Spine Fusion Surgery & Herniated Disc: Personal Injury Lawyer Deep Dive

Join me, Arkady Frekhtman, a personal injury lawyer in New York, as I delve into the world of spinal surgeries in my latest YouTube video. As a trial attorney preparing for a case involving a spinal fusion after a herniated disc, I've done extensive research to educate myself and now, I'm excited to share that knowledge with you.

In this video, we'll explore the anatomy of the spine, the concept of herniated discs, and the various types of spinal surgeries, with a particular focus on fusion procedures. Discover how these surgeries aim to alleviate pain and restore mobility, but also uncover the potential complications and challenges patients may face, such as non-union and nerve compression. Gain valuable insights from actual surgeons, as we discuss the intricacies of the procedures and the delicate balance between successful fusion and non-union. Whether you're considering surgery or simply curious about the topic, this video is a must-watch for anyone interested in spinal health. Join me on this educational journey into the world of spinal surgeries.

Frekhtman & Associates specializes in serious and catastrophic injury litigation and are recognized as some of the best personal injury lawyers in the New York City area.

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✅  CHAPTERS:

00:00 Introduction and Preparation
00:40 Understanding Herniated Discs
00:59 Anatomy of Discs
01:19 Disc Leakage and Nerve Roots
01:38 Spinal Cord and Innervation
02:15 Pain and Treatment Options
02:41 Spinal Surgeries Overview
03:27 Fusion Surgery Explanation
03:53 Bone Graft and Hardware
04:38 Additional Spinal Issues
05:08 Non-Union and Revision
06:00 Nerve Regrowth and Pain
07:00 Revision Surgery Considerations
08:00 Relevant Spinal Structures
08:36 Dermatomes and Nerve Control
09:35 Specific Nerve Functions
09:56 Surgical Techniques Explained
10:32 Avoiding Complications and Artery
10:58 Post-Surgery Complications
11:18 Accessing Bones and Discs
11:46 Surgeon's Teaching Videos
12:02 Variations in Disc Shapes
12:25 Sagittal MRI Images
13:00 Different Surgical Approaches
14:00 Hardware Failure Risks
15:00 Nerve Control and Dermatomes
16:00 Spinal Cord and Compression
17:00 Nerve Root Anatomy
18:00 Muscle Transgression in Surgery
19:00 MRI Readings and Comparisons
20:00 Cervical Myelopathy Symptoms
21:00 Hand Function and Spasticity
22:00 Surgical Treatment for Hand
23:00 Balance and Gait Disturbance
24:00 Finger Escape and Hoffman's Sign
25:00 Cervical Spine Disorders
26:00 Importance of Posture
27:00 Various Spine Procedures

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Frekhtman & Associates Injury Lawyers represent people who suffered a serious or life-changing injury and had their lives destroyed or disrupted because of the negligence of others.

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Transcript

[00:00:00] Hi everybody. This is a Arkady Frekhtman, a New York City personal injury trial attorney, and I'm actually preparing for a trial to start May 15th, and it involves a spinal fusion after a herniated disc. With radiculopathy. So I thought I would do a video all about spinal surgeries, just to educate the audience and as well as to learn myself, because I recently learned a lot of this by doing my own research and watching some YouTube videos and other resources.

[00:00:40] So I wanted to share it with you. So what is, um, a herniated disc? I mean, many of you know, a herniated disc is basically, the back is made up of vertebrae, which are the bones, and then you have the discs in the middle. And the discs are like this, like a, they're cushion, basically like a jelly donut.

[00:00:59] And a [00:01:00] jelly donut is a really good analogy because there's the annulus fibrosis. Which is the outer wall and it's hard. Okay. And then you also have the nucleus PU posters, which is like the center, the nucleus. And that is softer. And what happens is when you get into an accident or an injury, when you fall, everything falls.

[00:01:19] What happens is that nucleus, the center, the jelly can break through all of those walls cuz there are a few walls and then finally start to leak outside the disc. And that you could see in the red part here, and when it starts to leak, it's touching the nerve roots. You see them, yet the yellow part, that's the nerve roots.

[00:01:38] Now, this is not all of the nerve roots. What you have is you have the. It's almost like a canal, right? They call it the kata equine, which is the horse's tail. Because the horse's tail has all those nerve fibers, or imagine like an electrical circuit, right? The main electrical circuit in your house is where all the electricity runs, right?

[00:01:57] So this is like the control panel. It runs from your brain [00:02:00] down to down your spinal column, and then it exits and you have different nerves and they keep going, right? So they go from your back and they'll go to your arms all the way to your fingers. And that's how basically you move. That's how you feel pain.

[00:02:15] If you touch your finger, that's how you feel pain. So it'll travel all the way from your brain down your spinal column, uh, to your hands, to your feet, to your entire body. That's called innervation. Uh, you have nerves and your whole body gets innervated, right? So that's how it works. So then what happens is because you have that leak from the disc, it's touching the nerve, it's causing you pain, severe, severe pain.

[00:02:41] And so people try physical therapy. They try pain management, including injections to make the pain go down. They try a percutaneous discectomy to remove, uh, decompress the disc, remove uh, the leak from the disc, make the disc more of a perfect circle. But sometimes that disc is just damaged and there's nothing anyone can do.

[00:02:59] [00:03:00] And it's not just a disc. There are also other types of problems people could have. For example, the bone, uh, could start growing bone spurs and then that could lead to, uh, impingement on the nerve. So there's a lot of different things that could happen. So basically, Um, the most common is the herniated disc, and then when you can't do anything else, people sometimes have spinal surgery, and there are different types of spinal surgeries, and one of the popular ones is a fusion.

[00:03:27] With a fusion. What the doctor is basically doing is he's removing the disc and he's putting in a graft bone graft. Oftentimes it's from the hip crest right here. He takes it from the iliac crest, takes the bone graft, and, and puts this. Uh, graft in there. And then what they have to do is they have to drill screws into the vertebrae, into the bone, above and beyond where the disc is.

[00:03:53] And they put a plate, sometimes called a cage. And the reason they do all that is that they're hoping that [00:04:00] the two bones are gonna fuse together. Meaning they're gonna grow together, they're gonna bridge together. And if they do that, you're gonna lose mobility. Cuz now you don't have a disc, right? You, you put in bone graft there.

[00:04:12] But you're hoping that the two bones will fuse together, and then once they fuse, you're gonna lose a little bit mobility, but you're, you're not gonna have that pain because the nerves are behind and they're still gonna, and you have of course, these, uh, Phin, which are the holes where the nerves exit. And you have the facets, which are these things back here where, uh, each, each disc, um, you know, sits on top of each other in the back.

[00:04:38] So basically that's the that's the hope, right? Of what effusion should be. But then people have all these sorts of problems like radiculopathy. Radiculopathy is radiating pain, and that's nerve root compression. People sometimes have myelopathy. Myelopathy is cord compression where the entire spinal cord is being compressed.

[00:04:57] That's much more serious than [00:05:00] just, um, radiating pain. So that's also something that happens. Myelopathy.

[00:05:08] And so sometimes a patient will have something known as a non-union. A non-union means that the two, uh, vertebrae that we talked about, right, the two bones above and beyond, uh, above and b and below where the herniated disc is, these two bones, they don't fuse and it's just, they just don't fuse properly.

[00:05:31] What the doctor will do is sometimes he'll actually use like a bur a high-speed burr, and he'll shave some of the bone. At the, at the cortical bone, he'll shave it because, you know, when you shave bone, it's gonna regrow. Then, the wound actually helps it to regrow. So they'll do that and they'll put in the, the, the, the bone graft from the hip.

[00:05:49] That's all an attempt to have the bone bridge and have it grow together, but sometimes it doesn't. And I've been watching some videos from, from surgeons, actual surgeons that are [00:06:00] doing a lot of these A C D F procedures. And what they, a lot of them say is it's a race and it's a race between what will happen first, the non-union or the fusion, right?

[00:06:10] One or the other's gonna happen first. And oftentimes you get a non-union. So, um, after a non-union, people experience really severe pain and it usually happens six months to a year after the surgery. And so that happens if the two vertebrae do not bridge together, and do not unify. And what it hap, what it does is it leaves a hole.

[00:06:32] Because you have, a hole of space between these two vertebrae in your spine, and then the nerves in the spinal column. What they do is they re-innovate, meaning they grow again, and then they fill that hole. So now you know you're gonna have pain again, because now instead of having a perfect bridging, you're gonna have the nerves re-innovate.

[00:06:55] And one of the doctors explained this is why non-unions are so [00:07:00] painful because of those sensory nerve fibers. Will, will come back in and they could touch, uh, and the nerve roots get impinged again. Um, and he actually said that the pain fibers will regrow into the non-union area, and that's when someone might need a revision surgery, like a second surgery.

[00:07:19] And oftentimes the second surgery isn't the same as the first surgery, but it has to be more involved. Uh, so the first surgery could be an anterior approach, meaning from the front. Where they just put a plate and screws, but then the revision surgery may have to be from the back where they put rods, uh, with pedicle screws.

[00:07:38] And then sometimes people need both the posterior and the anterior. And that really, I mean, really holds the spine together. But he did a nice illustration where he talked about, uh, all of the different, uh, types of nerves like the recurrent nerve. There's the medial branch nerve. And, um, the sympathetic trunk [00:08:00] ganglion, uh, the blood vessels, the visceral, it gets a little, you know, complicated me, me medical, but he's explaining how these pain fibers regrow into the non-union area.

[00:08:10] And that's one of the reasons that people have a lot of pain after having a, uh, fusion surgery. And then basically, um, there's, uh, you know, there's a lot of different, uh, Things that, that, uh, you could talk about here. Uh, with, with, uh, the, the bone graft being between the vertebrae, uh, you have behind everything.

[00:08:36] You have the posterior, uh, longitudinal ligament known as the pll. You have the spinal cord, you have cerebral spinal fluid, known as the C S F. Um, you have, like we talked about, dermatomes, right? So you have the nerves running from the spinal column down to the arms, down to the, the back, into the legs, everywhere.

[00:08:59] [00:09:00] And there are specific, uh, nerves, specific areas that control specific parts of your body. Like, for example, between C seven, which is the final. Neck vertebrae, right? C seven, cervical seven, and t1, which is the first mid-back vertebrae. So C seven t1, you have what's known as the C eight nerve root and the C eight nerve root runs down and it controls the fingers, and it'll control specifically like the middle finger and the ring finger.

[00:09:35] So, and, and the, and the pinky. So for example, if you have a damaged C eight nerve root, Then your, uh, pinky finger could become spastic, meaning it'll just stick out because that's, that's what the nerve controls. So each nerve controls a specific part of the body. And, um, I'll put up a slide to show you.

[00:09:56] There, there's, uh, slides that show exactly what everything controls. [00:10:00] So then, um, the other thing, it's just, I mean, to me it's really interesting. He was talking about, um, A posterior cervical laminectomy infusion, and he was talking about how you have to follow the facet with the screws. And when you put in the screws, you have to do it at an angle and you have to be very careful because the main thing that the surgeon wants to do is avoid the vertebral artery because of course you have the vertebral artery, which is the artery in the neck that supplies blood to the brain and spine.

[00:10:32] So if that gets nicked, Even a little bit by the screw coming in, not at the proper angle, but let's say straight in, then obviously the patient would suffer severe brain damage and could even die. So that's very, very serious. And he, he did some drawings of, of uh, how he does it, the technique. Um, And then there are complications that people have after the surgery.

[00:10:58] For example, when you do the anterior [00:11:00] approach from the front, one of the known complications is difficulty swallowing, difficulty talking. Cuz when they go in, there's a lot of things they have to move around. They have to have to move. The esophagus, the Sterno Kline mastoid muscle. The platysmal muscle has to be like, cut and moved because to get to this area and the neck, and the neck gets much smaller.

[00:11:18] But to get to all these bones and uh, discs, you have to go through a lot of uh, material and with the posterior approach from the back that leads to a longer recovery. So, so like we talked about, he says that a fusion surgery is a race between a non-union implant failure versus a bone fusion, which will happen first and oftentimes, unfortunately, the non-union happens first.

[00:11:46] And the other, um, thing that some of these surgeons talk about when they do their videos, and these are videos that they're doing not for laypeople, but for other doctors to teach them how to do surgery. But I wanted to learn as much as possible about it. So I, I was watching some [00:12:00] of these videos and I felt like some of it was very, very interesting.

[00:12:02] One of the things he was talking about is that every disc in the spine, so if you imagine the spine vertically and then looking down almost like a, uh, a sagittal image, right? All of the planes of. The disks, all of them are a different shape. So for example, the C2 one looks, um, almost like, uh, uh, I don't know, like a certain shape.

[00:12:25] The C6 is more of an elongated shape. Uh, the L three is more triangular. Uh uh, so is the L two. The L five is very triangular, whereas the C4 is more like a hard shape. So each of them, and the C1 is more like a circle. So each of them have a different shape. So that means that. When the nerve roots, uh, when, when the discs, uh, herniate and when the the leaks come out, each of them has to be dealt with differently.

[00:12:53] And basically the sagittal views of the MRIs show how blocked that canal is because it is almost like a tunnel, a [00:13:00] canal, but it's not like a, a tunnel. Like when you go through a tunnel with your car, it's just like one shape, right? You go through the tunnel and then you're out of the tunnel. Here, it's a tunnel, but each part of the tunnel going from your neck down to your.

[00:13:11] Um, sacrum is a different shape, so then the doctor has to account for that. And of course, that's one of the reasons that people have, uh, different types of pain and sometimes it's hard to diagnose where the pain is coming from. Uh, so yeah, he talks about the L two, for example. The lumbar two has large opening, but others are much smaller, like L 4 0 5, and some have blocks like, uh, L five S one.

[00:13:37] And then he talked about lumbar Lamin Ectomies, which is a type of surgery where the lamina in the back, this is the lamina, the the big part here that actually gets cut off to allow for the nerves to move. And a foraminotomy. That's when the, the hole, that little circular hole behind where the nerves come out, that gets opened up.[00:14:00] 

[00:14:00] So a doctor will go in and open that up. Um,

[00:14:07] Yeah, so there's a lot of, there's a lot of different things that can happen. Sometimes patients hear noises after a fusion surgery. The reason they might be hearing noises is because of a spinal device failure, especially when a cap, like a locking cap, because remember, they're putting in those screws and they're pedicle screws, and they're supposed to lock.

[00:14:24] There's a locking mechanism, but sometimes the cap could like fall off and if the cap falls off, well, Now you're gonna hear noises. The other thing that happens is sometimes the screws just, you know, for whatever reason, the screws are in your bone. So if you're moving, obviously you're gonna be moving.

[00:14:42] This is your spine, right? All motion comes from the spine. With your hands, you're gonna move. You're gonna walk. So those, those screws are in your vertebrae, in your bone. So the screws will start going. Up and down was like a windshield wiper within your bone. So now they're gonna open up a canal, open up, [00:15:00] its its own hole, create a hole, and then the screws are gonna start moving.

[00:15:04] And that's known as like, that's a type of hardware failure. So he talks about that as well. And um, yeah, here's an illustration of all the different D tones and where they go. Like we talked about the C seven goes to the. Uh, these fingers. The C eight goes to these, these fingers in the, this part of the hand.

[00:15:27] C6 goes to the thumb, but it also goes all the way up the arm. And he has like a specific, um, they have many illustrations. You could maybe Google it. There's a lot online that talk about it. C3, c4, there's more like the neck here. See five also goes to the trapezus in the back. So it, it just, um, controls different parts of the body.

[00:15:54] Like, for example, yeah, C5 is known to control the bicep C uh, [00:16:00] C seven is the wrist wrist flexion, which is like the wrist flexion. Um, so there's a lot of different things that, uh, and there's actually an A S I A Asia spinal cord injury sheet where it's a standard neurological classification of spinal cord injury.

[00:16:20] There's motor and there's sensory, and the doctor will fill that out and try to understand where the pain is coming from, what's happening. And then, uh, like we talked about with the nerve roots, one of the things that is interesting is that the nerve roots that come from the, um, you know, from the spinal cord behind the disc include the dorsal root ganglion.

[00:16:47] And that's part of the nerve. And the dorsal root ganglia holds all the pain receptors. So that's where the pain, uh, receptors are. And so, um, you could see it, uh, on this [00:17:00] image. It's almost like the nerve is just a line. It's the nerve, kind of like you see here, right? This is the nerve, just like a thin piece, but then it becomes a little bit thicker.

[00:17:11] Becomes almost like a little bit thicker. Kind of like when you look at, uh, some leaves. They, they might get thicker in parts or something. Or just, yeah. So it gets thicker and that's where it gets thicker. That's the dorsal root ganglion. And then it branches off and it branches off. That's the dorsal Remus.

[00:17:28] And the nerves keep branching and branching. That's how they innovate, you know, your entire body. So, um, yeah. So we have some pictures of nerve roots here. And um,

[00:17:51] also he was talking about if you do the posterior approach from the back with a patient laying on their stomach and cutting from the back and doing the surgery from the back, um, [00:18:00] all the muscles have to be transgressed during the operation. And he showed this photo and he showed all this brown and there's a lot of brown, and all the brown is is muscle.

[00:18:09] And he says that's why it takes so much longer to heal and so much painful to do the posterior surgery. And then, like we talked about, the foraminotomy. The foraminotomy, that's when they open up the hole so the nerve isn't touched. And it makes a circle in the medial border of the facet joint so that the nerves, uh, have more of a pathway to exit without being impinged, without being compressed.

[00:18:34] Cause any kind of compression on those nerves is what's causing the pain. Um, and myelopathy is an injury to the spinal cord caused by severe compression that may result in spinal stenosis. It could be because of spinal stenosis, disc degeneration, which means like the normal aging process. It could be from a disc herniation, it could be from an autoimmune disorder or other trauma.

[00:18:58] So, um, [00:19:00] that's a serious diagnosis of myelopathy. And then he did one video about how to read an mri, and he talked about that it's a magnetic field, has to be strong enough. Um, 1.5 Tesla is strong enough to pick up a car, so it's a magnet and um, it reads energy and radio waves, and it gives us sections or slices of what it's seeing.

[00:19:26] And then he compared a normal MRI of a child with perfect discs, and you could see the spinal cord and the entire canal is not compressed. There's plenty of room for everything. And then he compared it and contrasted it with a, uh, damaged mri, which shows, uh, somebody who's injured. And you could see that's, it's very, very different, uh, just, uh, very, very different because.

[00:19:54] You could see that the canal is just getting compressed either by bone or by, [00:20:00] uh, the herniated discs. And then you just don't have that movement of, um, of the nerves. And the nerves are, are, are becoming very, very painful. Yeah. So that's very interesting. There's a lot of medicine here. Um,

[00:20:23] Yeah, here's a, here's a picture of cervical myelopathy. And it's very good because on the left you see what's normal and you see like the open canal. And then on the right you see the, uh, what's known as stenosis, which is basically narrowing stenosis. Just means that everything's gotten narrower, so there's not enough room.

[00:20:43] Um, so really cervical myelopathy is a space issue. There's not enough space for the spinal cord to send signals from the brain to the arms, from the brain to the legs and the rest of the body. So it's really an architectural or a structural issue. And when there's no other option to fix it, then you [00:21:00] need the surgery and, and then, uh, compression of the neck of the cervical spine, uh, it, it will affect, uh, your, your hands and mild up.

[00:21:13] Myelopathy, it's known as a mild myelopathic hand and it results with difficulty with grip, difficulty with release, loss of motor strength, um, and sometimes spasticity, which is a condition where there's an abnormal increase in muscle tone or stiffness of the muscle, which might interfere with movement speech.

[00:21:34] And be associated with discomfort. And there's different types of spasticity. Sometimes people with developmental disabilities will get spasticity, a hand like this or like a pronated forearm or a clenched fist, and you just can't, your hand is like that. You can't do anything about it. Sometimes the palm will be in the thumb like this, and that's all because the nerves are damaged.

[00:21:57] Moving from the neck down to the arms, into the [00:22:00] hands. So sometimes what doctors will have to do is they'll have to do the surgery on your spine, but they'll have to also do a surgery on your, on your actual hand, cuz you have different tendons in the hand. And there's, um, hand surgeries. Usually it's a transfer.

[00:22:15] They'll transfer a nerve or a ligament from one part of the hand to another, which is also a very complicated involved surgery. Um, So this doctor, um, basically he was saying that when you have compression of the spinal cord and when it affects hand function, the patient will have difficulty with hand dexterity.

[00:22:37] He'll have something known as hyperreflexia, a positive Hoffman sign, which is the type of test that they do, a positive Romberg sign and gate disturbance and, um, Basically like the Hoffman sign, what they do is they tap or flick the nail of the middle finger or ring finger to produce flexion. Of the index finger to the [00:23:00] thumb and a positive Hoffman sign occurs when snapping the patient's distal failings of the middle finger bleeds to a spontaneous flexion of the other finger.

[00:23:09] So that's a nerve injury, right? You're moving, you're touching one finger, but now the other fingers are spontaneously moving, so something's wrong. So that's the Hoffman's, and that's one of the ways they test for it. And then the Romberg is a neurological examination that's used to test for balance and coordination.

[00:23:26] And it really checks the patient's ability to stand with their feet parallel together with their eyes open and closed for about 30 seconds. And so it's more of a balance test. And the doctor basically said that if a patient will have difficulty with hand dexterity and um, a positive Hoffman's, a positive Rombergs, and then they'll feel unstable on their feet.

[00:23:48] And, um, so yeah, that's really like a big sign if you have that issue with, um, With balance and you can't have a steady, uh, gate. That could be an indication that [00:24:00] you need spinal surgery. And then there's the finger escape sign. So basically just the finger escapes and you ask the patient to hold the fingers extended and abducted like this, just regular.

[00:24:11] And if one finger escapes, then that means that if it's spontaneously abducted due to weakness of the intrinsic, uh, muscle, then that is, uh, Th that's a sign of spinal cord and, uh, compression and hand function compression from the neck. And he said basically, the condition is usually progressive, meaning it gets worse with time and it rarely improves without surgery.

[00:24:35] And, uh, surgical surgical treatment involves decompression and stabilization of the neck of the cervical spine. And like we talked about, gate dis gate problems, any problems with walking, problems with gate, problems with balance, gait disturbance, that's a telltale sign of cervical myelopathy and an indication that you need surgery.

[00:24:54] And then cervical spine myelopathy sometimes is [00:25:00] caused by spady. Spady, which is the um, kind of like when the bone. Leads to these spurs and when the bone gets a little bit, um, um, like spurs, that will impinge on the nerves as well. Cervical spine myelopathy. And then there's compression of the cervical spinal cord.

[00:25:28] So yeah. And then kyphosis, of course, is when you sit with your neck forward. You wanna sit with your neck back as much as badly as possible cause your spinal cord is behind you. But people are always like texting, and looking at their phones, so they tend to wean their heads forward. But it's actually really bad for you.

[00:25:45] I have that habit too, but you have to always keep your uh, shoulders back and your neck back as much as possible. That's really important. That's one of the ways that it can lead to problems. And then here's an illustration of the cervical spine. It's a spine concept, cervical spine, [00:26:00] and they show you the c1, which is the first.

[00:26:02] Vertebrae in the neck all the way down to C seven, and then flexion-extension occurs at c4. C five. The rotation occurs at C1 C two, and basically meaning like 50 50% of like when you rotate your head. 50% of it is happening at c1 C two at that vertebrae, and flexion in extension is mostly happening at c4. C five, and cervical disc problems usually affect the lower nerve root, so, It's very common to have a problem at C six C seven, and, um, that's, and it affects the C seven nerve root

[00:26:43] and the C seven deals with the elbow extension of the elbow as well as the triceps reflex, whereas the CA eight is the finger flexion, the C6 is elbow flexion. So all of them will correspond to different, uh, nerves that travel to different parts of the hand.[00:27:00] 

[00:27:04] And there's a lot of interesting slides that show, um, that show the D tones and show what gets involved with, um,

[00:27:24] Yeah. Okay. So we hope this has been helpful. Let us know what questions you have and if you have any other questions about spine issues, spinal surgeries. This video is more about the anatomy of the spine a little bit, as well as. Uh, spinal fusions, but there are a lot of other types of procedures. There's pain management.

[00:27:44] There's, uh, epidural steroid injections, percutaneous discectomies. There are laminectomies and discectomies. There's. Other types of procedures. Sometimes people don't need any procedures, right? They just get better through maybe, you know, through physical therapy or through working out or fixing the problem.

[00:27:59] [00:28:00] And then there's, of course, there's a lot of new techniques, like more like laser surgeries or uh, disc replacement surgeries rather than fusions where the disc is removed and you're hoping the bone bridges together are unified. So let us know what you think. We are here for you and have a great day.

[00:28:15] Okay, bye-bye.