Anterior cervical decompression (discectomy)
A cervical disc herniation can be removed through an anterior approach to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness and tingling. This procedure, called a cervical discectomy, allows the offending disc to be surgically removed.

The anterior approach to the cervical spine (from the front of the neck) can provide exposure from C2 down to the cervico-thoracic junction. Spine surgeons often prefer it because it provides good access to the spine through a relatively uncomplicated pathway. All things being equal, the patient tends to have less wound pain from this approach than from a posterior operation.

After a skin incision is made, only one thin vestigial muscle needs to be cut, after which anatomic planes can be followed right down to the spine. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery. The main trouble that patients have after surgery is a sore throat and difficulty swallowing, which produces a sense of a ‘lump in the throat’ caused by the surgical manipulation of the area.

The general procedure for the decompression surgery includes the following:

1. Surgical approach

The skin incision is one to two inches and horizontal, and can be made on the left or right hand side of the neck.

The thin platysma muscle under the skin is then split in line with the skin incision and the plane between the sternocleidomastoid muscle and the strap muscles is then entered.

Next, a plane between the trachea/esophagus and the carotid sheath can be entered.

A thin fascia (flat layers of fibrous tissue) covers the spine (pre-vertebral fascia) which is dissected away from the disc space.

2. Disc removal

A needle is then inserted into the disc space and an x-ray is done to confirm that the surgeon is at the correct level of the spine.

After the correct disc space has been identified on x-ray, the disc is then removed by first cutting the outer annulus fibrosis (fibrous ring around the disc) and removing the nucleus pulposus (the soft inner core of the disc).

3. Dissection

Dissection is carried out from the front to back to a ligament called the posterior longitudinal ligament. Often this ligament is gently removed to allow access to the spinal canal to remove any osteophytes (bone spurs) or disc material that may have extruded through the ligament.

The dissection is often performed using an operating microscope or magnifying loupes to aid with visualization of the smaller anatomic structures.

Possible risks and complications of anterior cervical discectomy surgery may include:

Inadequate symptom relief

Failure of bone graft healing (a.k.a. non-union or pseudarthrosis)

Persistent swallowing or speech disturbance

Nerve root damage

Damage to the spinal cord (about 1 in 10,000)

Bleeding

Infection

Damage to the trachea/esophagus

Also, the small nerve that supplies innervation to the vocal cords (recurrent laryngeal nerve) will sometimes not function for several months after neck surgery because of retraction during the procedure, which can cause temporary hoarseness. Retraction of the esophagus can also produce difficulty with swallowing, which has usually resolved within a few weeks to months.

There is little chance of a recurrent disc herniation because most of the disc is removed with this type of surgery.

An anterior cervical fusion is usually done as part of a cervical discectomy. The insertion of a bone graft into the evacuated disc space serves to prevent disc space collapse and promote a growing together of the two vertebrae into a single unit. This ‘fusion’ prevents local deformity (kyphosis) and serves to maintain adequate room for the nerve roots and spinal cord.

By: Peter F. Ullrich, Jr., MD

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IDET - IDET (Intradiscal Electrothermal Therapy) back surgery animation
IDET is a minimally invasive outpatient back surgery to treat patients with chronic low back pain that is caused by tears or small herniations of their lumbar discs. This animation walks you through the steps involved in an IDET back surgery.

Click on link to see animation...

http://www.spine-health.com/dir/idet.html

Here is a good monograph on Methadone/Metabolism/drug interactions:

http://www.atforum.com/pdf/Drug_Interactions.pdf

I am putting these up for reference only. Sometimes people need to look up this information.
Not all conversions listed in tables work for everyone equally either...there is variation. So make
sure you have an experienced doctor when an opiate adjustment is needed.

http://www.globalrph.com/narcotic.cgi

for fentanyl:
http://www.medicineau.net.au/clinica...2.html#anchor1

http://www.mywhatever.com/cifwriter/...y/70/4932.html

Fenfanyl is hard to convert either way.
And Methadone has special requirements too.
Since Methadone can stop the heart in sensitive people, you should insist
upon an EKG before starting it. Converting high doses of other opiates to methadone gives a high starting dose which can be dangerous. I have a post
earlier in this thread about that risk.

Here is a newer (as of this post) Opioid Conversion Calculator (same disclaimers apply) developed by three pain experts, based on latest up-to-datest medical evidence, for Practical Pain Management (PPM).

The first link is the introductory article that discusses conversions (tables, calculators) in general and this new one specifically, including background information, safety concerns, and special cases like methadone. I encourage everyone to read it before jumping to the calculator (There WILL be a QUIZ! )

PPM Launches Online Opioid Calculator

Thereafter, the direct link is:

Opioid Calculator

Doc

Brain Atrophy with Chronic Pain

The Intractable Pain Patient's Handbook For Survival by Forest Tennant, MD, DPH

Hormone Therapy for Chronic Pain

Hormone Replacement Therapy in Morphine-induced Hypogonadic Male Chronic Pain Patients
Testosterone Replacement in Chronic Pain Patients

Testosterone Replacement in Female Chronic Pain Patients

From Research To Practical Application: Long Term Testosterone Treatment

Hormone Treatments in Chronic and Intractable Pain An Emerging Practice

Hormone Replacements and Treatments in Chronic Pain: Update 2010

Hormone Therapies: Newest Advance in Pain Care

Human Chorionic Gonadotropin in Pain Treatment

HCG and Diabetic Neuropathy

HCG and Testosterone

Cortisol Screening in Chronic Pain Patients

I'm seeing some references to the hormone oxytocin (not to be confused with the opioid pain medication Oxycontin) having much potential, but as yet, I have not seen much else. It is very early in its investigation.

Oxytocin May Offer Benefits in Treatment of Chronic Pain

Intrathecal Administration of Oxytocin Induces Analgesia in Low Back Pain Involving the Endogenous Opiate Peptide System Study done on rats. As Good Ol' Charlie Brown would say, "RATS!"

Doc

This June 2012, Science News has a very interesting article on
specific sodium channels in the peripheral nervous system, that may be targets for non-opiate blocking drugs eventually. This may lead to the development of pain relieving drugs with few side effects.

http://www.sciencenews.org/view/feat...e/Hurt_Blocker

Here's a series of well-written easy to understand articles on various chronic pain topics from eorthopod.com.

Adult Pain Management Patient Guides

Topics Include:

• Body Talk (A complimentary/alternative medicine approach)
• Chronic Pain and Nutrition
• Chronic Pain and Sleep
• Chronic Pain Management
• Complex Regional Pain Syndrome (CRPS)
• Epidural Steroid Injections
• Facet Joint Injections
• Injections for Pain
• Medication Approach to Chronic Pain
• Pain Management Medications
• Pain Pumps
• Piriformis Muscle Injections
• Radiofrequency Ablation
• Relaxation Training
• Sacroiliac Joint Injections
• Spinal Cord Stimulators (SCS)
• Transcutaneous Electrical Stimulation (TENS)

Doc