“Video of Dr. Nosari’s interview and summary of her speech:”
In the name of God, I am Dr. Massoud Asghari Nosari
Graduated in Neurosurgery from Shahid Beheshti University of Medical Sciences.
Mr. Doctor, as a neurosurgeon, what is the title of the title that you can help patients with?
Neurosurgery includes a variety of brain tumor surgeries, endoscopic brain surgeries and related diseases, as well as spinal diseases, as well as a variety of diseases of the lumbar disc, neck, fractures of the spine and other cases, depending on the type of university. At the center where we were, we went through all these courses, including cerebral endoscopy, pediatric neurosurgery, cranial base surgery, cerebral endoscopy, and almost all routine courses.
Please tell us about lumbar disc surgery and its symptoms and treatment methods, what problems does the patient face when he comes to you?
In general, lumbar disc disease is one of the most common diseases in the field of neurosurgery. It can be said that a very large percentage of people in the society suffer not from lumbar disc disease but from diseases related to the spine. Given the lifestyle we have now and the sedentary lifestyle, sitting at a desk, inactivity and mobility, these diseases naturally spread with each passing day. The main symptoms of these diseases appear as back pain, which we have in a huge range of diseases, and eventually may manifest itself as pain that spreads to the legs.
But the important thing is that the back pain of many of these patients is due to spasms, it is due to cramps, it is due to activities that they do during the day and these activities may damage the spine, ie it is not the main cause of back pain. After the investigations that are done and in the continuation of your service, I will explain in what ways; And our examinations may be suspicious of the lumbar disc, and in that case we will do additional examinations.
So, in general, their main symptom is back pain and pain that spreads to the legs. In general, back pain is one of the most common diseases in society today, and that is because of the lifestyle we have now. Sedentary lifestyle, type of daily activities … all of these are the main causes of back pain. But lumbar disc has a completely different category, that is, we should not say that someone who has back pain has a lumbar disc. Lumbar disc has its own symptoms and is usually accompanied by back pain that spreads pain to the legs and is characterized by symptoms of numbness of the toes, tingling in the legs, diffuse pain and the like and is a very general category, ie it must be with Initial examinations We suspect that the patient has lumbar disc herniation, and then our diagnostic examinations begin with plain photographs and graphs, and finally we request an X-ray to examine the condition of the discs, spinal cord, and so on to make a diagnosis. Lumbar disc. Well, there are very common questions about lumbar disc and there are vague points in this regard that are very important to express to the general public.
Well .. The patient who has a lumbar disc and this disc has been diagnosed is divided into different categories according to the type of disc protrusion.
These are cases if the patient’s lumbar disc is in an acute condition and has debilitating pain for the patient and has caused spinal cord injuries, including a decrease in the patient’s lower limb strength or urinary disorders for the patient. Which require emergency surgery and no delay is allowed at all because if something happens the symptoms are irreversible. But the rest we have to categorize for treatment.
By no means does a neurosurgeon initially make a diagnosis based on the surgery of all patients.
Because many of these patients can control their symptoms by changing their lifestyle, losing weight and exercising, pool physiotherapy, hydrotherapy and the like.
The important thing is that the protruding lumbar disc can never be reversed (because this is a routine question that many people ask), no, this does not happen to a person. A person can live in such a way that his symptoms do not increase and his spinal cord is not damaged.
One of the most important cases is weight loss, especially in women. Given that women are normally less active than men due to their lifestyle, the weakness in their back muscles is further exacerbated by the fact that if our spine had strong muscles This in itself increases the strength and prevents the disk from protruding. So the important thing for women
Going to the pool is regular hydrotherapy, physiotherapy and weight loss, as well as in men.
These are some of our initial recommendations for patients and the types of medications available, anti-inflammatory drugs, analgesics, and the like, and we recommend these treatments and revisit them after a few weeks. During this time we monitor the patient, if the patient’s symptoms have improved or are improving, treatment is effective and we recommend continued treatment, but if the patient’s symptoms are aggravated and become severe and disable the patient , And the patient has to be a candidate for surgery because of the working, occupational and living conditions that are affected.
Of course, the important point here is that these cases include simple discs, ie simple spinal discs in patients who do not have a problem with the structure of the spine, and include patients with spinal slippage and similar diseases (which have a wide range of diseases. Well, in the case of lumbar disc surgery, the surgery that is used all over the world, and we do, is microscopic surgery.
In this way, we make a very small incision in the skin exactly where the lumbar disc is, which we can either pinpoint exactly before the operation with the device, and according to the experience used by surgeons, a small skin incision is made. And with the help of a microscope, the same area where the disc is exactly, we enter the surrounding tissues without any damage and without affecting the muscles, and the disc is emptied, and the patient’s recovery, ie recovery and hospitalization, takes a maximum of one day. The ward walks and does its personal and daily activities, and if it is good, God willing, it can be released after one day.
There is a concern that many patients say that the patient used to sleep at home for a long time, was hospitalized and wanted care. And the special care that patients have to follow and change their lifestyle. If he has been doing things so far that have led to lumbar disc herniation, he should change his lifestyle. He should not bend his back too much and use his knees to bend and straighten, he should not lift heavy loads, heavy activities of harmful and destructive sports that are common among men, he should not have bodybuilding, driving for a long time and he can easily observe these. Return to your normal life within a few days. So another important question to ask is that
Do you use artificial disks in lumbar disc surgery?
No, not at all. In lumbar disc surgery, we remove and protrude the protruding part of the disc and release the nerve fiber, but if we want to use platinum-assisted spine fixation in spinal surgery, because this fixation occurs from the back of the vertebrae with some techniques. The disc is completely emptied and an artificial disc is used for the upper and lower vertebrae. Artificial can be used to strengthen the spine. Two of the most common diseases are related to the spine in the neck, cervical disc and cervical spinal canal stenosis, which affects a wide range of diseases of the neck.
These two diseases can have different symptoms as well as different treatments.
Patients with cervical disc herniation usually present with pain in the neck and arms. Depending on the type of nerve root involved, it may be from the arm to the elbow to the fingers, which is mostly in the area of the fingers.
The pain may be so debilitating that the person is no longer able to lift, which occurs in the advanced stages of the disease.
Of course, there are groups of cervical discs that occur due to trauma in an accident, the story of which is completely different.
These patients who come with cervical disc, I emphasize again that no neurosurgeon in the first stage does not consider the surgery of these patients, they must first go through non-surgical courses. Well … never the first encounter with patients with cervical disc surgery , Except in emergency cases, ie a person with debilitating pain and numbness and a sudden decrease in hand strength, in which case he is a candidate for emergency surgery. In other cases, after examinations and diagnostic procedures such as plain imaging, MRI and EMG NCN, which is a nerve and muscle tape, the patient eventually becomes a candidate for treatment and supportive measures.
For example, do not lift heavy loads as before, do not put pressure on the neck and hands, do not bend the neck too much, do medications and supportive treatments … anti-inflammatory, swimming pool and hydrotherapy and the things that are recommended to them.
The important thing about the neck disc is that, unlike the waist, we do not carry a lot of weight on the neck, so weight loss is not very effective in these people.
Most of these patients’ symptoms are such that pain spreads to the upper limbs, their hands. The person then suffers from tingling, numbness and numbness of the fingers, and then changes the sensation and cooling of the fingertips, and finally a decrease in muscle strength and force. He finds that this is in the advanced stages of the disease. That is, if a person presents at a stage where there is pain, the response to treatment is much better than at a stage where the strength of the hand is reduced.
Cervical disc surgery is also one of the main questions of the clients. Due to the sensitivity in the neck as well as the concerns, many questions are asked about this surgical method. Can you explain?
This surgical procedure is microscopic. It is performed from the anterior part of the front of the neck. In this method, after being cut from the front with the help of a microscope, the whole disc is emptied, then the spinal canal is released, the nerve roots of the neck are released, and since the whole disc is emptied between the upper and lower vertebrae, the cage or cervical disc is used. We try to fuse or fix the vertebrae up and down together. Depending on the cervical discs, there may be one lobe, two lulls, sometimes 3 to 4 lollipops of the cervical disc.
The length of hospital stay, like the lumbar disc, is one to two days, but the important thing is that they have to be very careful after the surgery. Most of this is due to the fact that one vertebra is fixed to the upper vertebrae. Do not bend and straighten the neck like before so that no pressure is applied to the upper and lower discs of the operation site. But their normal lives are not disrupted and they can do the natural things they used to do. But again, we emphasize by observing more of these cases. But another disease that creates ambiguity for patients is cervical spinal stenosis.
The ambiguity of this disease is that the symptoms that a person has, unlike the cervical disc, may not be in the hands and neck itself. That is, a person has a spinal stenosis of the neck, but does not mention much of a problem with his hands or pain in the neck.
In these patients, their symptoms may sometimes manifest as motor symptoms. The motor symptoms of these patients are such that they may have difficulty walking. When walking, their knees may become hollow, their lower limbs may weaken, and their arms may be weak. As a result, many of these patients, when they have spinal stenosis, their first reaction is that well, my neck does not hurt … well, it is true that it may not hurt. This disease usually occurs in older people and is due to the pressure that enters the spinal cord from the back. We can also have a neck disc, but the greatest amount of pressure is from the back to the spinal cord. Parts that must have a flexible tissue to protect From the spinal cord, they become stiff and take on a bony state, and pressure is applied to the spinal cord from behind, and this pressure causes their symptoms and narrows the spinal cord. The surgical method of these patients is also different from cervical disc surgery
The surgical method of these patients is completely different from the cervical disc. The same is true of the pressure on the spinal cord as a result of our diagnostic and therapeutic approach.
Generally, older people have lumbar disc disease. The surgical method of these patients is also different from patients with cervical disc, although the pressure is from the back to the spinal cord, surgery should be performed from the same part. An important issue in these patients is the age of these people, who are older than those with cervical discs, so their length of hospital stay or other conditions may vary.
Depending on the type of underlying disease and the degree of cervical spine instability, this procedure is done before the operation to examine the cervical spine forward or backward to see if we really need to do this. Fix the operation of their neck spine from behind with platinum or not.
If necessary, fixation is performed during it, and if it is not necessary, the same routine neck spinal stenosis surgery is performed for them. All these patients must get out of bed in the morning after the operation, we help them to move in the ward, walk and start their activity and the sooner they return to their normal activity, the best way to improve the main disease and their background. The patient we serve is Mr. Saeed, one of our good friends who has become even more friendly after the operation. He is a 36-year-old man who has a long history of violent martial arts, bodybuilding and cases that really hurt the spine and pose a serious threat to the spine. They had a simple disc surgery a few years ago, but again they had very progressive complications and it really bothered them that I would ask them to tell me their symptoms themselves.
Patient: Let me tell you that about 5 and a half to 6 months ago, because my job is to sit at a desk, I wanted to move the desk a bit, but I felt a slight pain in my lower back, but well, I looked negative. I did not have it and arbitrarily took a few painkillers from the pharmacy and took them. It was good for a day or two, until a few days later I felt my pain increase day by day, and this pain unfortunately spread to the pelvis and the back of my right thigh. I had a lumbar disc and I had surgery. But unfortunately, over time, the pain started again and the pain continued so much that it was caused by a deviation from the right side of my body to the left, which was very severe and the pain in the back of my pelvis and right leg was so great that my whole body weight I was throwing it on the left side of my body, and in the same way, the deviation to my left was increasing day by day, and these pains had reached such a point that no painkillers or any other medicine really worked, and I went to several neurologists, many of whom were doctors. They said that we would not touch the back with such severity of the disease, because it was clear from the MRI images of how far the disease had progressed. Then they suggested to me that if you want to prevent the operation (because I had surgery once and I did not want to have surgery again) go for a few sessions of hydrotherapy, which did not work, I went to about 22 sessions of physiotherapy that had no effect and not only me I was not treated, but my body deviated more and more day by day, so that my friends and acquaintances asked me why I was walking crookedly and I said that I had back pain. And … I even did acupuncture and after a while that none of these treatments had any effect, one of Bahman’s doctors suggested that you can do something to relieve this back pain without surgery and inject it and I will inject it. I asked what the gel looked like, and he said it was the gel we injected to relieve disc adhesion and pain, and you could go back to normal, which unfortunately I did twice and gave me a second time. They injected ozone, which I do not know exactly from a medical point of view, but unfortunately, after 3 to 4 days, it became so that even with a sneeze, which I tried to control very much, my pain was so great that I unconsciously cried and the pain was gone. Finally, one of my friends, who had operated on his mother two months ago, introduced Dr. Nosari to me. After all these steps, the doctors told me to do it, and after doing it, I realized that they had no effect.
On the other hand, some doctors disagreed with the operation, saying that the operation would cause you to lose your ankle and even lead to paralysis, and I gave up the operation until one of my acquaintances, whose mother had a lumbar disc and had undergone surgery. And platinum must have been used on their backs, but fortunately they performed without platinum and represented me and I arrived at the doctor’s office.
Thank God my action was great and I am very satisfied. And of course, Dr. Bahman himself said that there is a lot of surgery, surgery, and why did you allow yourself to be so injured? They said that it is not a problem, you act today and you will be released tomorrow morning ….
He operated, I expected to rest a lot in the hospital after this operation, but the next day the doctor came and I got out of bed and walked a few steps and I did not feel the pain I had before and my happiness was more when it was completely clear. I was and everyone who was there was happy because after 5 months of crooked walking I was completely flat.