Doctor Luis Lombardi

Since 2000, Dr. Luis Lombardi has served as a privately practicing non-traumatic spine surgeon in Los Angeles, California. Dr. Luis Lombardi draws on a comprehensive knowledge of both normal and abnormal vertebral anatomy. The human spine is made up of 33 interlocking vertebrae, 24 of which are independently mobile. Each of these vertebrae consists of a cylindrical solid structure known as the vertebral body, which can withstand body weight and bears compression generated from pressure and movement. On the interior side of this structure lies the vertebral arch, which together with the vertebral body makes a circle around the spinal canal. The vertebral arch connects to a series of bony processes, to which the skeletal muscles connect. In between each pair of vertebrae lies the intervertebral disc. The disc consists of a shock-absorbing nucleus, which is contained within a harder protective annulus. The exterior third of the annulus contains pain-sensitive nerve fibers that activate in instances of disc damage. The primary nerves in the spine, however, pass down the spine behind the vertebrae and discs. Located close to the interior edge of the disc, the nerves branch out to become nerve roots, which come together to become the larger nerves of the legs

As a non-traumatic spine surgeon, Dr. Luis Lombardi employs a minimally invasive approach that targets the cause of a patient’s pain without unnecessary damage to surrounding structures. Dr. Luis Lombardi applies this treatment methodology to a range of spinal conditions, including sciatica. The term sciatica refers not to a diagnosable medical condition, but rather to a set of symptoms that indicate an underlying issue. Such symptoms typically stem from an irritation or compression of the sciatic nerve in the lower back. This often occurs when an intervertebral disc in the lower spine becomes worn and herniates. This causes the soft core of the disc to leak out through its protective coating and encroach on the surrounding nerves, including the sciatic nerve. The sciatic nerve, the longest in the human body, begins in the lower back and then splits into two. Each branch runs through a buttock, hip, leg, and feet. For this reason, when the sciatic nerve becomes compressed, patients experience pain that begins in the back and radiates down part or all of the long nerve. Patients typically describe the pain not as an ache but as a sharp, burning, or tingling discomfort. It may co-present with weakness or numbness in the same leg and may cause difficulty walking, though the pain itself is often worse when sitting.

Here are some basic spinal care tips:

Some patients get MRI studies during the immediate period following a non-traumatic back procedure. Once performed, these MRI have the potential to confuse the entire clinical picture rather than to shed light about the healing process.

Many authors in the country and internationally have published important scientific papers about the characteristics of MRI changes in the postoperative of asymptomatic (no complaints) patients who had a successful lumbar disc operation. They found that there was no good correlation between symptoms and MRI images during that period. The MRI showed changes that mimic (look-like) the pre-surgical images; however, the patients were doing very well from the clinical standpoint. These MRI changes could sometimes persist for up to a year.

Scott Boden, MD published an article in Radiology, 1992, where he states that in the postoperative, the normal and typically expected enhancement pattern: “was indistinguishable from that seen with a recurrent (re-appearance) or a residual (the herniation was not taken out completely) disk fragment surrounded by scar or inflammatory tissue” and continues:  “Decisions about surgery made on the basis of MR studies obtained during the first 3 to 6 months postoperatively must be carefully considered”.

Andrew Deutsch, MD (Spine 1993) performs MRI studies in 23 asymptomatic patients 1 year after successful lumbar disc operations. He found that 50 % of the patients showed posterior disc problems that mimicked the original herniated disc problem. He went on to describe 15% of cases in which no change or an even greater disc problem was shown in the MRI after a year of successful disc operation.

Even though these studies were performed in patients that did not have (or had minimal) symptoms, I wouldn’t like to give the false impression that post-surgical MRI studies are useless. Under special circumstances, they could add valuable information when ordered at the proper time. In conjunction with the clinical picture and an in-depth analysis of the actual films,  these radiological studies could help the surgeon determine what is the best course of action for one’s particular case during the postoperative recovery.