Posts Tagged ‘spine surgery’

As an Academic Medical Center, Emory Provides Superior Spine Care

Dr. Scott BodenI am often asked questions like “Will YOU actually be doing my surgery?” and “Does a teaching hospital mean someone will be practicing surgery on my back?” These questions made me realize that many patients don’t understand what it means to receive care in an academic medical center, so I thought I would try to explain this in more detail.

Most of the differences in a true academic medical center, especially for a spine center, represent benefits that the patient may not even realize. First, to be a physician at an academic medical center, the surgeon also must be a professor, usually in a School of Medicine. As part of the medical school faculty, these physicians, in addition to taking care of patients, are teaching surgical techniques to the future generation of surgeons and/or performing research that is allowing for new discoveries and advancements in the field. This means that patients are exposed to the latest advances in surgical techniques and technology.

In addition, because of the teaching process, the patient will likely have a second MD assisting (helping retract and hold tissues), rather than just one surgeon and a nurse or surgical assistant. I would liken it to a pilot and co-pilot flying an airplane. Spine surgery is serious business, with little room for error, so you can rest assured that at any reputable academic center (such as Emory), the key portions of the surgery will be performed by your surgeon.

A second benefit comes from the collaborative environment in a multidisciplinary spine center. At the Emory Spine Center, one of the largest in the U.S., there are physical medicine/rehabilitation, occupational medicine, psychology, orthopaedic surgery, and neurological surgery physicians all seeing patients side by side every day. This spectrum of physicians ensures that no matter what a patient’s spine problem may be, he or she is sure to find a true expert among the staff. This environment takes the worry away from the patient about which type of specialist to see.

All of the surgical and nonsurgical physicians working at the Emory Spine Center have been fellowship trained (which means they’ve received extra training to specialize in spine care) and spend the majority of their clinical practice diagnosing and treating only patients with spine problems. This level of sub-specialization is harder to find outside an academic center. In addition, academic medical centers usually have the resources to have the latest and highest quality imaging technology—which is also very helpful in spine care.

A third benefit comes from the fact that some of the toughest cases are referred to academic centers. As a result, these physicians have more experience with the toughest problems and rarest complications, so that in the unlikely event you do experience a complication, they are very comfortable diagnosing and managing it to minimize any long-term impact on your outcome.

Most of these and other advantages of an academic medical center typically go on behind the scenes, which is probably why so few people truly understand the difference.

How have you benefitted from spine treatment in an academic medical center? We welcome your questions and feedback in the comments section below.

About Dr. Boden
Scott D. Boden, MD, Director of the Emory Orthopaedics & Spine Center and Professor of Orthopaedic Surgery, is an internationally renowned surgeon, lecturer, and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH). Dr. Boden started practicing at Emory in 1992.

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.

Outpatient Spine Surgery? You Bet!

Dr. Tim YoonMany people have misconceptions about spinal surgery. They think spinal surgery has to be a big operation or that the recovery time after surgery has to be long. The truth is that there’s a common spinal surgery we perform as an outpatient procedure here at Emory, and with it we get great results. It’s called a lumbar microdiscectomy.

A lumbar microdiscectomy may be right for you if:

  • You have leg or foot pain, weakness, or numbness.
  • You’ve tried epidural steroid injections and they just don’t work.
  • An MRI has shown that you have a disc herniation that needs surgery.

What happens during a lumbar microdiscectomy? A lumbar microdiscectomy takes an hour or less of surgical time. In most cases, you can go home the same day you have surgery—usually within a few hours after the procedure. During the procedure, your surgeon removes the small portion of the disc that has herniated (protruded) and is compressing the nerve root to relieve the neural impingement causing your pain or weakness.

Lumbar MicrodiscectomyTo reduce surgery and recovery time, we use minimally invasive techniques, including:

  • anesthesia designed for outpatient surgery
  • x-ray guidance to make the most ideal incision
  • the smallest incision possible
  • a powerful microscope for better visualization through that small incision

After the surgery, you’ll be able to walk and do non-strenuous activities right away.

Our success rate at Emory for a lumbar microdiscectomy is very high, with patients often experiencing complete relief of pre-operative leg pain immediately after surgery.

Have you had a lumbar microdiscectomy, 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.

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.

Been Told you Need Spine Surgery? Be Sure to Get a Second Opinion

If you’ve been told you need spine surgery, here are some thoughts to consider first:

1) 90% of back/neck problems will resolve without surgery.

2) Rates of recommending surgery for the same problem vary widely in different parts of the country (and world), suggesting that the indications for surgery are not always clear.

3) Some spinal conditions have a high success rate after surgery, while other spinal conditions 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.

Patients should always take an active part in the decision-making process for spine surgery. You need to be sure you 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 has insisted that you must have an operation or has not discussed all of the points above with you, then you may benefit from a surgical second opinion.

Have you been told you need spine surgery? Have you already had spine surgery? Let us know about your experience. We welcome your questions and feedback in the comments section below.

About Scott D. Boden, MD:

Dr. Boden is the Director of the Emory Orthopaedics & Spine Center and Professor of Orthopaedic Surgery, an internationally renowned surgeon, lecturer, and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH). Dr. Boden began practicing at Emory in 1992.

Minimally Invasive Spine Surgery

Many patients ask me if they are a candidate for minimally invasive surgery or laser surgery or video-assisted surgery. The answer is that it really depends. It depends on the diagnosis, the number of levels of discs involved, the specific anatomy of the individual patient…the list of issues to consider is very long. However, whenever possible, I use minimally invasive techniques to reduce the pain and overall recovery time after the surgery.

A wonderful illustrative case involves Billy Rider, a 77-year-old gentleman who had been very physically active his whole life. Mr. Rider’s pleasures in life included taking walks and gardening. Unfortunately, he developed spinal problems and had so much pain in his back and legs that he just couldn’t do the things that gave him joy. He could stand or walk only for very short intervals. Conservative treatments had failed, and things were getting worse. His x-rays showed a significant curvature (scoliosis), and his MRI showed multiple areas of spinal narrowing (lumbar stenosis), causing nerve pinch.

At his age and considering the extent of Mr. Rider’s problems, some surgeons may have said no to surgical treatment or compromised and performed only part of the necessary surgery. However, I thought that by combining minimally invasive surgery methods with traditional surgery, it would be possible to reduce the overall “hit” to Mr. Rider’s body. Mr. Rider, his family, and I carefully went over the options and risks and potential benefits and decided to go ahead with the surgery.

The surgery was divided into two separate days to decrease the overall stress on Mr. Rider. On the first day, we performed “anterior spinal fusion” from L1 to L5. This was done in a minimally invasive manner to place “cages” between the vertebra to regain the height that he had lost and straighten out his scoliosis significantly. Mr. Rider recovered well from this and was able to get out of bed right away. His spirits were high.

About three days later, we did the bigger surgery on Mr. Rider’s back. This involved doing the traditional laminectomies to decompress his nerves that were “pinched” by the lumbar stenosis. We then placed in screws, rods and cages to stabilize the whole curve– from T10 down to the sacrum (part of the pelvis). We were able to reduce the amount of soft-tissue injury because we had already completed much of the fusion work on the first day. It was tougher for him to recover from the second surgery, but he did much better because of the less invasive techniques we used. As a result of the surgery, he has excellent curve correction and overall alignment. He recovered nicely and was discharged to go home.

Now, when I see him in the office, Mr. Rider is one of my happiest patients because he can walk without pain, and can work in his garden again.

Have you had or are you considering having minimally invasive spine surgery? We welcome your questions and feedback in the comments section below.

About S. Tim Yoon, MD, PhD:

Dr. Yoon 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.