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Jaideep Chunduri, M.D.

Comprehensive Spine Care that
Puts Each Patient First

My singular objective is to help you reach your goals through exceptional orthopaedic spine care. I take into account what you want to be able to do after treatment, and I help you devise the best treatment plan to get there.

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Low Back and Leg Pain Treatment Options

Fusion Procedure

Depending on your medical history and the outcome of the diagnostic imaging, a lumbar fusion may be recommended. This procedure joins two of your vertebrae with a bridge of bone. In order to fuse the bones together, a bone graft is required and may be obtained from the patient’s hip, a cadaver, or it may be manufactured. Aside from the fusion, the surgery may include:

  • Discectomy – The removal of the damaged portion of a disc.
  • Laminectomy – The removal of the posterior portion of a vertebra.
  • The removal of a bone spur or other spinal growth.

Depending on your condition, your surgeon may choose an open fusion surgery or a minimally invasive fusion surgery (MIS).

  • Open Surgery uses an incision large enough to directly view and access your spine. In some cases, an open procedure may be required. However, it can cause your recovery to take longer and you may have to stay in the hospital longer than if you have an MIS procedure.
  • MIS surgery uses a smaller incision in which a surgeon works through a narrow channel. Because less disruption is caused to your muscles and boney anatomy is preserved, your recovery and hospital stay tend to be shorter than for an open procedure.

Lateral Lumbar Interbody Fusion Procedure

Lateral Lumbar Interbody Fusion (LLIF) is a type of minimally invasive fusion surgery in which access to the spine is gained from the side. Lumbar interbody fusion surgery involves removing the disc material between two vertebrae and replacing it with an implant. The implant restores the disc space to its normal height and provides support and stability while the spine heals. The LLIF approach allows your surgeon to avoid the major neural and vascular structures that surround the spine, reducing the risk to these structures compared to other approaches. The LLIF approach also allows your surgeon to restore proper disc height and spinal alignment and may relieve your pain more effectively than other approaches.

You can learn more about the LLIF procedure that Dr. Chunduri does here. You can see an example of a patient who has had an LLIF procedure here.

Duo™ Expandable Interbody Fusion System Animation

Frequently Asked Questions & Answers About Spine and Neck Pain or Treatment

Is back pain normal?
Back pain although very common (up to 90% of the general population will have an episode of back pain in their life is not normal. Back soreness that can be seen with overuse (feeling of soreness) usually goes away fairly quickly. Back pain that does not go away within a few weeks usually needs treatment including medication, therapy, or injections. If someone has radiating pain, weakness, or loss of function this could be a sign of something more severe.

What are the common causes of back pain?
The origin of spinal pain can be degenerative, traumatic, neoplastic or metabolic, with vast majority being degenerative and traumatic. Most low back pain follows injury or trauma to the back. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain.

What causes neck pain?
Pain in the neck can be caused by a variety of conditions including: local trauma to structures such as muscles or ligaments that would occur with a stretch injury of direct trauma. Intervertebral discs can become degenerated and or injured causing pain similar to the way lumbar discs can cause pain, see above. The small supportive joints of the neck called the facet joints can mediate pain when they become stressed or degenerated.

How do disc injuries cause back pain?
Injuries to the intervertebral discs cause pain by several known mechanisms. There is the physical presence of a solid object such as a disc on a sensitive tissue such as nerve, as would be seen in spinal stenosis. There is a chemically-mediated irritation of the same sensitive structures as would be seen in common herniated discs. There is a structural failure of various spine components due to secondary to disc injuries that can cause pain such as scoliosis and degenerative spondylolisthesis.

Is it true that a bulging disc can be normal?
A bulging disc indicates a weakness in the tough outer fibers of the disc. This can cause the overall disc material to push through. Usually, a bulging disc does not cause symptoms as they can be seen in 60% of the normal population over the age of 40. Bulging discs are part of the aging, wear and tear and is part of the entity known as degenerative disc disease.

They can cause back pain, leg pain, or a combination of both. Usually bulging discs will start to cause pain when they are combined with arthritis of the spine or what we call facet arthropathy. Symptomatic patients can be treated with therapy, injections, chiropractic care and other alternative treatments, and occasionally surgery.

If I have to have a fusion, does that mean I will never bend?
A fusion means to make several bone into one solid bone by placing bone graft or substitutes and usually instrumentation between the vertebrae or the joint surfaces. Typically in terms of bending, most of the bending comes from the hips and L5-S1 disc space. So if these are intact there should be a minimal loss of bending. Actually some patients can bend more after surgery because they do not have the pain that they did prior to surgery.

When is hardware needed in the spine?
Hardware is generally placed in the spine to old the bones in appropriate alignment until fusion and increase the chance of the fusion. It can also be used to replace the disc or the vertebrae. There are also hardware that can be placed to open the spaces around the spine. This can involve instrumentation such as pedicle screws and rods, cervical plate, intervertebral cages, and disc replacement.

When is surgery necessary for spinal problems?
Surgery is performed for several reasons. This includes failure of all conservative care including physical therapy and interventional injections, progressive neurological dysfunction (progressive weakness), progressive instability and persistent pain.

Will fusing my spine cause damage to adjacent areas?
Fusing your spine may lead to an entity known as “adjacent segment degeneration” which is an acceleration of the degeneration of the level above or below the fusion. The reason this happens is because permanent fixation at one level of your spine results in additional stresses loading the mobile segments above or below the fusion which may lead to premature degeneration of the discs and facet joints in the spine. This may or may not be painful. It is not known how long this process may take.

What are the risks associated with spine surgery?
The risks of spine surgery include the general risks of surgery such as anesthesia, nerve damage, infection, and blood loss. It also includes failure to relieve pain, chronic pain, spinal fluid leak, scarring, failure of fusion, hardware failure, risks of bone grafting, persistent numbness, and the fact there is no guarantee as to the outcome of the procedure. There are specific risks which are particular to the approach used to the spine which can be discussed with your doctor in detail.

When should I have an MRI?
An MRI should be ordered if you have pain in your back or neck that has persisted despite adequate conservative care, pain shooting down the leg or arm that has not gotten better with time, medication, or therapy. Other reasons to get an MRI include weakness, abnormal physical examination, bowel or bladder symptoms, or to evaluate for a fracture or tumor.

What is minimally invasive surgery? Am I candidate?
Minimally invasive surgery involves small incisions, less muscle stripping, and specialized instruments to perform your surgery compared to the traditional “open” surgery. Depending on the surgery that needs to be done there are approaches from the back, the side, or the front that can be performed in this manner.

What can I do to avoid surgery?
Sometimes surgery can not be avoided despite adequate conservative care. By doing your physical therapy and improving your core strength, trying epidural injections, and other conservative measures (medication, chiropractic care, yoga, pain management) would be ways to avoid surgery.

Why do some doctors approach the spine from the back, the abdomen, or the side?
The approach to the spine depends on where the pathology of the problem is as well as previous surgery may have been performed. The decision is made upon consultation with your physician and deciding the advantages and disadvantages of the approach to the spine. Typically neck surgery may be performed through the front of the neck for a herniated disc as this is the direct approach to the disc. Low back surgery is typically performed from the back because of where the ease of getting to a herniated disc.

When do I need a fusion in the neck?
Fusions are necessary in the neck anytime that disc material is removed from the neck to prevent collapse of the disc space. In addition, when a laminectomy in the neck is performed, it is necessary to do a fusion to prevent a chin on chest deformity. The other time a fusion is performed from the back is if there is failure of fusion in the front of the neck. A fusion may be performed for deformity, nerve compression, and degenerative disc disease.

Interested in learning more about non-surgical or surgical treatments for spinal injuries and conditions? Call Dr. Chunduri’s team at (513) 354-3700 or schedule online.

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Sacroillia (SI) Joint Conditions and Treatment Options

The sacroiliac joint connects the last segment of the spine, the sacrum, to the pelvis. The integrity of the sacroiliac joint depends on strong ligaments that encase and cover the joint. These ligaments compress and stabilize the joint.

The ligaments that encase the sacroiliac joint may be disrupted due to injury or degenerate due to age, allowing the joint to have excessive motion. This excessive motion may inflame and disrupt the joint and surrounding nerves.

Your physician may also refer to sacroiliac joint pain by other terms like sacroiliitis, SI joint degeneration, SI joint inflammation, SI joint syndrome, SI joint disruption and SI joint strain.

iFuse Implant System for Sacroiliac Joint Fusion

Causes of sacroiliac joint disorders can be split into five categories:

  • Traumatic (lifting, fall, accident)
  • Biomechanical (leg length discrepancy, prior lumbar fusion)
  • Hormonal (pregnancy / childbirth)
  • Inflammatory joint disease (sacroiliitis)
  • Degeneration (age related wear and tear)

In order to diagnose the sacroiliac joint as the pain generator, your physician will typically start with a history and a physical examination. During the physical examination, your physician may try to determine if the sacroiliac joint is the cause of pain through movement of the joint. If this joint movement recreates the pain, the SI joint may be the cause of the pain.

Your physician may also use X-rays, CT-scan or MRI to help diagnose the sacroiliac joint. It is also important to remember that more than one condition (like a disc problem) can co-exist with sacroiliac joint disorders.

Finally, your physician may request sacroiliac joint injections as a diagnostic test. Sacroiliac joint injections involve injecting a numbing medication into the sacroiliac joint. If the injection alleviates your symptoms, then your sacroiliac joint may be the likely source of your pain.

Do you have SI joint pain? Take this short quiz.

For more information about sacroiliac joint disorders, please click here. You can schedule your appointment with Dr. Chunduri here.

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