1. Mark A. Giovanini M.D. NeuroMicroSpine Specialist Andrews Institute
Oh my aching back
Mark A. Giovanini M.D.
NeuroMicroSpine Specialist
Andrews Institute

2. Overview Spine Anatomy Definition of Terms Spine evaluation Conditions
Treatment options

3. Spine Components

4. Terms Axial Pain Radiculopathy Mechanical Pain Pain Parasthesia
Motor Weakness
Sensory
Sciatica
Mechanical Pain

5. Pinched Nerve

6. Nerves

7. Low Back Pain

8. Causes of Low Back Pain

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

10. Home Remedies

11. Where Can You Go Andrews Comprehensive Spine Center
Physical Medicine and Rehab
Pain Management
Physical Therapy
Diagnostics MRI
NeuroMicroSpine Specialists
OrthoPaedic Spine Specialists
Athletic Performance Center

12. See your Physician

13. Conservative Specialists

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

15. Spine Surgery Who get’s better? Questions to ask yourself
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

16. 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

17. Open vs. MISS

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

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

20. Lumbar Disc Herniation

21. Minimally Invasive Discectomy

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

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

24. Cervical Disc Surgery: Anterior Cervical Discectomy and Fusion

25. Cervical Disc Replacement
Indications
Age
Single level
Soft Disc herniation
Benefits
Preserves motion
No Recovery time

26. Spinal Stenosis Definition Symptoms Warning Signs
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

27. Spinal Stenosis

28. Minimally Invasive Laminectomy
Outpatient
Minimal recovery time
Minimal Tissue Damage

29. 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

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

31. DDD and Spondylolisthesis Surgery

32. Compression Fractures
Kyphoplasty
Video

33. Conclusion

34. 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
NeuroMicroSpine Specialist
Mark Giovanini
Orthospine surgeon
Dave Chandler