Mark A. Giovanini M.D. NeuroMicroSpine Specialist Andrews Institute Oh my aching back Mark A. Giovanini M.D. NeuroMicroSpine Specialist Andrews Institute www.markgiovanini.com www.NeuroMicroSpine.com www.theandrewsinstitute.com www.smiss.org

Overview Spine Anatomy Definition of Terms Spine evaluation Conditions Treatment options

Spine Components

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

Pinched Nerve

Nerves

Low Back Pain

Causes of Low Back Pain

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

Home Remedies

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

See your Physician

Conservative Specialists

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

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

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

Open vs. MISS

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

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

Lumbar Disc Herniation

Minimally Invasive Discectomy

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

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

Cervical Disc Surgery: Anterior Cervical Discectomy and Fusion

Cervical Disc Replacement Indications Age 20 -45 Single level Soft Disc herniation Benefits Preserves motion No Recovery time

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

Spinal Stenosis

Minimally Invasive Laminectomy Outpatient Minimal recovery time Minimal Tissue Damage

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

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

DDD and Spondylolisthesis Surgery

Compression Fractures Kyphoplasty Video

Conclusion

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