6 Signs of Herniated Disk or Slipped Disk


  1. Leg pain – this may be pain radiating down the back or the side of the leg to the knee or foot.   Sometimes this pain is felt in the front or inner thigh or even the groin.  The pain may worsen with straightening the leg or siting up.   Arthritis pain is different from slipped disk.  arthritis pain  is usually only found in the hip, knees or ankle and does not radiate down the whole leg.
  2. Numbness and tingling – this may be felt as pins and needles, burning or decreased or absent feeling in the area of the pain or beyond it.  Sometimes numbness may appear without pain.
  3. Weakness – the leg may give out or drag.  You may have problems getting up from sitting, stepping onto a stool or moving your foot.
  4. Reflex loss – patients may loose reflexes at their knee or ankle or from the bottom of their foot.  Usually this is picked up from your doctor.
  5. Walking – the leg may drag or catch on the floor, you may have to lift the leg high to avoid this
  6. Bowel and bladder – if the disk compresses the cauda equina (the nerves to the bowel and bladder)  the bowel and bladder may stop working.  You may retention of pee or bowel movements or become incontinent of them.  If this happens you should seek medical attention immediately.

About Dr. Carl Spivak

Dr. Spivak is the president of Executive Spine Surgery and has offices in New York and New Jersey.  He is well known for his cutting-edge, minimally invasive endoscopic spine surgeries and regularly teaches courses throughout the USA.  For more information please call 908-452-5612 or click on schedule-an-appointment.

6 Best Treatments for Back Pain

1. Physical therapy focusing on core strength and flexibility.

2. Weight loss.  Weight loss alleviates back pain by reducing stress and strain on your back and decreases damage to disks and joints.

3. Steroid injections may relieve back pain.  Steroids and local anesthetics work to decrease inflammation, washout chemicals that cause pain and directly reduce pain often breaking the destructive pain cycle.  Steroid injections are an effective treatment for conditions that cause back pain such as arthritis of the spine (called facet arthropathy) and disk disease.

4. Stem Cell Therapy.  Disk regeneration is a new therapy where stem cells taken from your hip are injected  into your damaged disk to regenerate the disk.  The stem cells make new disk cells increasing the fluid and size of the disk reducing back pain and suffering.

5. Endoscopic Laser Discectomy.  As the disk wears out, or degenerates, it turns black on MRI, collapses, bulges and may tear causing back pain.  Removal of the degenerated disk and treatment of the annular tear has been found to reduce back pain and suffering.   The discectomy and annuloplasty can be done with the spinal endoscope.  A scope the size of a pencil can be placed through an incision the size of your finger nail.  The disk is found and repaired under direct visualization.

6. Endoscopic Fusion. Painful degenerated disks, spinal instability, spondylolithesis may lead to severe back and/or leg pain.  This pain can be disabling.  Patients that have failed other treatments may be a candidate for fusion surgery.  Today fusion surgery can be done through a very small incision with the aid of an spinal endoscopic to reduce soft tissue and bone damage and quicken recovery.


Dr. Spivak is the President of Executive Spine Surgery and is a leader in Endoscopic Laser Spine Surgery.  He see patients in New York and New Jersey and teaches doctors his advanced surgical techniques throughout the United States.  For more information please call 908-452-5612 or click schedule-an-appointment.

Can spinal epidural steroid injection hurt my brain?

Spinal epidural injections are very common treatments for back pain and sciatica.  Sciatica is leg pain running down the back of your leg caused by a slipped disk pinching a nerve.  Imagine the disk is a marshmallow (even though it really isn’t).  The disk like a marshmallow may expand out if you squeeze it.


You can try this at home – take a marshmallow and squeeze it from the top and bottom.  See how the marshmallow expands out as you flatten it.  This is similar to a herniated disk .  The bulging disk may pinch a nerve causing the nerve to swell up and get “hot” called inflammation causing back and leg pain.

Spinal epidural steroid injections are the placement of steroid medicine into the spine onto the hot and swollen nerve to cool down the inflammation and relieve the pain and suffering.  Think of it like putting an aspirin on the nerve.

Even though spinal injections are generally safe there are risks and side effects to all medical procedures. These include bleeding, infection, dural puncture or “wet tap” causing headaches and nerve damage.  Patients may also experience increased pain, headaches, red face, anxiety, problems sleeping, fever, high blood sugar, decreased immunity, stomach ulcers, severe arthritis, cataracts and menstrual irregularities.

TO ANSWER YOUR QUESTION the most common way spinal epidural steroid injections affect your brain is through headaches.  Usually these headaches will resolve with time.  If they are related to “wet tap” you may require bed rest, caffeine, fluids and rarely blood patch.  Blood patch is the injection of blood into the spine to stop spinal fluid leak and “plug” the hole from the “wet tap”.


Dr. Spivak is a neurosurgeon fellowship trained in minimally invasive spine surgery and spinal epidural steroid injections.  He has practices in New York and New Jersey.  For more information on spinal epidural injections or laser endoscopic spine surgery please call Executive Spine Surgery at 908-452-5612 or click schedule-an-appointment.

How can I get relief from my bad back pain?

Sorry to hear about your back and sciatica. The L5-S1 disk is probably pinching your sciatic nerve causing leg pain called sciatica. Lumbar disk surgery may be considered if steroid injections have not relieved the pain. Traditionally lumbar disk surgery was done through a large incision with significant muscle retraction, damage and bone removal to get to the disk. Today most lumbar disk herniations can be removed minimally invasively with the spine endoscope. This outpatient surgery is done with a small camera the size of a pen through an incision the size of your finger nail. Most people have quick relief from their pain and decreased recovery.

Patients are admitted to the hospital or surgery center for same day surgery.  They change into a gown and IV and EKG stickers are placed by the nurse and taken to the preoperative area.  The patient is seen by the surgeon, anesthesia and nursing.  The risks and benefits of surgery are explained to the patient if not already done.  The patient then signs an informed consent sheet verifying they understand the risks and benefits of surgery and want to go ahead with surgery. The patient is then taken into the operating room.  The patient is sedated (called conscious sedation) or put to sleep (general anesthesia) by the anesthesiologist and then position face down onto the operating room bed. The back is cleaned with a disinfectant and then a drape is placed over the patient.  X-ray machine and endoscopic equipment are brought to the bed.  After the surgery is completed the patient is transferred back onto their bed and taken to the recovery room.

For more information on minimally invasive spine surgery (MISS), endoscopic spine surgery or laser spine surgery please call Executive Spine Surgery at 908-452-5612 or click on schedule-an-appointment.

Can scoliosis cause chronic back pain?

The spine is made up of a stacked alternating vertebral bodies and disks.  The spine is usually straight on anterior posterior x-ray.  Scoliosis is an abnormal curvature of the spine.  The spine may look like a C or S on X-ray. Scoliosis may arise from birth abnormalities where the spine was formed wrong, such as missing half of a vertebrae or from changes resulting from arthritis.  The cause of scoliosis in young people is unknown and is called idopathic even though certain genetic traits have been defined.

Children are commonly screened at school for scoliosis, especially at the time of the growth spurt when the development and progression is most common.  Patients suspected of having scoliosis undergo a history and physical and relevant laboratory investigations.  This may include x-rays, serial x-rays, CT and MRI.  Patients found to have a spinal curvature of greater than 10 degrees are diagnosed as scoliosis.

Scoliosis alters the mechanics of the back and puts significant strain on the vertebral bodies, disks, muscles and even the nerves leading to chronic pain and suffering.

Treatment is complex and requires individualization.  Smaller curvatures are watched while larger curvatures greater then 20 to 30 degrees may require bracing. Surgery is usually reserved for very large curvatures greater then 45 to 50 degrees which have high likelihood to progress even more.  Other indications for surgery include pain, weakness, difficult mobilizing and breathing.  Surgery usually involves spinal fusion surgery, this may be done through the front (anterior), side (lateral) or back (posterior) combined with spinal instrumentation (screws and rods).

Overall prognosis of scoliosis depends on the likelihood to progress.  Patients with larger curvatures, thoracic curves, double curves and immature spines (such as adolescents) have higher chance or progressing.


Dr Spivak is a neurosurgeon who specialized in minimally invasive endoscopic spine surgery.  He is a well known teacher and speaker in laser spine surgery.  For more information on scoliosis, other spinal disorders or laser spine surgery please call 908-452-5612 or click schedule-an-appointment.

Where do you get the bone for spinal fusion?

People often ask 2 questions about spinal fusion:

1) Why do you need bone?

Bone is a key ingredient in spinal fusion.  Spinal fusion is done when the spine is weak and needs to be made stronger.  One vertebral body is connected to another vertebral body with metal screws and rods.  Bone is placed in-between the vertebrae so the vertebrae will grow together and form one solid bone.  If bone isn’t placed  and a solid spinal fusion is not obtained the screws and rods will eventually loosen and fall out or break.

2) Where do you get the bone from?

In the old days the bone was taken from your body.  Usually a piece of your hip would be cut out and then used as graft for the fusion.  Sometimes only the inside of the hip bone would be scraped out.  Today  donor bone or synthetic bone alternatives like hydroxyapatite are usually used.. Bone removed during the operation is rarely used.  This may still be done if the person last fusion surgery failed to fuse and now the surgery was been redone or if they are very high risk for the fusion failing such as smoker, sick or on chronic anti-inflammatory medications.

About Dr. Carl Spivak and Executive Spine Surgery

Dr Spivak is a neurosurgeon with expertise in minimally invasive spine surgery and is a pioneer in endoscopic spine surgery.  He routinely teaches workshops and courses for doctors throughout the United States for JOIMAX USA.  For more information on how Dr. Spivak can help you, please call 908-452-5612 or click schedule-an-appointment.

When can I have Sex after back surgery?



No wonder people are concerned!






Should I hire a nurse after spinal fusion?

Spinal fusion surgery is the joining of one backbone to another backbone (bony vertebrae to another bony vertebrae).  This is usually done for instability, that is when the spine is weak and falling apart.  Spinal fusions can be large, painful and debilitating procedures, but hiring a nurse is not usually not necessarily required after lumbar fusion surgery.   That said each person, spinal disease and surgery is different.  If you are very concerned you could set up just in case.

Minimally Invasive Spine Surgery (MISS) tends to be less painful and debilitating then open surgeries. Multilevel surgery is more painful then single level surgery.  Minimally invasive surgery is less painful then open traditional surgery because there is less tissue destruction.  In traditional surgery there is a large skin incision, signifiant retraction of the back muscles and a lot of bone removal resulting in severe pain.

Tissue damage is minimized with minimally invasive surgery.  The skin incision is small instead of large.  The muscles are dilated (pushed apart) rather than retracted.  Muscle retraction damages muscles producing scar tissue and weakness resulting in pain.  Little if any bone needs to be removed during minimally invasive fusion (this is especially true for endoscopic lumbar interbody fusion (ELIF).  These benefits results in less pain then with traditional fusion surgery.

For more information on spinal fusion click Spinal Fusion and Options

For more information on how Executive Spine Surgery can help you please call 908-452-5612 or inquire at schedule-an-appointment.

What is the sciatic nerve?

The sciatic nerve is made up of the spinal nerve roots exiting the lower spine. The sciatic nerve travels through the pelvis and down the leg. When disk or bone spur pinches the sciatic nerve in the back it causes back and leg pain called sciatica. This pain tends to be in the back of the thigh and calf.  This may be associated with numbness in the little toes and difficulty walking on your toes.  Bending forward or lifting your leg may aggravate the pain.  People with sciatica benefit from rest, anti-inflammatories, pain medicine, physical therapy, steroid injections and spine surgery.

Today spine surgery is not like how it used to be.  Most spine surgeries can be done with laser or spinal endoscope.  The arthroscopic procedure is done through a small incision the size of your finer nail through a tube the size of a pen.  The herniated disk is found and removed under direct visualization un-pinching the nerve relieving pain and suffering.  Patients are discharged home the same day after one to two hours.  Many people have little post-operative pain and need for pain medication after surgery and can return to most activities within a few weeks after surgery.

To learn more about sciatica and endoscopic spine surgery please see What is Sciatica? and Laser Spine Surgery.

Click to schedule-an-appointment or call 908-452-5612.

Can I have surgery for an old ruptured disk?

The spine or back bone is composed of vertebrae separated by disks. The disks support and cushion the spine.  Over time the disks may become damaged and wear out causing back pain.  If the outer disk lining (annulus fibrosis) tears the inner jelly nucleus  (nucleus pulposus) may herniate out of the disk and “pinch” a leg nerve causing sciatica.  This usually is felt as back pain shooting down the back or side of the leg.

The disk pushing on the nerve causes inflammation around and in the nerve leading to irritation, swelling and pain.  The pain and inflammation may settle quickly over a few weeks in some people, but other people the pain may continue for years.   Unfortunately long term nerve pinching may cause breakdown of the nerve myelin covering and loss of nerve fibers causing nerve damage.  Nerve damage may or may not improve even after the nerve is “un-pinched”.

People with a pinched nerve and pain, numbness and weakness usually require removal of the disk “pinching” the nerve.  Sometimes recovery will be longer if the nerve has been “pinched” for a long time.

Yes it is recommended to have surgery for an old ruptured disk if:

1) The disk is still pinching nerve on recent MRI (usually 6-12 months old)

2) The disk causes the type of pain the patient has

3) The disk causes the type of weakness or numbness the patient has

Today Endoscopic Spine Surgery is a new answer to disk surgery.  The disk can be found with a small high definition video camera that is inserted into the spine through a skin incision the size of a finger nail.  The nerve is then “unpinched” relieving pain and suffering.  For more information on minimally invasive endoscopic laser spine surgery please contact Executive Spine Surgery 908-452-5612 or email appt@executivespinesurgery.com Good Luck!