Good Morning Spine

Archive for the ‘Spinal Medicine’ Category

Each time I see a patient, I try to understand how they must feel after trying so many different treatments from various doctors or therapists. The most important thing is a proper diagnosis! This may require several things including MRI or a visit with my partner Dr Geisse to perform very specific nerve testing. So much of good outcomes requires a thorough review of these tests. I even have a new Dr that specializes in gait to look at patient’s shoes and how they rotate their pelvis when walking. The goal is less surgery and more using a team approach to decrease pain and increase function for the vast majority of patients with neck and back pain.

I think how much trust a patient needs to have to move forward with spinal surgery on the neck and back region given all the bad press regarding spinal surgery. A lot of this is actually good as patients should be cautious on making any decision. There are real risk and surgery gives less then perfect results. However, there is a window after which results are less certain if chronic weakness and pain are treated with narcotics and excessive nerve blocks. Know your options and research on the Internet as well. Education is a fundamental goal in my practice with all patients.

I read a lot about laser for spine surgery. This tool is very easy to use but has very little role for treatment of spinal disorders. There are reasons most advanced trained surgeons do not use it. We would if it help with outcomes. Most of these “lasercenters” do not have peer-reviewed content or doctors that have felllowships in spine. Procedures are performed outside a hospital where Bthere is much monitoring of complications and efficacy. If u are thinking of this option do a complete Internet search of a center including complaints to board of medicine,lawsuits,and community chat centers. Be careful!

I strongly believe spine surgeons should discuss all serious potental complications with surgical patients.I feel that patients should be a little nervous if they are properly prepared for surgery. The results are good but not perfect In most situations. Managing each patients expectations is extemely important. I also find the other extreme, where patients with very correctible problems , are told surgery on their neck or back will not work. In fact, surgery has come along way over past five years with newer technology and more more highly trained spine specialists. Too much narcotics are being prescibed that have no proper role for treatment of stenosis or herniated disc disease.

I read a lot of articles about repeat spinal surgical procedures and want my patients to understand some basic reality.In most cases, the underlying process is a form of aging with degeneration of structures such as disc or facet joints. This ongoing process cannot be changed with surgery. Rather we try to lessen the symtoms of pain or weakness so a patient can be more functional. The undelying process may then pass on to other levels with time requring either non-surgical or possibly more surgery in the future. This process is seen quite often in heart surgery as well. Coronary arteries at other level also nay get blockage over time needing second and even third surgeries. I clearly relay this process to all my patients. Fortunately, new techniques for spine surgery make recovery very rapid from just a few years ago.

I see more patients confused about which procedures are their best options. When asking about success ,I always give a percentage that is based on reported results in the published liturature. If doctor are being honest, they should also stress the complications that may occur. In reality, newer less invasive surgeries have really improved the outcome to lessen pain or weakness in conditions associated with disc herniation or spinal stenosis. I also reveal the number of procedures performed each year. Patients should look up their doctors credential using the Internet as well. Be prepared!

A lot of my patients with neck pain do not realize they have weakness of the bicepts and deltoid muscle groups. They may have had nerve blocks,this will only correct their pain. Very important to exam patients prior to these blocks. So many patients are seen in pain clinics without full examination. Unfortunately, this masking of symptoms can lead to permanent weakness.

I find that sciatica or pain down the buttock to back of leg is still a growing cause for patients to seek out care from a spine specialist. This is usually from inflammation from the disc or blockage of nerve at lower two disc spaces. Spinal stenosis is the other big cause. Most of the times stretching in combination with nerve block under fluro removes 80 percent of the symptoms and surgery is not necessary. We then try to look at wellness and even gait to help prevent future return of pain. The main goal is return to activity such as golf,tennis,and even bowling!

I have recently begun to ask patients to consider their diet and nutritional preparation prior to surgery. We ask all patients to take vitamins but review specifics if they are taking any herbal products. I also try to get them exercising within their pain limits two weeks prior to surgery as well. We all feel, as a team ,this has clearly improved patients outcomes and ability to handle pain in post- operative phase of their care.

Our team can now prevent 95 percent of need for sugery when patients are compliant. We now use acupuncture and added fitness training to the team. Surgery is now less invasive with rapid return to activity. So much progress in just a couple of years.I am still amazed that patients do not look at all their options and try our approach. Wellness is fundamental to a good team approach.