Welcome to the Spinal Diagnostics, Therapeutics and Surgery blog written by Indiana Spine Group.  The main purpose of this blog is to provide an overview and highlight of procedures and treatments for spinal problems and deformities.  For more information, visit our web site or call toll-free (866) 947-7463.

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 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.

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.

For individuals diagnosed with a contained herniated disc or protruding disc, which are suffering from leg or lower back pain - one newer treatment option for pain relief is nucleoplasty. 

Nucleoplasty provides a minimally invasive spine treatment alternative.  With this minimally invasive spine procedure, radio waves which produce energy are used to dissolve (ablate) the unwanted disc tissue, and this relieves the pressure causing the lower back pain or leg pain.

This procedure is performed by a physician who is a minimally invasive spine specialist.  During this spine procedure, which takes less than an hour, the patient is awake and the physician will use a local anesthetic.  Guided by fluoroscopy (internal X-ray), the physician will insert a catheter-like device to the affected spinal disc. This catheter will deliver small amounts of radio wave energy to the damaged disc that will create a molecular reaction that will result in the spongy tissue in the damaged disc to dissolve.  This will reduce the pressure in the damaged disc, and thereby allow the herniation in the disc to retract.  The goal of nuceloplasty, is to reduce the pressure on the affected nerve and therefore eliminate back pain.

One newer treatment option for lower back pain is Intradiscal Electrothermal Therapy (IDET).  This minimally invasive treatment uses heat energy delivered to the affected disc.  During the procedure, a heat coil is inserted into the disc of the spine by the use of a catheter that is guided by X-ray.  The coil is heated to a temperature slightly below that of boiling water.  This heat energy destroys the nerve endings that have been found to grow inside of painful, torn discs, therefore eliminating the cause of the back pack.

This minimally invasive IDET procedure is used for the treatment of lower back pain that is a result of spinal disc damage (tears or small herniations in the lumbar disc).  Prior to the procedure, testing is performed to clearly identify the affected disc and to confirm the diagnosis. 

Indiana Spine Group is participating in a multinational, multi-site investigational study for chronic low-back pain (CLBP).  

Investigators with the study include Dr. Kevin Macadaeg (minimally invasive spine specialist) and Dr. Rick Sasso (spine surgeon).  They are assessing the effectiveness of a study drug in reducing pain levels experience by adults who have had chronic low-back pain for more than six months.  Chronic low-back pain, affects 80 percent of the population at some time in their lives. 

A minimally invasive spine specialist is a physician that specializes in the treatment of patients with spine disorders.  The focus of their patient care is to diagnose the cause of the spine problem, and then to treat the specific cause of the problem which will usually alleviate the symptoms; i.e. back pain.

A physician who is a minimally invasive spine specialist is usually board-certified in anesthesia as well as pain management.  Other terms used for this specialty include pain management, interventional spine specialist or minimally interventional spine specialist.  Regardless of the term used, key is physician’s board certification.

Spinal therapeutics is the term used to treat spinal pain and disorders that is non-surgical.  In approximately 80% of the time, non-surgical treatment is effective – depending upon the diagnosis.

Spinal therapeutics is divided into two categories and these are medical and minimally invasive treatments.  Types of medical treatments include physical therapy, bracing and medications.  Types of minimally invasive treatments include the spinal injections, IDET, radiofrequency rhizotomy and nuceloplasty. 

In upcoming blog entries – we will review some of the common treatments, and when they would be recommended by your physician.

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!

Indiana Spine Group is a center of excellence for the treatment of spinal disorders and abnormalities.  Located in Indianapolis - with offices in Kokomo and Anderson, we provide comprehensive spine care – including interventional pain management treatments, nonsurgical spine treatments, minimally invasive spine procedures, minimally invasive spine surgery and spine surgery.  Treating both adults and children, some common diagnoses that we treat include degenerative disc disease, spinal stenosis, herniated cervical disc, failed back syndrome, osteoporosis and scoliosis. 

Physicians with Indiana Spine Group include:

§          Ken Renkens, MD (neurosurgical spine surgeon)

§           Rick Sasso, MD (spine surgeon)

§           Kevin Macadaeg, MD (minimally invasive spine specialist)

§           Thomas Reilly, MD (spine surgeon)

§          Jonathan Gentile, MD (minimally invasive spine specialist)

§          John Arbuckle, MD (minimally invasive spine specialist