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. 

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. 

Another breakout session, at this continuing medical education symposium for physicians and health care practitioners, will address injuries incurred by athletes and the weekend warrior.  With the increased number of sports activities and programs, unfortunately this also includes an increase in back pain and injuries. 

During this session, Kevin Macadaeg, MD, and Nate Blume, DC, will provide the latest information for the prevention and diagnosis of spine-related sports injuries.  Additionally, they will discuss when spine problems should be evaluated by a spine specialist and what the more serious warning signs are; i.e. stress fractures.

This special interest symposium, The Physical Exam, will be lead by Laurie Scott, RN, MSN, NP-C, and Jodi Hetterman, PA-C.  Laurie is a nurse practitioner with Indiana Spine Group, and she works with spine surgeon Thomas Reilly, MD.  Jodi is a physician assistant with Indiana Spine Group and she works with our neurosurgical spine surgeon Kenneth Renkens, MD. 

During this workshop, they will demonstrate using a live-model, the diagnostic steps in conducting a physical exam related to spine pain (back and neck).  In their presentation, they will include key points in evaluating both lumbar and cervical problems.  Additionally, with the lumbar exam – they will specifically discuss the identification of radicular pain from low-back pain, and the evaluation process to rule out hip abnormalities or knee problems. 

In an ongoing effort to meet our patient’s needs, we now provide physical therapy services.  Under the direction of Adam Ebbert, PT, our physical therapy coordinator, we are able to facilitate physical therapy when ordered by one of our physicians. 

Once physical therapy is ordered by one of our physicians for their spine care, Adam will evaluate the patient and develop an individualized treatment plan.  Physical therapy services can then be provided at one of our Indianapolis offices, or we will coordinate physical therapy services at another location closer to the patient’s home.

Physical therapy is one effective treatment option for many spine problems is physical therapy.  With physical therapy the goals of treatment are to improve the patient’s strength, flexibility and, most importantly, function. 

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. 

We all have heard about the importance of exercise for our cardiovascular health – but exercise is also critical to our spine health.  Exercise helps to build bone mass and strengthen the spine.  For a spine wellness fact sheet on back exercises, click here.

Additionally, here are a few links to exercises for your spine.  These sites provide useful spine wellness exercises on theNorth American Spine Society web site and Back.com.

One common term used to describe pain is sciatica.  Sciatica is used to describe the pain that radiates along the sciatic nerve.  The sciatic nerve is the longest and largest nerve in the body – connecting the spinal cord with the leg and foot muscles.  When someone has sciatic pain, they generally describe it as “shooting pain”. 

This pain is caused when the nerves in the lower spine are either compressed or irritated.  There are many causes of sciatica and a few include:  pinching or stretching of the sciatic nerve, herniated disc, spinal stenosis or spondylolisthesis, just to name a few.  

Many times, this pain will go away with minimal treatments; i.e. avoiding the activity that causes the pain, cold / heat treatments, pain relievers and/or exercise.  If this pain continues for more than 6 weeks or becomes severe, it is recommended that the individual see their physician or a spine specialist. 

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.