+ What is Radiosurgery?

Dr. Kimberly Walpert at Athens Brain & Spine has collaborated with Dr. Gordon Schoenfeld at University Cancer and Blood Center to provide the Athens and northeast Georgia community with the only radiosurgery program in the area. Utilizing the BrainLab Varian system, brain and spine tumors are treated with surgical precision with high dose radiation, utilizing the most advanced live imaging techniques and robotic technology to treat cancer and avoid damaging normal tissues. More intense doses of radiation are delivered directly to the rapidly growing tumor cells, allowing us to be more effective at controlling them. Side effects from damage to normal tissue are avoided. The invasive skull frame required by Gamma knife technology is gone, replaced by a custom-fitted mask. Extended treatment times, with weeks of therapy, are often replaced with a single treatment. Patients fight their battle with cancer using the most advanced tools available, with the least impact on their real lives.

Noncancerous conditions such as acoustic neuromas, trigeminal neuralgia are also often amenable to this type of treatment.

Surgical results for many patients without an incision, without a single night in the hospital.

Specialized training and a multidisciplinary team-based approach to caring for our patients means we can bring the best care to our community. The most technically advanced treatment, customized plans formulated by a team of doctors focused on our patients as individuals.

+ Do I need a fusion?

Although our physicians are trained and experienced in these techniques, a fusion is not a procedure to be taken lightly. The success rate in cervical fusion for disc herniation approaches 95% when patient selection is appropriate, and most of these patients resume normal activities within a few months of their procedure.

In the lumbar spine, however, the success rate is fairly low, and the complication rates clearly seem to outweigh the benefits for most patients. Simple disc herniations that require surgery do not need to be fused in the vast majority of cases. Instability is the commonly accepted indication for fusion; in patients that meet the strict criteria for instability in the lumbar spine, a procedure with or without instrumentation will be discussed.

An inordinate number of lumbar spinal fusions are currently being done in this country, with little agreement on indications and requirements for this procedure. What is known, is that the complication rates and failures in patients chosen with liberal criteria are quite high. Dr. Walpert takes these considerations very seriously and recommends lumbar and cervical fusion only when rigid criteria are met.

+ What about chiropractors?

Our practice maintains an excellent relationship with several of the chiropractors in the area. We will gladly work with your chiropractor and suggest chiropractic treatment in appropriate situations. Since the treatment for these conditions is often non-surgical, the chiropractor, physical therapist, and other non-surgical professionals can be an integral part of your treatment and recovery from lumbar disc problems.

+ Spinal stenosis, what's that?

Arthritis, (bony overgrowth) that occurs in the facet joints can compress single or multiple nerve roots causing spinal claudication, which is the feeling of leg weakness with activity. Essentially, the bony growth blocks blood flow to the nerves, causing heaviness in the legs, ultimately causing the patient to sit down to recover. This can also lead to spinal instability due to the facet joint compromise from the arthritis. These patients may require a more extensive decompressive laminectomy. Some may be unstable, benefiting from a fusion.

Unfortunately, the condition often mimics the pain of arthritis (such as night pain at rest, morning stiffness, and central back pain). The success rate for the procedure runs around 65 - 70%. Many of the patients still suffer postoperatively from their persistent arthritic pain. We try very carefully to select patients with true nerve compression symptoms for this surgery.

+ My doctor says that I need a fusion. What's that all about?

The specific indications for lumbar fusion are spinal instability, i.e. a slippage of angulation of the vertebral bodies. It is rare to prescribe a fusion for a simple disc herniation. Unfortunately, there are a lot of more vague indications being marketed today for fusions, resulting in a lot of procedures that we feel are unnecessary, and possibly very harmful for these patients. While modern medicine is making vast improvements in the ability to perform fusions in the lumbar spine, the indications remain controversial. Seek out several opinions on whether a lumbar fusion is recommended.

+ I have painful disc herniation, now what?

For patients not responding to rest, massage, therapy, etc., the choice of a microdiscectomy may be offered. A skilled neurosurgeon who performs this procedure should be sought out. Microdiscectomy is a modernization of the standard laminectomy procedure that is designed to be done through a small incision, with minimal muscle and bony trauma, thus limiting the postoperative discomfort. Most patients can go home the same day and be back at work in a few days.

+ Who needs surgery?

A small number of patients who have suffered from a herniated disc will not respond to conservative measures such as massage, exercise, or steroid injections. These usually have gone for several weeks and have just not tolerated the pain from the nerve root compression. A very small number of patients have a huge tear (herniation) and become bedbound, with weakness in the muscles supplied by the compressed nerve, requiring early surgery (in the first week or so). In essence, it is the large herniations with clear signs of nerve root compression (leg pain, weakness in the leg muscles) and/or numbness that benefit from a disc procedure.

+ How do I know if my back pain is serious?

Most of us suffer from back pain at one time or another. But persistent back or leg pain, possibly associated with weakness or numbness may represent a more serious condition such as a torn disc (herniated disc) or spinal stenosis -- an arthritic condition. Your physician should consider an MRI or other appropriate study in these cases.

+ Why should a neurosurgeon do my spine surgery?

Neurosurgeons train in surgery of the spine including microdiscectomy, laminectomy, cervical and lumbar fusion and instrumentation during their entire residency training. Their experience is not limited to a one year fellowship or a few weekend courses as with other specialties that sometimes operate on the spine, or who claim expertise in spinal surgery.

Approximately 80% of a neurosurgeon’s training is dedicated to the spine. Our practice is devoted to assessing the needs of our spinal patients as individuals and designing the safest, most precise procedure that will accomplish our goals of pain relief and neurologic recovery in those patients who ultimately require a surgical repair. Our knowledge of neurologic function and microsurgical techniques are invaluable tools in the pursuit of a functional recovery for our spinal patients.