What to Expect When Treating Spinal Scoliosis with SurgerySpinal scoliosis is a degenerative spinal disease that can cause extreme pain or weakness in the legs while walking. In some extreme cases it can even lead to a curvature in the spine that causes…
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July 19, 2016
Bone Health
Brain and Spine Dr. Miller: Surgery for spinal scoliosis. We're going to talk about that next on Scope Radio. Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on the Scope. Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Darrel Brodke, he's an orthopedic surgeon at the University of Utah. He's also a spine specialist. Darrel, after conservative therapy some patients may not do as well as expected and they end up in your hands again where you may advise surgery. Tell us a little bit about that expectation and what happens. Dr. Brodke: Patients often with adult scoliosis often caused by degenerative disease, degenerative disc disease, and therefore in a subsequent deformity also have other problems related to that lumbar spine. Specifically low back pain and pain radiating into their legs. They may also have pain with associated numbness and weakness and fatigue. All of that may progress despite non-operative treatment, despite physical therapy, medications, even injections. And it's then that we start to talk about surgical intervention. And surgery often necessitates a big surgery, not a little surgery, and by big surgery I mean surgery that may take many hours and require several days in the hospital and several months of recovery. Dr. Miller: This is because you're operating on multiple levels of the spine, trying to straighten that curve that shouldn't be there. Dr. Brodke: Exactly. We're working both on making room for the nerves, decompressing anything that's pressing on the nerves, and then straightening the spine and holding it there with metal instrumentation: screws and rods and spacers. Dr. Miller: So this is a long surgery, but I imagine the recovery is also long. Dr. Brodke: Yes. The surgery itself can take many hours. It varies depending on how many levels of the spine are involved and how much we need to do. The recovery, likewise, can vary but usually is on the order of months, not on the order of hours or days. Dr. Miller: So tell us how you advise, sounds like the rehabilitation after the surgery is a significant part of the treatment. So do you send a patient to just physical therapy or do you send them to a physical therapy physician? Tell us a little bit about that. Dr. Brodke: Postoperatively we're working with physical therapy immediately after surgery. While still in the hospital, patients are getting up and walking and learning techniques of movement and balance with a physical therapist. Once they leave the hospital, some patients go straight home and can walk as their main therapy and their therapy for the next few months as the bone is healing is walking. Some patients aren't quite ready to go home and will end up in a rehab facility where they work every day with physical therapy until their strength and balance has come around. Dr. Miller: And that's very intensive Dr. Brodke: It can be very intensive, several hours a day work in order to get to the point where they're ready to be walking around the home and even outside the home. Dr. Miller: Now you mentioned you put some hardware in the back and to straighten the spine, I think you use metal rods and hooks and things like that and it sounds kind of daunting and it actually really helps straighten that spine. Dr. Brodke: Yes, it does sound daunting and it's rather impressive when patients and their families see the X-rays but the screws and rods that we use, mostly made out of titanium today, really help us straighten the spine and hold it there while the spine is healing from the surgery. Dr. Miller: So the hardware once it's implanted doesn't cause pain. It actually helps prevent it. Dr. Brodke: Exactly. It helps prevent the pain, it helps hold the position that we want to hold, and it doesn't really hurt long-term either. Most patients don't need their hardware removed. It just goes along for the ride for the rest of however long that ride is. Dr. Miller: So for our audience, it sounds like a small number of patients would need to have surgery to repair scoliosis. Basically this is a long and complex procedure followed by several months of rehabilitation but at the end of that if everything is going correctly you're going to feel better, you're going to have a better . . . going to have less pain, and you're going to be more functionable with your life. Announcer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com. |
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Over 40 and Have Searing Leg Pain When Walking? It Might Be Spinal StenosisSpinal stenosis is a narrowing of the spinal canal that can put pressure on the nerve roots in the back. It’s caused by age-related wear and tear or congenital factors in younger people.…
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July 05, 2016
Bone Health Dr. Miller: Spinal stenosis. Do you have that, and what do you about it if you do have it? We're going to talk about that next on Scope Radio. Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope. Dr. Miller: Hi, I'm here with Dr. Darrel Brodke and I'm Dr. Tom Miller, and Darrel is a professor of orthopedic surgery at the University of Utah. Darrel, what is spinal stenosis? Dr. Brodke: Well, spinal stenosis, Tom, is a narrowing of the spinal canal. The spinal canal is where the nerve roots coming off of the spinal cord come down through the remainder of your spine and then out to form nerves that go down your leg. This can also happen in the cervical spine, by the way, or the neck, but classically it's in the lumbar spine. So spinal stenosis is a narrowing in the space, like a pipe that had sediment built up so that the space is now so narrow that it's compressing the nerves. Dr. Miller: So the spinal cord, the main nerve, is compressed. Now does this happen because of trauma, does it happen in younger patients or older folks? What causes it? Dr: Brodke: Spinal stenosis is largely a disease of older folks, although we can see congenital stenosis in younger folks. Classically it would be an older person who started having problems with pain radiating from their buttocks down their legs, particularly when they walk. Dr. Miller: And does it come on suddenly? What kind of a pain is it? Is it burning, is it sharp, is it lancinating? I mean, is there a type of pain that one typically experiences when they have spinal stenosis? Dr. Brodke: Sure. So the pain, it can vary in nature from person to person, but it's common, most commonly, a pain that feels like pressure or a pain that feels fairly sharp and searing down the legs. It can also take the form of fatigue in the legs rather than actually frank pain and it commonly limits the distance that a person can walk or a time that they can stand. Dr. Miller: So when they stop walking the pain gets better, then they start walking again and it recurs. Dr. Brodke: Often they have to sit down or bend over for the pain to actually get better because that posture of flexion allows for increased space for the nerves and therefore better blood flow, better nutrients, and the nerves start feeling better. As soon as they stand up again, they start getting that compression of the nerves and then after a short period of time the nerves start responding by hurting. Dr. Miller: Darrel, is there a particular place in the spine that is more common to see spinal stenosis? Dr. Brodke: Yeah, most commonly we see spinal stenosis in the lumbar spine, that is the low back, and therefore it most commonly affects the buttocks and legs. We can see spinal stenosis in the cervical spine as well where it's actually pressing on the spinal cord causing problems with balance or stability or fine motor dexterity in the hands, but most commonly we see it in the low back. Dr. Miller: How does one treat this? Are there conservative ways to treat it? Do you go to surgery? Dr. Brodke: So we will often try to treat spinal stenosis, particularly in the lumbar spine, conservatively first. That means physical therapy, anti-inflammatory medications, changing . . . Dr. Miller: Things like ibuprofen, Motrin? Dr. Brodke: Exactly. We'll also have them change the way they do activities. In physical therapy we do exercises, for example, bent over inflexion because that opens the space for the nerves. So it's a specific kind of physical therapy. Dr. Miller: So the conservative therapy is something that you would prescribe for a patient. They would generally go to a physical therapist who would then carry out the type of exercise and treatment that you had recommended? Dr. Brodke: Yes. Dr. Miller: Now how often is that effective? Dr. Brodke: That's effective quite a fair amount of time. It's hard for me to estimate but I can quote you statistics from the literature in which maybe half the patients really feel like that was very effective, another third of patients feel like it was somewhat effective, and then there are a fair number of patients where that didn't work at all and we end up talking about surgery. Dr. Miller: And what percentage of patients would maybe need to go on to surgery, and if that is the case, tell me a little bit about that. Dr. Brodke: That's a number that's a little hard to get to because the total number of patients with spinal stenosis is not well identified, but if we look at studies in which only spinal stenosis patients are enrolled and we look at operative and non-operative treatment options, somewhat under half of the patients end up in surgery, and those patients that end up in surgery do extremely well. In fact, they do better than the non-operative patients do. Dr. Miller: So what's important is to go to someone who is a particular specialist in spine surgery so that they could actually select the patient for surgical procedure after having gone through rather conservative therapy. Dr. Brodke: Exactly. We'll often try conservative therapy whether you're seeing the surgeon first, or your primary care physician, or a physiatrist. All of those types of physicians are certainly well-capable of prescribing the physical therapy and anti-inflammatory medications, ibuprofen for example, that are the beginning of treatment for spinal stenosis. But as the disease progresses and for those patients that that actually doesn't work on, the next step would be to see a surgeon whose specialty is treatment of lumbar spinal disease. Dr. Miller: So for our listeners, if you're having burning pain radiating down from your buttocks down the sides of your legs that causes you to stop, you rest, it goes away, it starts again when you walk any distance, it's relieved when you're bending forward, you might have spinal stenosis. You'd probably see your primary care provider who can then refer you on to a spine specialist who might start with conservative therapy, likely would start with conservative therapy and that would generally do the trick in a number of patients, and if not, they would best advise you on what the next steps are and that might include surgery. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com. |
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Scoliosis is a Common Problem that Can Turn SeriousScoliosis is common and usually isn't progressive, and, fortunately, those with the condition often can live without much trouble. For some, however, scoliosis can cause pain and even impair…
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June 25, 2019
Bone Health
Brain and Spine Dr. Miller: Scoliosis - A Bend in the Spine. We're going to talk about that next on Scope Radio. Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope. Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Darrel Brodke. He's an orthopedic surgeon and a spine specialist here at the University of Utah. Darrel, what is scoliosis exactly? Dr. Brodke: Scoliosis is a curve in the spine. Technically it's a curve that goes sideways in the spine, because our spine naturally curves in the forward-backward plane, but sideways it's supposed to be straight. Dr. Miller: How do we get scoliosis, which sounds kind of abnormal? Dr. Brodke: Yeah, there are a number of ways to get scoliosis. The most common, frankly, is arthritis in the spine as an older adult. That is a very common way to get scoliosis as an adult. But what we commonly think of when we think of scoliosis is teenaged kids with a curvature in the spine that was picked up by the school nurse. That's called, the most common version of that, adolescent idiopathic scoliosis, and it's also fairly common but not quite as common as the degenerative kind in the elderly. Dr. Miller: So we hear that a lot of people have scoliosis. Do the majority of those people not have problems, they just live with the scoliosis? Dr. Brodke: Absolutely. In fact, most kids and adults with scoliosis often find out they have scoliosis because they're being evaluated for a different problem and never really had known that they had scoliosis before that evaluation and it doesn't really affect them in any way. Dr. Miller: It doesn't change their lifestyle, doesn't impact their livelihood. Dr. Brodke: Exactly. Dr. Miller: And it doesn't progress? Dr. Brodke: It doesn't progress in most people. Dr. Miller: Now the other type of scoliosis you mentioned is due to arthritis, so as patients are getting older that sounds a little more concerning. Dr. Brodke: It can be. It can also be fairly benign. It can be an incidental finding when somebody is being evaluated for low back pain, for a muscle strain, for example, and it might have nothing to do with the low back pain. Alternatively, it may be very involved in the patient's problem in their low back, for example, when there's involvement of nerve compression, and we often see that in degenerative scoliosis. Dr. Miller: Now patients that have scoliosis who don't have any problems, I suppose they would not need to see anyone. When would a person with scoliosis need to see a spine surgeon such as yourself? Would it be because of pain or limited mobility? Dr. Brodke: There are probably two main reasons and then a third that's common. I'll start with that third. The common reason is because they're concerned about it. They don't know very much about it and they want to talk to somebody who treats this regularly and would like to get more information. That's a very common reason to see a physician, and that's a completely valid reason. Most of those appointments are about patient education and reassurance and they don't lead to surgical intervention. There are times when the scoliosis can be a problem and should be seen by a specialist that sees and treats and operates on scoliosis. Probably the most common in adults, the adult scoliosis form, is when the patient feels very out of balance, either forward or sideways in a way that they can't straighten up, or they feel like their pain radiates down their legs and/or they have numbness and weakness in their legs and they can't do the things that they would like to do. Dr. Miller: So treatments would include graded therapy. So you'd start conservatively or do you need to go to operative therapy? Dr. Brodke: We will almost always start conservatively with physical therapy and medications like ibuprofen or naproxen, anti-inflammatory medicines, and sometimes we'll escalate to an epidural steroid injection or a little bit more aggressive treatment of pain. And if all of those fail we may talk about surgery. Dr. Miller: So the small percentage of patients with scoliosis would go on to surgery? Dr. Brodke: That's correct. Dr. Miller: So to wrap that up for our audience, basically scoliosis is a fairly common condition especially in the younger patients or in younger people, and usually is not progressive, does not cause symptoms, and you live with it without any trouble whatsoever. But in some people it is problematic. It can impair function, it can cause pain, and for that reason you would see a spine specialist and they would prescribe variable therapy from conservative therapy, including physical therapy and non-opioid analgesics such as ibuprofen and Naprosyn, and then a few would need surgery ultimately. Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.
Scoliosis can cause pain and even impair function if left untreated. When you should visit your physician for scoliosis and ways to lessen the pain. |