The advancements and preliminary research results for cervical artificial disc replacements as an alternative spine surgical treatment for degenerative disc disease are promising.  When spine surgery is required for degenerative disc disease, the traditional procedure has been a spinal fusion.  This has been considered the “gold standard” of treatment.  I predict that in the future, the “gold standard” of surgical treatment of certain types of cervical radiculopathy caused by a herniated disc will be a cervical artificial disc rather than a spinal fusion. 

A recent article that I co-wrote, provides an overview and summary of the different cervical artificial discs that are currently being used in FDA-trials.  The Prestige Disc was approved last summer (2007).  Also last summer, the BRYAN cervical artificial disc received preliminary FDA-approval and the Prodisc-C was approved earlier this year.

In August, Indiana Spine Group sponsored a medical education conference/symposium for physicians and other health care practitioners.  At this conference, one of the topics I spoke on was What is on the Horizon?  In this talk, I discussed some of the latest spine surgery developments currently available, in FDA-trials or under development. 

One of the things I discussed was the results of a research project on spinal kinematics related to lumbar and cervical artificial disc replacement.  Generally speaking kinematics – is the study of motion. 

The purpose of this study was to study the kinematics of the cervical spine and lumbar spine – then how it relates to the motion of the artificial discs that are being used in spine surgery for cervical artificial disc replacements or lumbar artificial disc replacements.   With this information, it provides spine surgeons more information as they work with their spine surgical patients that require cervical artificial discs or lumbar artificial discs to help them select the type of disc that best meets the patient’s needs. 

Here is a link to the article I co-wrote, Cervical Kinematics After Fusion and Bryan Disc Arthoplasty. 

This blog entry will answer some common questions asked about vertebral compression fractures.

What exactly is a vertebral compression fracture? 
A vertebral compression fracture is where a bone or bones in the spine fracture/break. 

What causes a vertebral compression fracture? 
A vertebral compression fracture can be caused by severe trauma.  For example an automobile accident or a fall from extreme height.  In older individuals the most common cause is if from osteoporosis.  Additionally, cancer can also precipitate a vertebral compression fracture.  Generally, a vertebral compression fracture is of the lower, back (lumbar spine).

Are vertebral compression fractures common?
It is estimated that osteoporosis will result in approximately 1.5 fractures annually.  Although you hear more about hip fractures, the most common fracture as a result of osteoporosis is a vertebral fracture.  It is estimated that more than half of the fractures as a result of osteoporosis are vertebral compression fractures, over 700k annually.

What are the symptoms of a vertebral compression fracture? 
The most common symptom is sudden onset back pain that becomes persistent. If the vertebral compression fracture is the result of osteoporosis, this fracture and accompanying pain can be caused by normal activities and not the result of trauma; i.e. a fall. Other symptoms include back pain that is more severe when  standing or walking, limited spinal mobility and height loss or a forward stooped posture (Dowager’s hump). 

How are vertebral compression fractures diagnosed? 
Vertebral compression fractures are diagnosed with an X-ray.  If there is a spinal fracture on the X-ray, the physician may order a CT-scan to determine the extent of the fracture or an MRI – depending upon the patient’s symptoms. 

When you think of proper posture – you may envision movies where the star is learning how to properly walk with a book resting on her head.  Although not entirely accurate, it does hold some merit. 

In this spine wellness blog entry on proper posture – we will focus on standing.  The goal of proper posture is to maintain the normal, or “neutral” position of your spine.  In doing this, hold your head up straight with your chin in.  Your feet should be shoulder-width apart and the pressure should be on the balls of your feet not your heels.  Hold your shoulders back, stand up straight - keeping your knees straight but not locked.  Additionally, hold in your stomach.

In Spine Universe, they describe a “wall test” to help you see how your posture is.  To test your posture and see how your back / spine is aligned - stand against a wall.  Lean your head, shoulders and back against the wall. Then put the heels of your feet forward about 5 to 6 inches.  Then hold in your stomach (lower abdomen), to decrease the arch in the lower back.  And finally, push away from the wall – and then try to maintain this position. 

For more tips on maintaining proper posture to help eliminate spine or back pain, go to www.spineuniverse.com – and for topic search enter “proper posture”.

If you think back – at sometime in your childhood you probably remember your mom telling you to stand up straight or not to slouch.  In this case, mom did know best. 

Proper posture does not only look good – but it does provide many health benefits.  If your posture is correct, then the muscles, joints, bones and organs are where they are supposed to be. 

At the Back Talk medical education symposium in August, Alta Skelton, RN, MSN, NP-C, discussed The Healthy Spine.  In her talk, she identified the following benefits of proper posture* for spine wellness.  They are:

• Keeps the bones and joints in correct alignment.
• Helps decrease the abnormal wearing of joint surfaces.
• Decreases the stress on ligaments holding the spine together.
• Prevents the spine from becoming fixed in abnormal conditions.
• Prevents fatigue.
• Prevents muscular pain and back pain.

*Source:  Cleveland Clinic

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:

• Consider leave raking 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.