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. 

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. 

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.

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.

With summer around the corner and school out – there are many recreational options for children.  This blog entry will provide a few spine wellness and summer safety tips for kids; to help prevent back pain as well as spine and other related injuries.

Now found in many backyards - trampolines were once just found in gyms/training facilities  In that the same safety precautions are usually not used at home, there is an increased risk for injuries. The American Academy of Orthopaedic Surgeons provides these recommendations to help prevent injuries on trampolines.

• Children under six years of age should not jump on trampolines.
• Trampoline usage should always be supervised.  Do not rely on safety net enclosures.  Most trampoline injuries occur on the jumping surface.
• Only one individual should be on the trampoline at a time.
• The jumping surface of the trampoline should be placed close to the ground.
• After each use, if a trampoline ladder is being used; remove it to prevent unsupervised access.
• If someone is jumping on the trampoline, there should be spotters.  Additionally, high-risk maneuvers such as somersaults should only be done with proper supervision, protective equipment such as harnesses and instruction. 

Spinal disorders such as spinal stenosis, excessive kyphosis, vertebral fractures, degenerative disc disease or other spinal disorders – can sometimes affect more than one vertebrae level of the spine.  In instances where surgery is necessary, this can provide a challenge to spine surgeons.

With summer around the corner and school out – there are many recreational options for children.  This blog entry will provide a few spine wellness and summer safety tips for kids; to help prevent back pain as well as spine and other related injuries.

Historically found in gyms and training facilities, trampolines are now found in many backyards.  In that the same safety precautions are usually not used at home, there is an increased risk for injuries. The American Academy of Orthopaedic Surgeons provides these recommendations to help prevent injuries on trampolines.

• Children under six years of age should not jump on trampolines.
• Trampoline usage should always be supervised.  Do not rely on safety net enclosures.  Most trampoline injuries occur on the jumping surface.
• Only one individual should be on the trampoline at a time.
• The jumping surface of the trampoline should be placed close to the ground.
• After each use, if a trampoline ladder is being used; remove it to prevent unsupervised access.
• If someone is jumping on the trampoline, there should be spotters.  Additionally, high-risk maneuvers such as somersaults should only be done with proper supervision, protective equipment such as harnesses and instruction. 

At this special interest session Drs. John Arbuckle and Jonathan Gentile will discuss what to do with patients that continue to have back pain despite spine surgery and/or ongoing treatments.  A diagnosis that remains a challenge to phyiscians, this session will define what a failed back is and what the warning signs are.  Additionally, treatment options will be discussed including pharmacological therapy and implantable therapies; i.e. spinal cord stimulator. 

On Friday the continuing medical education session will also be on spine surgery.  Dr. Rick Sasso, a spine surgeon with Indiana Spine Group, will discuss the indications and surgical options for the cervical patient.

Dr. Sasso’s discussion will:

§          Review traumatic and degenerative cervical pathologies.

§          Review the indications and considerations for cervical disc fusion and artificial cervical disc replacement.

§          Provide a brief overview of the surgical procedures and expected outcomes for cervical disc fusions and artificial cervical discs.

One of the tools that we use to diagnose back pain is selective nerve injections (SNI).  Imaging studies, such as MRI’s, do not always show which nerve is causing the back pain, and selective nerve injections are effective in helping us to isolate the source of the patient’s pain. 

With diagnostic selective nerve injection, just enough medication is used to numb one or two spinal nerves.  This medication is then injected, and this helps us to determine if the nerve root is causing the pain. 

Additionally, a study that I co-investigated concluded that selective nerve injections were also a valuable tool for patients requiring surgery for radiculopathy; a lumbar cervical decompression.  This study determined that selective nerve injections can accurately determine the presence of a specific painful nerve root in cases where physical exam and/or MRI findings are equivocal.  This helps spine surgeons determine their surgical treatment and oftentimes limiting its scope.  Here is a link to the research study. 

This continuing medical education program will also provide in-depth information on spine surgery – areas focused on will be lumbar surgery and cervical spine surgery. 

This session will be presented by neurosurgical spine surgeon Kenneth Renkens, MD, and will provide an overview of spine surgery procedures for the lower back and indications. 

Topics discussed will include:

 §     Identify and discuss the indications for common lumbar surgical  procedures, including decompression, lumbar spinal fusion and disc replacement.

An experimental procedure for the treatment of degenerative disc disease is to replace the nucleus.  The goal of this procedure is to replicate the normal disc function and to maintain motion.  The procedure was first developed in 1988, and contiunes to be modfied and refined. 

To learn more about this spine surgery procedure, here is a link to a chapter that I co-authored, “Nucleus Replacements”.