Spine Pain

90% of Back Problems Can Be Resolved Without Surgery

The thought of having to have spine surgery is terrifying to most people. The good news is that only about 10% of patients who have back or neck problems are candidates for surgery. At Emory Orthopaedics, Sports & Spine, we have non operative as well as operative physicians who specialize in the diagnosis and treatment of acute back and neck pain injuries. The non-operative physicians, physiatrists, only recommend surgery in the cases where it is absolutely necessary. There are many non-surgical spine treatment options that may fix back problems before opting for surgery. These non-surgical back treatments include anti –inflammatory medication, ice, heat, gentle massage, physical therapy, orthotics, and injections.

Patients should only consider surgery if all of the conservative treatment options have been exhausted. In this short video below, Emory’s non-operative sports medicine and spine physician, Dr. Oluseun A. Olufade describes Emory’s approach to caring for active individuals with back or neck pain. It is important to note that if your physician immediately suggests you have back surgery before giving you other options for your care, it may be a good idea to get a second opinion.

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About Dr. Olufade
Oluseun Olufade, M.D.Dr. Olufade is board certified in Sports Medicine, Physical Medicine & Rehabilitation and Interventional Pain Medicine. He completed fellowship training in both Interventional Pain Medicine and Sports Medicine. During his fellowship training, he was a team physician for Philadelphia Union, a major league soccer (MLS) team, Widener University Football team and Interboro High School Football team. Dr Olufade is also the team physician for Emory University and Blessed Trinity High School.

Dr. Olufade employs a comprehensive approach in the treatment of sports medicine injuries and spinal disorders by integrating physical therapy, orthotic prescription and minimally invasive procedures. He specializes also in treatment of sports related concussions, tendinopathies and platelet rich plasma (PRP) injections. He performs procedures such as fluoroscopic-guided spine injections and ultrasound guided peripheral joint injections. Dr. Olufade individualizes his plan with a focus on functional restoration. Dr. Olufade sees patients at our clinic at Emory Johns Creek Hospital.

Dr Olufade has held many leadership roles including Chief Resident, Vice-President of Resident Physician Council of AAPM&R, President of his medical school class and Editor of the PM&R Newsletter. He has authored multiple book chapters and presented at national conferences.

About Emory Ortho, Sports and Spine in Johns Creek and Duluth
Emory Orthopaedics, Sports & Spine has recently opened two new clinics, one in Johns Creek and one in Duluth. Emory physicians, Kyle Hammond, MD, and Oluseun A. Olufade, MD see patients in Johns Creek. Mathew Pombo, MD and T. Scott Maughon, MD see patients in Duluth. Our new clinic locations care for a full range of orthopedic conditions including: sports medicine, hand/wrist/elbow, foot/ankle, joint replacement, shoulder, knee/hip, concussions, and spine. To schedule an appointment call 404-778-3350.

Atlanta Opera Violinist Back on Her Feet Thanks to Emory Orthopedists!

Fia Mancini Durrett, Atlanta Opera Orchestra Violinist and Emory patient, recently played her violin for Emory Sports Medicine physician Sam Labib, MD and his clinic staff. Fia made a deal with Dr. Labib that if he could help rid her of foot and back pain, she would play her violin for him in clinic.

Dr. Labib held up his end of the deal, so on her last visit to the Emory Orthopaedics & Spine Center, Fia brought her violin along.

Patient Video Story: Back to Life after Spinal Tumor Surgery

Spine Tumor Patient Story VideoDoug House is an Emory Spine Center patient who had a large spinal tumor. Doug was in pain for over 10 years and had several problems performing basic daily activities including walking, sleeping, and controlling his bladder. He thought he would live the rest of his life unable to perform basic life functions. Doug was referred to our team at the Emory Spine Center and now is back to his old self and able to enjoy life again.

Watch Doug’s incredible story in the video below and learn more from Emory physicians Dr. Gerald (Rusty) Rodts and Dr. Daniel Refai on what makes spinal tumor treatment at Emory different.

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

Scoliosis, or a curvature of the spine, is a condition that affects almost 7 million people in the U.S. While it does occur in adults, it is most commonly seen in children, especially girls, during periods of growth. Although the deformity is complex and 3-dimensional, often times the spine in a person with scoliosis looks like an “S” or a “C” instead of a straight line.

Scoliosis

Adolescent scoliosis is the most common spinal deformity affecting pre-teens and teenagers, however it does not always result in significant pain or discomfort. Scoliosis may also occur in younger children and is often referred to as early onset scoliosis (EOS) in children less than five years old. EOS may significantly worsen as the children grow and cause severe spinal deformity and problems with the lungs or other internal organs.

Signs & Symptoms of Scoliosis

  • Uneven musculature on one side of the spine
  • Uneven hips, shoulders, or legs
  • Difference in the chest or breast area
  • Slowed nerve action (in some cases)

Causes of Scoliosis

About 65% of scoliosis cases are from unknown causes. Congenital scoliosis (caused by abnormally shaped vertebrae) accounts for about 15% and the rest is speculated to be caused by neuromuscular disease. Some researchers think genetics may play a role in who develops scoliosis, but it is not completely understood at this point.

Scoliosis Treatment Options
At Emory, we typically use non-operative treatments to minimize the worsening of scoliosis before we consider surgical treatments. Surgery is typically reserved for more severe cases of scoliosis. The vast majority of adolescent scoliosis can be managed with non operative measures including careful observation or spinal braces. Our surgeons have access to many local orthotics groups allowing for accurate and effective bracing for scoliosis.

Emory’s Experience in the Treatment of Scoliosis
Emory Healthcare orthopaedic surgeons have tremendous experience in caring for children of all ages with scoliosis. Our physicians are also unique in that they provide care to patients with scoliosis of all ages. When combined with our adult spine center, Emory is the only center in Georgia capable of treating patients from infancy into adulthood.

Emory pediatric orthopaedists Dr. Robert Bruce, Jr. and Dr. Nicholas Fletcher have extensive experience with growing rod and Vertical Expandable Prosthetic Titanium Rib (VEPTR) for the management of severe scoliosis in young patients. These techniques allow for continued growth of the spine in younger children to allow normal development and function. Emory is also one of the few centers in this region offering Mehta casting which is a non-surgical treatment in which the doctor manipulates the spine and then places the child’s torso in a plaster cast. This is especially useful for young children with early onset scoliosis and has been found to actually correct the curvature in certain patients.

Scoliosis Research On the Horizon
Our physicians have been involved in research evaluating opportunities to maximize scoliosis care in children of all ages and assess the long term outcomes of scoliosis surgery. Our research has been presented locally, nationally, and internationally in places as far away as Japan. Dr. Fletcher’s research has focused on clinical outcomes following scoliosis surgery including one of the longest term follow up studies on modern surgical treatment ever published.

Drs. Bruce and Fletcher are currently heading a study highlighting our post operative care following scoliosis surgery which has resulted in discharge 50% faster than the national average without any difference in complications allowing for early return to school for children and work for their parents. Another study is examining discrepancies in access to healthcare and the impact this may have on scoliosis severity.


Dr. Robert Bruce, Orthopedic SurgeonAbout Dr. Robert Bruce, Jr.
Dr. Bruce has been a fixture in the Atlanta community for 17 years having started practicing at Emory in 1995. His interests in spinal conditions include caring for all forms of pediatric spinal problems with an emphasis on idiopathic scoliosis and scoliosis in patients with cerebral palsy and other neuromuscular disease.

He is the director of the Children’s Healthcare of Atlanta (CHOA) cerebral palsy program and has a tremendous experience caring for all types of orthopaedic conditions in children with cerebral palsy from the spine to the hips to the feet. Dr. Bruce is also specialty trained in Ilizarov and the treatment of leg length differences and angular deformities. Outside of his clinical duties, Dr. Bruce serves on the CHOA medical board, is the past medical director of Egleston campus, and is currently the head of the orthopaedic team at Egleston hospital.

Dr. Nicholas FletcherAbout Dr. Nick Fletcher
Dr. Fletcher has been practicing at Emory since 2010 and cares for all forms of pediatric spinal problems including adolescent scoliosis, neuromuscular scoliosis, congenital scoliosis, early onset scoliosis, kyphosis, and spondylolisthesis.

He also has spoken locally, nationally, and internationally on his research in scoliosis. His work on adolescent scoliosis has been presented as far away as Japan and he has published multiple studies on early onset and adolescent scoliosis. His current research on comparing spinal casting and growing rod surgery was recently nominated as a top 10 podium presentation at the Pediatric Orthopaedic Society of North America meeting. He also received the 2010 T. Boone Pickens Award for Spinal research for his research in Adolescent Idiopathic Scoliosis.

Dr. Fletcher also specializes in pediatric and young adult hip conditions including hip dysplasia, femoroacetabular impingement (FAI), perthes disease, avascular necrosis, and slipped capital femoral epiphysis. He is one of only a handful of surgeons in the southeast with expertise in the Ganz or periacetabular osteotomy (PAO) for hip dysplasia and the modified Dunn osteotomy for slipped capital femoral epiphysis. He takes care of children of all ages with hip conditions in addition to young adults with hip dysplasia and impingement.
emoryhealthcare.org/orthopaedics

Understanding the Potential Benefits of Physical Therapy

National Physical Therapy MonthThe American Physical Therapy Association (APTA)’s National Physical Therapy Month (NPTM) is celebrated each October as a way to bring awareness around the potential health benefits to be sustained via physical therapy. Over 90% of back and neck problems, for example, will resolve themselves without surgery, and for some patients, there are unique benefits achieved from treatment by a physical therapist.

Physical therapy is a form of treatment—practiced by a licensed physical therapist under the referral of a physician. The purpose of physical therapy is to improve and/or restore mobility in patients for whom it is limited due to a medical condition, surgical procedure, accident or fall, neurological disease or other medical condition that has limited a patient’s functional mobility.  Often the injury limits the performance of everyday tasks.

Physical therapy programs at Emory Healthcare are available to support every type of mobility and functionality issue patients may experience. Whether a patient’s functional mobility issues relate to a neurological occurrence like a stroke, or an athletic injury like a torn ACL, our physical therapists available on both an inpatient and outpatient basis are here to help.

For more information on our physical therapy programs, including information on our department of Rehabilitation Medicine, please visit the links below.

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3 Things You Can Do Now to Prevent Future Back Pain

At some point in our lives, most of us struggle with lower back pain. The good news is it’s never too late to make positive changes in your lifestyle. Preventive steps now can help keep your back healthier down the road.These three things may make the difference between future suffering and living pain free:

1. Get active. Staying active may be the single most important thing you can do to maintain a healthy back. When you don’t get enough exercise, the muscle tone in your lower back can weaken, which may cause the pelvis to tilt too far forward, causing back pain. Regular exercise helps prevent back pain by strengthening your back and abdominal muscles. Just 30 minutes a day of a low-impact exercise like swimming, walking, or stationary cycling can increase muscle strength and flexibility. Yoga is also great for stretching and strengthening muscles and improving posture. If you’re already experiencing back pain, you may want to meet with an Emory physiatrist or physical therapist, who can customize an exercise plan for you.

2. Lose weight. If you’re overweight or obese, chances are you already experience back pain. One of the best things you can do now to ease pain and prevent future back pain is to lose weight. Being overweight or obese affects not only the cardiovascular and endocrine systems but the skeletal system. The skeletal system is made to support a healthy weight. Obesity puts an extra strain on all your weight-bearing joints, such as the hips and knees, but also on the spinal column. The resulting poor posture can cause chronic back pain.

3. Stop smoking. If you’re a smoker, you already know it’s not healthy. But you may not have realized it can contribute to back problems, not just later in life, but now. Many of the chemicals in cigarettes, including nicotine, have been shown to be toxic to spinal disc cells in laboratory experiments. Also, the carbon monoxide in cigarettes decreases the amount of oxygen in the blood. Because spinal discs have no capillaries, they rely on osmosis for oxygen delivery. Without oxygen-rich blood, the discs don’t get the nutrients they need, making them brittle and at risk for rupture.

Do you suffer from back pain? If so, what treatments have worked best for you? We welcome your questions and feedback in the comments section below.

Minimally Invasive XLIF Spine Surgery Can Speed Recovery Time

Dr. Tim Yoon, spine surgeonDr. Jim Rothermel, a retired ob/gyn, had been living with back and leg pain for more than three years. He was told that he needed extensive open spinal surgery. However, he came to the Emory Spine Center for another opinion and met with Dr. Tim Yoon, an internationally recognized spine surgeon and expert in minimally invasive techniques. Dr. Yoon diagnosed Jim with stenosis and scoliosis. His condition would typically require complex open spinal surgery, but Dr. Yoon determined that using a less invasive method, the XLIF technique, would reduce the stress on his body and reduce recovery time.

XLIF (eXtreme Lateral Interbody Fusion) is an approach to spinal surgery in which the spine surgeon accesses the intevertebral disc space and fuses the lumbar spine from the side rather than from the front or the back. By going through the side of the body with a small incision rather than through a large abdominal incision, much less soft tissue is traumatized, resulting in a faster recovery. XLIF may be an option for patients who have scoliosis, spondylolisthesis (where the vertebrae have slid in relation to one another), or spinal stenosis. These diagnoses typically causes leg pain and back pain.  When XLIF is used to perform a simple one-level fusion surgery, the patient often is able to go home the next day.

The XLIF technique can also be used to access multiple different discs and may be combined with other procedures, such as minimally invasive screws, to handle more complex cases, like Jim’s. This less-invasive approach can make surgery an option for people who, in the past, might not have been chosen surgery because of the prolonged recovery time or because the doctors thought the surgery was too invasive for a frail patient. Therefore, XLIF allows surgeons to treat more spinal conditions and different types of patients.

Emory spine surgeons have extensive experience performing a wide variety of spine surgeries. They know when the minimally invasive approach won’t be effective or should be combined with a bigger surgery. “Not everybody is going to be best treated by an XLIF, but I know who will be, and I choose those people,” Dr. Yoon says. “That way, you maximize the best results and minimize any likelihood of complications.”

Jim and his wife, Midge, couldn’t be happier with Dr. Yoon and their experience at the Emory University Orthopaedics & Spine Hospital. Jim says, “Dr. Yoon spent quality time with me. He thought he could do this XLIF procedure with a three-level fusion. He explained it in detail and then referred me to a website. I looked at the procedure carefully and thought it sounded like the proper way to go about doing it. He scheduled the surgery for two stages. We did the XLIF on a Monday, and he was able to do it in a manner that wasn’t muscle cutting. The recovery time was markedly improved.” Three days later, Dr. Yoon performed the second stage of the surgery, and a few days after that, Jim went home.

“Jim was extremely uncomfortable for over three years, and to see the difference in him now is just an absolute miracle. He’s happy. He’s always been a big teaser and silly, and I’ve got him back again,” Midge says.Have you had XLIF spine surgery, or would you like to learn more about spine surgery at Emory? We welcome your questions and feedback in the comments section below.

 

Can Osteoarthritis Be Prevented?

preventing osteoarthritisIf you’re starting to feel the twinges of pain or stiffness in your joints or spine, you may be wondering what’s causing it and whether you can prevent it from getting worse. One common contributor to joint and spine pain is osteoarthritis. Osteoarthritis is a common joint disease that is caused by degeneration of the cartilage, the cushiony substance between the bones, and if severe, it can then affect the bone itself. Osteoarthritis most commonly affects the weight-bearing joints (hips, knees, and spine).

The chance of developing arthritis increases with age. Although some people may have it as early as their 20s and 30s, it is more likely to develop osteoarthritis in your 50 and 60s and older. There is no cure for osteoarthritis, so prevention is the key. There are some risk factors that you can’t change, such as your genes (heredity) and your age. The goal is to decrease risk factors that you do have control over to help prevent osteoarthritis. These include:

  • Weight – obesity increases risk of arthritis
  • Trauma
  • Performing repetitive-motion tasks over a long period of time
  • Weaksurrounding muscles

The same factors that will help you prevent osteoarthritis can also help treat the pain and discomfort from osteoarthritis. Extra weight puts a strain on your joints, so try to keep your weight in a healthy range or lose weight if you’re not in that range. If you’re not sure what a healthy range is for you, check with your doctor. Also, keeping your muscles strong can help decrease the weight on your joints. If pain occurs while you’re doing an activity, listen to your body and decrease your intensity. Bear in mind that repetitive activities can cause joint pain and stiffness. Repetitive activities might include working on the computer or repeated bending or lifting. Try to find other ways of performing daily activities and be sure to take frequent breaks.

If you’re experiencing ongoing or increasing pain and stiffness, it may be time to see one of the physicians at the Emory Orthopaedics & Spine Center for further evaluation and treatment.

Emory physiatrists are physicians specially trained in rehabilitation and pain management. Our physiatrists can work with you to develop a plan that includes daily strengthening and stretching exercises to reduce pain and stiffness. Because osteoarthritis can occur in different areas of your body, you want a plan designed to target the affected joint or joints. Your physician may suggest formal therapy or bracing the joint to help ease pain. Finally, your doctor can suggest an over-the-counter anti-inflammatory medication or prescribe medication to help with the pain if needed.

Do you have osteoarthritis? What do you do to ease the pain and stiffness? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

Dr. Diana SodiqAbout Diana Sodiq, DO:
Diana 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.

Patient Story: Cynthia & Minimally Invasive Spine Surgery

Did you know spine surgery can now be done with only a small incision? Minimally invasive spine surgery is a relatively new set of techniques that has opened up surgery as an option for people who might otherwise have continued to suffer without surgery.

Patients often have the preconceived notion that spinal surgery will put them in bed and unable to walk for a long period of time. The fact is most spinal surgery does not lead to such a disabled state. And with minimally invasive surgery, patients can get back on their feet, out the hospital, and back to their normal routine faster than they’d ever have thought possible.

Cynthia Burnett is a great example of a patient who’s had minimally invasive spine surgery at Emory with excellent the results. In 2008, 56-year-old Cynthia Burnett woke up one day with excruciating nerve pain down her leg. Over the next two years, she suffered with this pain, despite multiple epidural injections. The pain just would not go away, even with the best non-operative treatment. Cynthia said she felt as if she’d aged 10 years. Her daughter recommended she come to Emory, where Cynthia saw one of our physiatrists, a nonsurgical physician who specializes in diagnosing and treating spine pain. He diagnosed a spinal stenosis (nerve pinch) and a slippage of one of her vertebrae on another. After careful analysis and discussions of options, she was told she’d be a good candidate for surgery. That’s when Cynthia came to me to discuss the surgical option.

At first, Cynthia didn’t want surgery. She said later, “My big concern about having surgery was the invasiveness. I’m healthy. I don’t go to the doctor very much. I haven’t been very sick. I just really didn’t want to choose to go under the knife.”

While not all cases can be treated with minimally invasive techniques, Cynthia was a great candidate for minimally invasive surgery. If this had not been the case, we could have used a traditional surgical technique with good results. But it would have required using, a relatively large incision to visualize the problem areas of the spine, thus a longer recovery time.

VIDEO: Cynthia’s Story of Minimally Invasive Spine Surgery

Instead, with Cynthia, we used highly specialized retractors that are placed through small incisions with X-ray guidance to minimize the soft tissue damage. Through these small incisions, the spinal nerves were decompressed (“unpinched”), and the slipped vertebra was stabilized with a spinal fusion procedure. The factors that enabled me to do this include advanced surgical instruments, advanced imaging systems (three-dimensional computer-guided navigation), and years of surgical experience. These things lead to surgical results that are safer, less invasive, and more reliable than ever before.

Cynthia had the surgery December 16, 2010. Afterward, she said, “It was amazing to me how easy it was to walk around, and my nerve pain was gone immediately.” Cynthia also said, “It’s amazing to think they could do that with the small incision that I have. I wish I had done it years ago. And I’ve already told other people who are in pain, you need to go.”  She was truly thrilled. At Emory, our goal is to get patients back to health as quickly as possible. That’s what minimally invasive surgery is all about.

Have you had minimally invasive spine surgery, or would you like to learn more about minimally invasive spine surgery at Emory? We welcome your questions and feedback in the comments section below.

Dr. Tim Yoon, spine surgeonAbout S. Tim Yoon, MD:
S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and is assistant professor of orthopedic surgery and chief of Orthopedics at the Veterans Administration Medical Center at Atlanta. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.

Is Your Desk Job Hurting You?

Neck Back Pain Desk Job PostureThese days, more and more jobs are desk jobs, meaning many people spend a minimum of eight hours a day behind their desks and at their computers. I frequently see patients with neck and back pain with no specific injury, but who spend many hours behind a computer. This type of work can have a number of health implications, including muscle and joint pain.

If you’re a desk jockey, one of the easiest things you can do to prevent pain from a poor workstation set-up is to have an ergonomic setup designed just for you. You want your chair and work station to fit you properly. Here are a few tips to help get you started:

  • Be sure your body is properly aligned with your desk and your computer. You should be able to sit straight in front of your computer and not have to turn from side to side to access it.
  • Keep your head, neck, and torso in line, and keep your arms and elbows close to your body but within reaching distance of your keyboard. You shouldn’t have to reach forward to use your keyboard.
  • While typing, your elbows should be at a 90-degree angle from your body, and your wrists and hands should be in a straight line, with your wrists in a neutral position, not arched or bent.
  • To prevent back pain, be sure your chair has good back support.
  • When you’re sitting, your thighs should be parallel to the ground or a little higher than your knees, and your feet should touch the ground. You don’t want the end of chair hitting the back of your knees—you want a little gap there.

Neck pain is a common complaint of people who spend a lot of time on the phone. 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.

Don’t forget to get up and move around regularly throughout the day. If you feel pain during your work day, stretching and moving around can help ease that pain, as can a heating pad or ice pack. You may even find some relief by treating yourself to a massage at one of the many Atlanta spas. I always tell each patient to listen to your body. If you are having pain, your body is trying to send you a message. If you are having neck or back pain that isn’t improving after trying the tips above, make an appointment with an Emory Spine physiatrist for further evaluation and treatment.

Do you spend a lot of time behind a desk? What do you do to get moving and ease pain? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Diana Sodiq, DO:

Diana 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.