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.
A recent reader of Indiana Spine Group's blog, asked a question about spinal cord stimulator's. The question asked was, "Can a chiropractor adjust your back with a spinal cord stimulator implanted in your back?" 
According to Jonathan Gentile, MD, a minimally invasive spine specialist with Indiana Spine Group, the bottom-line answer is that is is not recommended. If a patient has a spinal cord stimulator implanted, it is possible that the leads can migrate during the spinal adjustment, therefore it is not advisable. Lead migration can cause the loss of stimulation to the patient. If the leads migrate (move), revision or replacement of the leads would be required to "re-capture" stimulation.
For more information about spinal cord stimulator's, visit this link, which provides an overview of the procedure.
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.
A recent blog entry discussed a spinal cord stimulator as a treatment for failed back syndrome. For additional information – here are a few links: 
And here are a few links about spinal cord stimulators from the manufacturers:
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.
The second day of Back Talk, the continuing medical education symposium for physicians and health care practitioners, will provide a series of concurrent sessions where attendees will choose which topics they would like to attend. There are four series of sessions that will address specific diagnoses, overall spine wellness, discuss minimally invasive spine treatments including spinal cord stimulator and verteboplasty as well spine surgery treatments. Additionally, case studies will be reviewed. For a complete continuing medical education agenda, click here.
One treatment for ongoing back pain following spine surgery - sometimes referred to as failed back syndrome, is a spinal cord stimulator. A spinal cord stimulator uses electrical impulses to help relieve chronic back pain. Previous blog entries have highlighted this procedure.
Dr. Jonathan Gentile, MD, a minimally invasive spine specialist with Indiana Spine Group, implants spinal cord stimulators - when indicated - in patients suffering from failed back syndrome. To watch him discuss this procedure, click here.
This blog entry will highlight Rapp Medical Systems Inc. | Medtronic Spinal & Biologics, a silver sponsor of Back Talk. Back Talk is the continuing medical education program that Indiana Spine Group is sponsoring for primary care physicians and practitioners.
Rapp Medical Systems Inc. is a local medical product distributorship representing Medtronic Spinal and Biologics. Working with physicians, their mission is to provide superior products and service which will enable our physician partners to provide the highest level of patient care possible.
Medtronic Spinal and Biologics, is a division of Medtronic which focuses on spinal and musculoskeletal therapies. Their key product areas include:
- Minimal Access Spine Technologies (MAST™) for treating painful conditions of the spine, such as degenerative disc disease.
- Fusion systems1 that correct and stabilize abnormal spine curves.
- Artificial cervical discs2 to replace damaged or degenerated discs in the neck. Our latest disc is made of surgical-grade stainless steel and allows motion so patients can go back to doing everyday activities they love.
- Infuse® Bone Graft,3 a biologic that stimulates the body to regrow bone and is used to treat certain spinal, tibial, and maxillofacial conditions. Infuse Bone Graft eliminates the need to harvest bone from another area of the patient's body, thus eliminating an additional, often painful, surgery.
For more information, visit Medtronic Spinal and Biologics and for consumer education information visit their patient education site.
To learn more about how spinal cord stimulators are placed, click here – (when on the spine education page, then scroll down to "spinal cord stimulator", and click "procedure overview". Prior to the placement of a spinal cord stimulator, the patient will go through a trial period - where the spinal cord stimulator is temporarily placed. After the trial period, if the patient feels the treatment is effective to minimize their back pain, then the implant is placed underneath the skin.
Two manufactures of spinal cord implants are Medtronic and Advanced Bionics. To learn more about the spinal cord stimulators, here are links to their sites – Medtronic and Advanced Bionics.
Spinal cord stimulation, is one of the treatments that minimally invasive spine specialists perform at Indiana Spine Group to treat failed back syndrome. Minimally invasive spine specialists with Indiana Spine Group include Jonathan Gentile, MD, Kevin Macadaeg, MD, and John Arbuckle, MD.
For more information, call our office at (317) 228-7000
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.
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.
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.
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.
Dr. John Arubuckle and Dr. Jonathan Gentile are minimally invasive spine specialists with Indiana Spine Group. They see patients at both our Indianapolis and Kokomo offices.
On March 18, Anne Marie Tiernon with WTHR did a story on the spinal cord stimulator. For this story,
Dr. Jonathan Gentile, a minimally invasive spine
specialist with Indiana Spine Group was interviewed. Additionally, one of Dr. Gentile's patients was interviewed who suffered from "failed back syndrome", technically called post-laminectomy syndrome.
For patients who suffer from lower extremity pain and back pain following back surgery / spine surgery a spinal cord stimulator implant is a treatment option when other medical management treatment options are ineffective.
Read Anne Marie Tiernon's story, "
Spinal stimulator eases back pain."
Today, the Indianapolis Star published a story about the spinal cord stimulator. The patient highlighted in the story had a spinal cord stimulator implanted in March 2007. Prior to the spinal cord implant, the patient was side-lined from normal actvities as a result of her back pain. Since the procedure she has taken up ballroom dancing. Here is the link to the story.
This procedure, spinal cord stimulator implant, was performed by Dr. Jonathan Gentile. Dr. Gentile is a minimially invasive spine specialist with Indiana Spine Group. Other minimially invasive spine specialists at Indiana Spine Group are Kevin Macadaeg, MD, and John Arbuckle, MD.
A small certain percentage of patients that undergo back surgery / spine surgery; may continue to have chronic back pain and/or lower extremity pain following surgery, that is referred to as failed back syndrome. This is not an actual syndrome or medical diagnosis – but more a description of the symptoms. The technical term for this is post-laminectomy syndrome.
When medical management and other therapies are ineffective, one minimally invasive interventional pain management treatment for patients if they are suffering from both back pain and lower extremity pain is to implant a spinal cord stimulator. A spinal cord stimulator, also called a neurostimulator uses a tiny programmable generator and electrical leads/ electrodes placed underneath the skin. The electrodes are placed in the spinal canal, adjacent to the spinal cord. (Photo courtesy of Medtronic, Inc.)
To learn more, read this recent press release. This press release profiles a patient who had chronic back and lower extremity pain following back surgery. Now she enjoys ballroom dancing!
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