We have asked our physicians some commonly asked patient questions and they have answered. You may be asking yourself the very same questions as other patients. Check out what they have to say about common types of Orthopaedic conditions, how to pick the right surgeon if you end up needing one, what kind of treatments are used to manage pain, as well as many other inquiries.
The most common types of spinal conditions that we see include: sprains and strains of the spine, nerve compression/pinched nerves/sciatica due to a variety of causes, disk degeneration/arthritis of the spine, disk herniations/bulges, spinal stenosis, fractures of the spine/osteoporotic compression fractures, and spinal tumors.
The most important reason to make an appointment with a Spine Surgeon is to find out why you are experiencing pain, numbness or weakness in your neck, back, arms, or legs. Understanding what is happening inside your body is critical to finding non-operative solutions for the problem and preventing possible worsening of the condition. Our practice is focused on finding non-invasive solutions for our patients. Spine surgery is always considered the last resort of treatment used to resolve spine problems; however, is occasionally necessary when a patient begins to have signs of nerve damage, such as progressive numbness or weakness.
A sprain is a partial or complete ligament tear. A fracture is a broken bone. These conditions are very different, but both can cause a similar degree of pain. It is important to be evaluated to understand what is really happening in your body so that you ultimately pursue the correct treatment.
Cervical and Lumbar spinal stenosis is a condition that results in ‘pinching’ of the spinal cord and/or nerves most commonly due to severe arthritis. Patients with advanced spinal stenosis should avoid excessive stretching of the neck and back, especially through extension, side bending, and rotation. You should also avoid excessive involvement in sports and activities that bring out the ‘shoulder/arm’ and ‘buttock/leg’ pain that is often associated with these conditions.
Minimally Invasive spine surgery refers to a type of surgery with a minimal/lesser amount of injury to the tissues. There are many techniques and technologies available these days to increase the success of these minimally invasive surgical approaches. Many of these surgeries are performed on an outpatient basis, and patients can go home a few hours after the surgery is performed. Our surgeons are extensively trained and extremely proficient in many minimally invasive alternatives to traditional open spine surgeries.
If spine surgery is recommended, a thorough explanation of your spine problem is the most important starting point. Next, you will be guided on all of the necessary steps to prepare for a successful surgical procedure. You will also get detailed instruction on your role and your surgeon’s role in the follow up period after the surgery is performed. Your surgeon is your partner in the process of correcting your condition. Surgical options can improve patients’ quality of life by reducing pain, numbness, and/or weakness.
Orthopaedic Spine Surgery is its own subspecialized field of general Orthopaedic Surgery. Typically, general Orthopaedic surgeons have specialized training after medical school, called residency, of 5 years. In residency, all fields of Orthopaedic Surgery are learned and experienced. Physicians who designate themselves as specializing in Orthopaedic Spine Surgery have undergone a full extra year of training after general Orthopaedic residency, called Fellowship, where the entire year is dedicated to the field of Spine Surgery. Once this Fellowship is completed, usually at least two years of practice are required in order to become Board Certified by the American Academy of Orthopaedic Surgeons.
Every spine surgeon and his/her practice is different, but a few main things to consider would be
1) is the surgeon Board Certified and
2) did he/she complete a Fellowship in Spine Surgery and
3) is spine surgery a significant portion of his/her practice.
Physiatry is also known as physical medicine and rehabilitation, or sometimes just rehabilitation.
Physiatrist is a physician who specializes in the field of physiatry, also known as physical medicine and rehabilitation. Typically, physiatrists have specialized training after medical school, called residency, of four years. In residency, all fields of physiatry are learned and experienced. Once this residency is completed, usually at least two years of practice are required in order to become Board Certified by the American Academy of Physical Medicine and Rehabilitation.
A Physiatrist is a medical doctor (M.D.) who assesses a patient’s medical condition and current health status through history, physical examination, labs, diagnostic testing as well as review of his/her medical record. A physiatrist determines the most appropriate treatment plan such as prescribing medication or determining the most appropriate therapy (i.e. physical therapy, occupational therapy, speech therapy). The physiatrist may also determine possible exercises that can best alleviate a patient’s symptoms.
In contrast, the physical therapist works with the patient to complete the prescribed therapy (such as strengthening and stretching exercise, massage, heat and cold compression, ultrasound, nerve therapy, etc.) based on the prescription from the physiatrist.
Based on the patient’s symptoms and etiology, treatments offered can include medications such as anti-inflammatories, muscle relaxers, narcotics, etc. The physiatrist can also recommend non-invasive specialists (physical therapists, chiropractors, acupuncturists) and other outpatient procedure options including small joint injections and trigger point injections.
Common conditions that a Physical Medicine and Rehabilitation physician would treat include musculoskeletal pain (neck, back, joint pain in arms and legs), amputation, stroke, traumatic brain injury, spinal cord injury, or other nerve injuries.
The key to an accurate diagnosis of ailments includes a thorough medical history, comprehensive physical examination, review of medical records, diagnostic testing (X-ray, MRI, CT scan, NCS/EMG) and consultation referrals to appropriate specialists.
The Physical Medicine and Rehabilitation Physicians focus on pain management, nerve conduction study/Electromyelography to assess nerve injury, as well as management of patients with rehabilitation needs for stroke, traumatic brain injury, spinal cord injury, amputation, wheel chair and other assistive devices.
NCS stands for nerve conduction study, and EMG stands for Electromyelography. NCS is done by electrically stimulating nerves in arms and legs responsible for sensation and muscle movement, while EMG is done by inserting a small needle antenna to look and listen to the electric signal sent from nerves to muscles. NCS/EMG testing provides physiological evidence of nerve injury caused by spinal disk degenerative disease / radiculopathy / nerve impingement, as well as nerve entrapment injury in limbs such as carpal tunnel syndrome or cubital tunnel syndrome.
Pain management is a branch of medicine that applies science to the reduction of pain. It covers a wide spectrum of conditions including neuropathic pain, sciatica and postoperative pain. The goal of pain management is to minimize pain, rather than eliminate it. This is because quite often it is not possible to completely do away with it. Two other goals are to improve function and increase quality of life. These three goals go hand-in-hand.
Your doctor may refer you to pain management if she or he determines that your pain has become out of control.
Acute pain is of short duration, usually the result of an injury, surgery or illness. This type of pain includes acute injuries, post-operative pain and post-trauma pain.
Chronic pain is persistent and may be mild or severe. It is defined as pain lasting longer than 6 months. It is well documented that if acute pain is not treated appropriately it can progress to chronic pain.
Treatments for acute and chronic pain are generally quite different. In some cases, pain can be stopped or alleviated by a single procedure or series of procedures. Sometimes, chronic pain is part of a widespread disease process, and the specific cause may be difficult to pinpoint. Once we have identified the specific factor causing the pain, we may be able to treat it so that the condition no longer occurs. In some patients, the specific factor causing the pain–such as cancer–cannot be changed, but we may be able to reduce the pain or help the patient to better cope with the pain through a combination of medical, psychological and rehabilitation techniques.
Clear communication with your physician is vital in receiving proper diagnosis and effective treatment for pain. People who are informed and prepared will have more productive medical visits—by relaying critical details and asking the right questions. Here are some simple steps you can take to communicate with your healthcare professional:
Tell your doctor why you are there. At the beginning of the appointment, clearly describe your pain symptoms and any related symptoms, such as nausea, lack of appetite, and difficulty sleeping. In addition, tell your doctor if the pain interferes with activities—at home and/or work, or regarding leisure activities, and whether the pain has affected your mood.
Show your doctor where it hurts. Be as specific as you can. Tell your doctor if it hurts in one particular spot or over a region of your body.
Describe your pain with adjectives. Only you know how your pain feels, but you can better relay it to your doctor by using words such as aching, throbbing, shooting, stabbing, gnawing, sharp, tender, burning, exhausting, penetrating, nagging, numb, and unbearable.
Rate the severity of pain on a scale. Use a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine. Rate your pain for a period of time before your doctor visit, noting each timeframe for when pain is better or worse. Some people keep a pain diary to help them record how they feel over a period of time.
Provide information about when and how long your pain continues. Tell your doctor if your pain is continuous, periodic, or occasional. Recall the time of day when your pain is the worst, and if it is triggered or alleviated by particular activities — like standing, walking, getting in/out of a car, etc.
Devise a treatment plan with your doctor. Treatment varies. Your doctor may recommend treatment, such as massage or yoga, and can also prescribe medications to help the pain. Every patient has unique needs, so adjusting the plan with your doctor is essential to pain management.
Speak up. If prescribed medicine isn’t helping, talk with your doctor about different treatment options and adjust your pain management plan accordingly. Your symptoms are real, and you deserve to have your pain relieved.
As a first-time patient in a pain management clinic, you might experience the following: Clinical evaluation and prescribing of pain medications. Diagnostic tests, if necessary, as determined in the evaluation. Interventional treatment, such as injections or spinal cord stimulation. Physical therapy to increase range-of-motion and strength, and to prepare you to go back to work. Referral to surgeon, if indicated by the tests and evaluation. Psychiatry to deal with depression, anxiety and/or other issues that may accompany your chronic pain. Alternative medicine to provide a complement to your other treatments.