Dr. Joseph Yazdi is a board-certified neurosurgeon with Arch Neurosurgery in St. Louis. He performs a range of surgical procedures, all aimed at relieving his patients pain – often permanently – in the least invasive way possible. The procedures Dr. Yazdi offers in the surgery center range from carpal tunnel release, kyphoplasty, sacroiliac joint fusion and ulnar nerve decompression to installing pain pumps, dorsal column stimulation for the relief of chronic leg and pack pain, and more.
PAIN PUMP
SYMPTOMS: Patients experiencing cancer pain; chronic pain that failed dorsal column stimulator trial; intractable pain that is not effectively managed through oral pain medications.
DEFINITION: A pain pump provides pain medication through a small pump that is placed in the abdomen. Studies have shown that pain pumps, also called intrathecal drug pumps, work more efficiently than oral pain medication because they deliver the medication directly to the cerebrospinal fluid. As such, they require lower doses of medication – one study estimates patients with pain pumps need about 1/300 of the amount of pain medication they required for the same level of relief when taking pain medication through traditional routes. Additionally, patients who’ve had pain pumps installed generally experience fewer side effects from the drugs the pumps administer.
TREATMENT: Once Dr. Yazdi has determined you are a candidate for a pain pump, he will schedule your surgery, which is done under outpatient general anesthesia in his surgery center. During the procedure, Dr. Yazdi will make a 4-6 inch incision and places a device about the size of a hockey puck – the pain pump – just under the skin of your abdomen. From there, Dr. Yazdi will insert a spinal needle into the spine and pass a catheter through it. He uses fluoroscopy, or moving x-ray, to ensure exact placement, the removed the needle, leaving only the catheter. Dr. Yazdi then programs the pump, which will need to be checked and filled at regular intervals.
CARPAL TUNNEL RELEASE
SYMPTOMS: Patients can experience numbness or tingling of the thumb, index and middle fingers. These symptoms are typically brought on by holding a telephone, or steering wheel, and during sleep. Typing is particularly hazardous with this type of injury.
DEFINITION: Carpal tunnel syndrome is caused by the compression of the median nerve by the transverse carpal ligament at the wrist. Dr. Yazdi will typically conduct minimally invasive tests – an electromyogram and nerve conduction velocity test – to confirm the diagnosis.
TREATMENT: Dr. Yazdi will perform the procedure under sedation rather than general anesthesia. He will numb the hand of the affected arm and create an incision in the crease of the palm, cutting down to the tough, thickened ligament that is causing pressure on the nerve. He then splits the ligament over the nerve, so the entire length of the nerve is decompressed. Dr. Yazdi closes the incision and the patient is discharged home same day. Use of the hand will return slowly over the course of the next week.
ULNAR NERVE DECOMPRESSION
SYMPTOMS: Patients will experience numbness and tingling on the inside of the forearm and hand, and on the ring and pinky fingers, with symptoms that worsen when bending the elbow. This injury is frequently caused by wear and tear from work.
DEFINITION: This condition is caused when bone spurs and thickened ligaments compress the “funny bone,” or ulnar nerve, at the elbow.
TREATMENT: Dr. Yazdi performs this procedure under general anesthesia. He makes an incision in the elbow over the “funny bone” tunnel, also called the cubital tunnel. He then removes bone spurs and thickened ligament, thereby decompressing the nerve. Dr. Yazdi will check that the nerve is completely freed and moves easily when bending the elbow and extending the arm. He discharges the patient soon after the surgery and light duty can be resumed in about two weeks.
SACROILIAC JOINT FUSION (SIJ)
SYMPTOMS: Sacroiliac joint pain causes chronic lower back pain that does not benefit long-term from physical therapy. Patients with SI joint pain tend to respond favorably to SI joint injections, but the relief is temporary. SI joint pain is typically severe enough to interfere with the performance and enjoyment of daily activities.
DEFINITION: Sacroiliac joint inflammation is typically caused by excessive movement of the SI joint. It is the most common cause of chronic lower back pain
TREATMENT: The goal of SI joint surgery is to prevent unwanted movement. The procedure Dr. Yazdi performs involves taking a lateral approach to place three spacers connecting the sacrum and the ilium and providing stability.
KYPHOPLASTY
SYMPTOMS: When a vertebra fractures, it compresses into itself, thus losing height. Not only does the fractured vertebra cause pain, but it throws off the biomechanics of the spine.
DEFINITION: Vertebral fractures most commonly occur due to trauma, osteoporosis or cancer, and usually in the thoracic spine, which runs from the base of the neck to the abdomen. Left untreated, fractured vertebra can cause the patient to take on a hunchback appearance.
TREATMENT: Kyphoplasty is a minimally invasive procedure. Dr. Yazdi inserts a special needle through the posterior aspect of the spine into the fractured vertebra. He passes a special balloon through the needle and slowly inflates it under fluoroscopic guidance until the bone is brought back close to its original stature. Then the balloon is removed, and a special cement is inserted into the newly made cavity until the bone is adequately filled.
In most cases, any pain associated with the fracture improves right after the procedure, and patients can resume most activities soon after the procedure.
DORSAL COLUMN STIMULATOR
SYMPTOMS: Patients with chronic back pain and chronic leg pain, as well as those who continue to experience pain after lumbar surgery may be candidates for dorsal column stimulators. Additionally, this treatment can be beneficial for patients suffering from neuropathic pain such as diabetic neuropathy that causes significant burning and sharp pain in the legs and feet.
TREATMENT: To determine if a patient is a candidate for a dorsal column stimulator,Dr. Yazdi has an unbiased colleague assist in the procedure. Studies have shown that this to be more accurate. The Colleague will use a needle to insert temporary wires into the patient’s spine, where they stay for four to five days while the patient performs their routine activities. The wires emit an electrical signal that can, in some patients, disrupt the pain signals. If the electricity coming through these wires helps decrease the patient’s pain by about 50 percent, the patient qualifies for a dorsal column stimulator from Dr. Yazdi.
There are two methods for placement of the stimulators, and they each depend on a number of factors that Dr. Yazdi will discuss with the patients.
The percutaneous method is performed similar to the trial in that the wires are placed into the spine through needles then tunneled under the skin to where a battery is positioned. Another incision is made in that area, and a pocket is created under the skin for the battery. Dr. Yazdi connects the wires to the battery, which is then secured into position.
The other method for placement of the wires is through an incision over the spine. Dr. Yazdi removes part of the lamina – the posterior structure of the spine – and places a paddle lead over the spinal cord. Similar to the percutaneous method, an electrical current delivered to the spinal cord interrupts the pain signals to the brain, providing the patient with pain relief.
ANTERIOR CERVICAL DISCECTOMY AND FUSION WITH PLATE FIXATION VS. CERVICAL TOTAL DISC REPLACEMENT FOR CERVICAL DISC HERNIATION
SYMPTOMS: Patients diagnosed with a cervical disc herniation experience neck and arm pain, weakness and numbness. This pain and pressure may be caused when a disc ruptures, or herniates, causing some of the disc’s softer nucleus to bulge through its tough fibrous outer ring, pressing on a nerve. Additional nerve pressure may be caused by bone spurs,or rough edges of bone, that sometimes develop around degenerated discs.
DEFINITION: Discs are the small masses of rubbery tissue that act as natural shock absorbers between the individual bones of the spine. Anterior cervical discectomy is a procedure performed on the upper spine that can eliminate the pain, numbness and weakness associated with cervical disc disease by relieving pressure on the spinal cord and nerve roots.
TREATMENT: Dr. Yazdi will perform a thorough evaluation including a review of spinal films to ensure surgery is the proper approach. He will also determine whether a discectomy with fusion and plate fixation or a total disc replacement is the correct procedure.
Some of the factors that determine one procedure over the other are the degree of arthritic changes around the surgical site as well as the degree of motion present throughout the cervical spine.
Both procedures are performed under general anesthesia. Dr. Yazdi will make an incision in the front of the cervical spine within one of the natural creases of the neck. The incision is taken down to the affected disc, which is fully removed. Then Dr. Yazdi places either a prosthetic disc or a fusion and plate.
The procedure takes about one hour, and patients go home the same say. Post-surgical appointments with Dr. Yazdi will follow and patients can usually return to light activities in about two weeks and can be back to work in four to six weeks.
LUMBAR DECOMPRESSIVE LAMINECTOMY FOR LUMBAR STENOSIS
SYMPTOMS: Standing up straight when walking, having to lean on the shopping cart when shopping; leg pain, numbness or tingling within minutes of standing; the need to frequently sit down. These are all symptoms of lumbar stenosis. Physical therapy and injections can help but only provide partial relief. Is surgery the best long-term solution?
DEFINITION: Narrowing of the spinal canal, usually caused by aging, that compresses the nerves and causes low back and leg pain.
TREATMENT: Dr. Joseph Yazdi at Arch Neurosurgery will perform a thorough evaluation and review of all spinal imaging. He may consider a lumbar decompressive laminectomy to treat the lumbar stenosis. This procedure relieves the symptoms associated with spinal stenosis, a condition that is a by-product of aging and may be marked by degenerated, or bulging, discs as well as thickened ligaments and the overgrowth of bone in the lumbar spine. During surgery, the overgrown bone and thickened ligaments that are causing pressure on the spine and nerve roots are removed through an incision in the lower back.
If surgery seems to be the best option for you, Dr. Yazdi will perform it using minimally invasive techniques under general anesthesia. He will make an approximately 1-inch incision over the area of disc herniation, moves the muscles aside, then under microscopic magnification he removes the bone spurs and thickened ligaments using specialized surgical instruments. The entire procedure takes about one hour.
Patients are able to go home the same day and will have regular follow up appointments with Dr. Yazdi. They can usually return to light activities in about two weeks and return to work in four to six weeks.
LUMBAR DISCECTOMY FOR LUMBAR DISC HERNIATION
SYMPTOMS: Disc herniation can cause severe leg pain. Physical therapy and injections don’t always provide significant help, so surgery is the next option. did not help much. Now you are considering surgery. Dr. Joseph Yazdi at Arch Neurosurgery will perform a thorough evaluation and review of your spinal imaging.
DEFINITION: A herniated disc is a rupture in which the center of the disc has pushed beyond its center cavity and into the spinal column, putting pressure on nerves and causing pain, numbness, weakness and tingling. Some herniated discs can impair the ability to walk, lift or stand while others cause few symptoms. Excision of the lumbar disc is a treatment that can relieve pressure on the nerve roots that result from a disc rupture. During the procedure, the extruded fragments of the disc are removed through an incision in the lower back.
TREATMENT: If surgery seems to be the best option, Dr. Yazdi will perform it using a minimally invasive technique under general anesthesia. He will make an approximately 1-inch incision over the area of of disc herniation, moving the overlying muscles out of the way so they aren’t damaged. Then under microscopic magnification, Dr. Yazdi makes a small bone window so he can get access to the herniated disc and remove it. He then checks inside the disc space to make sure there are no loose fragments in there. The entire procedure takes about one hour.
Patients are able to go home the same day and will have regular follow up appointments with Dr. Yazdi. They can usually return to light activities in about two weeks and return to work in four to six weeks.