Archive For The “Other Treatment Options” Category

Localizing the Lesion

By | May 22, 2015

I have been meaning to do a blog on the value of physiologic testing for some time now and Tuesday the perfect patient walked into the Burbank office of Schlesinger Pain Centers. Marcy Peters (not her real name) is an 85-year-old woman whom I have been treating for radicular back pain and neck pain for […]

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Continuous Mathematics vs. Discreet Human Experiences

By | May 19, 2015

As complicated as all of the mathematics that we have been looking at for the past several days is, the problems of trying to apply any of what we have learned to individual patients here at Schlesinger Pain Centers are even more daunting. The central philosophical problem is the unique and discrete nature of human […]

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Risk Reward Analysis III

By | May 18, 2015

In this blog we will look at the last major variable, the personal response to either therapeutic success or failure. We will look at it in terms of risk tolerance and we will see that although it may be hard to quantify its effects can be huge. Risk Tolerant   Treatment Outcome Pain Level Reward […]

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Risk Reward Analysis II

By | May 14, 2015

Now that we have mastered the basics of risk reward analysis we can begin to question the effect of the major variables on decision-making. In today’s blog we will look at the effect of changes in the likelihood of different outcomes in making decisions and tomorrow we will look at the effect of changes in […]

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Adjacent Segment Disease: Etiology

By | May 6, 2015

How does one make sense of all of this? I think that the explanation lies in the basic etiology of spondylolisthesis in the first place, We see a malalignment of two bones and think that the bone must somehow be at fault, but I believe that almost all cases of spondylolisthesis result from stiffness an […]

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Adjacent Segment Disease: Location

By | May 5, 2015

Another conundrum is location. It appears that failure rates are a bit higher when fusing L5 & S1. Some patients even skip levels. One case at Schlesinger Pain Centers that I remember particularly well is a retired physician who underwent a successful fusion at L4-5 only to develop a significant spondylolisthesis at L2-3 about a […]

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Adjacent Segment Disease: The Real Problem

By | May 4, 2015

I am sure that many of you have jumped ahead and figured this out, but for those who haven’t, the thing that I find most disturbing about lumbar fusion is that your chances of losing increase every time you play the game. A 10% chance of failure requiring another operation isn’t all that bad in […]

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Adjacent Segment Disease: Incidence

By | May 3, 2015

The real mystery is why some people get it and some people don’t. If increased wear and tear on the next segment above or below were an inexorable concomitant of all fusions we would expect to see it to some degree in all cases of fusion, worse in some and less severe in other patients. […]

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Adjacent Segment Disease

By | May 2, 2015

The second major complication that I want to discuss, adjacent segment disease is among the most frequently seen problems here at Schlesinger Pain Centers. It is quite a bit less mysterious than post-laminectomy syndrome. It occurs only after spinal fusion with a delay of 1-2 years or more. The etiology is thought to be mechanical […]

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Post-Laminectomy Syndrome (continued)

By | May 1, 2015

We treat many patients with post-laminectomy syndrome[1] at Schlesinger Pain Centers and they are among the most difficult patients we see. The etiology of the disease is unknown. Many people have postulated that scarring plays a role in the pathogenesis of this condition, but this has never been proven.   We have learned that reoperation almost […]

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