Posts Tagged ‘spinal stenosis’

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 >>

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?

When is Spine Surgery Necessary?

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

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

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

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

Sign Up for the Chat

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

About Scott Boden, MD

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

 

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

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

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

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

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

Purpose of Study:

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

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

Study Findings:

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

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

yoon-s-timAbout Dr. Yoon:

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

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

Spinal Stenosis: Treatment Options

spinal stenosisSpinal stenosis is a condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed (or narrowed). This narrowing occurs most often in the lower back or neck, and can put pressure on the spinal cord and nerves, causing a “pinching” of the spinal cord and/or nerve roots. The pinching can lead to a variety of symptoms, including pain, weakness and numbness. Symptoms often start slowly and get worse over time, and typically a person with this condition complains of severe pain in the legs, calves or lower back when standing or walking. Other symptoms include abnormal bowel/and or bladder function and loss of sexual function. Depending on where the narrowing takes place, you may feel these symptoms in the lower back and legs, neck, shoulder or arms. Usually, it is relieved by sitting down, leaning over or sitting forward.

In most cases, the narrowing is caused by osteoarthritis of the spinal column and discs between the vertebrae. It may also be caused by a thickening of the ligaments in the back, as well as by a bulging of the discs that separate the vertebrae. If you suffer from any or all of the above you should schedule an appointment with an orthopaedic spine specialist to determine if you have spinal stenosis.

How is Spinal Stenosis Treated?

The preferred treatment for cases of persistent back pain from spinal stenosis is a combination of physical therapy, prescribed exercise, and medications for chronic pain. Only if you have persistent pain, or if your pain does not respond to these efforts, will your physician consider surgery to relieve the pressure on the affected nerves or on your spinal cord. Here is what you can do:

  • Exercise: Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs. This will help to improve your balance, ability to walk, bend and move about, as well as control pain. A physical therapist will identify and show you what exercises are right for you.
  • Medications: The most common treatment for chronic pain in spinal stenosis is non-steroidal anti-inflammatory drugs (NSAIDs). These include: ibuprofen (Advil, Motrin), acetaminophen (Tylenol) and Naproxen (Aleve). Your physician may also prescribe other medications to help with pain and/or muscle spasm.
  • Cortisone injections: Injections directly into the area around the spinal cord (known as epidural injections) may provide a great deal of temporary, sometimes permanent, relief. These medications include: Cortisone (Celestone, Kenalog) and methylprednisolone acetate (Depo-Medrol, Medrol).
  • Surgery: In some cases you may need surgery to relieve spinal stenosis, particularly if a disc fragment is lodged in your spinal canal and is pressing on a nerve, which can cause significant loss of function. Some patients with severe or worsening symptoms (but who are otherwise healthy) may be candidates for what is known as a decompression laminectomy. This surgery removes the bone spurs and buildup of bone in the spinal canal, freeing space for the nerves and the spinal cord. This may be done in conjunction with a spinal fusion to connect two or more vertebrae and better support for the spine. It should be noted that while surgery may bring some relief, it will not cure spinal stenosis and symptoms may recur.

Living With Spinal Stenosis:

Spinal stenosis can be a real challenge day to day, but certain steps can be taken to ease some of the symptoms. Some treatment options include:

  • Get moving. If you’re capable, regular exercise is very important and you should do it often – at least three times a week for about 30 minutes. Start slowly and as you begin to feel stronger, add walking or swimming to your plan.
  • Modify activity. Don’t do anything that can trigger or worsen pain and disability such as lifting heavy objects or walking long distances.
  • Hot or cold packs. Some symptoms of cervical spinal stenosis may be relieved by applying heat or ice to your neck.
  • Canes or walkers. In addition to providing stability, these assistive devices can help relieve pain by allowing you to bend forward while walking.

About Dheera Ananthakrishnan, MD

Dheera Ananthakrishnan, MDDr. 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 routinely 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 as an adjunct to surgical care of her patients.

Related Resources:

Spinal Stenosis: Diagnosis and Symptoms

Spinal StenosisAs the baby boomer population ages, approximately 2.4 million Americans will experience lumbar spinal stenosis by 2021, according to the American Academy of Orthopaedic Surgeons.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases describes spinal stenosis as the narrowing of the spaces in the spine. This results in pressure being applied on the spinal cord and nerve roots. This narrowing condition can happen in three parts of the spine:

  1. The canal in the center of the spinal column, which holds the spinal cord and nerve roots
  2. The canals at the base of nerves that branch out of the spinal cord
  3. The openings between the vertebrae, which the nerves leave through to spread to the rest of the body

Sometimes this narrowing of the space inside the spinal canal produces no symptoms. However, if this places pressure on the spinal cord, cauda equina (a bundle of spinal nerves and nerve roots at the base of the spinal column), or nerve roots, there could be a slow onset and progression of symptoms. The neck or back may or may not hurt. Most often, people suffering from spinal stenosis experience weakness, cramping, numbness or pain in their arms or legs. If the pressure is mainly on a nerve root, they could experience a shooting pain down their leg, also known as sciatica.

If the spinal stenosis is severe, people may have issues with their bowel and bladder function, or even disorders of the foot. Cauda equina syndrome is an extremely rare, but serious form of spinal stenosis, and can cause loss of control of the bowel, bladder, sexual function, and/or loss of feeling, weakness or pain in the legs. This is a serious condition that requires immediate medical attention.

Because of the range of severity and symptoms, it is important to get a proper diagnosis from your doctor. They can use several methods to diagnose spinal stenosis and to rule out other conditions:

  • Questions about your medical history: you may have to explain details about any injuries, conditions or general health problems that could be causing these symptoms.
  • Physical examination: Your doctor will examine you to determine your range of movement, to see if you have pain or other symptoms when you bend backwards, and if you have normal neurologic function (sensation, muscle strength, and reflexes) in your arms and legs.
  • X-Ray: An x-ray of your back may be taken to find signs of an injury, tumor, or other problem. It will show the structure of the vertebrae and if there is any calcification.
  • MRI (Magnetic Resonance Imaging): An MRI can produce cross-sectional 3D images of your back, and can detect damage or disease of the soft tissues in your spine, and can show enlargement, degeneration or tumors.
  • CAT (Computerized Axial Tomography) Scan: This method can also show cross-sectional and/or 3D images, but can also display the shape and size of the spinal canal, what is in it, and the structures around it.
  • Myelogram: This is a liquid dye that x-rays can’t go through. It is injected into the spinal column and circulates around the spinal cord and nerves, which show up as white on the x-ray film. It can show the doctor if there is any pressure on the spinal cord or nerves from herniated disks, tumors or bone spurs.
  • Bone Scan: Your doctor may inject radioactive material that can attach to bone, especially where the bone is breaking down or being formed. This helps detect fractures, infections, tumors and arthritis (though it’s hard to tell between them). So a bone scan might be done along with other tests.

If you feel any of the symptoms outlined above, contact your doctor for a diagnosis. Though there is no complete cure for this ailment, with the guidance of your physician, steps can be taken to reduce pain and discomfort, and improve flexibility.

About Dr. Howard Levy

Howard Levy, MDDr. Levy is an Assistant Professor in the departments of Orthopaedics and Physical Medicine & Rehabilitation at Emory University School of Medicine. Dr. Levy specializes in non-operative spine care and focuses on helping patients achieve their best functional level. Dr. Levy started practicing at Emory in 1993.

Related Resources

Orthopedics at Emory

8 Types of Low Back Pain that Mean You Should Visit Your Doctor

What is the Sciatic Nerve? What is Sciatica? 

When Does Back Pain Call for an Epidural Steroid Injection? 

Ironman Triathlete Back on Track after Lumbar Laminectomy

Dr. Tim YoonWhen it comes to spinal disorders, there’s good news for the weekend warrior who enjoys vigorous athletic training and competitive sports activities. Being in great physical shape plays a large role both in your recovery and getting you back to an active lifestyle.

Joann Pope, one of my current patients, has an impressive athletic resume. She completed the half Ironman in Panama City, Florida, 21 times straight. She qualified for the world-famous Hawaiian Ironman seven times and finished four times. But two years ago, at the age of 74, her back started hurting and she had to stop racing due to lumbar spinal stenosis.

Lumbar spinal stenosis is a degenerative condition that causes a narrowing of the spinal column in the lower back, known as the lumbar area. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord. It can also squeeze and irritate the spinal cord itself, causing pain, numbness, or weakness, most often in the legs, feet, and buttocks.

You might think that the physical stress of being a triathlete took its toll on Joann’s back, but that isn’t the case. In fact, if she hadn’t been in such great shape, her spine might have begun degenerating long before it did. For more than 20 years, Joann has been running, biking, and swimming. She was 47 when she started running, back in 1984. After she ran the Boston Marathon, her daughter talked her into doing a triathlon, the ultimate endurance test – a grueling three-part race with no stops.

So, thanks to her level of fitness, it’s as if Joann has the body of someone 20 years younger. Despite her active lifestyle , the lumbar stenosis progressed, and Joann’s pain, which came on slowly, continued to get worse.

Before Joann came to see me, she’d been experiencing lower back pain for a year. To address it, she’d been taking pain pills twice a day and was undergoing physical therapy, the first line of defense for lumbar stenosis. But when therapy didn’t ease her pain, her physical therapist told her she needed to see a surgeon. She chose to come to the Emory Orthopaedics & Spine Center.

In July of 2010, I performed a lumbar laminectomy and fusion on Joann. This procedure, also called a decompression, relieves pressure on the spinal cord or spinal nerve by widening the spinal canal. In Joann’s case, I removed the portion of the bony roof of the spine, or lamina, that was pressing on her lumbar nerves. Then I fused the two lowest lumbar vertebra, L4 and L5, with screws. When she woke up, the pain she had before surgery was gone.

Because Joann had been in such great physical shape before the surgery, she recovered rapidly and was swimming and walking again quickly. Now she’s walking two miles a day and is working up to getting back on her bike. Joann remains pain free and plans to go back to racing.

Have you had a lumbar laminectomy, or would you like to learn how spine surgery at Emory can get you back to the active life you enjoy? We welcome your questions and feedback in the comments section below.

About S. Tim Yoon, MD:
S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and cervical spine surgery. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.