September 1st, 2010
I’ll take a moment now to discuss decompression therapy. I get asked about this type of treatment almost on a daily basis. It seems every time you turn on the television or open the Sunday paper, you see an advertisement for decompression that will “cure” your back pain. Degenerative Disc Disease is a chronic condition, and nearly everyone will have radiologic evidence of it by age 60. So, will it “cure” you? No. Can it help relieve symptoms? Absolutely. However, it’s hardly a new concept. Descriptions of this treatment date to Hippocrates (460-370 BCE), who reported joint manipulation and use of traction. Spinal decompression is a type of traction that works by gently stretching the spine. This can temporarily take pressure off the disks and spinal nerve roots that control your arms and legs. I include traction and decompression in […]
August 25th, 2010
The major difference in minimally invasive technologies and others is that the normal tissues are not injured. In true minimally invasive surgery, the blood supply and the nerve supply to the normal tissue is left intact. The only tissue addressed is the pathologic tissue causing pain. Because of these techniques, there is very little blood loss and no other soft tissue injury resulting in significantly faster recovery. In addition to the more rapid recovery, the ultimate outcomes are far more predictable; therefore, we get the best of both worlds, a predictable, successful outcome with a rapid recovery. This is truly “smart” technology. Because the surgical techniques are so focused on the specific pain pathologies (pain generator), we require much more thorough diagnostic testing. We call this pain mapping. A diagnostic work-up includes a thorough history and physical, an appropriate imaging […]
August 18th, 2010
If you have back or neck pain that won’t go away and you are selecting a specialist, there are some important things to consider. There are many different specialists that treat the spine. It takes years beyond medical school, internship and residency to master the treatment of spine-related disorders. Patients should look for specialists that have completed post-graduate fellowships and are familiar with all aspects of spine care. Doctors that perform these procedures must be specially trained and demonstrate competence in these procedures. The more extensive the physician’s training, the better. Physicians that train other physicians, contribute to research, and design or develop surgical technologies are usually the best. I continue to be published in numerous scientific publications, am asked to speak at national and international medical meetings and hold several patents on medical devices for the spine. In fact, […]
August 11th, 2010
This is a very long topic, so I will just touch on it here and expand on it later. Provocation of concordant daily pain with lumbar discography has been well demonstrated. This is a purely diagnostic injection in which the patient is put to sleep quickly with propofol, while needles are placed in the center of the discs in question, along with a control disc. Then, I allow the patient to wake up and be fully alert before I start testing. Then, I pressurize the center of the disc with about 1/2 cc of contrast dye. I watch the dye flow out of any disc tears on live xray (fluoroscopy). But, the most important aspect of the test is the patient’s response to injection. A normal disc only has nerve endings on the outer third periphery of the disc, and […]
August 4th, 2010
My first clue to discogenic pain begins with my first view of the patient as I walk into the room. Patients with discogenic pain may prefer to stand or pace around the room. If seated, they may recline back to one side to relieve the pressure. First, I take note of height/weight/obesity. Inspection of the lumbar region may reveal surgical scars or a kyphotic or scoliotic deformity. Palpation of the spine may reveal midline tenderness at one of the vertebral levels. The muscles on either side of the spine may reveal spasm and trigger points. If there is a spondylolisthesis (slip of one verterbral bone on another), there may be a “step deformity” on exam where the bony projections appear to step down at one level. The so called “straight leg raise” may put pressure on the disc and cause […]
July 28th, 2010
There are a variety of ways to get a good image of what is going on in the spine. Some are not very expensive and some cost more and are considered the gold standard. Here are a few commonly used technologies: Radiography (xrays): This is the quickest, cheapest, easiest study to get, and it can be done in the office within a few minutes. I usually obtain at least anteroposterior (AP) and lateral views. The disc is best visualized on lateral views. These images show the disc height, bone spurs, and any spondylolisthesis (slip of one vertebral bone on another). If spondylolisthesis is detected, I will add flexion and extension views to see if the slip increases or decreases when bending at the waist. I will obtain oblique images usually only if I’m looking for spondylolysis (pars fracture). CT scanning: […]
July 21st, 2010
Log into your Facebook account, then go to the page you would want to recommend that your friends “Like”. For Center for Spine Care, click here. Underneath the profile picture in the upper left hand corner, click on “Suggest to Friends”. In the pop up window, click on friends you would like to invite. You will see a check mark appear at the bottom of the friend’s photo if you’ve selected it. When you’ve checked everyone you want to invite, click “Send Invitations”. Your friends will have the chance to “confirm” or “ignore” the invitation. That’s it! Thanks for your support. . To learn more about Center for Spine Care, visit our website!
July 21st, 2010
The patient’s history, as always, is extremely important in my effort to pin down the pain generator. Multiple key questions help me diagnose the disc or facets as the source of pain. With pressures within the disc increasing significantly with forward flexion at the waist, patients will typically report exacerbation of pain with prolonged sitting, driving, rising from a seated position, first thing in the morning, bending over to pick something up, tie their shoes, doing dishes, bending over to shave, etc. However, the discs bear some amount of pressure in all positions, so there is some variability. Often there is a specific trauma: I’ve heard coughing, sneezing, vomiting, picking up a table, picking up something as light as a pen. However, just as often, there is no inciting event and patients will “wake up with it.” Relieving positions often […]
July 16th, 2010
Sex/Age Pain associated with degenerative disc disease affects men and women equally. Spine pain secondary to degenerative disc disease most often affects young to middle-aged people with peak incidence at around 40 years old. However, I have seen teenagers with significant degenerative disc disease. Factors such as genetics, trauma, environment can contribute to an earlier presentation. And of course, radiologic evidence of disc disease increases with age to nearly 100% by age 60. However, not all degenerative discs are painful. Frequency Up to an astonishing 90% of people will experience low back pain at some time in their lives. According to the National Center for Health Statistics, over 14% of new visits to primary care physicians are for low back pain. by Nathan S. Walters, MD . To learn more about Center for Spine Care, visit our website!
July 7th, 2010
Two of the most common pain generators in the lumbar spine are 1) the disc, and 2) the facet joints. Typically, the disc bears more weight in all positions, but increases to around 90% of forces transmitted through the lumbar spine in SITTING. Rotation and lifting, when added to lumbar flexion (bending at the waist), naturally will increase the forces on the disc. As the degenerative process progresses, the disc-facets force transmission approaches parity; with facet mediated pain being more common the older you get, and discogenic pain being more common overall. However, this is a generalization. Persistent, recurrent, and/or excessive forces to the spine lead to microtrauma of the disc and facet joints, triggering and continuing the degenerative process. The degenerative cascade, described by Kirkaldy-Willis, is the widely accepted pathophysiologic model describing the degenerative process as it affects the […]
Center for Spine Care offers stem cell therapy as a conservative treatment to promote natural healing for back or neck pain. Utilizing mesenchymal stem cells, this new method is used to treat patients with neck and back pain caused from degenerative disc disease.