Oh my aching back Mark A Giovanini M

Oh my aching back Mark A. Giovanini M. D. Neuro. Micro. Spine Specialist Andrews Institute www. markgiovanini. com www. neuromicrospine. com www. theandrewsinstitute. com www. smiss. org

Overview �Spine Anatomy �Definition of Terms �Spine evaluation �Conditions �Treatment options

Spine Components

Terms �Axial Pain �Radiculopathy �Pain �Parasthesia �Motor Weakness �Sensory �Sciatica �Mechanical Pain

Pinched Nerve

Nerves

Low Back Pain

Causes of Low Back Pain

What can you do? �Home remedies �Conservative Treatment �Physician consult �Emergent Evaluation �Neurologic Dysfunction �Bladder Incontinence

Home Remedies

Where Can You Go �Andrews Comprehensive Spine Center �Physical Medicine and Rehab �Pain Management �Physical Therapy �Diagnostics MRI �Neuro. Micro. Spine Specialists �Ortho. Paedic Spine Specialists �Athletic Performance Center

See your Physician

Conservative Specialists

Conservative Management �Physical Therapy �Medications �Anti-inflammatories �Steroids �Pain management �Epidural Injections �Facet Blocks �Chiropractic Care �Performance Enhancement

Spine Surgery �Who get’s better? �Patient motivation �Nerve pain vs. back pain �Does everything add up? �Questions to ask yourself �Can I live with this condition? �Is it getting worse? �Have I given it enough time? �Spine surgery is usually a temporary fix in most cases

Surgery Minimally Invasive �Benefits �Smaller incisions �Back to the good life earlier �Less pain post op and long term �Less blood loss �Less tissue damage to surrounding support structures �Goals �Same as traditional surgery through smaller less destructive portals �Artistry in Spine �Surgery designed specific to a patients problem

Open vs. MISS

Conditions �Disc Herniations �Lumbar �Cervical �Arthroplasty �Spinal Stenosis �Degenerative Disc Disease �Spondylolisthesis �Scoliosis �Compression Fractures

Lumbar Disc Herniation Symptoms Axial back pain Sciatica/Pinched Nerve Weakness Foot Drop Numbness Conservative Care PT Analgesics Massage Chiropractic 3 to 6 weeks

Lumbar Disc Herniation

Minimally Invasive Discectomy

Cervical Disc Herniation �Symptoms �Neck pain �Arm pain or paresthesias �Weakness/Numbness �Aggravating factors �Lateral bending �Neck extension �Sleeping with head back �Compression activities

Treatment �Physical Therapy �Traction �ROM �Decompression Therapy �Pain Management �Epidurals �Surgery �Neurologic Deficit �Intractable Pain

Cervical Disc Surgery: Anterior Cervical Discectomy and Fusion

Cervical Disc Replacement �Indications �Age 20 -45 �Single level �Soft Disc herniation �Benefits �Preserves motion �No Recovery time

Spinal Stenosis �Definition �Narrowing around the spinal cord and nerves �Symptoms �Back pain �Burning pain in legs or arms made worse with walking �May have “Neuropathy” �Warning Signs �Weakness, Numbness or Bladder dysfunction

Spinal Stenosis

Minimally Invasive Laminectomy �Outpatient �Minimal recovery time �Minimal Tissue Damage

Degenerative Disc Disease �Definition �Aging disc �Not a disease � Cause �Normal aging with aggravating activities �Symptoms/Signs �Axial Pain with motion �May have associated mechanical limb pain

DDD Treatment �Conservative �Pain management: Facet blocks, Epidurals �PT �Chiropractic �Modification of Activities �Surgical � Fusion � Anterior � Posterior � Side

DDD and Spondylolisthesis Surgery

Compression Fractures �Kyphoplasty �Video

Conclusion

Andrews Institute Spine Team � Coordinator � Bette Harrimen � Patient Liason � Maria Halpin � Physical Therapy � Pain Management � Neuropsychologist � Joel Fairbanks � Physical Medicine and Rehab � Robert Jensen and Dave Lemay � Neuro. Micro. Spine Specialist � Mark Giovanini � Orthospine surgeon � Dave Chandler