Spine Wellness

In a prior blog entry, I highlighted a few of the talks I participated in at the annual Scoliosis Research Society meeting. The acronym for this annual continuing medical education meeting is IMAST, and stands for International Meeting on Advanced Spine Techniques.

This international meeting brings experts on spine surgery from all over the world to discuss the latest surgical techniques, devices as well as it provides a forum to provide the latest on research in progress.

The overall educational objectives of this meeting are listed below.

At the completion of this program, participants should be able to:

1. Assess the most recent advances in surgical techniques for the treatment of spinal disorders and when to use them, in the interest of providing optimal patient care.

2. Analyze the indications and potential complications for various spine fixation systems including spinal arthroplasty.

3. Recognize emerging technology that has the potential to improve patient outcomes for specific indications and populations.

4. Understand when it may be appropriate to use biologic options to enhance spinal fusion.

Saturday’s continuing medical education sessions will include three concurrent sessions with nine different topics for conference attendees to choose from.  This blog entry will highlight those sessions available in “Concurrent Sessions Three” that will be on Saturday morning (9/11/10). 

These sessions will include:

The Anatomy of the Exam - This is a clinical workshop that will be co-presented by minimally invasive spine specialist Kevin Macadaeg, MD, and nurse practitioner Alta Skelton, RN, MSN, NP-C.  This workshop will provide an in-depth look at the patient exam and will utilize a live-model to demonstrate the critical components of the physical exam.  What is normal and abnormal during the cervical and lumbar exam will be discussed, as well as a review of the neurological exam.  Additionally, this session will also discuss multiple problems that present as back or should/neck pain and will review clinical algorithms. 

Active and Injured | A Look at Sports Injuries – This session, presented by chiropractic physician Tony Origer, DC, ATC, will highlight common sports injuries related to popular recreational activities of adults, e.g. golf, tennis, weights/fitness training and running.  This continuing medical education session will review the anatomical and physiologic functional changes of the spine that result with aging, and the effects of sports on the spine.  Additionally, the patient assessment of patients that present with spinal pain and injuries from sports-related activities will be discussed, as well as appropriate levels of care and red-flags. 

(Tony Origer, DC, ATC, is a chiropractic physician with Performance Chiropractic and Sports Rehabilitation.)
 

The Workplace | Back Pain and Injuries |  This continuing medical education concurrent session will be presented by Marc Duerden, MD, FAAPM&R, CIME.  Dr. Duerden is a physical medicine and rehabilitation physician with Rehabilitation Associates of Indiana. 

According to the Bureau of Labor Statistics, it is projected that annually more than one million workers injure their back representing one out of five work place injuries.  During this session Dr. Duerden will review common workplace spinal injuries and their contributing factors to back pain.  Additionally, the short- and long-term effects on the worker’s status will be reviewed.  Spinal conditions and physical attributes that predispose an individual to back injuries will be discussed as well as the indications and treatment options for low back pain.  

For more information about Back Talk, or to register click here, or call (317) 228-7000.

Back Talk, Indiana Spine Groups continuing medical education symposium, will provide concurrent sessions in addition to the two educational tracks (general and in-depth) and general sessions. These concurrent educational sessions will provide conference attendees a wide array of topics related to spinal conditions and treatments. A few of the concurrent sessions include:

Myths and Realities | Treatment of Vertebral Compression Fractures – This session, which will be presented by Indiana Spine Group minimally invasive spine specialist Kevin Macadaeg, MD, will highlight the symptoms, diagnosis and treatment indicators for vertebral compression fractures. Vertebral compression fractures have been identified as one of the most common fragility fractures in the U.S. During this educational session, two common treatment procedures for vertebral compression fractures will be discussed – this includes kyphoplasty and vertebroplasty.    

The Wellness Paradigm – Presented by chiropractic physician Nate Blume, DC, this continuing medical education session will apply the concept of functional medicine to spine health. The role of functional medicine in spinal health looks at contributing factors such as genetics and lifestyle. In this session, how to apply a wellness model to patient care and the role of functional medicine to improve the quality of a patient’s back health will be discussed. 

(Nate Blume, DC, is a chiropractic physician with Lakeside Chiropractic.)

One spine surgery research study that I participated in - compared the post-operative results of cervical arthroplasty and arthrodesis on approximately 500 patients. The objective of this study was to compare any side effects of patients undergoing a cervical arthroplasty with the implantation of a Bryan Cervical Artificial Disc to those patients that underwent a spinal fusion.

In this study, of which there were 31 institutions where patients underwent spine surgery, there were 242 patients who received the Bryan Cervical Artificial Disc and 221 patients that underwent cervical discectomy and spinal fusion. Patients that participated in this study were over 21 years of age, had single level cervical degenerative disc disease causing radiculopathy or myelopathy as well as a few other clinical indicators. Once identified, these patients were evaluated before spine surgery and post-operatively at regular intervals beginning one and one half months following spine surgery up to 2 years. 

This study concluded that both procedures are safe, and that there is not a significant difference in adverse effects with the newer arthroplasty procedure utilizing the Bryan Cervical Artificial Disc when compared to the traditional surgical option of spinal fusion.

 To read the complete study,link here.

Paul Kraemer, M.D., a spine surgeon with Indiana Spine Group, presented at the annual continuing medical education meeting of the American Association of Neurological Surgeons.  (Highlighted in a previous blog entry.) Dr. Kraemer was a co-faculty member for the session entitled, “Cranio-Cervical: Stabilization Techniques, Surgical Approaches and Indications.” 

This session was a practical clinic and it included the evaluation of craniocervical anatomy and pathology, as well as the development of a treatment plan.  In addition to the presentation, this clinic also included a hands-on demonstration.  The objectives of this session were, to:

• Formulate craniovertebral junction surgical approaches
• Classify and differentiate craniocervical lesions
• identify current techniques and strategies in occipito cervical fixation

Exercise is not only beneficial for cardiovascular health, or to stay in shape or lose weight, exercise is critical to your spine health. Research has shown that individuals who exercise routinely are less likely to have back pain. Additionally, those that exercise recover more quickly if they do injure their back. When selecting an exercise program it should contain three components: strengthening, stretching and cardiovascular activities. For a spine wellness tip sheet with exercises for your back, click here.

Spine Wellness Tip #3 – Get Moving – Exercise! 

At Indiana Spine Group’s Back Talk continuing medical education symposium, as highlighted in a previous blog entry , there are two educational tracks that will be available for conference attendees on day one.  In addition to the general track discussed in the prior blog, there is a more in-depth track entitled, More Specifics | Spinal Diagnostics and Treatment. 

In this education track there will be a few sessions focusing on the diagnosis of spinal disorders and abnormalities.  One session titled Spinal Imaging | Technology and Diagnosis, will be presented by Stephen Pomeranz, MD. Dr. Pomerance is a radiologist. In this session, Dr. Pomeranz will provide an in-depth look at spinal imaging technologies and highlight the latest developments in spinal imaging technology and their applications in spinal diagnostics.  Additionally, using case studies, he will review radiological finds and diagnostic indicators. 

The second session of this educational track will focus on The Electrodiagnostic Evaluation, and will be presented by physical medicine and rehabilitation specialist Dr. Shashank Dave.  During his presentation, Dr.Dave will discuss the role and application of electromyography in the diagnosis of spinal disorders and diseases.  Additionally, he will review case studies which utilize electromyography and identify specific diagnoses. 

Another session presented for the in-depth track will focus on Diagnostic and Therapeutic Injections of the Spine.  This will be presented by minimally invasive spine specialist John Arbuckle, MD.  During this session Dr. Arbuckle will review and differentiate between the different type of therapeutic injections and will review the treatment efficacy of injections, the clinical protocols, indications and expected outcomes. 

The last session of this continuing education track will highlight spine surgery, and is entitled Surgical Perspectives | Fusion vs Arthroplasty, presented by spine surgeon Rick Sasso, MD.  During this session, Dr. Sasso will provide a detailed analysis of spinal fusion and arthroplasty and he will discuss motion preservation modalities for the treatment of generative disc disease.  He will highlight lumbar and cervical artificial discs as well as review research studies and discuss patient selection, indications and expected outcomes. 

Planning continues for Back Talk | Comprehensive Concepts in Spinal Diagnosis and Abnormalities, Indiana Spine Group’s 4^th 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. 

Time and time again, we hear the dangers of smoking - cancer, stroke and  heart disease.  But did you know that smoking also affects the health of your spine?  This spine wellness blog tip will address your spine and smoking. 

To learn the best way to stop smoking, talk to your physician.  Additionally, resources are provided on the American Cancer Society’s web site. 
 

Spine Wellness Tip #2:  Put Out the Cigarettes

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 

A recent blog entry highlighted articles about the cervical artificial disc, written by Dr. Rick Sasso  - a spine surgeon with Indiana Spine Group.

In this spine wellness educational video, Dr. Sasso discusses cervical artificial disc; the indications, overview of surgical procedure and the advantages of this procedure. 

According to the National Osteoporosis Foundation one in two women and one in four men will sustain an osteoporotic fracture sometime in their lives.  One of the most common fractures as a result of osteoporosis is a spinal fracture. 

In this spine wellness educational video, Dr. Kevin Macadaeg discusses osteoporosis and vertebral compression fractures.  Dr. Macadaeg is a minimally invasive spine specialist with Indiana Spine Group. 

·         Understand the clinical algorithms to effectively diagnose and treat patients that present with back or neck pain. 

·         Discuss comprehensive evidence-based treatment options for the spine patient, from a non-operative and operative treatment prospective; including indications, applications and expected outcomes.

·         Identify common and uncommon spinal disorders; including spinal trauma, and discuss the symptoms, diagnosis and treatment options. 

·         Address conditions and prevalent diagnoses that affect patients at specific life-stages.  Additionally, discuss intrinsic and extrinsic factors affecting these diagnoses, as well as prevention, diagnosis and treatment of these spinal disorders.

·         Highlight new and emerging technologies for the treatment of spinal disorders and abnormalities; including the indications and potential benefits. 

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.

This spine wellness blog entry will address more about the effects of smoking and your spine’s health.  In this Spine Universe article, it summarizes the negative effects of smoking and its impact on the spine surgery procedure of spinal fusions. 

A general definition of a spinal fusion is that it is a spine surgical procedure that joins bony segments of the spine (vertebrae) – this spine surgery can be performed at the lumbar, thoracic or cervical areas of the spine.  As a part of the healing / fusion process of this spine ssurgery there needs to be new bone growth.  Many factors can affect the success of a spinal fusion and can include the patient’s overall health, other medical conditions and smoking. Research has shown that habitual cigarette smoking results in less successful spinal fusions when compared to similar spine surgical procedures performed on nonsmokers.  Additionally, another study indicated that individuals that smoked had a higher post-operative infection rate than nonsmokers. 

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.

This blog entry is part of a series on scoliosis, and will address commonly asked questions about screenings.

At what age should I have my children screened for scoliosis and how frequently should this be done?

In that scoliosis is typically diagnosed between the ages of 10 and 16, I generally recommend that parents have their children screened for scoliosis as a part of their annual physical.  Depending on the school system, the school nurse may do scoliosis screenings as part of their wellness / health initiatives. 

Are there any visible symptoms of scoliosis that I can look for in my child? 

There are a few visible symptoms that as a parent you may notice in your child.  Some of these visible signs may be uneven shoulders, or a protrusion of one or both of the shoulder blades, an elevated hip, or uneven waist.  Sometimes, you may notice clothes do not fit properly – that pant legs may appear longer on one side than the other.  If you notice any of these symptoms in your child, it is recommended to talk to your family doctor.    

What is the screening test called that is commonly performed – when you are bending forward?

This is one of the most common initial screening tests for scoliosis and is called the Adam’s Forward Bending Test.  For this test, the individual puts his or her feet together,  leans forward and bends at the waist 90 degrees.  Often times, they are asked to put their hands together like they are diving.  The screener will then look at the spine for any abnormal curvatures and asymmetry of the trunk.  This screening can tell if there is a curve – but not the degree of the curve.

How do you determine the degree of spinal curvature?

If an initial screening such as the Adam’s Forward Bending Test indicated that they was a curvature – further testing then measures the degree of the spinal curvature.  To determine this – an X-ray of the spine is taken.  A process called the Cobb Method is then used to measure the amount of spinal curvature. 

With the Cobb method of measuring spinal curvature, lines are drawn on the X-ray parallel to the end plates of the vertebral bodies at the beginning and end of the curve.  A perpendicular line is then drawn – and the angle between these two lines equals the degree of curvature – called the Cobb measurement.  It is important to note, that the actual measurement can vary 3 to 5 degrees, depending upon the exact positioning of the patient for the X-ray.  That is why major treatment decisions are not made on one single X-ray.

This spine wellness blog entry highlights, WebMD's tips for avoiding back pain: 

ü      Standing:  Keep your head and stomach pulled in.

ü      Sleeping:  Use a mattress with enough spine support.  If your mattress is too soft or too hard – it may result in back pain.

ü      Lifting:  Use proper lifting techniques.  Do not stoop over; lift with your knees and keep the object close to you. 

In October, I was a faculty member at the 8^th Annual Symposium on “Innovative Techniques in Spine Surgery.” This continuing education meeting, hosted in Phoenix, addressed the innovative and emerging technologies of spinal surgery including; arthroplasty, minimally invasive procedures, motion sparring technologies and biologics.  At this meeting I gave a talk on Lumbar Artificial Disc Replacement, and presented the results of the FDA studies for the Cervical Artificial Disc.

This education program was sponsored by the Organization of Spinal Teaching and Research.  The purpose of this group is to facilitate education and discussion among spine care providers and industry and this organization includes leaders in the field of spine surgery and technology that utilize the most advanced and effective technology available for the treatment of spinal disorders.