With the temperatures still skyrocketing, it is hard to believe that fall is around the corner.  But if the calendar is correct, soon it will be time to rake leaves! As you get ready to rake leaves – there are a few simple safety tips to help you avoid back injuries and back pain:

• View raking leaves as exercise – stretch before you rake.
• Avoid twisting and keep your back mainly upright.
• To avoid overreaching and twisting – step side to side – using your legs to move rather than your arms.
• To reduce stress on one side of the body -  switch hands throughout the job, and keep your elbows bent.
• And don’t forget to take breaks as needed.  This includes stretching and briefly bending backward to reduce back pressure.

At a recent continuing medical education program one of the speakers Dr. James Anderson discussed the assessment of low-back pain.  Dr. Anderson is a family practice physician in Greenfield.

During his presentation, Dr. Anderson highlighted a few spine wellness / patient education sites.  These sites provide spine eucation information as well as other health information on other topics.  These sites are  http://orthoinfo.aaos.org, http://www.nlm.nih.gov/medlineplus/, and www.uptodate.com/patients.  A few books that he recommended include:  Kortz, JN, Parkinson, G. Heal Your Aching Back.  McGraw Hill, New York, 2007 and Dumhi, HA.  All You Need to Know About Your Back Pain.  Arthritis Foundation, Atlanta, 2002.

Additionally,this link on Indiana Spine Groups web site provides a listing of other useful spine related web sites.   

This continuing medical education session will address caring for the patient with traumatic spine injuries.  These spine injuries can occur from motor vehicle accidents, work-related injuries, falls and even sports.  At this session, Dr. Paul Kraemer will discuss the caring for the patient with acute traumatic spine injuries and will also discuss when spine surgery is an option.  The latest research and updates for the treatment of spinal cord injuries will also be reviewed.

Dr. Paul Kraemer is an orthopaedic spine surgeon, who has recently joined Indiana Spine Group. 

With summer days quickly passing by, and school around the corner, it is time for back to school shopping.  And most likely on your list is a backpack.  Today, backpacks make a fashion statement.  The colors and style are endless.  But as you choose your backpack, shop with care.  Certain styles of backpacks are more prone to causing back problems and back pain.

To learn more about selecting a back pain, and tips for using a backpack, click here to read out spine wellness backpack sheet.

In continuing my blog entries on the lumbar spine and degenerative disc disease, I will answer some frequently asked questions by my patients.

What is lumbar degenerative disc disease?
Generally speaking, degenerative disc disease is the result of the normal aging process.  This is where the disc becomes more brittle and less flexible.  When the discs of the lower back are affected, this is referred to lumbar degenerative disc disease.  Often this results in lower back pain. 

 Technically called invertebral discs, spinal discs are discs found between each vertebrae that act as a cushion..  The spinal discs are what helps maintain the position of your spine, as well as allows motion between each vertebrae.  Sometimes they are called the “shock absorbers” of the spine - in that they compress with weight, and spring back when weight is removed. 

Anatomically, the discs are flat and round – and less than an inch thick.  The outer shell is a tough tissue and this is called the annulus fibrosis.  This tissue is filled with a jelly like consistency fluid that is called the nucleus pulposus.  Cartilage then connects the spinal discs to the vertebrae. 

Even though degenerative disc disease is a part of the aging process, everyone ages differently and no - everyone does not get degenerative disc disease. 

In addition to aging, wear and tear can also cause degenerative disc disease.  There are many lifestyle factors that can affect the health of the spinal discs.  For example, for individuals who are over weight; this would increase the stress on the spine.  Additionally, someone who has a job that requires heavy lifting – this can increase their risk for degenerative disc disease.  In some instances, trauma can lead to degenerative disc disease – lumbar or cervical. 

For my next few blog entries I will talk about the lumbar spine and discuss a few spine surgery procedures for the lumbar spine.  But first – I will define what the lumbar spine is. 

The lumbar spine is what is commonly known as the lower back. The spine is made up of 24 vertebrae.  And the lower part of the spine – are the lumbar vertebrae – L1 – L5.  The neck region of the spine is the cervical spine and the chest area of the spine is the thoracic spine.  One of the reasons that the lumbar spine is the cause of back pain is that it carries a majority of the body weight and is subject to the forces and stresses of the spine. 

One recommended treatment for neck and back pain /problems is physical therapy.  At this session, the goals of physical therapy for treating neck pain and lower back pain will be discussed.  Additionally, the different treatment modalities, indications and limitations of physical therapy will be identified. 

The speaker for this session is Guillermo (Bill) Cutrone, PT, DSc, OCS, Certified MDT.  Bill is a physical therapist with St. Vincent Health and he is the clinic coordinator for their Fishers physical therapy clinic

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This blog entry is in response to a recent comment where I was asked if there was a clinical study for a lumbar artificial disc.  The answer to that question is yes.  Currently I am participating in a FDA-approved clinical trial for the Flexicore artificial lumbar disc.  This lumbar artificial disc is a metal on metal disc used as a spine surgery treatment option for lumbar degenerative disc disease.  Here is a link to an abstract of a recent article published an article in Spine. I co-authored this study entitled, Prospective, Randomized Trial of Metal-on-Metal Artificial Lumbar Disc Replacement: Initial Results for Treatment of Discogenic Pain.

To find out more about this study and participant criteria, my research nurse can answer your questions.  Please call our office at 317.228.7000 and ask to speak to Dr. Sasso's research nurse. 

In some of my blog entries, I have discussed surgical procedures for a herniated cervical disc.  These surgical procedures include spinal fusion and artificial cervical disc replacement.  The good news is that very few individuals with a herniated cervical disc require surgery.  It is projected that only about 5-10% of patients with a herniated cervical disc need surgery.

Many times medical management is an effective treatment for herniated cervical discs.  To learn more about the non-operative spine treatment options for a herniated cervical disc, click here.  This is an article that I wrote for Spine Universe, which outlines the non-surgical treatments for herniated cervical discs. 

Often times, individuals w/ neck or back pain can be treated without surgery; by medical management or minimally invasive therapies.  It is estimated that approximately 10% of those with back problems require spine surgery.

If you have been told that you need spine surgery, this blog entry will provide a few guidelines of questions to ask your spine surgeon.  Prior to spine surgery, or any surgery, it is important to get all of the facts.

A Few Questions to Ask

1. Find out why you need the surgery.
2. Ask about the expected outcome of the surgery.
3. Get a detailed explanation of the procedure (and get the technical name of the procedure).
4. Find out if there is an alternative surgical procedure or alternative treatment to the surgery.
5. Find out the risks of the surgery.
6. Ask about the recovery time following the surgery, and the side effects of the surgery.
7. Ask about anesthesia; find out if you will receive a local, regional or general anesthetic. 
8. Find out how long you should be in the hospital.
9. Find out if you will need any special arrangements for home care after you are discharged.
10. Ask which hospital you will have the procedure in.
11. Find out what the risks are if you decide not to have the surgery.
12. Ask the spine surgeon what his/her qualifications are, and his/her experience with the specific procedure.

Remember, it is okay to get a second opinion and many times insurance companies will require it.  Also, it is good to talk to the spine surgeon’s billing department to review all of the costs associated with the procedure; and then to talk to your insurance regarding all of their pre-certification guidelines as well as projected reimbursement.

In some of my blog entries, I have discussed surgical procedures for herniated cervical disc.  These surgical procedures include spinal fusion and artificial cervical disc replacement.  The good news is that very few individuals with a herniated cervical disc require surgery.  It is projected that only about 5-10% of patients with herniated cervical disc need surgery.

Many times medical management is an effective treatment for herniated cervical discs.  To learn more about the non-spine surgical treatment options for herniated cervical disc, click here.  This is an article that I wrote for Spine Universe, which outlines the non-surgical treatments for herniated cervical discs. 

As you are probably aware – anytime you have a cut or wound, there is a risk for an infection.  But did you know that this infection can affect the bone?  When there is an infection of the bone, which is caused by bacteria, this is called osteomyelitis.             

When an individual has spinal osteomyelitis, generally they have severe back pain.  To learn more about osteomyelitis, here is a link to an article that I wrote for Spine Universe. 

During this education session, Dr. Rick Sasso will discuss common spinal deformations which affect younger patients; including scoliosis.  This will include the latest diagnostic information and screening guidelines as well as treatment information.  Additionally, Dr. Sasso will discuss when spine surgery is a treatment option.

In one of our last blog entries, we announced our new services – physical therapy.  Again, physical therapy is an effective treatment modality for individuals suffering from spine problems; including neck and back pain.

Our physical therapist, Adam Ebbert, is a native Hoosier.  He received his degree in Exercise and Wellness from Ball State University and his physical therapy degree from Indiana University.

His area of special medical interest includes hands-on manual therapy.  Additionally, he has developed a flexibility program called “Advanced Flexibility Training”.  When Adam is not at work, he can be found enjoying time with his wife and five-year-old twins  (pictured here).  His hobbies include cooking and exercise.

One of the breakout sessions will be presented by Alta Skelton, RN, MSN, NP, and Jennifer Turner, PA-C.  Alta is a nurse practitioner with Indiana Spine Group and Jennifer is a physician’s assistant – also with Indiana Spine Group. 

During their continuing medical education presentation, they will discuss the expected outcomes following spine surgery for a lumbar fusion.  Additionally, they will review patient care post-op for the spine surgery and how to identify complications following spine surgery.  Other discussion topics include expectations following discharge and patient recovery.

This blog entry will highlight more frequently asked questions about degenerative disc disease.

Q: How do you treat degenerative disc disease?

A:  The most common treatment for degenerative disc disease is non-operative treatment.  Usually, it gets better with rest - in a few days to a week. If necessary, people will get steroid injections to help eliminate the back pain.

Unfortunately, in some cases it does not resolve itself with non-operative treatments - especially if it's associated with weakness or tingling. Approximately, 200,000 people in the United States each year will undergo spine surgery for degenerative disc disease.  The goal of this spine surgery is to take the pressure off of a nerve in the neck.

Q: What does that operation consist of?

A: The standard spine surgery procedure for degenerative disc disease is a spinal fusion.  This is where we take the pressure off the nerve and then fuse that segment. The main disadvantage of the spinal fusion is that when we fuse a disc, there may be a quicker wearing out of those discs next to the fused disc.  Once a patient has a fusion, there is about a 30 percent chance, that in the next 10 years the patient will need a spinal fusion at a different disc level.

A:  Is there an alternative procedure to a spinal fusion for the treatment of degenerative disc disease?

Q:    Over the decades, medical researchers have been trying to develop artificial discs that would allow continued normal motion across that segment – a mobile disc.  Needless to say, it is s a lot harder than the development of an artificial hip or knee.

Fortunately, there has been great success in this development.  Just last summer, the Food and Drug Administration approved a surgical cervical disc replacement and recommended approval for another cervical disc.  (To see FDA announcement, click here.)  Additionally, there are many more similar devices under development.  
 

If gardening is one of your passions or you just plant a few annuals each year – it is important to prevent back pain and injuries while gardening.  This blog entry will provide a few spine wellness tips for gardening.   

• Think of gardening as exercise.  To keep you muscles loose, warm up before and after gardening, and do a few lower-back stretches.
• When lifting bags of dirt or heavy planters – use proper lifting techniques.
• When weeding and planting (tasks that require stooping, kneeling or bending) for long periods of time, take a break every 10 to 15 minutes to stretch and walk around.  Then change your position. 
• Use a cushion, if you will be kneeling for long periods of times.  When kneeling, keep your back straight and do not sit on your heels. 
• If you suffer from chronic back pain/problems or arthritis, consider raised garden beds (approximately 2 to 3 feet tall).  This will allow you to sit on a chair/bench while gardening.

Last year, I was interviewed for an article in The Indianapolis Star.  This interview was by health reporter Shari Rudavsky.  This interview was about degenerative disc disease. 

The following are a few of the common questions about degenerative disc disease, which were asked during this interview.

Q:  How common is degenerative disc disease?

A:  Degenerative disc disease is quite common, especially in people in their 30’s and 40’s.  It is one of the main reason’s that people see their family doctor.

Q:  What causes degenerative disc disease? 

A:  Usually this occurs from normal degenerative changes as a result of aging. The discs in the spine are specialized joints.  Just like a knee or hip that can get arthritic, the disc can also get arthritis.  A common analogy used for the spinal discs is a jelly doughnut.  The inside is soft and it is surrounded by a shell.  When this outer shell tears, the degenerated pieces can extrude through this shell (outer covering) and then sit on the nerves on the spinal cord.

Q: What are the symptoms of degenerative disc disease?

A: The most common symptoms are neck and arm pain that radiates down the arm, below the elbow, down to the hand, associated with weakness and tingling.

One of the main reasons people go to their doctor is for back pain!  This session, will provide physicians and health care practitioners the necessary tools to treat their patients with acute low back pain.  The presenter of this session is James Anderson, MD.  Dr. Anderson is a family practice physician with Anderson Family Practice located in Greenfield, Indiana.

At this session, Dr. Anderson will provide an overview of the initial assessment and neurological exam.  He will discuss the differential diagnoses for acute low-back pain, including red flags.  Additionally, initial management and patient education of patients with back pain will be reviewed.