Spinal Stenosis

In a prior blog entry, I highlighted a meeting the IMAST continuing education meeting that I participated in late this summer. (link to prior blog entry). At this meeting, a few talks/topics that I presented or facilitated discussion on included:

·         A paper that I co-authored on Cervical Spondylotic Myelopathy Study: Perioperative Complication Rates Associated with Surgical Treatment Based on a Prospective Multicenter Study of 302 Patients

·         At a debate on Multilevel Cervical Stenosis in the Straight Spine: Optimal Treatment, I presented the viewpoint of Anterior Decompression, Instrumentation and Fusion as the optimum spine surgical treatment.

·         I also moderated an instructional lecture on Options in Cervical Motion.

This blog entry is part of a series of interview responses provided by Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group. Dr. Macadaeg was recently interview about back pain and spinal treatments.

What are some of the different causes or reasons for chronic neck or back pain? What would you say is the most common cause of back or neck pain?

The most common causes of chronic neck or back pain are degenerative disc disease and degenerative spondylosis (degeneration of the spinal joints, development of bony spurs, disc degeneration and calcification of spinal ligaments).

Other causes include herniated disc, spinal stenosis (narrowing of the spinal canal) and spondylolisthesis (slipping of a vertebra).

What are the different options available to treat this type of pain?

I co-authored a book chapter on “Cervical Disc Replacement”, that has been recently published in Rothman Simeone The Spine – 6^th Edition.

The Spine is a continuing medical educational resource for spine surgeons and highlights state-of-the-art spine treatments and spine surgery techniques. In addition to the text, there is also a video resource for physicians highlighting different surgical techniques and procedures.

Some sections of this book include: Basic Science, Spinal Diagnosis, Surgical Anatomy and Approaches, Thoracic and Lumbar Disc Disease, Minimally Invasive Surgery, Spinal Stenosis, Spinal Fusion and Instrumentation and more. For more information about The Spine and a table of contents, visit this link.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

One series of sessions at Indiana Spine Group’s continuing medical education / continuing education spine symposium will focus on the diagnosis of spinal disorders.  In one series of talks, speakers will highlight key issues and steps critical to spinal diagnosis. Topics will include:

• Spinal Anatomy – differentiating between normal and abnormal spinal anatomy (Speaker: Jonathan Gentile, MD, minimally invasive spine specialist with Indiana Spine Group)

• Diagnostic Pearls – identification of the critical components of the physical exam, and essential elements of the diagnostic work-up (Speaker: John Arbuckle, MD, minimally invasive spine specialist with Indiana Spine Group)

• Common Spinal Disorders – diagnostic indicators for disorders such as herniated discs, degenerative disc disease, spinal stenosis, spondylosis and more (Speaker: Kevin Macadaeg, MD, minimally invasive spine specialist with Indiana Spine Group)

• Disorders of the Bones – a review of conditions such as osteomalacia, Paget’s disease, spinal arthritis and osteoporosis (Rashid Khairi, MD, FACP, FACE, an endocrinologist with Diabetes & Endocrinology Associates) 

• Uncommon and Benign Disorders – a discussion of disorders such as infections and vascular disorders. (Kenneth Renkens, MD, FACS, spine surgeon with Indiana Spine Group)

•  The Role of EMG – the role and indications of EMG in the diagnosis of cervical and lumbar radiculopathy. (Larry Lett, MD, Center for EMG and Neurology)

Congratulations to Dr. Rick Sasso for his recent publication! (Dr. Sasso is a spine surgeon with Indiana Spine Group). Dr. Sasso recently co-authored an article published in the recent issue of the SAS Journal. This journal is a publication of the International Society for the Advancement of Spine Surgery and the Society for Minimally Invasive Spine Surgery.

This article entitled, Lumbar Extraforaminal Decompression: A Technical Note and Retrospective Study Looking at Potential Complications as an Outpatient Procedure, published the results of a recent spinal study. This spine study retroactively evaluated the medical records of 100 patients from the same spine surgeon, who underwent spine surgery for lumbar disc herniation or stenosis. The spine surgical procedure was a type of decompression. This study concluded that extraforaminal lumbar decompression can safely be done as an outpatient spine surgical procedure.

This spine wellness blog entry will answer a question from a reader.

Question:  “I am looking at exercise equipment, which would you recommend – a treadmill or elliptical machine for back health?”

Answer:  The bottom-line answer is that one piece of equipment is not necessarily better than the other – it all depends on the individual’s needs and preferences. The following highlights considerations for each:

Elliptical Machines:  Elliptical machines provide exercise with little or no impact. This is a very good option for people with knee or back pain. When shopping for an elliptical machine, it is important to purchase one that allows you to adjust the stride length. If the stride length is too long, it can cause you to hyper-extend your lower back. (This is similar to taking to very big steps).

Treadmills: Walking is a great exercise for your back, and no equipment is needed for this! Walking helps increase blood flow, which brings nutrient-rich blood to the spine.  Additionally, it promotes strength and flexibility. HOWEVER, for individuals with spinal stenosis or spondyloslisthesis walking can increase the stress on the spine.

Recumbent Bikes:  These can be an excellent option for individuals with spinal stenosis or spondyloslithesis. When using recumbent bikes, you are sitting and your spine is in a more flexed posture, this decreases stress and pressure on the spine. 

This spine wellness blog entry was answered by Adam Ebbert, PT.  Adam is the physical therapy coordinator with Indiana Spine Group.

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group, who was just awarded his eighth patent!  This is patent number 7,727,266 for a method and apparatus for retaining screws in a plate.  
 

This patent is for an anterior cervical plate, now called Venture.  This plate is used in spine surgery for patients suffering from a herniated disc or stenosis (disc degeneration), or after trauma, tumors or other conditions causing neck instability.  The plate is used to stabilize the cervical spine after removing the disc. 

Below is an abstract of this patent:

A retention system for maintaining a screw to a vertebral plate. One or more screws extend through apertures within the vertebral plate. A cavity is positioned adjacent to and overlaps into the aperture. A ring is positioned within the cavity and held in position by a cap. The cap attaches to the plate to prevent removal of the ring. The ring is deflectable between a first shape to allow the screw to be inserted and removed from the aperture, and a second shape to prevent screw back-out from the aperture. A method of using the system is also included and comprises positioning the ring within a cavity in the plate, maintaining the position of the ring to the plate by attaching a cap, inserting a screw through the aperture and attaching the plate to a vertebral member, and positioning the ring over the screw head and preventing the screw from backing-out.

The next series of blog entries will focus on a few spine wellness tips.  Simple solutions that provide health benefits to your spine. 

One popular New Year’s resolution is to go on a diet and lose weight.  Losing weight provides many health and wellness benefits, including spine wellness.  Did you know that obesity is one contributing factor to back pain? 

Spine Wellness Tip #1: Drop Some Pounds 

Spinal stenosis is a general term that refers to the narrowing of the spinal canal. Often 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.

Recently we have updated the educational resources on our Indiana Spine Group web site.  With this update, we included a few educational videos.  These videos include myself and other physicians with Indiana Spine Group discussing different topics; i.e. artificial cervical disc, spinal pain, spinal stenosis, etc.

Other topics that will be discussed during Back Talk, the continuing medical education conference sponsored by Indiana Spine Group, are common spinal disorders. 

Dr. Paul Kraemer, a spine surgeon with Indiana Spine Group, will highlight common spinal diagnoses that affect the pediatric, adolescent and adult population. Recommended screening tests will be reviewed, and Dr. Kraemer will discuss how to differentiate between patient complaints and symptoms for effective spinal diagnosis. A few common diagnoses that will be reviewed include spinal stenosis, spondylosis, spondylolisthesis and scoliosis.

Recently, I had the honor of being the co-chairman of an annual spine meeting hosted by the American Academy of Orthopaedic Surgeons.  The focus of this meeting was “Contemporary Techniques in Spinal Surgery 2008”.

At this meeting I gave presentations on spinal decompression and reconstruction techniques, including; ACDF, corpectomies and struts.  I also presented information that compared the cervical artificial replacement procedure with the spinal fusion.  Additionally, I was a lab instructor – which provided hands-on training to orthopaedic surgeons. A few procedures reviewed included X-Stop – a procedure which utilizes a device in spine surgery for lumbar spinal stenosis; XLIF – this is a minimally invasive spine surgery procedure used to treat back pain that is caused by degenerative disc disease. 

In an earlier blog, I talked about the AO Spine International meeting that I presented at in December. With this blog entry, I wanted to define a few of the terms that were used. These were spine surgery topics that I presented on.

One term is cervical myelopathy. In defining cervical myelopathy – first I will define myelopathy. When the word myelopathy is used it refers to any condition that affects the spinal cord. Therefore cervical myelopathy is a condition of the cervical (neck) area of the spinal cord. In respect to cervical myelopathy it means that there is compression on the spinal cord that is either a result of disc herniation or spinal stenosis. Cervical myelopathy is a degenerative spine disease that is more common in the elderly. 

Another term used in the blog entry was cervical radiculopathy. The term radiculopathy refers to a disease of the spine nerve roots and spinal nerves.  Cervical radiculopathy is when a spinal nerve root in the neck (cervical) is compressed and/or irritated. This can be caused by disc herniation, spinal stenosis or other degenerative spine disorders. 

A recent blog entry highlighted a surgical procedure for lumbar spinal stenosis the X-STOPÒ.  This newer procedure decompresses the spinal cord that has narrowed as a result of lumbar spinal stenosis.  Once decompressed (opened), the pressure on the spinal cord is relieved, thereby eliminating the pain. Dr. Rick Sasso, a spine surgeon with Indiana Spine Group was one of the first surgeons to perform this procedure in Indianapolis.  This device was approved by the FDA in November 2005.  Here is a link to the press release, which provides more detail on this procedure. 

Here is more information about spinal stenosis. 

A prior blog entry provided an overview of a spine surgical research study that Dr. Kenneth Renkens is participating in for severe spinal stenosis.  This blog entry will highlight another spine surgical treatment for less severe lumbar spinal stenosis. 

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. 

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.

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. 

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