Back Pain

The best (and worst) exercises for lower back pain

lower-back-painOver 80 percent of Americans will experience lower back pain at some point in their lives. If you have it, you may think rest is the key to recovery. In fact, back pain is one of the most common reasons people miss work.

But most lower back pain will actually get better when you stay active. Exercise can:

  • Ease your lower back pain
  • Help you heal faster after a lower back injury
  • Maintain your strength and flexibility
  • Prevent re-injury
  • Reduce your risk of disability from chronic back pain

Lower back pain exercises

You should focus on activities that strengthen your back, such as walking, swimming and walking in waist-deep water in the pool.

Also, these strengthening exercises can help combat back pain:

  • Back extensions. While lying on your stomach on the floor, press your elbows into the ground and push your upper body toward the ceiling. Hold this pose for 30 seconds, then allow your body to relax. Repeat four to six times.
  • Chair stretch (for hamstrings). Sit in a comfortable chair with your legs straight out in front of you in another stable chair. Reach forward gently to one foot and then repeat with other foot.
  • Hip stretch. Stand with your feet shoulder-width apart. Take a step back with your right foot and bend your left knee while shifting the weight to the right hip until you feel a stretch. Repeat on the other side.
  • Knee-to-chest stretch. Lie on your back on the floor and bend your knees while keeping your heels on the floor. Place your hands behind each respective knee and bring your knees to your chest for a gentle stretch.
  • Neck stretch. Sit in a comfortable chair with a straight back. Bend your head forward until your chin hits your chest, or you can feel a light stretch in the back of the neck. Return to the starting position.

Note: If at any time you notice increased pain while doing a stretch or exercise, stop immediately.

Exercises to avoid if you have lower back pain

If you have lower back pain, it’s best to avoid these exercises:

  • Heavy lifting above the waist
  • Leg lifts
  • Sit-ups, either with straight legs or with bent legs
  • Touching your toes while standing with legs straight

Many people can relieve lower back pain with simple at-home strengthening and stretching exercises. However, if you have a question about whether you need medical attention, it’s best to talk to your doctor to rule out a more serious injury.

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Back Pain Diaries: Herniated Disc – Signs, Symptoms and Treatment 

Dr. Lisa Foster discusses herniated discs

Dr. Lisa Foster, Emory Clinic

A herniated disc is a common lower back injury, but did you know lower back pain is the number one cause of disability around the world, according to the 2010 Global Burden of Disease study. For this blog, we spoke with our own Emory Clinic physician, Dr. Foster, to better understand those rubber like discs that sit between our spinal bones.

Your spine is made up of 26 vertebrae bones. Between them are soft disks filled with gel-like substance. These discs cushion the vertebrae bones and keep them in place. As we get older, the discs tend to degrade. When this happens, the discs lose their ability to cushion the vertebrae bones and this can lead to pain if the back is stressed.

What is a Herniated Disc?

A herniated disc, also commonly referred to as a ruptured disc or slipped disc, occurs when a cartilage disc in the spine becomes damaged and moves out of place. Sometimes, it can result in a pinched nerve. You can have a herniated or ruptured disc in any area of your spine but most often it affects the lumbar spine (lower back area).

How Does a Herniated Disc Occur?

When a disk is damaged, the soft rubbery center of the disk squeezes out through a weak point in the hard-outer layer. A disc may be damaged by sports injuries or accidents, repeated strain, a sudden strenuous activity or sometimes, it can happen spontaneously without any specific injury.

What Are the Risk Factors?

  • Genetic predisposition
  • Jobs or tasks that require you to repeatedly lift heavy objects, especially if you are lifting with your back and not your legs
  • Being overweight can add stress on the discs of your lower back
  • Smoking can reduce the amount of oxygen/nutrition reaching your discs to cause more rapid degeneration.

What Are the Symptoms?

  • Back, leg and/or foot pain (sciatica)
  • Numbness or tingling in the leg and/or foot
  • Weakness in the leg and/or foot
  • Loss of control over the bladder or bowels (very rare.) This requires immediate medical attention.

How Do I Prevent a Herniated Disc?

  • Build muscle strength in the core and legs. This stabilizes the spine, increases shock absorption and decreases overall muscle fatigue.
  • Alternate activities to help prevent injury. Warm up before exercising, including stretching.
  • Practice correct posture while you are walking, sitting, standing, lying down or working.
  • Don’t lift with your back; use your thigh muscles to do the lifting.

What Are Herniated Disc Treatment Options?

Each patient’s treatment plan will be different and is customized based on the precise location of the pain within the spine, the severity of pain and the patient’s specific symptoms. For the most part, patients usually start with non-surgical treatment options, such as physical therapy, spinal manipulations, massage therapy and more. A process of trial and error is often necessary to find the right combination of treatments. If a course of non-surgical treatments prove ineffective, surgery may be considered as an option.

 

Did You Know?

Emory Healthcare has a dedicated Orthopaedics and Spine Center, with locations throughout metro Atlanta. To make an appointment, please call 404-778-3350.

View Emory Orthopedics & Spine Center 

 


By Dr. Lisa Foster

Dr. Lisa Foster is a board certified, fellowship trained interventional physiatrist, specializing in non-operative spine care. Dr. Foster has published numerous articles and presented at national conferences in the fields of spine and rehabilitation medicine. Most recently, she was a contributing author for a book chapter on the workup and conservative management of lumbar degenerative disk disease in JL Pinherio-Franco’s Advanced Concepts in Lumbar Degenerative Disk Disease.

 

Back Surgery: Should You or Shouldn’t you?

Learn when back surgery is a good idea and what your surgical and nonsurgical options might be, from an Emory specialist.If you’re like most Americans, you’re no stranger to back pain. When the pain interferes with your life, it’s time for treatment. But is it time for back surgery?

Today’s surgical techniques are safer and often less invasive than in years past. But any surgery carries some risks, such as infection, bleeding, blood loss or nerve damage. Always get a second opinion from a qualified spine specialist before you have back surgery. And, try other treatments first, such as physical therapy, cortisone shots or medication.

“Even surgeons don’t always agree on whether to operate or what type of surgery to perform. Back and leg pain can be complex,” explained Emory spine specialist Dheera Ananthakrishnan, MD. “At Emory, we take a team approach and we consider your goals and preferences as priority.”

Back surgery options might include:

  • Discectomy: Removal of the herniated portion of a disk to relieve pressure and pain.
  • Laminectomy: Removal of the bone overlying the spinal canal to relieve nerve pressure from spinal stenosis.
  • Fusion: Connection of two or more bones in your spine to make your back more stable and prevent painful motion between the bones.
  • Artificial disk: Removal of a disk and replacement with an artificial one. Artificial disks are fairly new and may not be an option for many people.

Is back or leg pain affecting your life? The Emory Orthopaedics and Spine Center in Atlanta can help. Do you want to learn more now? Yes, I want to learn more now.

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About Dr. Ananthakrishnan

ananthakrishnan-dheeraDr. Ananthakrishnan trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, she practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University, where her focus is on adult and adolescent scoliosis.

In 2009, Dr Ananthakrishnan co-founded Orthopaedic Link, a non-profit dedicated to improving orthopaedic care in the developing world by mobilization of unused implants from the United States.   She is also a candidate member of the Scoliosis Research Society.

Although Dr Ananthakrishnan routninely performs complex spinal reconstruction surgery, an injury in 2012 caused her to reevaluate her own approach to musculoskeletal health.  Her practice philosophy now focuses on strengthening, stretching and general conditioning  (“prehab”) as an adjunct to surgical care of her patients.

The Importance of a Second Surgical Opinion

spine-second-opinion-squareIf you’re one of the 13 million Americans suffering from back pain, neck pain or sciatica (pain running down your leg), your doctor may recommend surgery to relieve your discomfort.

While surgery can be life-changing for the better, it certainly isn’t a decision to be taken lightly. Surgery comes with its own risks and doesn’t always solve the problem. It may even introduce new ones.

You should get a second opinion before you have surgery. Don’t worry about offending your doctor. Second opinions are common practice. It can give you peace of mind that you’re making the right decision, especially if that decision is to go through with surgery.

Questions to Ask your Doctor

Before you jump into surgery, be sure to ask:

  • What is the likelihood of success?
  • What is the possibility of residual or worsened symptoms?
  • What are the risks of anesthesia?
  • What are the risks of spine surgery?
  • What is the chance of recurrence of my symptoms in the future?
  • What will happen if I don’t have surgery?

Rethinking Surgery

The good news is that most cases of back and neck problems can be resolved without surgery. In fact, spine surgery is only absolutely needed in a small percentage of cases.

If pain is the only symptom, then surgery is almost always elective, and the decision to proceed is based on weighing the risks versus potential benefits.

Surgery is usually the best option for severe weakness due to nerve or spinal cord compression; however every case is unique. Every patient has a different set of symptoms, exam findings, medical comorbidities (other health disorders) and life goals that drive the decision-making process.

Weighing the Options

Fortunately, most of the patients seen at the Emory Spine Center can be treated with less invasive treatments such as physical therapy, spinal injections or tweaking lifestyle choices that affect spine health. Usually surgery should only be considered once the conservative therapies have been exhausted. If you haven’t already, be sure to talk to your doctor about nonsurgical treatment options for your condition.

The decision to have surgery for most people with back or neck problems usually comes down to your lifestyle goals and desired quality of life.

For example, some people don’t mind living with a certain amount of pain and are content to manage it with anti-inflammatory medications. They can function well through day-to-day tasks and are willing to give up some activities, like running, in favor of lower impact exercise like walking. For them, they may feel the investment and risk of surgery isn’t worth it.

Other patients at this same level of discomfort may prefer to have surgery in hopes of less pain and more mobility. For some people, pain may interfere with daily tasks like doing the laundry or even just getting in and out of the bathtub. They may feel the potential benefits of surgery far outweigh the risks.

If your pain and other symptoms keep you from doing the kinds of activities you enjoy, and less invasive treatments haven’t helped you achieve your health and lifestyle goals, surgery might be a reasonable choice.

We Can Help

If you have been told you need surgery and would like a second opinion, then the Emory Spine Center is a great place to start. We will review your current imaging and obtain any necessary X-rays the same day. Once your records are reviewed and a history and physical exam are performed, we will give our own opinion on the best course of action. This will give you peace of mind that you are making the right choices for you and your family.

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About Dr. Gary

gary-matt-webMatthew Gary, MD, attended medical school at the University of Florida where he was inducted into Alpha Omega Alpha for academic excellence.  Following medical school, he completed residency training in neurological surgery at Emory University. During his residency, he gave numerous presentations at local and national neurosurgical society meetings and received research awards at the Congress of Neurological Surgeons and Georgia Neurosurgical Society.  He went on to complete a complex and minimally invasive spine fellowship at the University of Miami/Jackson Memorial Hospital under the tutelage of Drs. Barth Green, Allen Levi and Michael Wang.  He is interested in all facets of spine health and maximizing patients’ quality of life with a focus on minimally invasive spine surgery.

Could I Be Suffering from a Herniated Disc?

Herniated DiscLower back pain has been found to be the number one cause of disability around the world, according to the 2010 Global Burden of Disease study. Though many conditions can cause back pain, a herniated disc is a common cause.

Discs are the soft, rubber-like pads that fit between the bones (vertebrae) of the spinal column and cushion it. The discs allow the back to flex and bend and absorb shock.

Herniated discs, which can also be called slipped or ruptured discs, are caused when all or part of the disc is forced through a weakened part of it, which places pressure on the nearby nerve and/or spinal cord, causing numbness, and most commonly, pain. Herniated discs can occur both in the lumbar spine (lumbar herniated disc) and the cervical spine (cervical herniated disc).

This can happen when the disc moves out of place (herniates) or breaks open (ruptures) due to injury or strain. It is most commonly found to happen in the lower back, but can also affect the neck’s discs, or, even more rarely, the discs in the upper-to-middle back.

Herniated Disc Risk Factors

If you’re not sure if a herniated disc is causing your pain, the American Academy of Orthopedic Surgeons point out a few factors that can put you more at risk:

  • Usually, herniated discs are caused by the natural aging of your spine. When we’re young, our discs have a high water content, making them spongy. When we age, they begin to dry out, becoming weaker and narrowing the spaces between our vertebrae. This is called disc degeneration.
  • Men between 30-50 are more likely to have a herniated disc
  • Jobs or tasks that require you to repeatedly lift heavy objects can put you at risk, especially if you are lifting with your back and not your legs, or if you are twisting while you lift.
  • Being overweight can add stress on the discs of your lower back
  • If you are frequently in the car, staying seated for long periods of time along with the vibrations of the car, can put pressure on your spine and discs
  • Staying sedentary can cause herniated discs
  • Smoking can reduce the amount of oxygen reaching your discs to cause more rapid degeneration

Herniated Disc Symptoms

For most people suffering from a herniated disc, lower back pain is the first symptom. The pain may come and go, but can eventually lead to leg pain, numbness or weakness. These sensations can reach all the way below the knee, to the ankle and foot.

Additionally, the symptoms can be all or one of the following:

  • Back pain
  • Leg and/or foot pain (sciatica)
  • Numbness or tingling in the leg and/or foot
  • Weakness in the leg and/or foot
  • Loss of control over the bladder or bowels (very rare.) This could be a more serious problem known as cauda equina syndrome, which is caused by compression of the spinal nerve roots. This requires immediate medical attention.

If you feel like you may be suffering from a herniated disc, see your orthopedist for a physical examination or MRI scan, so they can make sure that it’s the cause of your back pain. Due to a wide range of non-surgical and surgical treatments available, most patients are free from their symptoms in 3-4 months!

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About Dheera Ananthakrishnan, MD:

Dr. Dheera AnanthakrishnanDr. Ananthakrishnan trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, Dr. Ananthakrishnan practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors Without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University. She maintains an interest in developing-world orthopedics and is currently involved in projects in the Philippines and Malawi.

Dr. Ananthakrishnan’s practice focuses on adult degenerative conditions, including scoliosis. She also treats adolescent spinal disorders as well as tumors and cervical conditions. Dr. Ananthakrishnan started practicing at Emory in 2007.

Related Resources:

Using Heat and Cold to Treat Injury

back-painIt’s hard to get through life without straining a muscle, spraining a ligament, or wrenching your back. When something hurts, ice and heat are often the go-to solutions, and using temperature therapy to complement medications and self-care can be very effective. But while both heat and cold can help reduce pain, it can be confusing to decide which is more appropriate depending on the injury. Our tips below give you the facts on when to use (and not use) heat and cold therapies.

When to Use Cold Therapy

Cold is best for acute pain caused by recent tissue damage is used when the injury is recent, red, inflamed, or sensitive. The inflammatory process is a healthy, normal, natural process that also can be incredibly painful. Here are some examples of common acute injuries:

  • Ankle sprain
  • Muscle or joint sprain
  • Red, hot or swollen body part
  • Acute pain after intense exercise
  • Inflammatory arthritis flare ups

When you sprain something, you damage blood vessels causing swelling to occur. Applying something cold causes the blood vessels to constrict, reducing the swelling and limiting bruising. Cold therapy can also help relieve any inflammation or pain that occurs after exercise, which is a form of acute inflammation. However, unlike heat, you should apply ice after going for a run to reduce post-exercise inflammation.

Tips for Applying Cold

  • Cold should only be applied locally and should never be used for more than 20 minutes at a time.
  • Apply cold immediately after injury or intense, high-impact exercise.
  • Always wrap ice packs in a towel before applying to an affected area.
  • Do not use ice in areas where you have circulation problems.

When to Use Heat Therapy

While ice is used to treat acute pain, heat therapy is typically used for chronic pain or conditions. Unlike cold therapy’s ability to constrict blood vessels, heat allows for our blood vessels to expand and our muscles to relax. That’s why overworked muscles respond best to heat. Heat stimulates blood flow, relaxes spasms, and soothes sore muscles. Some common chronic conditions that heat is used to treat are:

  • Muscle pain or soreness
  • Arthritis
  • Stiff joints

Tips for Applying Heat

  • Unlike cold therapy, heat should be applied before exercising. Applying heat after exercise can aggravate existing pain.
  • Protect yourself from direct contact with heating devices. Wrapping heat sources in a folded towel can help prevent burns.
  • Stay hydrated during heat therapy.
  • Avoid prolonged exposure to heating sources.

Low Level Heat

If you find that heat helps ease your pain, try a continuous low-level heat wrap, available at most drugstores. You can wear a heat wrap for up to 8 hours, even while you sleep.

What to Avoid

Heat can make inflammation worse, and ice can make muscle tension and spasms worse, so be careful. Just like anything else, don’t overdo it! It’s normal for your skin to be a little pink after using cold and heat therapies, but if you start to notice any major skin irritation like hives, blisters or swelling, you should call your doctor. Otherwise, use whatever works for you depending on your condition. Both ice and heat can be very effective if used correctly!

About Emory Sports Medicine Center

At the Emory Sports Medicine Center, our experts specialize in advanced procedures to treat and repair a wide range of sports related injuries. Recently recognized as one of the nation’s TOP 50 orthopaedics programs, Emory Orthopaedics, Sports and Spine has 6 convenient locations across metro Atlanta, as well as 6 physical therapy locations. Click to learn more >>

About Dr. Mines

mines-brandonDr. Brandon Mines is board certified in both family practice and sports medicine. He has focused his clinical interest on sports injuries and conditions of the shoulder, elbow, wrist/hand, knee, foot and ankle. He is head team physician for the Women’s National Basketball Association’s (WNBA) Atlanta Dream, Decatur High School and a team physician for NFL’s Atlanta Falcons. He is also a rotational physician for United States soccer teams.

Dr. Mines enjoys giving talks and lectures regarding the prevention of sports injuries. In fact, as an active member of the American Medical Society for Sports Medicine and the American Society for Sports Medicine, Dr. Mines has attended and presented at various national conferences. Through the years, he has helped all levels of athletes return to the top of their game.

Understanding Adult Idiopathic & Degenerative Scoliosis

spine-scoliosisScoliosis, or an abnormal curvature of the spine, affects an estimated 7 million people across the U.S., or approximately 2% of the American population. Often the onset of scoliosis begins during adolescence, but the condition can also exist in adults. When the condition is discovered after puberty, it is referred to as adult scoliosis.

Most scoliosis cases are considered idiopathic, meaning they have no known cause. Most idiopathic scoliosis cases among adults actually began during adolescence. It is important, whether you’re an adult who’s been living with adolescent idiopathic scoliosis for years, or an adult whose scoliosis has only recently discovered, that you have your spine regularly checked by a physician to monitor the curvature and its progression. In many cases, idiopathic scoliosis does not require surgical treatment, but in the event that the curvature worsens , intervention, including surgery, might be required.

In addition to idiopathic scoliosis, there are several other types of scoliosis, most of which predominantly affect children and teens. However, there is one other form of scoliosis, degenerative scoliosis that doesn’t develop until adulthood.

As we get older and our bones and joints begin to wear and break down, we can experience a variety of conditions ranging from osteoporosis to osteoarthritis. In some cases, these same diseases can also be a cause of degenerative scoliosis.

Degenerative scoliosis does not begin until after the age of 40 and is marked by degeneration of the discs in the lumbar spine and the development of a scoliosis curve in the spine. Often times, degenerative scoliosis presents as low back pain. There may be no curve present when symptoms begin, and a patient may simply visit the doctor due to a new, but persistent pain in the lower back

Once the degeneration progresses and the scoliosis curve has occurred, this combination can put pressure on the nerves in the spine, leading to numbness, tingling sensations, weakness, pain in the lower extremities, all of which can lead to difficulties with activities of daily living.

Treatments for degenerative scoliosis vary depending on the severity of the case. Usually, conservative treatment measures including exercise, medication, and use of braces or orthotics can provide sufficient pain relief and support for a deteriorating spine. In particular, strengthening and stretching of the lumbar musculature can be very helpful in decreasing pain, as well as providing “prehab”- that is, exercise treatment BEFORE surgery to maximize the chances of a good outcome.

Treatment of other conditions (osteoporosis, osteoarthritis) that may be playing a role in the degenerative scoliosis can also help improve symptoms or slow the progression of degenerative scoliosis. In some cases, significant nerve problems or pain and/or the development of other conditions such as lumbar stenosis can mean treating degenerative scoliosis may require surgery, such as a lumbar spinal fusion or lumbar laminectomy.

To learn more about scoliosis, visit the Emory Orthopaedics & Spine Center.

About Dr. Ananthakrishnan

ananthakrishnan-dheeraDr. Ananthakrishnan trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, she practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University, where her focus is on adult and adolescent scoliosis.

In 2009, Dr. Ananthakrishnan co-founded Orthopaedic Link, a non-profit dedicated to improving orthopaedic care in the developing world by mobilization of unused implants from the United States. She is also a candidate member of the Scoliosis Research Society.

Although Dr. Ananthakrishnan routninely performs complex spinal reconstruction surgery, an injury in 2012 caused her to reevaluate her own approach to musculoskeletal health. Her practice philosophy now focuses on strengthening, stretching and general conditioning (“prehab”) as an adjunct to surgical care of her patients.

Related Resources
Are You One of the 7 Million in the U.S. Affected by Scoliosis?

When is Spine Surgery Necessary?

spine-surgery-chatIf you have experienced ongoing back or neck pain, you may have asked yourself at one point, “do I need surgery?”

Low back and neck pain are common conditions that can range from dull, constant aches to sudden, sharp pains that make it difficult to move. There are many causes of spine pain, including injury, ruptured discs and the normal wear and tear that comes with aging. Some diseases and spine conditions may also cause pain, such as:
– Arthritis
– Scoliosis
– Spinal stenosis
– Spondylolisthesis
– Spondylosis

Seek an evaluation from a spine specialist if your pain is severe or persistent. The good news is that less than 10% of patients who experience back or neck problems are candidates for surgery. Many spine conditions can be treated non-operatively, but if you’ve been told you need spine surgery, it’s important to have the proper information before making a decision.

On Tuesday, August 25, 2015, at noon EST, join Scott Boden, MD, director of the Emory Orthopaedics & Spine Center, for an interactive web chat to discuss when you should — and shouldn’t — elect to undergo spine surgery. Sign up for the chat >>

Sign Up for the Chat

Related Resources
When Should You Consider Spine Surgery?
Emory Orthopaedics & Spine Center
Should You See a Spine Specialist? Take our quiz and find out>>

About Scott Boden, MD

boden-scottScott D. Boden, MD, is Professor of Orthopedic Surgery and Director of the Emory Orthopaedics & Spine Center. Dr. Boden started practicing at Emory in 1992. During his fellowship at Case Western Reserve Hospital in Cleveland, Dr. Boden trained with one of the founding fathers of modern spine surgery, Dr. Henry Bohlman. A primary original researcher on bone growth factor development and spine fusion technology, Dr. Boden is also an internationally renowned lecturer and teacher and the driving force behind the Emory University Orthopedics & Spine Hospital (EUOSH).

 

Dr. Boden’s Clinical Interests:
Dr. Boden’s areas of clinical interest include surgical and nonsurgical management of adult degenerative spinal disorders including herniated discs, spinal stenosis, and spondylolisthesis in the cervical and lumbar spine. He was recently named in another Becker’s list of Top 50 Spine Surgeons in the U.S. and is a skilled surgeon with techniques of microdiscectomy, laminectomy, spinal fusion, and laminoplasty.

The Road to Emory: Education
• Medical School: University of Pennsylvania School of Medicine, Philadelphia, PA 1986
• Internship: George Washington University Medical Center, Washington, D.C. 1987
• Residency: George Washington University Medical Center, Washington, D.C. 1991
• Fellowship: Case Western Reserve University Hospital, Cleveland, OH 1992

Personal:
Dr. Boden is the proud father of triplets who graduated first and tied for second in their high school class. He is also a baseball aficionado and coaches high school and travel softball teams.

Simple change to surgical procedure makes huge impact on post- lower back surgery patients

lumbar-painRecently, at the 2015 International Society for the Study of the Lumbar Spine (ISSLS) annual meeting in San Francisco, CA, Emory spine surgeon, S. Tim Yoon, MD, won the “Best Podium Presentation” award. It was one of two papers chosen among 600 papers submitted and 80 papers presented. Dr. Yoon was recognized for his research relating to lumbar spine surgery. A summary of the recognition and study findings is below:

Purpose of Study:

Dr. Yoon and Emory University School of Medicine student, J. Stewart Buck,  analyzed 17,232 patient outcomes cases to look at the effect of spinal fluid leakage on cost and length of stay post lumbar (lower back) spine surgery. They looked at first time spinal fusion surgery of the lumbar spine for the treatment ofspinal stenosis (nerve pinch).

Sometimes, during spinal surgery the covering around the spinal fluid (dura) becomes punctured and spinal fluid leakage can occur.  This is called incidental durotomy.  There has been incomplete understanding of what factors are associated with incidental durotomy and whether other complications and cost of hospitalization is affected.

Study Findings:

This study used a very large database that is representative of all hospitals in the United States in order to have enough numbers in the study to apply power statistical analysis.  The incidence of incidental durotomies was about 4.6% of spinal surgeries.  Interestingly, once statistical adjustments were made to account for multiple different factors, incidental durotomies were NOT associated with other complications except neurological complications. Complications from the durotomy caused the hospitalization length to increase by 1.4 days and hospital cost to increase by about $3800.

Drs. Yoon and Stewart speculated that utilizing a better, tighter method may allow for a patient to get back on their feet quicker, reducing the cost and length of hospitalization.

yoon-s-timAbout Dr. Yoon:

Dr. Yoon specializes in cervical and lumbar spine surgery using minimally invasive techniques. Dr. Yoon won the MIT robot and physics motor competitions while an undergraduate at the Massachusetts Institute of Technology. He attended medical school at Yale University where he earned an MD and a PhD in immunobiology. He is an award-winning researcher, focusing on spinal disorders of the neck, spinal stenosis, and spinal deformity.  Dr. Yoon attended elementary and high school in South Georgia.  He started practicing at Emory in 2000.

Related Resources: 
Spine Care at Emory Orthopaedics & Spine Center
Advancing the Possibilities in Orthopedic, Sports Medicine & Spine Care
Should You Make an Appointment With a Spine Specialist? Take our spine quiz >>

How Cell Phone Use Impacts Our Neck Over Time

neck-illustrationTechnology has become an incredibly integral part of our lives. As it has adapted and changed, so have humans in the 21st century; we’re constantly on our smartphones—texting, calling, checking our Facebook updates, often for hours every day—and it may have a significant detrimental effect on our bodies.

The average human head weighs between 10 and 12 pounds in a neutral position–when your ears are over your shoulders. But as the neck bends forward and down, the weight on the cervical spine (neck) begins to increase, causing stress. According to a study in 2008, if you lean 15 degrees forward, it’s as if your head weighs 27 pounds. If you lean 30 degrees, it’s as if your head weighs 40 pounds. If you lean 45 degrees, it’s 49 pounds. When you’re hunched over at a 60 degree angle, like most of us are many times throughout the day, you’re putting a 60 pound strain on your neck.

So what does this mean for your spine? This pressure can put a lot of stress on your neck and spine, pulling it out of alignment. Over time, this poor posture can lead to disc herniations, pinched nerves, metabolic problems, degeneration and even spine surgery. Think about the effect of 60 pounds for a moment – it’s the equivalent 5 bowling balls weighing 12 pounds or an eight year old child hanging around your neck.

While it is nearly impossible to avoid the technologies that cause these issues, there are some simple steps we can take to take this strain off of our necks. A few easy fixes include:

  • Take frequent breaks while using any mobile device or desktop computer.
  • Practice exercises to help you build strength, such as standing in a doorway with your arms extended and push your chest forward to build muscles that help posture.
  • Be mindful of your posture – keep your neck back and your ears over your shoulders.
  • Look down at your mobile device with your eyes without bending your neck.

In short, continue to enjoy the incredible benefits of your smartphone, but remember to keep your head up!

About Dr. Refai

refai-danielDaniel Refai is the director of spinal oncology at the Emory Orthopaedics & Spine Center. Dr. Refai focuses on both intradural and extradural spinal tumors as well as metastatic and primary tumors of the spine. He performs complex spine tumor surgery and spine reconstruction surgery. He also directs the stereotactic radiosurgery division of the Emory Orthopaedics & Spine Center for spine tumor treatment. Dr. Refai’s research interests include outcome analysis following surgery and radiosurgery for spine tumors. He has published extensively on the treatment of spinal disorders and has developed innovative multidisciplinary approaches for treatment. H  e is a member of the American Association of Neurological Surgeons, Congress of Neurological Surgeons, and the North American Spine Society.

Dr. Refai completed neurosurgical residency at Washington University in Saint Louis under the tutelage of Ralph Dacey MD. He spent six months as a specialist registrar in neurosurgery at Beaumont Hospital in Dublin, Ireland. He completed a combined orthopaedic and neurosurgery spine fellowship at the Cleveland Clinic under Edward Benzel MD, Iain Kalfas MD, Gordon Bell MD, and others. He specializes in all aspects of complex spine surgery and is actively in clinical research. Dr. Refai enjoys teaching and has received numerous patient and medical education distinctions throughout his training.volved in clinical research. Dr. Refai enjoys teaching and has received numerous patient and medical education distinctions throughout his training.

Sources:

[1] Hansraj, Kenneth. “Assessment of Stresses in the Surgical Spine Caused by Posture and Position of the Head.” https://cbsminnesota.files.wordpress.com/2014/11/spine-study.pdf