iron-man-3-730x400The movie smash hit of the summer is Marvel’s Iron Man 3 and its popularity can be explained on several different levels. The “superhero” in this blockbuster flick is both physically and emotionally scarred, so in many ways, he’s just like you and me. Plus, the action and special effects are non-stop. This science fiction, where the lead character’s  human body part is replaced by an artificial part, is science fact at Texas Back Institute.  How so? Read on.

Artificial disc replacement, pioneered by several spine surgeons at Texas Back Institute, including Dr. Scott L. Blumenthal, is in many ways more futuristic than the suit of iron that brash-but-brilliant industrialist Tony Stark wears to heroic advantage in Iron Man 3. Before delving into the reasons for Stark’s angst and ultimate redemption, we asked Dr. Blumenthal to gives us some insights into the ways he and his colleagues are transforming patients in pain to Iron Men and Women.

Artificial Disc Replacement – Medical Fact not FantasyScott L. Blumenthal, M.D

In post-movie interviews fans of Iron Man 3 have said that one of their favorite aspects of the story is the blurring of science fiction and medical fact. Since you have taken a part of the body – the disc that cushions the spinal vertebra – and replaced it with one that is artificial and more durable, what are your thoughts about this advancement?

When I started in medical practice, we talked about the TV show The Six Million Dollar Man. For anyone younger than 30, this was a fictional story about a man who had been critically injured and had many of his organs, muscles and limbs replaced by much stronger artificial ones. At this point in medicine, this replacement of real with artificial body parts is becoming reality, not fantasy. For generations, spine surgeons have been fusing vertebra when the discs wear out or are damaged.  Our patients were constantly asking “Why can’t you just  replace it?” Well, after much development and testing, now we can. In patients who have back pain resulting from damaged disc we can replace it with one that is man-made.  My colleagues and I formed the Center for Disc Replacement and now the fantasy is going to be main stream medicine.

What enabled Texas Back Institute to be at the forefront of this procedure?

Our advantage came from our opportunity to do the FDA testing of this procedure here at our clinic. This procedure had been very popular in Europe for many years (before being considered in the U.S.) and many people with the resources to travel there, were getting the benefit of this technology by going over there. Because we were asked to assist in this testing, we were the first practice to be able develop protocols for the procedure. Our experience here far outweighed other physicians in this country. We started lumbar disc replacement and went on to cervical disc replacement. We discovered extensive evidence that strongly suggested artificial disc replacement speeded recovery, so our patients returned to work sooner. We found this procedure had better outcomes than fusion and the overall costs were less.

What brought about the development of the artificial disc?

It’s a combination of factors. There is substantial patient demand and the technology in the composition of the artificial discs is excellent and continues to get better than it was 12 years ago when we started. Plus, there is a measurable economic benefit to disc replacement as opposed to other procedures.

Do you mean there are economic benefits to patients in the form of cost vs. outcome?

Exactly. This is why the major insurance companies – not known for their investing in medical technology simply because it seems to be good technology – have decided to cover this procedure. They clearly have good data that proves the costs for artificial disc replacement are reasonable when outcomes, long-term recovery and the incidence of future problems are considered.

What other medical advancements – which may seem like science fiction now – do you see becoming medical fact in the immediate future?

I see stem cell therapy becoming an important new frontier for back surgery and specifically disc damage. Patients are looking for different, non-invasive ways to alleviate back pain and these stem cells – some harvested from the patients suffering from the pain – have the potential to change the way we treat damaged tissue.

Watch Dr. Blumenthal comment on technology and spinal care.


What Makes Iron Man 3 So Interesting?

As the advertising blurbs about Iron Man 3 note, “the movie pits brash-but-brilliant industrialist Tony Stark (also known as) Iron Man against an enemy whose reach knows no bounds. When Stark finds his personal world destroyed at his enemy’s hands, he embarks on a harrowing quest to find those responsible. This journey, at more »every turn, will test his mettle.” Whew! All that in about 2 hours!

As fans of the three movies know, the first of the Iron Man films revealed Stark as a clever, resourceful scientist-adventurer-tycoon who launched his super-character and super-suit while trying to escape from a platoon of Middle Eastern terrorists. This film was followed by a sequel called, Avengers , which did not receive the same level of enthusiastic critical review or box office support. However, the third installment – Iron Man 3 – has critics and, more importantly, paying customers, raving.

Part of the reason this current Iron Man saga has been so successful has to do with the evolution of the lead character played brilliantly by Robert Downey Jr. This star has had his own, well-chronicled personal challenges and the Tony Stark character he plays in the movie is experiencing many of these same – all too human – difficulties.

Iron Man 3 is replete with action, special effects and the superhero formula that seems to cure all boredom. However, the lead character spends less time in his iron suit, fighting bad guys and more time contemplating his place in the universe. One reviewer was on the mark when he noted Stark discovers the answer to the question that has been haunting him: Does the man make the suit or does the suit make the man?

Watch the Iron Man 3 trailer here.

Since Dr. Blumenthal and his colleagues at Texas Back Institute  are turning what was medical science fiction a few years ago into medical fact today, we had to ask him if he had a favorite superhero when he was growing up? His answer should give hope to those who don’t particularly care for Iron Man, but do long to go where no man has gone before!

Blumenthal notes, “Actually, I was not a big fan of superheroes. I’m more of a Trekkie. Fortunately, the new Star Trek – Into the Darkness opens tomorrow and I will be there!”

Kentucky derby

Each year, on the first Saturday in May, horse lovers and sports fans turn their rapt attention to Churchill Downs in Louisville, Kentucky for the “fastest two minutes in sports.” Since its beginning in 1875, The Kentucky Derby has run consecutively each year and has become the premier event in thoroughbred horse racing.

Because of this pomp, pageantry and publicity associated with this race, many amateur riders become interested in equestrian sports and some of these will experience injuries from their new sport – especially in the area of the neck and back. This is where the advice of spine specialists at Texas Back Institute such as Dr. Ralph Rashbaum can come in handy. However, before getting some back health tips for equestrians, let’s take a two-minute look at the Run for the Roses.

A New Method for Qualifying This Year

The Kentucky Derby is a 1 and a quarter mile (2 km) race for 3-year old, thoroughbred horses and is the first race of horse racing’s championship series – The Triple Crown. Sports pundits call the race “The Run for the Roses” because the winning horse is draped with a blanket of stunning spring roses when it is in the winner’s circle after the race.

As every horse racing enthusiasts knows, there are hundreds of thoroughbred horses racing at tracks around the world each week. With this many horses, it’s interesting to note how the top 20 horses are chosen to line up at the gate in Louisville on Derby day. The eventual winner of the Kentucky Derby will have gotten there after competing in races around the country to qualify.

As the website of the Kentucky Derby notes, “This year marks the debut of a new way to determine which horses will join this select and storied field: The Road to the Kentucky Derby is a points-based system that replaces the previous selection method (graded stakes earnings) with a series of key races offering escalating points stakes during the course of the Derby year.

The Road to the Kentucky Derby is a long one, starting with the Prep Season races the previous September and building to a crescendo with the Championship Series in the weeks before the Kentucky Derby. Each race awards the top four finishers points that are tallied across all the races to determine the ranking of horses competing to make it into the Derby.”

For a listing of this year’s qualifying horses and their respective rankings, click here

Questions, Rumors and Facts about the 2013 Derby

As with all high-profile sporting events – the NFL’s Super Bowl, MLB’s World Series, and others – even the most minute facts, trends and rumors about the participants (in this case, the horses) entered in the Kentucky Derby are thoroughly scrutinized by experts and casual fans alike. This year’s Derby has a few questions that add to the drama of the race.

  • Highly successful trainer Todd Pelcher has 5 horses in this year’s race and he is teaming up with hall of fame jockey Calvin Borel on one of the favorites in this year’s race – Revolutionary. In 2010, the team of Pelcher and Borel won the Derby with Super Saver. Can they repeat this year?
  • One of the prominent prep races, The Bluegrass Stakes, was run on synthetic surface and since Churchill Downs is good, old fashion dirt, handicappers are trying to determine whether the winners of the race on synthetic surface will translate to the dirt track at the Derby.
  • Well-known and liked jockey, Gary Stevens, is returning to the sport at age 50. Stevens has been an actor and news anchor since retiring from racing a few years ago and will be riding one of the contenders – Oxbow – in this year’s race. Can someone who is old enough to be the father of most of the other jockeys win the race?
  • Highly respected trainer D. Wayne Lukus who is 77 years old and has been enormously successful at the Kentucky Derby will have two thoroughbreds in the race – Oxbox and Will Take Charge. Anytime Lukus has horses in the race, handicappers take notice because of his history.
  • The colt, Lines of Battle, is the only European entry in this year’s race and has won races going longer distances than the other horses in the race. Some feel that Lines of Battle is an excellent choice for a long shot.

Enjoy the Ride and Save Your Back

Just as NCAA’s Final Four tournament has the effect of getting many people out, shooting hoops, the Kentucky Derby energizes those who love horses. Since participating in equestrian sports can result in accidents and even long-term damage to the back, some caution and proper techniques should be considered before saddling up. To help us with this we’ve asked Texas Back Institute spine surgeon Dr. Ralph Rashbaum to give us some insights on back safety when involved in horseback riding.

In addition to diagnosing and treating patients with chronic back pain, herniated discs, back injuries and sacroiliac joint dysruption, Dr. Rashbaum has additional knowledge that most back specialists don’t have. He spent 16 years breeding Arabian horses and his wife and daughter have been involved in the sport of Hunter/Jumper equestrian competitions. With the Kentucky Derby approaching the final turn, we asked Dr. Rashbaum for some tips on back safety and riding.

RashbaumPatientWhat is the most serious health problem casual riders and competitors in equestrian sports should be concerned with? 

The biggest danger to the recreational rider is falling off the horse and injuring his/her spine, long bones (such as legs and arms) and pelvis. After a period of time, the ligaments of the rider get tired or become sore and the muscles become more lax. When this happens, a rider – especially one who does not ride on a regular basis – can be jostled off the horse and take a tumble. This can cause fractures in the vertebra and other injuries we would need to treat.

Are there any dangers to the neck and spine of riders who ride on a regular basis and if so, how can they avoid this? 

Riders who spend a lot of time pursuing this sport can experience a pinpoint injury or tenderness in the area where the sacroiliac joint and buttocks meet. This is not a spine injury but is caused by the repetitive concussion of the buttocks on the saddle when the horse is walking or jogging. This is not as big a problem when the horse is galloping.  Over time, this can result in a sharp pain. The best way to avoid this injury is to learn the proper posture and techniques for cushioning the constant bouncing when riding. This involves using the thighs and leg muscles to cushion the concussive bounces. This is a great argument for young riders to get professional instruction on riding techniques.

What are some physical signs a horse rider should come see a physician at Texas Back Institute? 

Anytime there is a burning pain, particularly if this runs down the leg and lower extremities, these suggest some problems and the rider should come see us. This is sometimes called “sciatica” and can be treated in several ways.

What is your opinion about the athleticism of the professional jockeys that will be riding in the Kentucky Derby Saturday?  

They are amazing athletes! Imagine getting into the posture they must get into in order ride – hips flexed, legs underneath, tremendous extension of the torso and neck all while keep their head up – for the length of time of a race. The jockeys who compete at this level have rigorous stretching exercises and are much more flexible than other athletes.

While their numbers are dwindling, there are still many men and women who raise cattle on large ranches. These folks spend a lot of time on horseback and this is not a sport but rather a job. What are the problems they should be aware of? 

Cowboys, whether they are working on a cattle ranch or competing in rodeos, have the same potential for concussive damage as a hunter/jumper contestant. Most learn, at an early age, how to reduce the concussive blows by using leg muscles to reduce this. However, rodeo contestants – particularly those who are involved in bulldogging where the cowboy ropes the calf, jumps off the horse, lifts the calf and then ties him – have a high risk of spine damage and disc herniation and we’ve seen a few in our examination rooms.

 

Protecting your neck and spine from wear and tear damage as well as injuries is an important part of enjoying equestrian sports. Plus, now that you have the scoop on the horses in this year’s Kentucky Derby, you’re ready for the race. All you need is a mint julep and you’re good to go!    

Dr. Scott Blumenthal was the first Orthopedic Spine Surgeon in the US to perform an Artificial Disc Replacement (ADR) surgery. This life changing surgery has now helped over 1,400 Texas Back Institute patients. Recently SpineUniverse.com featured the blog post below about the choosing the right spine surgeon for you.

Choosing the Spine Surgeon Who Is Right for You

Patients often wonder how to choose a spine surgeon to perform their total disc replacement.

The easy answer to this question is simple:  carefully.

The longer answer to this question is:  do your research, both on your surgeon and on the procedure.

Tips for Choosing a Spine Surgeon for Disc Replacement
While thousands of surgeons have been trained in disc replacement techniques, very few have adopted it into their clinical practice with any regularity.

Certainly, the bare minimum requirements for choosing a surgeon would be to ensure he/she is a board certified or board eligible orthopedic or neurosurgical spine surgeon.  “Board certified” means that the doctor has gone through a rigorous testing and peer evaluation process by a specialized medical board.

You can ask your doctor if he/she is board certified, or you can research it online.

Some tips to get a better feel for the expertise of the surgeon are:

  • Ask how long he/she has been performing disc replacement surgery and with what frequency they do this procedure.
  • Make sure your surgeon performs many types of surgery and can tailor your treatment to be most appropriate for your condition. Not every patient is best served with a spinal fusion, nor is every patient best served with disc replacement.
  • Make sure you have open communication with your physician.
  • Make sure you trust and have confidence in your surgeon’s abilities.
  • Look at the surgeon’s academic credentials or published papers.  Find out what they have written on disc replacement and if they are leaders in this specialized area of spine care.

A warning to patients:  Don’t depend on fancy advertising or marketing when choosing a surgeon.  Use all your resources when making a decision this critical. The Internet, medical directories and societies, as well as your regular physician can all be great resources in helping you decide which surgeon to go to.

There are also additional resources such as patient chat rooms and blogs where you can read about other patients’ experiences with surgeons.

Choosing a spine surgeon is a very important decision, and the more facts you can get, the better. Luckily, there are many resources to help you find a spine surgeon who is right for you.

1st US Service Member to Receive Artificial Disc Celebrates 8 Years Pain-Free

He was a U.S. Marine on Active Duty, planning a career as a Naval Aviator, when a herniated disc stopped everything. Alex Fender saw all his plans postponed, then stopped indefinitely, as physicians repeatedly told him that he would be ‘medically retired’ from the Corps at the age of 21. It was a prediction he refused to accept.

In 2004, Fender met Dr. Scott Blumenthal, a spine surgeon at Texas Back Institute in Plano. After the initial exam, Dr. Blumenthal suggested an artificial disc, which was a new procedure at the time.

Artificial Disc Replacement had just recently been FDA approved back then,” says Dr. Blumenthal, “I had exceptional outcomes since performing the first disc replacement in the US and I knew Alex would be a good candidate for this procedure.”

Fender was up and walking pain-free hours after his surgery. He had no complications, served four more years on Active Duty, and was honorably discharged in 2008.

Today, Fender is a successful entrepreneur in Dallas. He now serves as CEO of Funnel Science, an internet marketing and SEO agency.

“Staying healthy is objective number one,” says Fender. “You can’t get on with your life if you’re not able to get up and go to work. Texas Back Institute gave me that opportunity, and I’m glad to be an example of how well this surgery works.”

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