulging discs and arthritis. Lastly, we treat patients suffering from nerve compression in the arms and legs, such as carpal tunnel syndrome and other pain syndromes. There is some overlap in the two specialties but, in general, neurosurgeons deal more with anatomical and structural problems affecting the brain, spine, and peripheral nerves.
2. Why did you go into medicine?
I wanted to be a doctor ever since I was 5 years old. My grandfather was a physician in New Jersey and practiced for over 50 years. He was a Naval surgeon in the Philippine islands during World War II and was a pioneer in penicillin therapy for infections in the heart. As a kid, seeing my grandfather’s devotion to his patients, and his hunger for advancing medical knowledge, he was my idol. I still vividly remember as a little boy going on house calls with Grandpa Pizzi and knowing that this was what I wanted to be. And as I grew older, I would observe my uncles at the hospital and in surgery, 4 of whom were physicians (two still practicing). It only reaffirmed my desire to become a physician. And so now, 33 years later I am a 3rd generation physician in my family and I am living my dream. It’s what I have always wanted to be.
3. What is your philosophy about surgery?
Extremely conservative. When I take somebody to the operating room, in my book, that’s the most important day of their life. That operation cannot be under thought or underdone. There are certain diseases that require surgery, such as specific brain and spine tumors, large blood clots putting pressure on the brain, and patients with spinal fluid build up- these are problems that must be dealt with surgically. But for most neck and low back problems, most of the time they can be treated conservatively without surgery. Patients with these kinds of problems often need education, and preventative advice, sometime they need therapy either Physical or Chiropractic care, and some need cortisone shots. If all of these therapies fail then sometimes surgery needs to be considered.
4. What are the 3 most common causes of back pain?
The 3 most common causes of low back and neck pain include muscular injuries, arthritis, and herniated or bulging discs.
5. What can you tell us about muscular injuries to the neck and back?
Muscular injuries result usually from some kind of trauma, either a fall or a twist, a automobile accident, sporting injuries, or overdoing your normal routine. The pain from a muscular injury tends to be on the sides of the back and are worse with movement, and improved with rest. The pain is generated from small tears in the musculature and the release of irritating chemicals that cause the muscle soreness and spasm. In general ice in the first 24 hours combined with rest will decrease the inflammation. Then moist heat can be initiated which causes a dilation of the blood vessels increasing blood flow to the area. The increased blood flow washes the irritating toxins away, and augments healing.
6. What is arthritis of the neck and back?
The second cause of pain is arthritis. Usually this is not rheumatoid arthritis, a autoimmune disease, but more of an aging or osteoarthritis. This disease is partly genetic and partly a wear and tear phenomena. Pitchers get this kind of arthritis in their shoulders, runners get it in their knees, and old wrestlers get it in their necks! This problem occurs when the normal lubricant or oil for our joints dries up. Then the layers of tissue within our joints rub more vigorously against each other and become frayed. The ligaments also can become lax and the joints become loose. This results in pain. Usually this is an aching type pain within the middle of the neck or back. It typically is worse in the morning and better at night, and responds quite well to aspirin and non steroidal medications such as Motrin and Advil. Often times this problem can be managed with medications alone, and will have a waxing and waning course. Sometimes if it is severe or causing spinal cord compression surgery must be performed.
7. Some of your patients say that you describe the spine as a sky scraper. What do you mean by that?
This leads us into the third common cause of neck and back pain which are herniated or bulging discs. These are the shock absorbers of the body. If you think of the spine as a 31 story building, with the bones of the spine each being a floor of the building and the discs being the intervening segment between each floor you can imagine how the spine functions. Normally there is a perfect balance in the spine curvatures such that each curve balances out the next curve. If you drew a line down the center of the spinal column you would see an inherent balance. The disc functions as the intermediary between the bones of the spine. Each disc is like a steel belted radial tire with an outer envelope (the radial part of the tire) and the jelly like inner substance called the nucleus pulposus (the air part of the tire) When the spine is functioning normally, the discs act like fully inflated tires and absorb shocks and allow for twisting movements of the bones. If however the disc becomes degenerated due to trauma or because it looses it hydration, sometimes the envelope can tear either partially or completely. If there is a partial tear, there can be severe back or neck pain. If there is a complete tear some of the jelly can leak out and push on a nerve going out to the arm or leg. This results in not only neck or back pain but it can extend down into the arm or leg.
About 80 percent of people that have a herniated or bulging disc will get better with rest, medications and therapy. Sometimes steroid or cortisone injections are necessary. If the pain is prolonged or severe, or if there is evidence of nerve damage (weakness, severe numbness, clumsiness of the hands or legs, or bowel or bladder dysfunction) surgery needs to be considered.
8. What are the best ways to prevent these problems?
Be aware of your surroundings. Some of the most innocuous, non threatening places can be dangerous for your spine. For instance, the airport, your office, your car. I can’t tell you how many new patients I see in the office with the first words out of their mouth are: it all started at the airport. I was carrying my laptop or I lifted a bag off the conveyor belt, or I was pulling a bag out of my trunk bent over. These are activities that put your spine at risk because you are out of your normal routine. At the office people carry on long conversations on the phone with their head in a tilted position. This is a setup for neck and arm pain. Because as you tilt your head you are actually closing the channels where the nerves run out from your spine. And if that channel is already mildly compromised by some arthritis or a bulging disc, then you most likely will experience a nerve irritation after holding your head in that position for a long period of time. And often times the nerve pain is lasting. It doesn’t always go away right away because it can swell with that irritation. Then you have this vicious cycle of irritation swelling of a nerve in a narrowed canal, more irritation and swelling more pain. This is when patient comes to see me and needs some type of intervention. Its much better if you can avoid the whole thing by prevention.
Another area that can dramatically affect the chances of whether you will see me or not is the position of your car seat. A car seat needs to support your low back and your knees should be higher than your hips. This position keeps your spine in good balance. Think about all the time you spend in your car! You need to be proactive with your spine care.
The same holds true with your computer at home. What I tell my patients is that you should sit down in a good posture with the right chair. Sit in a comfortable upright position look straight ahead. And this is where your computer screen needs to be. You shouldn’t adjust your body to fit the computer, your should adjust your computer to fit your body.
9. What are the newest advances in spinal surgery?
Probably one of the best advances in spine surgery is the use of working tubes to make surgery less invasive. Nowadays I can make a tiny incision the size of a dime and work through a tube under a microscope to perform a discectomy. This approach is the same as it was 20 years ago only through a smaller incision and less pressure on the muscles. This translates into less disruption of the normal anatomy and preservation of more normal tissue. What does it mean for patients? Less pain and quicker recovery.
10. What are the newest advances in Brain surgery?
The most exciting advance in intracranial neurosurgery is the use of Image Guidance to make Brain surgery even more accurate. Through the use of little red lights, infrared lights that is, we use a global positioning system to guide a surgeon through a difficult case. Through the use of an optical camera and digitized instruments a computer can show a surgeon where to go.
This is particularly helpful in difficult cases where normal anatomical landmarks are distorted and the surgeon can have difficulty in knowing precisely where they are. It’s almost like radar guiding a pilot through a stormy night with an instruments only landing.
For both Brain and Spine Surgery another exciting area is telemedicine and international telemedicine. At St Francis we have an internet link where I can demonstrate delicate brain surgery under the microscope and video conference it in St Petersburg, Russia. The converse of this is true and we are developing an international consultation service where neurosurgeons in remote areas can do a video consult with me and I can advise them on certain difficult medical situations.
11. What can a person do to prepare for surgery?
A lot of patients think that surgery is a passive activity. They just need to show up for surgery and they will be healed. On the contrary! Surgery is like an athletic contest where the prepared athlete is more likely to succeed. For example there are certain things a patient can do to optimize their recovery and decrease their chances of complications.
Specifically patients can eat right several weeks before surgery. Good nutrition clearly has affects on wound healing and the body’s ability to fight off early infection. Also, staying fit and loosing excess weight, if possible, before surgery can decrease the strain on one’s heart during surgery. Often times if I see somebody that is noticeably overweight and might need surgery, I recommend that they loose 20 pounds before their surgery. You’d be amazed at how much easier their surgery is performed even with this seemingly minor alteration. In fact I’ve had a few that have come back after weight loss programs and their low back pain is improved to the point that they don’t need surgery due to less strain on their back. For smokers, this is the one factor that can really make an impact on your surgical outcome. If a smoker can quit even one month before their surgery, even a long time smoker, just one month before, they can significantly improve their blood oxygenation during their surgery, and decrease their chances of pneumonia. You really can improve your chances for a better outcome by being actively involved in preparing for surgery.
12. What is the most frustrating part of medicine?
The most frustrating part of medicine is clearly the Liability Insurance crisis that exists Nationally, but especially in Pennsylvania and New Jersey. It’s a very complex problem and one I don’t want to pretend to have all the answers for. But I can comment with certainty on how the liability crisis badly affects the doctor patient relationship, as well as medicine and the public. One indisputable fact that we all agree on is that malpractice insurance for many physicians in the region have become either unavailable or prohibitively expensive.
Some say it’s because of frivolous law suits and runaway jury verdicts. Others malign the insurance companies for raising their rates to make up for losses in the stock market by passing it on to the doctors. What I can say it that clearly no responsible doctor wants to see poor medicine practiced. And any reasonable person would agree that a person who has suffered as a result of a true medical error deserves to be compensated for their damages. The problem lies, and this is where the experts disagree, is how to go about compensating that person who has suffered as a result of a true medical error. The other major problem is that some plaintiffs and attorneys seek to benefit from medical episodes that do not constitute malpractice are merely unfortunate patients that have bad outcomes.
This is particularly true in Neurosurgery where we are performing extremely high risk procedures and often the odds are against us for a good outcome. As a result many doctors who perform high risk medicine are unable to obtain or cannot afford malpractice insurance and are leaving the state to go to more liability friendly states.
But the problem runs even deeper than that. The ripple effects of the Liability insurance crisis are causing veteran, seasoned physicians and surgeons to retire early. You know what this means? When an experienced doctor retires early it is like a giant library burning down to the ground! Nobody benefits from that doctor’s years of experience which is so critical in being a great doctor. Each year of experience is like a textbook of knowledge lost forever. I am trained to perform the most state of the art techniques in brain and spine surgery, but you know what? There isn’t a week that goes by that I don’t ask one of my more senior associates advice on a difficult case. They each have many years of experience-that’s like a 52 volumes of an encyclopedia . All the training in the world doesn’t match up to that. And we are losing doctors like these to early retirement. A legal system that has run out of control. I am staying in the area to fight for the well being of my patients and get this problem resolved.
13. What do you like most about medicine?
Brain and spine surgery, to me, are very similar to sports. You see in my younger days, before I was a doctor, I was a wrestler. My first coach had a tremendous influence on me. When coach Serrutto would speak to me before I went out to wrestle a tough match, he’d say: "Mark: take the mat like it’s yours. You own it." And coach Serrutto gave me that confidence to walk out on a mat, or into a classroom, or into an operating room knowing that I would do my best even in very difficult circumstances.
I see many similarities between wrestling and surgery. I still to this day go to a locker room, put on a uniform, scout out a specific opponent (the disease that I am treating), walk into a hallowed ground, and I have to perform. The only difference now is that my match has to be won every time! Also the rewards are greater. Because when I succeed in taking someone’s pain away, or curing them of their tumor, or give them their life back, it is the greatest feeling I know. It is a priceless inner sense of knowing that this is why I am here on earth. It is the most wonderful feeling.
LastUpdate: 2016-05-11 15:17:45