Posts Tagged ‘herniated disc’

Meet your Spine Surgeon: A Conversation with Dr. John Heller 

Spine Surgeon

The spine supports the body’s weight and protects the nerves in the spinal cord that run through it. It helps maintain the body’s muscle control and nerve coordination, and without it, we wouldn’t be able to function. Spine surgery, a subspecialty of orthopedic surgery, includes the treatment and management of a wide variety of conditions affecting the neck and back, including herniated discs and fractures.

For Emory Healthcare spine surgeon John G. Heller, MD, the care and treatment of patients with spine issues is personally rewarding. His practice works to improve the lives of patients while training the next generation of spine surgeons.

Patients, understandably, often have many questions regarding spine conditions and their treatment. Recently, Dr. Heller spoke with Dr. Bruce Feinberg for The Weekly Check-up on WSB Radio about a wide range of issues related to the spine surgery. The following are summarized excerpts.

Question: Tell us about your team.

Dr. Heller: Over the last 28 years I’ve been at Emory, our team of spine specialists has grown a lot and so has our field. Right now, we have a team comprised of 11 orthopedic and neuro-spine specialists who are surgeons. We also have more than a dozen non-operative specialists, whose job it is to keep people from meeting the surgeons. It’s the minority of folks who actually need to or end up seeing a surgeon.

Question: How have you seen your practice grow?

Dr. Heller: We’ve been really fortunate in recent years to have the Emory Orthopaedic & Spine Hospital, in addition to Emory Midtown, to work in. It’s been a game changer for us and our patients. We have an entire hospital with a mission focused on joint replacement and spine. It’s a smoother experience for patients and we’ve seen that in our patient satisfaction rates, which are some of the highest in the country. We’re very proud of what we have built as a team, and in doing that alongside our educational and research activities. We now have points of access across the region to serve patients closer to home.

Question: How do you spend your days?

Dr. Heller: I alternate days either in the office all day or in the operating room all day. If I’m in the office, I see about 15 to 20 patients a day, which means I get to spend a good bit of time with each patient.

What we do really takes some time to get to know the patient, what’s going on and their options, and to go over all the information. On the days I’m operating, it can vary between a few operations that are several hours long each, to one operation that lasts anywhere from 10 to 14 hours.

Question: What is myelopathy?

Dr. Heller: We see and treat many cervical spine conditions, and this is one of our most common. Myelopathy is compression of the spinal cord caused by wear and tear which creates multiple points of pressure. We see this most commonly in those aged 55 and over. Myelopathy commonly presents with little to no pain, wobbly legs, and clumsy hands. There are a variety of different operations that we can do to help people with this condition.

Question: What is spinal stenosis?

Dr. Heller: Spinal stenosis is the narrowing of the spinal canal. As patients get older, their discs wear out and the place for the nerves in the low back and neck get crowded out. This condition can be associated leg pain, arm pain, back or neck pain, and sciatica.

Question: What is disc herniation?

Dr. Heller: Disc herniation commonly occurs in young healthy people who have a piece of a disc break off and compress a nerve. More than half the time, they never need to see a spine surgeon.

Question: What are your thoughts on using opioids to manage pain, given the concerns from patients and the medical industry?

Dr. Heller: Opioid abuse is dangerous, and we take prescribing opioids very seriously. Daily, on average, 142 people in the U.S. die because of prescription opioid accidents. We also know that taking opioids for a long enough period of time can make the pain worse, not better since they change the body’s central nervous system. I tell patients to use common sense, use what you need to when you need to, and don’t use it when you don’t need to.

Listen to the full conversation >>

Dr. Heller practices at Emory University Orthopaedics & Spine Hospital. To learn more about Emory Orthopaedics & Spine surgeons and treatment options available to you, visit www.emoryhealthcare.org/ortho or call 404-778-3350.


About Emory Orthopaedics & Spine Hospital

Emory’s Orthopaedics & Spine Hospital has locations across the Atlanta metro area. Emory’s physicians diagnose and treat conditions ranging from simple herniated disc and lower back and neck pain to more complex problems such as spinal tumor scoliosis and spine fractures. Emory Healthcare has the only hospital in Georgia that is dedicated to spine and joint surgery as well as non-operative spine and joint surgical interventions for physical therapy. For more information, or to schedule an appointment or an opinion, visit www.emoryhealthcare.org/ortho.

About Dr. John Heller

John G. Heller, MD, is an orthopedic surgeon specializing in the research and development of instrumentation in cervical spine surgery, including cervical disc replacement and laminoplasty. His clinical interests include herniated disc sciatica, spinal stenosis, and spinal tumors. An internationally renowned lecturer and teacher, Dr. Heller is the past president of the Cervical Spine Research Society and was one of the first surgeons in the country to perform laminoplasty.

Learn more about Dr. Heller >>

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.

 

Pinched Neck Nerve Causing You Pain? Find Relief

Pinched Neck Nerve:  Causes and TreatmentsWhat Causes a Pinched Neck Nerve?

A pinched neck nerve happens when the nerve root in your cervical spine (located in your neck) is irritated, squeezed or damaged as a result of:

What Are the Symptoms of a Pinched Neck Nerve?

A pinched neck nerve can cause:

  • Pain in the arm, neck or shoulder
  • Numbness
  • Tingling or a “pins and needles” feeling
  • Loss of reflexes
  • Muscle weakness

You may feel these symptoms in the arm and neck, or they may radiate to the shoulder, chest, arm, hand or fingers.

How is a Pinched Neck Nerve Treated?

Pinched neck nerves (cervical radiculopathy) often heal on their own in several weeks or months. Sometimes healing takes longer. If you have a pinched nerve that doesn’t go away on its own, talk to your doctor. He or she may recommend:

  • Medicines, such an pain pills, medicine that helps with nerve pain, oral corticosteroids, nonsteroidal anti-inflammatory drugs
  • Epidural steroid injection or a nerve root injection
  • Physical therapy to teach you how to hold your neck and practice proper ergonomics, decrease spasm, strengthen and stretch neck muscles, and improve range of motion
  • Soft cervical collar, which helps your muscles rest
  • Surgery, if you don’t respond to more conservative treatments

About Dr. Dreyer

dreyer-susan-jSusan J Dreyer, MD, has helped patients reduce their pain and increase their function through exercise, medications and injections. She has lectured nationally and internationally on the care of neck pain, radiculopathy, back pain and other spine conditions. She has published more than thirty-five articles and chapters.

 

 

Would you like to learn more about cervical radiculopathy treatment and specialists right now?

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:

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

Do You Think You Have a Ruptured Disc? Check Out These Signs and Symptoms of a Herniated or Ruptured Disc

Herniated DiscA 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 resulting 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). There are many causes of a herniated or ruptured disc including:

  • Degeneration due to aging
  • Wear and tear
  • Injury to the vertebrae
  • Sudden strain or sprain in lower back
  • Sports injuries or accidents

Symptoms of a herniated or ruptured Disc

Symptoms of a ruptured disc will vary from person to person but the most common symptoms of a herniated or ruptured disc include:

  • Severe pain in the back around the ruptured area
  • Muscle weakness, numbness, shooting pain or tingling in the legs
  • Muscle spasms
  • Pain in shoulders, arms, chest, ribs or thighs (depending on where the rupture has taken place)

Treatment for a herniated or ruptured Disc

Most often herniated discs can be treated without surgical intervention. We typically recommend starting a patient on anti-inflammatory medications, ice and heat to reduce the severity of the pain. In some cases a steroid injection may be helpful, and in others physical therapy with back exercises can be added to the treatment plan. If all other options are exhausted and radiating arm/leg pain persists after 6 – 12 weeks of treatment, surgery may be recommended.

If a herniated or ruptured disc is identified quickly, treatments are more likely to be successful. Any one with a ruptured disc should modify their activity level to avoid lifting heavy objects as well as avoid bending or any activities which worsens the radiation of arm/leg pain. Sports activities should also be reduced while healing.

Some surgery options for herniated or ruptured discs are:

At Emory, our nationally renowned spine specialists work together to diagnose and treat cervical spine and lumbar conditions. Emory physiatrists (non-operative physicians) and surgeons use innovative approaches to spine care and have extensive experience that allows us to boast high success rates. Emory is one of the largest University – based Spine Centers in the United States. Our physicians typically exhaust non-surgical options first, but if surgery is recommended, most surgeries for herniated or ruptured discs are performed at Emory University Orthopaedics & Spine Hospital in Tucker. Emory University Orthopaedics & Spine Hospital is a dedicated orthopedic and spine hospital and it leverages the pioneering vision, latest research and medical advances to provide high quality patient and family centered care.

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.

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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.