Spine Pain

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:

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?

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

 

How Aging Affects Your Cervical Spine – Part II: Arthritis of the Neck

NeckArthritis_ 7-7Cervical spondylosis refers to the degenerative process of the vertebral disks in the neck (arthritis). Like the rest of the body, the bones in the neck slowly degenerate as we age, which frequently results in arthritis. Most of the time, this condition causes mild to moderate neck pain and stiffness.

Causes:

Neck pain is extremely common, with more than 85% of people over age 60 being affected. It’s typically caused by chronic wear on the cervical spine as a result of aging. Facet joints in the neck become enlarged, causing the ligaments around the spinal canal to thicken and bone spurs to form. Over time, these changes can press down on (compress) one or more of the nerve roots. In advanced cases, the spinal cord becomes involved.

Aside from aging, the other factors that can make a person more likely to develop spondylosis are:

  • Being overweight
  • Past neck or spine injury
  • Ruptured or slipped disk
  • Genetics – if your family has a history of neck pain

Symptoms:

Many people have spondylosis of the neck and do not know it. This is because most of the time, there are no symptoms, or the symptoms are mild. When symptoms do develop, they are typically neck pain, stiffness, headaches (especially in the back of the head), and sometimes shoulder pain. In rare cases, the pain may spread to the upper arm, forearm, or fingers.

Treatments:

Non-surgical

Treatment for cervical spondylosis depends on the severity of your signs and symptoms. Most patients who do not have neurological compression associated with spondylosis do not need surgery. Interventional treatments for cervical spondylosis may include:

  • Physical therapy – Strengthening and stretching weakened or strained muscles to relieve the pressure on the nerve root is usually the first treatment that is advised.
  • Medications – Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain and analgesics to relieve pain.
  • Steroid-based injectionsMany patients find short-term relief from steroid injections to help reduce swelling and treat acute pain that radiates to the hips or down the leg.

Surgical

For cervical spondylosis causing symptomatic compression of nerve roots or the spinal cord, surgery may be indicated to relieve pain and improve or preserve neurological function. For spondylosis without nerve root or spinal cord compression, surgery is typically avoided. In some unusual conditions, cervical spinal fusion can be performed.

Have you been told you need neck surgery? Over 90% of neck and back problems can be treated without surgery, but if surgery has been recommended, you may want to seek a second surgical opinion.

At the Emory Orthopaedic & Spine Center, our internationally-recognized spine surgeons research, pioneer and refine the most effective approaches to treating a variety of spine conditions.

To see if you may be a candidate for spine surgery, take our five minute spine quiz

About Dr. Rhee

John M. Rhee, MD, is a Spinal Surgeon and Associate Professor of Orthopaedic Surgery specializing in cervical spine surgery, lumbar spine surgery, complex spinal deformity surgery (scoliosis and kyphosis) and surgery for spinal tumors. Dr. Rhee is an active researcher and sought-after teacher/lecturer at the national and international level in multiple medical societies. He has served as faculty and been an invited lecturer at numerous meetings and courses on spine surgery. In addition, he has served as Program Chairman at numerous national and international spine surgery meetings. Dr. Rhee has also published extensively in a number of peer reviewed journals and books, and he has received numerous awards and honors. He is actively involved the training of international research scholars and other spinal surgeons and has been the author and editor of major textbooks on spine surgery techniques.

Emory Spine Patient Story: “I wanted to walk down my long driveway – I can now.”

By Sara Dollar, Emory Orthopaedics & Spine Center patient

Scoliosis PatientAt the age of 12, I started seeing a chiropractor. In my early teenage years, I was diagnosed with severe scoliosis. Doctors told me that by the time I reached the age of 45, I might not be able to breathe if the scoliosis got bad enough. My spine was shaped like a perfect “S.” I had my first surgery in 1977, followed by several more surgeries. Surgery after surgery left me in excruciating pain. I lived my life, but because my spine was stuck in a bad position, I walked crooked, I couldn’t stand up straight, I couldn’t walk my dogs, and I couldn’t walk five feet without my back spasming. I had become like a hermit crab.

In September 2014, I was referred to John M. Rhee, MD, a spinal surgeon at the Emory Orthopaedic & Spine Center, because I had a very delicate problem that my former surgeons could not handle. Dr. Rhee explained to me what could be done, and I was so excited that I wanted to have surgery on the same day as my office visit! But because my problem was very severe, and the required surgery would be complex, Dr. Rhee asked me to go home and discuss this with my family. I was so grateful for this! After much thought, I decided to have surgery – a lumbar osteotomy, which is a major operation done only at highly- specialized spine centers, like Emory, because of its complexity.

I had done so much research on Emory and Dr. Rhee that even before my first scheduled appointment I knew that I had made the right decision. I felt comfortable. Before I went into surgery, I made some goals that I wanted to attain after my procedures: mainly, I just wanted to live without pain. I am happy to say that Dr. Rhee helped me achieve this!

I had two planned surgeries to correct my severe scoliosis and kyphosis. They were done on January 22 and 23, 2015. Compression on the nerves had to be relieved along with fusion and correction of the deformed areas of the spine. My previous hardware had to be removed and repositioned properly, and a wedge of bone was removed from one of my vertebrae in order to realign my spine so I could stand up straight again. This was a major procedure because I had had multiple prior surgeries that left my spine severely deformed.

At my six week checkup, I was walking without any assistance from a cane, walker or person. I think I surprised Dr. Rhee with how well I was doing and how quickly I had recovered.

While I am still healing, I am not in any pain and am accomplishing all of my goals. I wanted to walk down my long driveway – I can now. I wanted to be able to walk down the beach – I can now. I wanted the freedom of walking into a store to grab some milk and bread without needing or using a shopping cart – I can now. When the time comes, I want to run after my future grandchildren, and because of my surgery, I believe I will be able to.

My advice to others considering spine surgery; do not be afraid, stop living in pain, quit suffering and get your good quality of life back. Surgery is not the answer for everyone, but if it is, I would not trust anyone other than the renowned spine surgeons at Emory Orthopaedic & Spine Center. Thanks to them, I am living well and attaining my goals.

About Dr. Rhee

John Rhee, MDJohn M. Rhee, MD, is a Spinal Surgeon and Associate Professor of Orthopaedic Surgery specializing in cervical spine surgery, lumbar spine surgery, complex spinal deformity surgery (scoliosis and kyphosis) and surgery for spinal tumors. Dr. Rhee is an active researcher and sought-after teacher/lecturer at the national and international level in multiple medical societies. He has served as faculty and been an invited lecturer at numerous meetings and courses on spine surgery. In addition, he has served as Program Chairman at numerous national and international spine surgery meetings. Dr. Rhee has also published extensively in a number of peer reviewed journals and books, and he has received numerous awards and honors. He is actively involved the training of international research scholars and other spinal surgeons and has been the author and editor of major textbooks on spine surgery techniques.

How Aging Affects Your Cervical Spine – Part I: Pinched Nerve

Pinched NerveThe cervical spine refers to that portion of the spinal column that is within our neck. This section of the spine has two essential roles: providing flexibility so that we can move our head up and down and side to side, and protecting the spinal cord nerves that pass through it. Cervical radiculopathy, or pinched nerve, tends to occur when the nerve roots are irritated or compressed by one of many conditions.

Cause

Cervical radiculopathy can occur in a wide variety of patients, with those younger than 50 tending to suffer as a result of disc herniations. Other than trauma or injury, degenerative conditions as a result of aging are the main cause of neck pain. As disks age, they lose height and the vertebrae move closer together, causing the body to respond by forming more bone—called spurs—around the disk to strengthen it. However, the spurs can also contribute to stiffening of the spine. Bone spurs may also narrow the area of the foramen and pinch the nerve root.

Symptoms

The primary symptoms of cervical radiculopathy include pain radiating from the neck into the shoulder, upper arm, forearm, or hand.  Sometimes the symptoms radiate into all of these areas, whereas in other cases, the symptoms may radiate to only some of these areas.  Other associated symptoms can include tingling and numbness.  In some cases, weakness of various muscle groups in the shoulder, arm, and hand may occur.

Treatments

Non-surgical:

Interventional treatments for cervical radiculopathy are generally attempted first and may include:

  • Physical therapy and/or exercise to help relieve the pressure on the nerve root. Stretching as many dimensions of the neck as possible is essential to maintain flexibility and relieve chronic stiffness.
  • Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain and analgesics to relieve pain.
  • Use of a cervical collar, cervical pillows, or neck traction may also be recommended to stabilize the neck and improve alignment.
  • Injections of steroid medications around the affected nerve root, commonly known as nerve root or epidural injections, can be considered for pain relief as well.

Surgical Treatment:

If symptoms persist despite nonoperative care, or if there is substantial motor weakness, surgical treatment is recommended and generally has excellent outcomes.  In fact, cervical spine surgery generally has the best outcomes of any spinal operation.  Surgical treatment generally involves relieving the pressure off of the affected nerve root.  Depending on the circumstances, it may be performed either from the front (anterior) or back (posterior) of the neck, although the anterior approach is more common.

Some of the surgical spine procedures used to treat cervical radiculopathy at the Emory Orthopaedics and Spine Center are:

At the Emory Orthopaedic & Spine Center, our internationally-recognized spine surgeons research, pioneer and refine the most effective approaches to treating a variety of spine conditions.

Should you make an appointment with an Emory spine specialist? Take our five minute quiz and find out!

About Dr. Rhee

John Rhee, MDJohn M. Rhee, MD, is a Spinal Surgeon and Associate Professor of Orthopaedic Surgery specializing in cervical spine surgery, lumbar spine surgery, complex spinal deformity surgery (scoliosis and kyphosis) and surgery for spinal tumors. Dr. Rhee is an active researcher and sought-after teacher/lecturer at the national and international level in multiple medical societies. He has served as faculty and been an invited lecturer at numerous meetings and courses on spine surgery. In addition, he has served as Program Chairman at numerous national and international spine surgery meetings. Dr. Rhee has also published extensively in a number of peer reviewed journals and books, and he has received numerous awards and honors. He is actively involved the training of international research scholars and other spinal surgeons and has been the author and editor of major textbooks on spine surgery techniques.

Related Resources

When Should You Consider Spine Surgery?

Spine SurgeryHave you been told you need spine surgery? If so, it’s reasonable to feel anxious or overwhelmed, which is why it’s especially important to gather appropriate information you’ll need to be an active part of the decision-making process. Below are a few things to consider before spine surgery:

  1. Over 90% of back and neck problems can be resolved without surgery. Nonsurgical treatments include anti-inflammatory medications, ice, heat, spinal injections and physical therapy.
  2. Rates of recommending surgery for the same problem vary widely in different parts of the country (and world), suggesting that the criteria for surgery are not always clear.
  3. Surgery does not benefit every type of spinal condition. While some conditions have a high success rate after surgery, others have less predictable success rates following surgery.
  4. 98% of all spine surgery is technically elective surgery, meaning it should be the choice of the patient, not something mandated by the surgeon.

Spine surgery is only needed in a small percentage of cases. Before surgery, it’s important to understand the likelihood of success, the possibility of residual or worsened symptoms, the risks of anesthesia, the risks of the spine surgery itself, and chances of recurrence in the future.

If your surgeon insists you must have surgery or has not discussed all of the points above with you, then you may benefit from a surgical second opinion.

In this radio clip taken during last month’s American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting, Dr. Boden shares more insight into spine surgery and when it’s appropriate. Listen>>

 

At Emory Orthopaedics & Spine Center, our spine surgeons and specialists are frontrunners in the research, development and perfection of the most effective approaches to treating spine, orthopedic, and sports medicine conditions, and our teaching other around the world to do the same.

To see if you may be a candidate for spine surgery, complete our spine quiz. Click to learn more about spine care at Emory, or call 404-778-7777.

 

About Scott Boden, MD

Scott Boden, MDScott 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.

Related Links

Spinal Tumor Symptoms & Treatment

Spinal TumorsTumors, whether cancerous (malignant tumors) or noncancerous (benign tumors), can develop and affect bones anywhere in the body, but when a tumor develops in or near your spinal cord or within the bones of your spine, it can be an especially serious condition.

Your spine is an extremely important part of your body as it holds up your head, shoulders and upper body. It also houses and protects your spinal cord and the nerve roots that control your arms, legs, and torso. The spine is made up of 31 small bones, called vertebrae, which are stacked on top of one another and make up the three sections of your spine (cervical spine, thoracic spine, lumbar spine) forming the natural curves of your back.

Your spinal cord runs through the middle part of the vertebra, which is called the spinal canal, and extends from the skull to the lower back. Spinal nerves branch out from the spinal cord through openings in the vertebrae, carrying signals between the brain and muscles.

The most common type of spinal tumor is one that spreads (a metastasis) from cancer arising in another part of the body, such as the breast, lung, kidney, prostate, thyroid, blood cells, or other tissues. Rarely, spinal tumors arise from the nerves of the spinal cord itself. Primary spinal tumors are those that arise from the bones in the spine – these are also relatively rare.

The closeness of a tumor to the spine and nerves that run through and between your vertebrae determines the severity of the condition. Tumors can compress and interfere with nerve function, affecting the messages being sent to and from your brain to the rest of your body. Since the spinal cord is relatively narrow, tumors within it may cause symptoms on both sides of the body. Tumors can also weaken the vertebrae, causing the spine to collapse and potentially cause pain or injure the nerves housed within.

Spinal tumors are different for each unique patient since they originate from different areas or develop from different cell types. Depending on where the tumor is, how advanced it is, how quickly it is growing and whether it is malignant or benign, symptoms and treatment options vary.

Common symptoms of spinal tumors include:

  • Pain
  • Muscle weakness
  • Loss of sensation or numbness (in the legs, arms or trunk)
  • Loss of bladder/ bowel control
  • Difficulty using arms or legs, inability to walk

Treatment for spinal tumors is determined on a case by case basis and may include surgery, radiation therapy, chemotherapy or other medications. If surgery is necessary, the goals are to stabilize the spinal column, relieve nerve pressure caused by the tumor, protect the nerves and spinal cord and remove as much of the tumor as safely possible.

For more information about spinal tumors and spine tumor treatment, visit Emory Orthopaedics & Spine Center. Our world renowned, highly skilled, specialized and experienced team includes orthopedic spine surgeons, neurosurgeons, orthopedic oncologists and radiologists, all working together to diagnose and treat a wide range of spinal tumors.

About Dr. Rhee

John Rhee, MDJohn M. Rhee, MD, is a Spinal Surgeon and Associate Professor of Orthopaedic Surgery specializing in cervical spine surgery, lumbar spine surgery, complex spinal deformity surgery (scoliosis and kyphosis) and surgery for spinal tumors. Dr. Rhee is an active researcher and sought-after teacher/lecturer at the national and international level in multiple medical societies. He has served as faculty and been an invited lecturer at numerous meetings and courses on spine surgery. In addition, he has served as Program Chairman at numerous national and international spine surgery meetings. Dr. Rhee has also published extensively in a number of peer reviewed journals and books, and he has received numerous awards and honors. He is actively involved the training of international research scholars and other spinal surgeons and has been the author and editor of major textbooks on spine surgery techniques.

Related Resources

Patient Video Story: Back to Life after Spinal Tumor Surgery

8 Tips to Fix Your Posture at Work

Good PostureFor the average working American, it is common to sit a minimum of eight hours a day and a majority of that behind a computer. I frequently see patients with neck and back pain that are not related to a specific injury, but rather from spending many hours at their desk (which usually involves using a computer). Sitting for extended periods of time can lead to a variety of health issues, including fatigue, muscle and joint pain.

Do you spend a lot of time behind a desk? If so, make sure your chair and work station are set up to fit you properly and influence good posture. Here are a few tips to help get you started:

  1. MONITOR POSITION: You should be able to sit straight in front of your computer and not have to turn from side to side to access it. The top half of the monitor should be in line with your eye height.
  2. DISTANCE FROM MONITOR: Keep your arms and elbows close to your body and parallel to the floor. You should not have to reach forward to use your keyboard. (Tip: try sitting about 18 inches from your computer screen).
  3. NECK: People who spend a lot of time on the phone often complain of neck pain. If you find yourself cradling your phone between your shoulder and chin so you can type and talk at the same time, switch to a headset or use a speaker phone. Also, be careful to not protrude your neck forward while looking at the computer screen. (Tip: Try keeping your ear in line with your shoulder)
  4. SHOULDERS: Keep your shoulders down and relaxed.
  5. BACK: Sit with your back pushed to the back of the chair with some form of lower back support between you and the chair back.
  6. ELBOWS and WRISTS: While typing, elbows should be at a 90-degree angle from your body, and your wrists and hands should be in a straight line. Make sure not to place stress on your wrists – keep them in a neutral position, not arched or bent. (Tip: Have the keyboard and mouse near each other and at the same height as your elbows).
  7. LEGS: When you’re sitting, your hips/thighs should be parallel to the ground or a little higher than your knees. Also, you don’t want the end of chair hitting the back of your knees—make sure to leave a little gap.
  8. FEET: Feet should touch the ground and lay flat on the floor. Sitting cross-legged or on one leg can lead to slouching. (Tip: if your feet cannot touch the floor, try using a footrest or box.)

Remember to give yourself breaks after you have been sitting for an extended period of time. Get up and move around regularly throughout the day, in fact, for every hour your work at your desk, give yourself several 1-2 minute breaks. Take a quick walk around the office, grab some water, chat with a coworker, or at least stand up and stretch.

I always tell my patients to listen to their body. If you are having pain, your body is trying to send you a message. If you experience neck or back pain that does not improve after trying the tips above, make an appointment with an Emory Spine physiatrist for further evaluation and treatment. To make an appointment, please call 404-778-3350 to speak to a member of our team.

About Diana Sodiq, DO

Dr. Diana SodiqDiana Sodiq, DO, is an Assistant Professor of Orthopedics and Rehabilitation Medicine. She is Board Certified in Physical Medicine and Rehabilitation (Physiatry). As an osteopathic physician, Dr. Sodiq is trained in both traditional medicine as well as osteopathic manipulative treatments (OMT). She started practicing at Emory in 2010.

 

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