In a prior blog entry, we highlighted a few of the concurrent sessions that will be presented at the Back Talk continuing medical education conference hosted by Indiana Spine Group. A few additional concurrent sessions that are available on the first day of Back Talk include:
The Nutritionally Healthy Spine – This continuing medical education session, presented by Lori Petrie, RD, will continue to focus on a healthy spine and the importance of nutrition in achieving and maintaining a healthy spine. This session will provide important nutritional recommendations for a healthy spine. In addition to diet and lifestyle other factors that will be addressed for a healthy spine will include popular over-the-count medications, and a review of herbal, vitamin and nutritional supplements. Ms. Petrie is an outpatient nutritional counselor with St.Vincent Hospital.
Back Pain | Chronic and Failed – It is estimated that approximately 40% of individuals that undergo back surgery continue to have back pain. Jonathan Gentile, MD, a minimally invasive spine specialist with Indiana Spine Group will address this ongoing issue. In this educational session he will address both chronic back pain and failed back syndrome and will discuss the differentiation factors, and the diagnostic perils. Additionally, Dr. Gentile will discuss the treatment options, indications and patient selection for various treatment options. One treatment option that will be highlighted will included the spinal cord stimulator, used as an option for failed back syndrome.
For more information about Back Talk, visit our web site, or call (317) 228-7000.
One general session that will be given at Back Talk, Indiana Spine Group’s continuing medical education symposium, is entitled Making the Diagnosis| Differential Facto
rs in Spinal Diagnosis. This presentation will be given by neurosurgical spine surgeon Kenneth Renkens, MD, FACS.
During this presentation, Dr. Kenneth Renkens will discuss the differential diagnoses of lower back and extremity pain. The importance of identifying coexisting conditions affecting spinal pain and treatment will be reviewed. Additionally, Dr. Renkens will discuss spinal infections and inflammations that present as back pain neck pain.
Planning continues for Back Talk | Comprehensive Concepts in Spinal Diagnosis and Abnormalities, Indiana Spine Group’s 4th annual spine symposium. For this year’s 
conference there will be two educational tracks. One track will provide more general information and one in-depth. These tracks will be held the morning of day one.
The general track is entitled: Spinal Care Boot Camp | Diagnostics and Treatment. There will be a session on spinal anatomy, entitled Spinal Anatomy 101, presented by minimally invasive spine specialist Kevin Macadaeg, MD. During this session, Dr. Macadaeg will discuss the functional anatomy of the spine, normal aging process, the spine’s degenerative cascading process and normal and abnormal spinal anatomy.
Another general session which will be presented by minimally invasive spine specialist John Arbuckle, MD, The ABCs of Spinal Diagnostics. In this session, the etiology of spinal pain and common spinal disorders that cause back pain will be reviewed. Additionally, Dr. Arbuckle will discuss the indications and applications of spinal testing, evidence-based guidelines for the diagnosis of lower back and neck pain, and he will highlight the red flags of spinal pain.
Two other sessions in this track include Understanding Spinal Therapeutics and The Spine Surgery Patient. In the spinal therapeutics session, presented by minimally invasive spine specialist Jonathan Gentile, MD, he will discuss the pharmacological management of acute and chronic back pain, review common noninvasive and minimally invasive spinal therapies and their indications. Spine surgeon Paul Kraemer, MD, will discuss the spine surgery patient and will provide an overview of common spine surgery procedures, their indications and expected outcomes. Additionally, Dr. Kraemer will discuss the applications and limitations of spine surgery, and when referral to a spine surgeon is indicated.
For a complete Back Talk agenda, link here.
The last few spine wellness blog entries have discussed the effects of smoking and the spine. For example smoking can increase your risk for lower back pain, increasing healing time following spine surgery and increase your risk for osteoporosis.
For a spine wellness fact sheet about smoking and your spine's wellness, click here.
A prior spine wellness blog entry highlighted the Great American Smokeout, held on November 19. This spine wellness blog entry will address smoking and your spine. Usually when you think about the health effects of smoking – you think about cancer and heart disease. But smoking also affects your spine wellness and as a recent study indicated, can contribute to lower back pain.
Study results published on Spine-Health.com indicated that there is a link between smoking and lower back pain. The study concluded that the development of lower back pain was linked to smoking history and hypertension. Additionally, the development of lumbar spondylosis was also associated with smoking history and hypertension.
For more details, here is the link to the study summary.
When an individual continues to have chronic back pain and/or leg pain following back surgery; it is referred to as failed back syndrome. A few treatments for this can include physical therapy or non-steroidal anti-inflammatory medications (NSAID). If medical 
management is ineffective another treatment option available is a spinal cord stimulator.
A spinal cord stimulator is an implantable device that uses an electrical current to provide a tingling sensation that helps to mask the chronic pain. Dr. Gentile describes it as “a kind of pacemaker for pain.”
In this video, Dr. Gentile describes the procedure for implanting a spinal cord stimulator. Dr. Jonathan Gentile is a minimally invasive spine specialist with Indiana Spine Group.
This procedure is available at Indiana Spine Group. For more information, call 317.228.7000 or toll-free 866.947.7463.
Spinal stenosis is a general term that refers to the narrowing of the spinal canal. Of
ten this is a degenerative condition resulting from aging. More commonly found in the lumbar (lower back) spine, it also occurs in the cervical (neck) spine.
Learn more about spinal stenosis, the diagnosis and treatment with this education video featuring Dr. Kenneth Renkens. Dr. Renkens is a neurosurgical spine surgeon with Indiana Spine Group. Orthopaedic spine surgeons with Indiana Spine Group include Rick Sasso, M.D., Thomas Reilly, M.D., and Paul Kraemer, M.D.
In the movie Princess Dairies there is a scene where Mia, played by Anne Hathaway, is practicing good posture with a book on her head and walking across the room.
A
lthough books are not required, good posture is important in preventing lower back pain.
This spine wellness tip will highlight how to evaluate your posture.
- Stand with your heels against the wall.
- Your head, shoulders, calves and buttocks should be touching the wall. (Once you do this, you should be able to place your hand behind the small of your back).
- Now, take a step forward – this is how your posture should be.
Dr. Renkens is the best. I had suffered for 10 years with neck pain, headaches, arm pain and finger numbness and tingling. He did an Cervical Anterior Disectomy with fusion on C5-C6 April 22, 2009, and I have no complaints. There is no pain, no numbness or tingling. There is however a little skin pain and numbness if I lay on the surgery site for a long period, but it is getting better. This surgery improved my life tremendously. Dr. Renkens also did a microdisectomy/Laminotomy on L4/L5 in October of 2008. At that time I could not sit for over two minutes. I had this problem for almost a year. He fixed the sitting problem, but I still have severe pain in my lower back which I have found out through a discogram that my discs are bad. They have annular tears or cracks. I will soon find out what the future holds for this problem. I have faith that whatever it holds, it will be for the better. I am anxious to get back to a normal life style. I know it will be rough at first, but in the long run, it will be worth it. Pain is no fun.
Name: Connie C.
Another session at Back Talk, the continuing medical education symposium for physicians and health care practitioners will address the failed back. Sometimes called failed back syndrome, failed back surgery or post-laminectomy syndrome – these patients continue to have ongoing back pain following spine surgery.
This session will be presented by minimally invasive spine specialists Jonathan Gentile, MD, and John Arbuckle, MD, and spine surgeon Paul Kraemer, MD. With Indiana Spine Group, these physicians treat patients at our offices located on the north side of Indianapolis.
During this continuing medical education session, the tools for physicians and health care practitioners to perform a diagnostic assessment of patients with chronic back pain following spine surgery will be highlighted. This diagnostic assessment will help caregivers to understand the underlying causes of ongoing back pain, and the mechanism of failed back. Additionally, medical and interventional treatments for failed back will be discussed – their indications and expected outcomes.
Many times, when people have chronic lower back pain – they experience a greater level of depression than individuals without chronic back pain. This continuing medical education session at “Back Talk” will provide physicians and health care practitioners insight into learning to recognize and assess psychological risk factors of patients with acute and chronic back pain.
During this session entitled "Psychological Barriers," Ricks Warren, PhD, ABPP, will identify psychological issues in patients with chronic back pain and malingering. Additionally, he will review the psychological barriers for effective treatment of acute and chronic spinal problems – and identify the warning signs and when referral to a metal health professional is indicated.
Ricks Warren, PhD, ABPP joins the Back Talk continuing medical education faculty from Michigan. Dr. Warren is a clinical lecturer and psychologist with the Department of Psychiatry at the University of Michigan Medical School in Ann Arbor.
I was recently interviewed for a news story that announced the FDA approval of the Bryan™ Cervical Disc. The Bryan Cervical Disc is an artificial disc used in cervical arthroplasty.
This story also appeared on their web site which generated a few reader’s comments/questions. This blog entry – will address some of those questions.
Blogger question: Can it be used in the lower back?
The Bryan Cervical Disc can only be used in the cervical (neck area) spine. There are two FDA approved artificial discs for the lower back (lumbar spine). They are: CHARITE Artificial Disc, approved by the FDA in 2004 and the ProDisc. Artificial lumbar discs are a surgical option for some patients who are being treated for degenerative disc disease or other related spinal conditions. These links provides more information about the artificial lumbar disc - (article one and article two).
Blogger question: Does this work for someone who has had a fusion done 10 years ago?
The answer to this is no. When a spinal fusion is performed, two bones are “fused” together; meaning that they are attached. In that this procedure is done with the goal of a permanency – it can not really be undone to have cervical arthroplasty performed.
This break out session, at the continuing medical education symposium “Bac
k Talk”, will focus on spine and sports. It is estimated that 20% of all injuries that occur in sports involve the lower back or neck. During this session, Dr. Paul Kraemer a spine surgeon with Indiana Spine Group, and Nate Blume, DC, a chiropractic physician will highlight common spinal injuries that result from organized and recreational sports; i.e. football, basketball, golf. They will discuss assessment guidelines and treatment protocols for spinal injuries resulting from sports. Additionally, initial on-site assessment and treatment, as well as recommendation guidelines for ‘continuing to play’ will be discussed during this medical education session.
As travel costs increase, most people find that if they are flying, they are flying coach. The good news is the savings – the bad news is the space. Sometimes – you may feel like a “sardine” in a can. Depending on the duration of your flight, these close quarters can result 
in back or neck pain.
This spine wellness tip provides a few hints to avoid neck and back pain.
· To help avoid back pain – support your lower back. To do this, roll two airline blankets or take two pillows, and place them on each side of your lower back. This will provide lower back support.
· To help avoid neck pain – use an inflatable pillow – place this around your neck if you are sleeping.
Another spine wellness tip while flying is to try to keep the space under the seat in front of you clear. This will allow you to stretch your legs. If this is not possible, then place your
item(s) in the middle, and place your legs on each side.
With spring time around the corner, now is the time many of us are brushing up on our golf game – getting ready for the season. But did you know that golfing, although a low-level physical activity does provide a potential risk for injury?
One common injury that golfers suffer is lower back pain. This lower back 
pain is attributed to poor swinging technique and poor conditioning. An article in Spine Universe, “Don’t Let Back Pain Handicap Your Golf Game”, states that eight times your body weight is forced through your spine as you make contact with the ball.
This spine wellness tip, will provide helpful information for golfers. To help prevent golf injuries, the American Academy of Orthopaedic Surgeons recommends that before you tee off - that you first do some stretching exercises. Also take the time to hit a few balls on the driving range, before you start your game. For more exercise tips, to help avoid lower back pain, and golfer’s elblow, click here.
This blog entry will answer a few common questions asked about spinal cord stimulators.
What are spinal cord stimulators used for?
Generally spinal cord stimulators are used to treat chronic / ongoing lower back pain that continues following back / spine surgery. Back pain following spine surgery is a condition called post-laminectomy syndrome, also referred to as failed back syndrome.
When are spinal cord stimulators considered as a treatment option?
Spinal cord stimulators are a treatment option for lower back pain, when other medical management treatment options are ineffective; i.e. epidural injections and/or medications.
What is a spinal cord stimulator?
A spinal cord stimulator is also called a neurostimulator – and this is a device that is a programmable generator that is the size of a stop watch, which has electrical leads/electrodes. The electrodes are placed in the epidural space near the spinal cord.
How does a spinal cord stimulator work?
With spinal cord stimulation electrical impulses are generated to relieve the chronic pain. The electrical impulses that are created interfere with the transmission of pain signals to the brain, and eliminate the sensation of pain that the patient would normal feel. Rather than pain, the patient feels a tingling sensation - which is called paresthesia.
One test for diagnosing back pain for patients suffering from chronic lower back pain (lumbar spine) is a discogram. The objective of this diagnostic test is to determine if a suspected disc, or discs, is/are a potential source to a patient’s lower back pain.
To perform this spinal diagnostic test, the patient is given medicine intravenously for mild sedation. Using an X-ray machine called a fluoroscope, a needle is placed into the spinal disc(s) that are suspected to be causing low back pain, as well as an unsuspecting adjacent disc to serve as a ‘control.’ A dye is then injected into the disc(s) of which creates pressure in the disc and outlines its internal structure.
In a normal disc, the patient typically experiences a slight pressure sensation in the back, and the X-ray image of the disc typically appears intact. If a disc is a source to a patient’s low back pain, the patient should experience pain similar in character and location of their usual low back pain. The X-ray image of a painful characteristically demonstrates a tear extending from the inner ‘nucleus’ through the outer ‘anulus.’
In an earlier blog, the results of a spinal cord stimulator study for the treatment of axial back pain were summarized. This blog entry will provide a definition for axial back pain.
Axial back pain is one of the most common types of lower back pain. Usually it is non-specific – which means that the exact cause is not identified in that many times this pain is limited and will go away. It is estimated that 90% of patients with axial back pain recover within six weeks.
A few characteristics of axial back pain include:
· The pain is localized in the back and does not radiate to extremities.
· The lower back pain gets worse with certain activities and positions; i.e. sitting a long time.
· The back pain can be relieved with rest.
One of the most common forms of arthritis, osteoarthritis, affects up to 30 million Americans. More commonly found in females, osteoarthritis is a degenerative joint disease in which the cartilage that covers the end of the bones deteriorates, and as a result bone rubs against bone in the joint area.
Osteoarthritis is a common cause of back pain. Arthritis in the back is called spinal arthritis, and this is the mechanical breakdown of the cartilage in the facet joints. As a result of this breakdown, these vertebral joints become inflamed and as the joint degenerates this creates more frictional pain.
The two types of osteoarthritis in the spine are lumbosacral arthritis and cervical spondylosis. As the names imply – lumbosacral arthritis is osteoarthrithis of the lower back (lumbar spine), and cervical spondylosis is osteoarthritis of the cervical spine (neck).
A study presented at the 23rd annual meeting of the American Academy of Pain Medicine early last year – presented the results of the effectiveness of spinal cord stimulators to treat axial lower back pain in individuals with Failed Back Surgery Syndrome (FBSS).
In this multi-center study, there were 226 patients from 14 different sites. In the screening phase of the study – which was the 5- 10-day trials, 76% (176) had an average decrease in back pain of 40%. Following this phase of the study, 159 patients received permanent spinal cord stimulator implants.
The study concluded that there was a significant reduction of axial low back pain as a result of the spinal cord stimulator. Preliminary data indicates that the spinal cord stimulator will effectively reduce low back pain on a long term basis, and that results should be similar to what was observed in the shorter time period.
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