Indiana Back Pain

This blog entry is part of a series of interview responses provided by Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group. Dr. Macadaeg was recently interview about back pain and spinal treatments.

Is it difficult, or tricky to know how to treat back/neck pain? Is it something that is difficult to measure or quantify?

It is widely stated that more than half of all cases of back or neck pain are non-specific, meaning that they cannot be clearly defined. This takes into consideration the multitude of tests available, including history, physical, MRI, CT scan, bone scan, and EMG.

This blog entry is part of a series of interview responses provided by Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group. Dr. Macadaeg was recently interview about back pain and spinal treatments.

What are some of the different causes or reasons for chronic neck or back pain? What would you say is the most common cause of back or neck pain?

The most common causes of chronic neck or back pain are degenerative disc disease and degenerative spondylosis (degeneration of the spinal joints, development of bony spurs, disc degeneration and calcification of spinal ligaments).

Other causes include herniated disc, spinal stenosis (narrowing of the spinal canal) and spondylolisthesis (slipping of a vertebra).

What are the different options available to treat this type of pain?

Recently Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group was interviewed for a magazine article about back pain and spinal treatments. The following few blogs will highlight responses to the questions asked by the reporter.

What is chronic pain, and how is it different than acute pain?

Acute pain is considered “physiologic.” That means it is present when there is an underlying problem such as an acute injury, certain sicknesses and diseases. This type of pain is usually self-limited, and resolves when the underlying primary problem is healed.

Chronic pain is considered “non-physiologic.” It is present despite the fact that the underlying problem has healed or stabilized. Examples include peripheral neuropathy, degenerative disc disease, arthritis and cancer. Chronic pain commonly has associated emotional effects including depression, anger, anxiety; and physical effects including loss of appetite, weight gain or loss.

For more information about Back Talk, call (317) 228-7000, or visit this link.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

During this current session Paul Kraemer, MD, a spine surgeon with Indiana Spine Group, will address the many myths and insights of spine surgery. This includes the what, when and why. A few topics that will be reviewed include evidence-based research documenting the indicators for spine surgery. Dr. Kraemer will also review the criteria for patient selection for spine surgery. A few of the common misconceptions of spine surgery that will be discussed include age appropriateness, rest requirements, postoperative pain and bracing.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

One challenge to physicians is ongoing back pain following spine surgery. This session will provide attendees a better understanding of failed back syndrome / post-laminectomy syndrome.

During this continuing medical education session during the Back Talk spine symposium, speakers will discuss the contributing factors and causes of failed back syndrome. Additionally, the medical and interventional treatments for failed back syndrome will be reviewed – their indications and expected outcomes. One treatment that will be discussed is spinal cord stimulators. Indications for salvageable spine surgery and the outcome predictors will be reviewed.

Faculty for this continuing medical education session includes minimally invasive spine specialist Jonathan Gentile, MD, and spine surgeon Thomas Reilly, MD, FACS.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

Another concurrent continuing medical education session will be an interactive workshop and will provide an in-depth look at the patient exam. A live model will be utilized to discuss common patient complaints that are seen and evaluated in the primary care setting.

This session will address both the cervical and lumbar patient exam. During this session, the speakers will review clinical algorithms in the diagnostic triage of patients suffering from neck and back pain. Additionally there will be a review of the necessary documentation specific to patient complaints, diagnostics and treatment.

The speakers for this session are Alta Skelton, RN, MSN, NP-C (a nurse practitioner with Indiana Spine Group), and Jodi Hettermann Blume, PA-C (a physician assistant with Indiana Spine Group).

Fourth of July celebrations usually include picnics and fireworks. According to Trip Advisor, of individuals surveyed, 35% will travel over the weekend - of which 63% will drive. For individuals with back pain, even a short trip can be painful.

This spine wellness blog, will provide a few tips for preventing back pain while driving.

• Before you travel - stretch!
• If you are the driver, when possible try to switch periodically. As a passenger, you can ride in a more relaxed and comfortable position.
• If your car seat does not provide good lumbar support for your lower back, use a pillow or roll a towel to provide lower back support.

Registrations are now being accepted for Indiana Spine Group's fifth annual spine symposium Back Talk. "This conference focuses on the latest information about spinal diagnosis and treatment, and is an excellent way for physicians and health care practitioners to get comprehensive information," states Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group and co-chairman of Back Talk.

Recognizing that back pain is one of the most common reasons patients seek medical care, this continuing medical education conference will highlight the latest, evidence-based clinical information on the diagnosis and treatment of spinal disorders. Back Talk features general and concurrent sessions, and new this year are clinical and cadaver workshops.

Back Talk | A Comprehensive Review and Practical Approach to Spinal Diagnosis and Treatment | November 11 and 12, 2011

For more information, call (317) 228-7000 or visit the following links:

Registration Form | Accreditation | Agenda

A recent blogger submitted a few questions about degenerative disc disease, and asked about treatment options for the lumbar spine. 

The blogger asked the following:

What about dynamic stabilization devices as an alternative to lumbar fusion? I have been doing some online research, hoping to get plugged into a 522 study, or otherwise explore whether insurance might cover something like this in my situation. (2 degenerating discs.)

Paul Kraemer, MD, a spine surgeon with Indiana Spine Group responded to these questions.

First, there is no perfect treatment for degenerative discs. The technology of motion stabilization is still very much in its early infancy, and at this point that is probably not the best solution.

There are two categories of implants that exist, disc replacement and motion stabilization, but trials have had problems and neither is currently being implanted.  One motion stabilization implant, sought to minimize motion of the disc to prevent pain and decrease revision surgery, but no definitive proof for either of those claims exists, and they have run into recent trouble with the FDA for their longer term data. Another motion stabilization concept, facet replacement devices are motion preservation devices aimed at facet joints, and at least one recent trial was ended early by the FDA.

Disc replacement in the lumbar spine has been done for over 20 years and works well in appropriately selected patients.  This procedure is FDA approved, but insurance companies frequently refuse to acknowledge convincing data. The results for this surgery seem very reproducible, but it’s only approved for single level disease with healthy facet joints.

All of this skips over the point that back surgery is usually not the first or best answer for back pain, and many people with degenerative discs have little or no pain. It's always recommended to talk to a spine surgeon to see what your specific treatment options are.

In respect to web sites that provide spine specific information – a few very popular sites are Spine Universe and Spine Health.  

Mark Your Calendars!

Indiana Spine Group is excited to announce the fifth annual spine symposium, 

Back Talk: A Comprehensive Review and Practical Approach to Spinal Diagnosis and Treatment.

 Mark your calendars, and plan to join us!

Date:  November 11 & 12, 2011

Location: Renaissance Hotel | Carmel, Indiana

Back pain continues to be a major health care issue. Not only is it one of the main reasons for physician visits, but it is also one of the most common reasons for missed work. According to the National Institutes of Health, back pain affects eight out of ten people at some point during their lifetime. This symposium will provide the latest information for the diagnosis and treatment of spinal disorders and abnormalities.

At the conclusion of this conference, attendees will be able to:

• Perform a comprehensive diagnostic examination and evaluation of patients that present with back and neck pain, including the identification and etiology of normal and abnormal spinal anatomy and conditions, and the effects of the degenerative cascade of the spine.
• Identify the diagnostic indicators and treatment options of patients with common and uncommon spinal disorders and abnormalities with a thorough understanding of non-operative, minimally invasive and operative treatment options, and the clinical indications of selected treatments.
• Discuss overall spinal health and wellness with an understanding of the role and importance of lifestyle and other wellness factors, e.g. diet and exercise, and the recommended prevention and screening guidelines. 
• Review case studies of common spinal disorders and abnormalities, and discuss indications of imaging studies and diagnostic  procedures, appropriate treatment protocols, clinical indicators and expected outcomes.
• Highlight the latest research, emerging treatment options and technology in spinal care with its applicability to the patient care model.  

This one and one-half-day continuing medical education symposium will feature general and concurrent educational sessions, and new this year are clinical workshops that will be hosted at the Medical Academic Center (located just north of the Renaissance). 
 

For more information and conference updates call (317) 228-7000. To sign-up for the mailing list send your contact information to info@indianaspinegroup.com.

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This activity has been approved for AMA PRA Category 1 Credit. Additional CME/CE categories will be applied for.

At the annual American Academy of Orthopaedic Surgeons continuing education meeting this past spring, one research study presented evaluated the effectiveness of kyphoplasty.

Kyphoplasty is a minimally invasive spine treatment used to treat vertebral compression fractures as a result of osteoporosis. In this procedure, a balloon tamp is inserted in the affected spinal area. Once inserted, it is inflated to return the spine to the normal height and shape. The balloon is then removed, and bone cement is placed in the cavity/space created by the balloon.

This study included patients who had no more than three non-traumatic vertebral compression fractures. There were 149 patients in the kyphoplasty group, and 151 patients who received non-surgical treatment. Patients were evaluated over a two-year period.

This study concluded that those patients who underwent kyphoplasty faired better than those who had nonsurgical treatments. The kyphoplasty group had improved quality of life, reduced back pain and disability. The study also concluded that both groups had similar adverse affects. To ready a summary of this study, visit this link.

Chances of a "white Christmas" are high, with snow on the ground and in the forecast. With snow, comes the dreaded chore of shoveling. This spine wellness blog entry, will provide a few tips to help you avoid neck and back pain.  

• Stretch - think of snow shoveling as exercise and stretch before you begin!
• Push - move the snow forward, rather than lifting when possible.
• Avoid twisting - do not lift the snow and throw it over your shoulder.
• Proper technique - when lifting the snow, use proper body mechanics, lifting from your legs and do not bend from your waist.

If your holiday plans include traveling. Sometimes that in itself can be a pain in your back! This spine wellness blog entry will provide a few healthful tips for minimizing back pain while traveling.

• Before you travel – remember to stretch! Stretch both your back and neck.
• If you are traveling by car – take frequent breaks to stretch. Also, switch drivers – when you are not driving this allows you to sit in a more relaxed position.
• Support your back, with either a lumbar pillow or place a rolled towel along your lower (lumbar) back.
• Remove your wallet or other items in your back pocket. Sitting on objects, can cause you to misalign your spine.

For more spine wellness tips for traveling by car, click here for a fact sheet.

For more travel tips, visit this page on the Spine Health website. This page provides “29 Best Travel Tips for Your Aching Back.”

In a prior blog entry, the results of a lumbar disc herniation study were reviewed. This study evaluated the results of the length of time, referred to DOS or duration of symptoms, prior to seeking treatment for lower back pain caused by lumbar disc herniation.

Again, this study concluded that the less the length of the back pain/symptoms (DOS), the more favorable the treatment results. Here is a summary of this presentation in a SpineUniverse article.

At the annual American Academy of Orthopaedic Surgeons meeting one podium presentation discussed “if the length of a person’s back pain/symptoms affects the outcome of treatment”.  

This was researched in respect to lumbar disc herniation. The purpose of the study was to determine if the duration of symptoms (DOS) affects outcomes following the treatment of intervertebral lumbar disc herniation (IDH).  This was evaluated for both operative and nonoperative spine treatments. 

Patients were evaluated with back pain / symptoms who sought care with less than six-months of symptoms, and those that had greater than six-months of symptoms. The study did conclude that treatment results were more favorable for both surgical and nonoperative treatments when patients sought treatment sooner for IDH. 

To read the poster presentation of this study, visit this link.

When someone twists their ankle, or pulls a muscle in their back – you know heat and cold are good remedies to help with swelling and pain. Often time though, it is hard to remember which you do first. A spine wellness tip to help you remember – think of the alphabet - c comes before h. So cold and then hot!

So next time you pull a muscle in your back  - for the first 24 to 48 hours after you hurt your back, use ice. This will help reduce the swelling, muscle spasms and back pain. Then after 48 hours, switch to heat, which warms and helps relax sore muscles. (And if the back pain is persistent and does not go away in a timely fashion, see your physician).

This spine wellness blog entry will answer a question from a reader.

Question:  “I am looking at exercise equipment, which would you recommend – a treadmill or elliptical machine for back health?”

Answer:  The bottom-line answer is that one piece of equipment is not necessarily better than the other – it all depends on the individual’s needs and preferences. The following highlights considerations for each:

Elliptical Machines:  Elliptical machines provide exercise with little or no impact. This is a very good option for people with knee or back pain. When shopping for an elliptical machine, it is important to purchase one that allows you to adjust the stride length. If the stride length is too long, it can cause you to hyper-extend your lower back. (This is similar to taking to very big steps).

Treadmills: Walking is a great exercise for your back, and no equipment is needed for this! Walking helps increase blood flow, which brings nutrient-rich blood to the spine.  Additionally, it promotes strength and flexibility. HOWEVER, for individuals with spinal stenosis or spondyloslisthesis walking can increase the stress on the spine.

Recumbent Bikes:  These can be an excellent option for individuals with spinal stenosis or spondyloslithesis. When using recumbent bikes, you are sitting and your spine is in a more flexed posture, this decreases stress and pressure on the spine. 

This spine wellness blog entry was answered by Adam Ebbert, PT.  Adam is the physical therapy coordinator with Indiana Spine Group.