One type of arthritis that affects the spine/back is rheumatoid arthritis.  This common type of arthritis is an autoimmune disease that causes chronic inflammation of the tissue around the joints and other organs.  One of the most debilitating types of arthritis, according to the Arthritis Foundation, rheumatoid arthritis affects approximately 1.3 million Americans.  This disease is more common in females, than males; there are 2.5 times more women with rheumatoid arthritis than men.

When rheumatoid arthritis affects the spine, generally it is the cervical spine (neck).  Rheumatoid arthritis rarely affects the lumbar (lower back) or thoracic (chest area) spine.A few symptoms of this rheumatoid arthritis affecting the spine may include headache, neck pain or stiffness or weakness in the arms and legs.  Once rheumatoid arthritis is diagnosed, if there are symptoms that indicate the cervical spine is affected, an X-ray of the cervical spine will be taken.  This X-ray can be used to assess the joints and intervertebral disc spacing and the overall structure.  Additionally, a MRI or CT Scan may be performed to evaluate if there is any spinal cord compression.

A prior blog entry highlighted a research study that Dr. Renkens, a neurosurgical spine surgeon with Indiana Spine Group, was participating in for lumbar disectomy.  Dr. Renken’s is also participating in a clinical research study for the surgical treatment of spinal stenosis. 

Spinal stenosis is a degenerative spine disease where one or more areas of the spine narrows.  Usually affecting individuals in their 50’s and 60’s, spinal stenosis is most often caused by osteoarthritis-related bone damage.
 
Symtpoms include pain or numbness in the lower legs, back, neck, shoulders or arms, a loss of sensation in extremities, tingling or weakness.  Depending on the severity of the spinal stenosis – treatment may range from physical therapy to surgery.  

The study that Dr. Renkens is participating in is for more severe cases of spinal stenosis – where surgery is required.  The name of this study is A Prospective and Randomized Controlled Trial to Evaluate the Safety and Effectiveness of Total Facet Arthoplasty in the Treatment of Degenerative Spinal Stenosis.  In this study, Dr. Renkens will be using the Archus Total Facet Arthoplasty System (TFAS), which is a non-fusion spinal implant for the treatment of patients with moderate to severe spinal stenosis.  This TFAS, provides an alternative treatment for spinal stenosis as an alternative to spinal fusion – which is one spine surgical treatment for spinal stenosis. 

For more study information, click here. 

Currently, Dr. Kenneth Renkens participating in a clinical research study sponsored by Anulex Technologies. Dr. Renkens is a neurosurgical spine surgeon with Indiana Spine Group.   

The purpose of this study is to evaluate the benefits of performing soft tissue repair during a lumbar discectomy as compared to a disectomy performed without tissue repair. The product that is being used to repair the tissue is the Xcloseä Tissue Repair System.  

A discectomy is a spine surgery performed to relieve back pain caused by a herniated disc – sometimes called a bulging disc.  During a lumbar discectomy, the standard of care is to remove the portion of the disc that is applying the pressure to the nerve.  To perform this procedure, a small incision is made into the outer layer of the disc – this outer layer is called the anulus fibrosus.  As a result of this small incision in the outer layer of the disc, it could re-herniate in the future - resulting in back pain and discomfort. 

Typically, during this spine surgical procedure the soft tissue surrounding the disc, the anulus is not repaired.  As a result, this material can push outside the disc and compress the nerve rood resulting in back pain and discomfort.  With the Xclose device it provides a method to repair the anulus during the lumbar discectomy. 

For more information, here is a link to a summary of this study that Dr. Kenneth Renkens is participating in.

Unfortunately pregnancy and back pain sometimes go hand-in-hand. 
For recommendations and tips to help eliminate or minimize back pain during pregnancy, click here for a spine wellness fact sheet. 

Diagnosing vertebral compression fractures can be difficult – in that X-rays do not always show the fracture.  In this instance, if the patient has back pain and an X-ray does not show a fracture – many times it is assumed that the back pain is caused by muscle strain.

That is why sometimes, it is important to see a spine specialist; i.e. a minimally invasive spine specialist that focuses on spine diagnosis and treatment.  One key component in diagnosing spinal fractures is the patient’s medical history.  Additionally, a clinical exam is important to determine the sensitivity and tenderness around the affected vertebrae. 

If a vertebral compression fracture is suspected, even if an X-ray does not show a fracture – other diagnostic tests may be ordered as a result of the patient’s medical history and clinical exam.  These tests can include a CAT scan, MRI or nuclear bone scan. 

If a vertebral compression fracture is diagnosed – it is important to determine the cause for effective treatment.  The most common cause of a vertebral compression fracture is osteoporosis but other causes are trauma or some types of cancer. 

If the cause of the vertebral compression fracture is determined to be osteoporosis, common treatment options include bracing, analgesics, medications to help sustain or restore bone mass, and vertebral augmentation. In vertebral augmentation, the goals of treatment are to stabilize and eliminate the pain caused by the vertebral compression fracture.  The two types of vertebral augmentation available include vertebroplasty and kyphoplasty. 

One of the most common causes of spine fractures – referred to as vertebral compression fractures, is osteoporosis.  One statistic projects that there are approximately 750,000 spine fractures resulting from osteoporosis per year in the U.S.

Many times, spine fractures resulting from osteoporosis are overlooked and not diagnosed.  Frequently, when older people complain of back pain – it is thought to be related to muscle strains or normal aches and pains due to aging.  It is important for individuals to recognize that if they have sudden acute back pain – following an activity such as golf (or other twisting), lifting or even a small fall – this could be the result of a fractured vertebra.  Following the acute pain resulting from the fracture – the pain may then lead to chronic back pain and therefore many times is thought of as just that – back pain.

When you think about osteoporosis and vertebral compression fractures – this does not just occur in the elderly.  Anyone who is 40 or over is susceptible to this – depending on their risk factors for osteoporosis.

If you suspect that your back pain is a result of a vertebral compression fracture, see your physician or a minimally invasive spine specialist.  For more information, call our office at 317.228.7000. 

Plans are underway for the 3rd annual spine symposium Back Talk.  Mark your calendars for September 11 and 12, 2009.  This continuing medical education symposium provides valuable information for physicians and health care practitioners on the diagnosis and treatment of spinal disorders. In that back pain/ problems is one of the top reasons people go to their physician - this conference provides the latest information for practitioners as they treat their patients w/ back pain / problems.   Continuing medical education and continuing education credits will be provided at this symposium. 

For more symposium information, click here.  This link will be continuously updated, as planning continues on this medical conference.  To be added to the mailing list, please send your contact information to info@indianaspinegroup.com. 

A recent spine wellness blog entry provided helpful tips for avoiding back injuries when raking your leaves.  Now that leaf raking is probably on everyone’s to do list – here are a few reminders to avoid back injuries and back pain. 

Remember to view raking as exercise; and warm up before you start. Avoid twisting and overreaching – Step side to side using your legs to move and not just your arms.  Additionally, try to  keep your back upright.
Switch sides – To avoid an overuse injury; use both arms when raking.  Try to switch sides every 10 minutes or so.

Once your leaves are bagged; you need to remember to avoid back injuries while lifting!  Use proper lifting techniques, squat down and do not bend over.  Do not lift with your back.  Do not overfill the bags so that they are too heavy.  And if you need to move the bags far, use a wheelbarrow. 

For more infomration, link to the spine wellness fact sheet.   

Physicians with Indiana Spine Group presented at the fall conference of the Indiana State Chiropractic Association this past weekend, on November 1 and 2. 

On Saturday Dr. Kevin Macadaeg, a minimally invasive spine specialist, spoke on minimally invasive techniques used to help manage spinal pain.  Additionally, he addressed diagnostic and therapeutic spinal injections.  Spine surgeons - Dr. Thomas Reilly, Dr. Kenneth Renkens and Dr. Rick Sasso also spoke on Saturday.  Dr. Reilly discussed when spine surgery is a potential treatment option.  Dr. Renkens’ talk entitled “Understanding Lumbar Surgery”, focused on the lower back and reviewed spine surgery options and indications for the lumbar spine.  Additionally, he discussed the different types of lumbar fusions and their applications.  Dr. Rick Sasso focused on cervical surgery, and his talk was entitled “The ABC’s of Cervical Surgery”.  In this talk, he discussed common cervical surgical procedures; including spinal fusion and cervical artificial disc replacement. 

On Sunday, minimally invasive spine specialists Dr. Jonathan Gentile and Dr. John Arbuckle reviewed case studies of minimally invasive diagnostic and therapeutic techniques.  Spine surgeons Dr. Thomas Reilly and Dr. Paul Kraemer also reviewed case studies of surgery patients.

For more information about this conference, click here. 

Recently the North American Spine Society (NASS) conducted a study entitled Back Pain in America.  This Pulse Opinion Research study completed in April 2007; concluded the following: 

Physicians with Indiana Spine Group are actively involved in research.  The goals of the research that they participate in are to develop minimally invasive surgical techniques, and to identify and develop minimally invasive procedures that allow the patients to return to normal activities as quickly as possible.

A few research projects that Indiana Spine Group has participated in include:

Lumbar Disc Implant – Drs. Rick Sasso (a spine surgeon with Indiana Spine Group) and Kenneth Renkens (a neurosurgical spine surgeon with Indiana Spine Group) participated in the FlexiCore lumbar disc study.  Used to treat degenerative disc disease, the lumbar disc implant replaces the damaged disc. This procedure is an alternative to a spinal fusion.

Percutaneous Reference Frame (PRF) – Dr. Rick Sasso developed this devise that improves the capability for spine surgeons to perform minimally invasive spine surgery.  By the use of an infrared camera and the PRF - this allows spine surgeons exact placement of spine surgical instruments – with less of an incision. This technology has been referred to as “global positioning of instrumentation” – and it works similar to the GPS technology used in cars.

Cervical Artificial Disc – Drs. Rick Sasso and Kenneth Renkens also participated in the study for the Bryan Cervical Disc, and performed the first cervical artificial disc implant in North America in 2002.  This cervical artificial disc has received preliminary approval from the FDA last summer. 

Electrothermal Disc Decompression (EDD) and Intradiscal Elctrothermal Therapy (IDET) Studies – Dr. Kevin Macadaeg, a minimally invasive spine specialist with Indiana Spine Group, participated in this study that evaluated the effectiveness of EDD and IDET to treat lower back pain and sciatica.  These treatments use a heat coil, which is inserted via a catheter in the disc of the spine.

In mid-October, I attended the North American Spine Society’s (NASS) 23rd Annual Meeting in Toronto, Canada. 

While attending this meeting, I was a co-presenter and here are a few of the presentations that I gave:

• Total Disc Replacement for Treating Lumbar Discogenic Back Pain: A Prospective, Randomized, Multicenter Study of Flexicore® vs. 360 Spinal Fusion
• Motion Characteristics and Related Outcomes for a L-TDR Device with a Fixed Center of Rotation
• Predictors of Outcome Following Anterior Surgery for Cervical Spondylotic Myelopathy: Results from a Multicenter Prospective Clinical Study with
  Independent Outcomes Assessments Surgical Treatment for Cervical Spondylotic Myelopathy: One Year Outcomes of a Prospective, Multicenter Study of 316 Patients
• A Comparison of the Dynamic Compliance Characteristics of Prosthetic Cervical Disc Materials
• Radiographic Results from the Bryan® Cervical Disc IDE Study

I also was a co-chair of a technique workshop on Interbody Fusion Technologies.

NASS is a medical organization dedicated to fostering the highest quality, evidence-based, and ethical spine care by promoting education, research and advocacy.  To learn more about the North American Spine Society, click here.

Physicians with Indiana Spine Group attended the 23^rd annual meeting of the North American Spine Society(NASS) in Toronto, Canada.  At this international meeting, all aspects of caring for the patient with spine problems were discussed.  This includes medical management, minimally invasive spine treatments and spine surgery. 

Additionally, Dr. Rick Sasso a spine surgeon with Indiana Spine Group gave numerous presentations.  A few of his presentations included:  A Comparison of the Dynamic Compliance Characteristics of Prosthetic Cervical Disc Materials and Total Disc Replacement for Treating Lumbar Discogenic Back Pain: A Prospective, Randomized, Multicenter Study of Flexicore® vs. 360 Spinal Fusion.  Additionally, he chaired a technique workshop on Interbody Fusion Technologies. 

Sometimes it feels like we are always carrying things; groceries, kids, laundry – the list is endless.  As you do these everyday chores, it is important to protect your spine, to avoid back injuries and/or back pain.  This spine wellness blog entry will provide a few tips for proper carrying. 

• Think close!  Hold the object(s) close to your body.
• Think balance!  If objects are heavier – try to disperse the weight evenly.  For  example, if carrying grocery sacks – try to create equal weight with the sacks, and split them up them equally for each hand.  If one object, frequently switch sides. 
• Think light!  For purses, backpacks and luggage – try to lighten your load.

And always, if an object(s) are too heavy to carry ask for help!

 If you do not carry your wallet in a purse – most likely you carry it in your back pocket.  And for men, this is common place.  But did you know that your wallet can cause lower back pain?  There is even a syndrome for this called “hip pocket syndrome.” 

This spine wellness blog entry, will provide a few tips for carrying your wallet and avoiding lower back pain.

• Thin it out!  Ideally, make your wallet as thin as possible, only carrying necessary items.
• Remove it!  If you are going to be sitting for long periods of time; i.e. at work sitting at your desk, or in a car – remove your wallet from your back pocket. 

One activity usually done by all, and quite frequently, is talking on the telephone.  Technology has allowed us to talk on the telephone, whenever and wherever!  But did you know that holding the telephone improperly can lead to neck pain and/or strain? 

This spine wellness blog entry will provide tips for talking on the telephone.

• Avoid cradling the phone between your neck and shoulders.
• If multi-tasking while talking on the telephone, use a telephone speaker or headset.
• Maintain a neutral head and neck position when talking on the telephone. 

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