Artificial Disc Replacement

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 a blog post about the history of artificial disc replacement.

The History of Artificial Disc Replacement

How Long Has This Spine Procedure Been Used?

          Submitted by Scott L. Blumenthal, MD on September 10th, 2012

Artificial disc replacement (ADR) or total disc  replacement (TDR) is a surgical procedure which replaces a degenerated disc in  the spinal column with an artificial motion device. It has been used in the  United States since the year 2000, but it originated in Europe almost 30 years  ago.

Before performing the first ADR in the United  States in March 2000, I did a lot of research on the procedure, including  visiting with a number of surgeons in Europe as well as the inventor of the  first FDA-approved ADR, Karin Buttner-Janz. Besides inventing the artificial  disc, she is well-known for being an Olympic and world champion gymnast from  East Germany.

With 12 years of experience, we have now  performed more than 1,400 disc replacements in our private practice alone.  Patients now have access to spine surgeons with extensive experience in disc replacement right here in the in the United  States.

Total disc replacement is an alternative to  spinal fusion. It is an innovative process of surgically removing a damaged  disc from the spinal column and replacing it with an artificial disc. This procedure can significantly benefit patients who suffer from herniated discs or degenerative disc disease with or without leg or arm pain.

Artificial disc replacement gives patients an opportunity to retain  mobility in both the neck (cervical spine) and lower back (lumbar spine). By  replicating the movement of a normal disc, ADR helps to alleviate adjacent disc  degeneration minimizing the need for additional spine surgery due to disc  degeneration or herniation.

Since 2000, a number of FDA studies of other  artificial discs began enrolling patients in the United States. Over a dozen  studies have been completed in the United States and currently there are four  discs approved for use in the United States.

The FDA-approved disc available for the low back  (lumbar spine) is the ProDisc-L.  For the  neck (cervical spine), the Bryan, Prestige, and ProDisc-C are available.

Looking forward to the future of artificial discs  in America: at least a dozen or so discs are either currently in-trial or have  completed the trials for FDA approval and will hopefully be available in the US  soon.

Chronic Back Pain and Depression

Is chronic back pain making you depressed?  Dr. Andrew Block explains.

Chronic pain is a problem affecting nearly 1/3 of the population in the US and depression is one of the problems which can accompany chronic pain. Statistics show about 85% of patients who have chronic pain experience symptoms of depression.

Some symptoms of depression include:

• Sleep disturbance – which includes sleeping too much or too little
• Appetite disturbance  – eating too much or not eating enough
• Loss of interest in previously enjoyable activities
• Withdrawal from other people
• Shortened sense of future or a fear of dying
• Loss of motivation

These symptoms plus a whole host of other symptoms make it very difficult to recover from chronic back pain.  In fact, there are a lot of indications chronic back pain and depression have primarily the same symptoms and they feed off of each other.  For example, when someone is hurting – they don’t sleep well, they lose their motivation and their enjoyment in life, which in turn creates depression and enforces chronic pain.

Fortunately there are many types of treatment available for chronic pain with depression.

Some treatment options of chronic pain with depression include:

• Anti-depressant Therapy –  Anti-depressants help to relieve the symptoms of depression but because the same biochemical pathways are involved in depression and chronic pain the anti-depressant medication can also have a secondary effect providing some pain relief.
• Cognitive Therapy – This type of therapy involves helping the patient observe their surroundings and find things they enjoy in their situation even though they are in pain. This helps the patient to be optimistic and the focus is not so much on the pain but the gains and good things in their lives which remain.
• The above treatments can also be combined with physical therapy exercises and rehabilitation to further help the patient learn ways to manage their pain.

If you are experiencing depression related to chronic back pain, don’t despair.  There are many treatment options available to help you.  Call us today and we can help get you the treatment you need.

Yoga Instructor Able to Increase Summer Classes Thanks to Back Surgery

Patient of the Month

Robbin Hallford went from unable to stand to increasing the number of yoga classes she teaches thanks to the miracle of 360 fusion.

Baby Boomer Robbin Hallford is a teacher and yoga instructor who can proudly state she is more active now than in her 20’s thanks to the miracle of modern surgery. Hallford, a 48-year old mother of three, underwent a 360 fusion around her L4 and L5 vertebrae in March of 2011. Since that time, she has proven daily that she can stay active and continue teaching yoga. In fact, she is planning to increase the number of classes she is teaching this summer, only a year after surgery.

Surgery was not Hallford’s first choice. After several days of pain and the inability to move her left leg, she attempted to manage the pain with chiropractic treatments. It was during these treatments that x-rays showed the lumbar area to be foggy. The chiropractor suggested an MRI, which Hallford took to a physician who recommended Dr. Michael Duffy of the Texas Back Institute.

“Dr. Duffy made every effort to help me control the pain, including steroid shots, pain control and anti-inflammatory drugs. Unfortunately, I had reactions to the medications, particularly the anti-inflammatory,” said Hallford.

Hallford collapsed in her class, which was the final straw. She decided to move forward with back surgery at Texas Back Institute. Dr. Duffy assembled a team of experts to ensure that Hallford’s surgery went smoothly. In March of 2011, they performed a 360 fusion on L4 and L5, giving Hallford much needed relief.

“We knew that Robbin’s condition would be considerably improved by a 360 degree fusion,” said Dr. Duffy. “Having a patient who was so dedicated to post-operative physical therapy certainly expedited her recovery.”

Hallford’sbackground is in physical therapy and kinesiology, so she was well aware of the effort it would take to recover from surgery.

“I was in devastating pain, thinking of giving up my yoga practice and going on disability,” said Hallford. “Thanks to Dr. Duffy and his great team, I am 100% better. I got the life back that I wanted. For me, surgery was the answer.”

Like many baby boomers, Hallford wants to continue an active life on her own terms and not let injuries or aging slow her down.

“My 48 does not look like my mother’s 48 or my grandmother’s. I do more now than I did when I was 20 years old. I’m stronger now. The surgery helped me to be able to keep that,” said Hallford.

Hallford is not a proponent of choosing surgery first. In fact, she chose to use her own knowledge and skills in yoga to postpone surgery as long as possible. In the end, it was the miracle of back surgery that gave her the life she wanted.

“If there is any way, do it without surgery. But it you cannot avoid it – go to TBI. I highly recommend Michael Duffy. To take me from where I was to where I am now, he’s a very skilled physician. The team they put together was top-notch. If you are facing [spine] surgery, I can tell you with all confidence you will get the best treatment and honestly I believe the best outcome.”

5 Tips for Dealing with Back Pain at Home

Back pain?  Try these at home treatments.

Do you know that 4 out of 5 Americans suffer from low back and neck pain at some point in their life? Many factors can contribute to this type of pain including poor posture, previous injuries, muscle strains or even disc degeneration.  The good news is most back pain and neck pain will get better without surgical intervention.

Try these tips if you find yourself fighting back pain or neck pain.

1. RELAX – As I mentioned above, most back and neck pain will heal on its own without surgical intervention.  Stressing out about back and neck pain will only add to your discomfort.
2. ICE – Apply a cold compress to the painful area.  Ice can be used for the first two or three days to help reduce swelling and inflammation and acts as a mild topical pain reliever.  Quick tip: You can easily make your own ice pack using liquid dish detergent and freezer bags.  Just pour detergent in the bag, seal tightly (removing air) and place it in the freezer.  You may want to double bag it just to be safe.
3. HEAT – Once any swelling/inflammation has subsided you may want to apply heat.  You can take a warm bath or shower or use a heating bad to help increase circulation to the painful area.
4. OTC PAIN KILLERS –For mild to moderate pain over the counter pain killers like aspirin, ibuprofen or naproxen can be helpful in easing discomfort. (Be sure to follow the suggested use instructions and don’t exceed the recommended daily dosage.)
5. STRETCH – Stretching will help extend the muscles in your neck and back and help release stress on your back and neck.  For your neck, slowly roll your neck from one side to the other holding on each side for 10 seconds.  Repeat 5-10 times.  For your back, lie face down and put your hands on the floor.  Slowly lift your upper body and slightly arch your back.  Hold for 10 seconds and repeat 5-10 times.

Most importantly, know when to seek MEDICAL ATTENTION.  If pain persists, seek medical attention from a physician.  If you aren’t sure what type of physician you should make an appointment with, call us! Dr. Effat Jehan is our triage specialist at Texas Back Institute and she can help determine what next step is most appropriate for your condition.

Uganda Mission 2012

Uganda Day 2

Contributed by Rachelle Lieberman

Today is our second day in Uganda and we are hitting the ground running.  The words “jammed packed” have several meanings for us today.  Our schedule is packed with appointments.  We were at Mulago hospital by 8 am this morning. Immediately we began to examine all the prospective patients for this year.  We also followed up with patients who had surgeries in previous years.

Below is a picture of some of the patients in the spine ward.

    

Izzy with Stella a patient he operated on in 2010 who is doing great!!!

 Izzy examines one of the kids from the orphanage.

 We ended up examining over 40 people in a matter of five hours. Today was undoubtedly another emotional day for all, but the look on the kid’s and parent’s faces when they find out they are going to get the surgery they need makes it all worthwhile!

Doctors examine a patient in the Mulago Spine Ward.

After all the patients were seen we then planned out the entire first week of surgeries as well as some of the second week. It is truly amazing to think about how many lives we are going to touch in just two weeks.

Izzy giving Dr. Nyatti a book Dr. Jack Zigler authored about spine trauma.

When I said earlier our day was jammed, I didn’t just mean at the hospital, I also meant the traffic! We were stuck in multiple traffic jams while traveling back and forth between the hospital, apartment, and dinner. To paint you a picture, imagine a small town with only a stoplight or two.  Sometimes they work, sometimes they don’t.  Now imagine no driving lanes and no rules of the road – other than honking your horn gives you the right of way. This was slightly stressful for those of us on our first trip to Uganda, but it didn’t seem to faze the mission veterans.

We have another full day tomorrow starting at 7:15 am. Two surgeries scheduled on the books so far, as well as lots of other meetings and organizing to do. More to come soon…

Uganda Spine Mission 2012

Uganda Spine Mission 2012

It is that time of year again when Dr. Lieberman and his team travel to provide spine care for the citizens of Uganda.  This year Dr. Lieberman’s team consists of the following members:

1) Izzy Lieberman (spine surgeon) Dallas

2) Brian Failla (equipment manager) Ft lauderdale

3) Paul Holman (spine surgeon) Houston

4) Krzysztof Kusza (anaesthesia) Poland

5) Zbigniew Szkulmowski (anaesthesia) Poland

6) Ejovi Ughwanogho (spine fellow) Dallas

7) Sherri LaCivita (scrub technician) Dallas

8) Elizabeth Wolhfarth (scrub technician) Ft lauderdale

9) Negozi Akotaobi (physical therapist) Dallas

10) Jason Ehrhardt (monitoring tech) Dallas

11) Rob Davis (equipment manager) Dallas

12) Rachelle Lieberman (teacher) Boulder, CO

13) Erin Sadler (medical student) Toronto

Today’s post was contributed by Erin Sadler.  Enjoy!

Day 1 – Arrival to Entebbe, Kampala

 The team all congregated at Heathrow Terminal 5 for a 9:15 pm departure to Entebbe International Airport.  After some brief introductions the team seemed to quickly mesh well together and a warm dynamic was almost instantly evident. The team this year is quite large with thirteen members with various backgrounds, from the United States, Canada, and Poland. After boarding the plane many of us were exhausted from our travels that brought us to Heathrow, and thus tried our best to take advantage of the 8 hour overnight flight to Entebbe and get some sleep!

We landed in Entebbe at 745 hrs after a few hiccups from the flight deck in their attempt to land with heavy tail winds. We were all pleasantly surprised by the beautiful weather with temperatures in the mid 20s (68 degrees fahrenheit). We all gathered our gear, minus a lost bag from Poland, and made our way to meet our buses that would be responsible for our transportation for the next 2 weeks. We loaded up the buses quickly and began our journey to Kampala. Along the route there was much to be seen and taken in. The first glimpse of the fertile Ugandan landscape, the vibrant Ugandan people everywhere you look, the pop-up stalls along the road, and the many handmade bed frames for sale along the roadside, without any mattress stores in sight kept us all entertained throughout the journey.

 We arrived at the Golf Course Apartments in Kampala where we will be staying for the next 2 weeks. These accommodations are very comfortable and well outfitted to suit our needs. Between the thirteen members of the team there are two apartments.  Once we had moved our luggage in and had a chance to refresh ourselves and brush our teeth for the first time in too long, we were once again off into Kampala to do some shopping to buy food items for breakfasts and other necessities like water, hand sanitizer, and the odd bottle of wine!  One hefty shopping bill later, and buses packed to the brim we headed back to the apartments to unload and organize ourselves before taking off again to go visit the two hospitals we will be working at.

The first hospital we visited was Case Hospital, which is a private hospital, relatively affluent with decent equipment, services and patient care; quite similar to a standard hospital in North America.

Izzy unpacking more surgical equipment.

Conversely, we then went to Mulago Hospital, which is the national public hospital; located on a sprawling campus of single story bunker-like buildings that serve as different wards. We specifically visited the Spine Ward, where we will be performing operations in the theatre, and the Orthopedic Ward.

Some surgical equipment at Case.

The spinal ward at Melago.

 

Supplies at the spinal ward in Melago.

Both were equally eye-opening: wide open rooms with several beds lined up side by side, filled with patients, and more surprising, the patient beds were surrounded by families. It was very interesting to see the dynamic of patient care in the Mulago setting, where the families seem to be the primary care givers despite the inpatient nature of the hospital accommodations. The families were huddled around the patients, sometimes having created a small area near the patient`s bed where they have essentially set up a temporary squatting home, feeding them self-prepared food, bathing them, and really the only people in the hospital providing vigilant care to these patients. Futhermore, the familial presence extends beyond the hospital walls, where as you walk outside you notice families have found a space to call their own on the hospital property and are essentially squatting there as their loved one remains in hospital. As I toured these poorly faciliated wards, I couldn`t help but question how these native Ugandans view us: as foreigners who are coming to try and help, or perhaps do they question our role in their medical care? To continue this enlightening cultural experience, we then went to walk through a nearby slum in Kampala. As a group we walked through narrow dirt alleyways for streets, which were covered in garbarge and had waste water running down the middle, as beautiful friendly people waved and smiled at us through the hanging laundry, and curtained doorways fondly yelling “Muzungu” as we passed them by. This was unlike anything I have ever experienced before in my life, and not because I haven’t seen images like this on television or in other popular media outlets, but I think I was most taken by the joy and sense of community that I felt in this incredibly extreme and impoverished environment. I guess I expected to feel sadder and helplessness, which I definitely did feel, but these negative feelings were overwhelmed by my feeling that although these people live in the most horrific conditions, their sense of community is really quite powerful and uplifting. Moreover, the throngs of beautiful children with toothy grinned smiles from ear to ear was also quite a powerful sight, for there seemed to be such a sense of responsibility of the older children to look after the young, and the spirit of the child was so clearly evident, it outshone any despair that they, or more likely I, was feeling.

Boy from the slums.

Ejovi playing soccer with some of the kids.

Picture of the slums.

As we got into our buses and drove 5 minutes down the road into our plush apartments it became very apparent how contrastingly different Ugandan life can be, just simply a few blocks apart. We couldn’t help but feel incredibly spoiled as we spent the rest of the afternoon cooling off by the pool, and then heading to an amazing Indian restaurant for a lively dinner and some delicious curries. Before everyone fell asleep at the table, we headed home to spend our first night in Kampala, and have sweet dreams of the upcoming days of hard, yet extremely meaningful work to come!

Our group at dinner.

Stay tuned for more updates!

I love my job because….

Guest blogger, Anabelle Gutierrez, Workers’ Compensation Specialist, love her job!

Workers’ compensation can be tricky which is why it’s important to have a concierge case manager dedicated to each patient. At Texas Back Institute we realize this and we have a team of dedicated work comp professionals to help each patient through the workers’ compensation process. My name is Anabelle and I am your resource for anything workers’ comp related at Texas Back Institute.

Anabelle and her beautiful nephew.

I love my job! I have worked at Texas Back Institute for several years and I still feel like every day I am going to make a difference in someone’s life.  My goal is to help walk each work comp patient through their treatment process.  When someone is injured on the job and unable to work it can be exceedingly stressful and I want to make sure when it comes to TBI, we make the process as easy as possible.

I strive to provide each one of my patients with individualized care and attentiveness.  I know it’s not only important for our physicians to communicate effectively; I also have to make sure I am keeping an open dialogue with my patients so they always know where we are in the process of their claim. I truly love the days when a patient expresses how much I have helped with their workers’ compensation process. When patients articulate they are able to do things now they couldn’t do before, I know I was part of the team who made it happen! My most memorable day thus far was when a former patient stopped by to let us know how she was doing. Her comment will always stick out in my mind. She said, “Texas Back Institute does get people back to life, look at me I can walk without pain!” I love knowing my job helps people get back to doing the things back pain or neck pain once prevented them from doing.

Scoliosis Awareness Month

June is Scoliosis Awareness Month

In honor of this special month we want to share more about our scoliosis and spine tumor center and some facts about scoliosis with you.

 

Dr. Isador Lieberman is our scoliosis and spine tumor specialists and on a daily basis he treats patients who are affected by scoliosis. Below are 5 things Dr. Lieberman wants you to know about scoliosis.

• In 85% of cases the cause of scoliosis is not known,  although we know there is a familial predisposition.
• The mother to daughter inheritance rate for scoliosis is 1 in 4 or 25%, father  to daughter is 1 in 10 or 10%,  mother to son is 1 in 10 or 10% and father to son is less than 1 in 20 or 5%.
• 3% of the people on the planet have a scoliosis curve that measures greater than 10 degrees, although the vast majority do not progress and only require observation.
• Book bags, sports, sitting slouched do not cause scoliosis.
• Scoliosis may be associated with back discomfort, however is not associated with debilitating back pain or neurological issues unless some other problem is also present.

Regardless of the extent of the scoliosis a general exercise program and maintenance of bone health is important.

Nikki Miller, a patient of Dr. Lieberman’s, shares her about her struggle with scoliosis and how she was finally able to find relief.

If you have been diagnosed with scoliosis please feel free to share your story in the comments section.

Weight Gain Causing Your Back Pain???

 Back Pain Weighing you Down?

Dr. Rey Bosita, Orthopedic Spine Surgeon at Texas Back Institute weights in on weight gain and back pain. 

 Could extra weight be to blame for your back pain?  According to a study published by the American Obesity Association, probably so.  The same study found nearly one-third of Americans are severely overweight or obese, and suffer from musculoskeletal (specifically back) pain.  Individuals with excess weight in their stomachs may experience back pain as a result of the excess weight pulling the pelvis forward and straining the lower back. 

With warmer weather on the horizon, why not make a plan to get outside and get some exercise?  Here are a few examples of things you can do outdoors to get yourself looking and feeling better in no time.

• Take a swim.  With the weather getting warmer swimming is great cardiovascular exercise and easy on the joints.
• Take the dog for a walk, at a moderate pace
• Toss the football or baseball with the kids
• Go for a bike ride
• Go on a family outing to the zoo, arboretum or aquarium.  Take the whole family!

Losing weight will not only do wonders for your waistline, but may also help alleviate back pain.

Do you have any great healthy recipes?  Share them here!

Patient of the Month – Denys Kendall

Denys Kendall….Back to Feeling Like a Person!

Denys Kendall never thought he would need spine surgery.  He was jumping out of airplanes, serving his country in Iraq and living the life of a true adrenaline junkie.  Denys served in the Army for 4 years, starting off in Special Forces and eventually moving into the First Cavalry at Fort Hood in Killeen, TX. 

Unfortunately for Denys, while receiving a series of vaccines to protect him from contracting anthrax, he developed a severe staph infection. The infection settled in his hip eventually eating away at the sacroiliac joint and the lower area of his lumbar spine. During the removal of an abscess, by surgeons outside of Texas Back Institute (TBI), one of his nerves was severed causing pain and weakness in his leg.

Denys’s pain got to a point where he knew he needed to seek attention from an expert and he began seeing Dr. James Cable, a pain management specialist at the Texas Back Institute to help determine what treatment options were available for his specific condition.  After performing a physical evaluation and reviewing Mr. Kendall’s case Dr. Cable referred him to his colleague Dr. Ralph Rashbaum, co-founder and orthopedic spine surgeon at the Texas Back Institute specialized in chronic pain management and interventional pain management.

Dr. Rashbaum and Denys discussed the possible treatment options and determined a spinal cord stimulator was going to give him the best possible results.  Luckily for Denys, the FDA had just approved the use of a new stimulator device that automatically adjusts to movements in his posture, making it virtually effortless to use.

Dr. Rashbaum recalls, “Denys came to Texas Back Institute with unrelenting pain radiating down his leg. He was the perfect candidate for the RestoreSensor because he is a very active gentleman and the sensor works well for people with active lifestyles.”

The decision to undergo the spinal cord stimulator implant was not an easy one for Denys, however, after doing his own research and his trust in Dr. Rashbaum Denys moved forward with the procedure.  “Dr. Rashbaum was very straightforward with me, and I love that,” said Denys. “He gave me realistic expectations but he was very confident this was going to be a life changer. Since my procedure the device has been doing its job like a champ.”

When asked what he most looks forward to doing now that his back pain is under control Denys states, “to me, it’s not so much about what activity, it’s about getting a life back! I can be a person again and that for me is invaluable. Dr. Rashbaum is a savior! He saved me.”