- Johns Hopkins Analyzes the Effectiveness of Electrical Stimulation Therapies on Spinal Fusion
- Lumbar Puncture – Tufts Medical Center Community Care
- Lumbar Strain
- What causes lumbar strain?
- What are the symptoms of lumbar strain?
- How is lumbar strain diagnosed?
- How is lumbar strain treated?
- When should I call my healthcare provider?
- Living with lumbar strain
- Use good posture to avoid reinjury
- Key points about lumbar strain
- Next steps
- JHU Medicine – Spinal Cord Injury
- Our Mission
- Our Focus
- About Our Lab
- Current Projects
- Pulled muscle in lower back: Symptoms, treatment, and recovery
- Bottom-to-heels stretch
- Pelvic tilts
- Back extensions
- Lift objects carefully
- Practice yoga
- Recent News Articles
- Low Back Pain
- What causes low back pain?
- How is low back pain diagnosed?
- How is low back pain treated?
- Can low back pain be prevented?
- When should I call my healthcare provider?
- Living with low back pain
- Key points about low back pain
Johns Hopkins Analyzes the Effectiveness of Electrical Stimulation Therapies on Spinal Fusion
Researchers from The Johns Hopkins University School of Medicine performed a systematic review and meta-analysis of published data on the effect of electrical stimulation therapies on spinal fusion. They found significant improvement overall in the rates of bone fusion following a course of electrical stimulation in both preclinical (animal) and clinical (human) studies.
Detailed findings of this study can be found in a new article, “The effect of electrical stimulation therapies on spinal fusion: a cross-disciplinary systematic review and meta-analysis of the preclinical and clinical data,” by Ethan Cottrill and colleagues, published today (October 8, 2019) in the Journal of Neurosurgery: Spine.
Background: Each year in the United States approximately 400,000 persons undergo spinal fusion surgery for spinal instability, pain, and/or loss of function. For some of these people, surgery alone does not produce complete spinal fusion. In those cases, adjuvant therapies must be instituted to aid in the process of bone healing.
One of these therapies is electrical stimulation. There are three types of electrical stimulation therapy in use today: direct current stimulation, capacitive coupling stimulation, and inductive coupling stimulation (also known as pulsed electromagnetic field).
Conceptual illustrations of the 3 types of electrical stimulation therapies used in spinal fusion. A: Posterolateral L3-5 inter-transverse process spinal fusion using bone graft, without electrical stimulation.
B-D: Same procedure illustrating postoperative adjuvant therapy with direct current stimulation (B), capacitive coupling stimulation (C), or inductive coupling stimulation (D). In B, the electric generator is typically implanted subcutaneously.
In C and D, the electric generators are externally located. Credit: Copyright 2019 Ethan Cottrill.
Direct current stimulation requires implantation of a stimulation device, which is usually done at the time of spinal fusion surgery. The device is small and is placed under the skin on the patient’s back.
Via electrodes, the device delivers a small direct current of electricity to the area where fusion needs to occur.
The battery powering the device is good for 6 to 12 months; after that time, it can be removed or remain in place as the patient or physician deems appropriate.
Capacitive and inductive coupling stimulation therapies are noninvasive. With capacitive coupling stimulation, two small electrode pads are placed on the skin over the region of desired bone fusion. These pads produce an electrical field surrounding that region when powered by an external alternating current generator.
This device is worn by the patient for 6 to 9 months and operates approximately 24 hours per day. Inductive coupling stimulation involves the use of electromagnetic coils placed on the skin over the site of anticipated bone fusion. Alternating current produces an electromagnetic field to induce bone fusion.
This device need only be used for 30 minutes to 2 hours per day until fusion is confirmed.
Each therapy has a particular mechanism of action and carries advantages and disadvantages. These are all described and compared in the paper by Cottrill and colleagues.
Present Study: Application of direct or alternating electrical current has been shown to induce and speed up the process of bone healing following spine fusion surgery.
Evidence for this has come from small studies.
Cottrill and colleagues set out to pool the data from small studies on the effects of electrical stimulation therapies and to comprehensively assess these effects overall and in specific subgroups.
The authors performed a systematic review of all English-language articles describing the effects of electrical stimulation therapies on spinal bone fusion.
Applying specific inclusion criteria, they narrowed the studies down to 17 preclinical and 16 clinical studies.
Meta-analyses of data from all of the studies that included a control group were also performed (11 preclinical studies [257 animals] and 13 clinical studies [2,144 patients]).
The authors found, overall, that electrical stimulation was effective at augmenting spinal fusion. They found nearly a fivefold increase in the odds of successful bone fusion in animals and a greater than twofold increase in patients treated with electrical stimulation therapy.
With respect to the various types of stimulation therapy, the authors found that in animals the effects of direct current stimulation on spinal fusion were very beneficial, whereas the effects of inductive coupling stimulation were little different from no electrical stimulation at all. (No preclinical studies involved the use of capacitive coupling stimulation.)
In humans, both direct current stimulation and inductive coupling stimulation were highly effective in aiding spinal fusion. The authors were unable to find a difference in efficacy between these two types of electrical stimulation therapies.
Only one study of capacitive coupling stimulation therapy in humans fit the inclusion criteria of the systematic review, and that paper showed no statistically significant difference between fusion rates in patients who received electrical stimulation and those who did not (control group).
In a subgroup analysis of clinical studies, the authors found that the number of spinal levels that were fused and whether instrumentation was used did not change the effectiveness of electrical stimulation devices. They also found that these devices improved the rates of fusion in patient groups prone to have difficulty in achieving total spinal fusion, such as patients with difficult-to-treat spines and smokers.
When asked about the importance of the study, the senior author, Daniel Sciubba, MD, said, “We were surprised by how large an effect these therapies have on spinal fusion.
It was also encouraging to see that the preclinical data aligned with the clinical evidence, which supports future translational research efforts in spine surgery.
Ultimately, we hope our findings will help to inform patients and providers to enhance outcomes following spinal fusion.”
Reference: “The effect of electrical stimulation therapies on spinal fusion: a cross-disciplinary systematic review and meta-analysis of the preclinical and clinical data” by Ethan Cottrill MS, Zach Pennington BS, A.
Karim Ahmed BS, Daniel Lubelski MD, Matthew L. Goodwin MD, PhD, Alexander Perdomo-Pantoja MD, Erick M. Westbroek MD, Nicholas Theodore MD, Timothy Witham MD and Daniel Sciubba MD, 8 October 2019, Journal of Neurosurgery: Spine.
Lumbar Puncture – Tufts Medical Center Community Care
A lumbar puncture is a procedure used to get a sample of spinal fluid from the area around your spine. It is also used to inject medicine or dye into the area.
The term lumbar refers to the lower part of your back, between your tailbone and your ribs.
A needle is put into your lower back between the bones of your spine to get the fluid sample or put in medicine or dye. This test is also called a spinal tap.
This procedure is used to:
- Check for infections, diseases, or other problems that may affect your brain and spinal cord
- Inject an anesthetic to numb your lower body. This may be done so that you will not feel any pain during childbirth, surgery, or other procedures. This is known as spinal anesthesia, or â€œa spinal.â€
- Inject drugs to treat cancer or diseases of the nervous system
- Inject dye for X-rays or a CT scan of the spine
Often no preparation is needed unless your healthcare provider gives you special instructions.
- You may or may not need to take your regular medicines the day of the procedure. Some medicines ( aspirin) may increase your risk of bleeding during or after the procedure. Tell your provider about all medicines and supplements that you take. Ask your provider if you need to avoid taking any medicine or supplements before the procedure.
- Tell your provider if you have any food or medicine allergies.
- Follow any other instructions your healthcare provider gives you.
- Ask any questions you have before the procedure. You should understand what your provider is going to do. You have the right to make decisions about your healthcare and to give permission for any tests or procedures.
A lumber puncture may be done in a clinic, surgery center, or hospital. It usually takes less than 20 minutes.
Before the procedure you may be given medicine to help you relax, but you will usually be awake during the procedure. You will be given a local anesthetic with a small needle to numb the area.
Usually, you will lie on one side with your knees bent and pulled up, with your chin touching your chest. Sometimes your provider will have you lean your head and shoulders forward onto a table or pillow.
These positions allows the bones in your spine to spread far enough apart for your healthcare provider to insert a needle into the area where a sample of spinal fluid can be removed or medicine or dye can be injected.
Usually, you can go home soon after the test. If you were given medicine to help you relax, you will be watched carefully until you are fully awake and alert. This may take 15 minutes to a couple hours.
If you were given dye, drinking a lot of fluids after the procedure helps your body get rid of the dye.
You may have a headache after the procedure. Follow your healthcare providerâ€™s instructions for things you can do to try to prevent a headache.
Ask your provider:
- How and when you will hear your test results
- How to take care of yourself at home
- If there are activities you should avoid and when you can return to your normal activities
- What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.
Every procedure or treatment has risks. Some possible risks of this procedure include:
- You may have problems with anesthesia.
- You may have infection or bleeding
- You may have headaches if fluid leaks from the needle insertion site.
- Other parts of your body may be injured during the procedure.
Ask your healthcare provider how the risks apply to you. Be sure to discuss any other questions or concerns that you may have.
Linkedin Pinterest Sports Injuries Sports Injuries
A lumbar strain is an injury to the lower back. This results in damaged tendons and muscles that can spasm and feel sore. The lumbar vertebra make up the section of the spine in your lower back.
What causes lumbar strain?
Injury can damage the tendons and muscles in the lower back. Pushing and pulling sports, such as weight lifting or football, can lead to a lumbar strain.
In addition, sports that require sudden twisting of the lower back, such as in tennis, basketball, baseball, and golf, can lead to this injury.
Certain risk factors, such as excessive lower back curvature, forward-tilted pelvis, weak back, or abdominal muscles, and tight hamstrings, can increase the risk for this injury.
What are the symptoms of lumbar strain?
The following are the most common symptoms of a lumbar strain. However, each person may experience symptoms differently. Symptoms may include:
- Sudden lower back pain
- Spasms in the lower back that result in more severe pain
- Lower back feels sore to the touch
The symptoms of a lumbar strain may resemble other conditions and medical problems. Always talk with your healthcare provider for a diagnosis.
How is lumbar strain diagnosed?
In addition to a complete medical history and physical exam, diagnostic procedures for low back pain may include the following. However, during many initial assessments and exams, specialized tests aren't usually recommended.
- X-ray. A diagnostic test that produces images of internal tissues, bones, and organs onto film.
- Computed tomography scan (also called a CT or CAT scan). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. A CT scan shows detailed images of bones, muscles, fat, and organs.
- Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
- Electromyogram (EMG). A test to evaluate nerve and muscle function.
How is lumbar strain treated?
Specific treatment for a lumbar strain will be discussed with you by your healthcare provider :
- Your age, overall health, and medical history
- Extent of the injury
- Your tolerance for specific medicines, procedures, and therapies
- Expectation for the course of the injury
- Your opinion or preference
Treatment may include:
- Ice packs and/or heat and compression applied to the back
- Exercises (to strengthen the abdominal muscles)
- Stretching and strengthening exercises (for the lower back as it heals)
- Education regarding the use and wearing of appropriate protective equipment
Medicines, such as anti-inflammatories and spinal injections, may also be used to relieve pain and inflammation.
When should I call my healthcare provider?
Call your healthcare provider if any of the following happen:
- You’re unable to stand or walk.
- You have a temperature over 101.0°F (38.3°C)
- You have frequent, painful, or bloody urination.
- You have severe abdominal pain.
- You have a sharp, stabbing pain.
- Your pain is constant.
- You have pain or numbness in your leg.
- You feel pain in a new area of your back.
- You notice that the pain isn’t decreasing after more than a week.
Contact your healthcare provider immediately for the following:
- Pain radiating down the leg
- Pain that is accompanied by fever, weakness in the leg, or loss of control of the bladder or bowels
Living with lumbar strain
Cold reduces swelling. Both cold and heat can reduce pain. Protect your skin by placing a towel between your body and the ice or heat source.
- For the first few days, apply an ice pack for 15 to 20 minutes .
- After the first few days, try heat for 15 minutes at a time to ease pain. Never sleep on a heating pad.
- Over-the-counter medicines can help control pain and swelling. Try aspirin or ibuprofen.
Exercise can help your back heal. It also helps your back get stronger and more flexible, preventing any reinjury. Ask your healthcare provider about specific exercises for your back.
Use good posture to avoid reinjury
- When moving, bend at the hips and knees. Don’t bend at the waist or twist around.
- When lifting, keep the object close to your body. Don’t try to lift more than you can handle.
- When sitting, keep your lower back supported. Use a rolled-up towel as needed.
Key points about lumbar strain
- Lumbar refers to your lower back.
- Strain can cause damage to the tendons and muscles causing pain and soreness.
- Nonsurgical methods can cure most low back pain.
- Call your healthcare provider if symptoms don’t get better over the next several days or if symptoms get worse.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
JHU Medicine – Spinal Cord Injury
Welcome to The Johns Hopkins University, School of Medicine, The Spine Team!
The mission of the Spinal Cord Injury Laboratory is to combine novel bioengineering methods with stem cell derivatives in order to develop a clinically relevant spinal cord injury therapy model.
We use oligodendrocyte precursors derived from pluripotent human stem cells and study their effect in repairing contused spinal cord tissue in conjunction with acute hypothermia.
The mechanism and extent of repair are studied in great detail using cutting edge tools such as electrophysiology, DT-MRI, electron microscopy and bioluminescence imaging.
The focus of our translational research is the use of oligodendrocyte precursor cells derived from either human embryonic stem cells (hESC) or induced pluripotent stem (iPS) cells for application in a rodent model of contusive spinal cord injury. We combine cell replacement therapy with acute hypothermia therapy, which has been demonstrated to have a neuroprotective effect and which limits the secondary phase of spinal cord injury.
About Our Lab
We utilize a variety of bio-engineering assessment technologies, such as DT-MRI and other imaging techniques, to monitor anatomical changes in the injured spinal cord architecture at various time points following treatment.
These images allow us to identify spared fibers, track the extent of secondary injury and determine the therapeutic benefits of the therapy.
Bioluminescence imaging (BLI) is also used to monitor the survival, integration, migration and tumorigenic potential of transplanted stem cells within the spinal cord parenchyma.
We also perform monitoring, recording and quantitative analyses of multi-channel somatosensory and motor evoked potentials to assess the electrical conductivity in the central nervous system at various stages, both pre- and post-therapy.
This is a very significant feature of our bioengineering laboratory which enables us to demonstrate functional improvement related to both acute and chronic treatment procedures in a reliable and objective manner.
In addition to validating the extent and progress of injury, our focus lies in determining long-term functional recovery within the axonal pathways.
The focus of our biomedical engineering team is to use stem cell-based therapies in addition to novel technologies and quantitative methods, such as evoked potentials and imaging, to establish a clinically relevant spinal cord injury model of treatment.
Ultimately, our spinal cord research team plans to develop and combine acute and chronic therapeutic strategies in a clinically relevant model of injury for scientists as well as clinicians (bench-to-bedside).
Explore some of our current projects in spinal cord injury.
Use electrophysiological monitoring techniques and advanced signal processing method to evaluate the integrity of ascending spinal pathways before and after injury.
Evaluate recovery the descending motor tracts after SCI by peripheral muscle activity after stimulating the motor cortex.
Using induced pluripotent stem cells that are derived simply from adult fibrobasts, we can derive the myelin producing cell of the central nervous system, oligodendrocytes, with the aim of remyelinating the many spared fibers that remain intact after spinal cord injury.
Study midline and unilateral contusion models that mimic human incomplete spinal cord injury or induce experimental autoimmune encephalomyelitis to study demyelinating conditions of the nervous system.
Explore hypothermia treatment to minimize the extent of secondary injury and inflammation following a contusion injury in order to aid in recovery.
Use somatosensory evoked potentials to measure the changes in brain activity and function of the sensorimotor cortex after spinal cord injury.
MRI can reveal plasticity of the central nervous system, and diffusion tensor imaging can be used to reconstruct models of the spinal cord
Design wireless interfaces that connect the brain and to electronics in order to control devices, computers, or prosthesis.
Pulled muscle in lower back: Symptoms, treatment, and recovery
Pulled muscles, or strains, are common in the lower back because this area supports the weight of the upper body.
Anyone can get a lower back — or lumbar — strain, which can be very painful and make normal movement difficult.
In this article, we discuss the symptoms and causes of a pulled muscle in the lower back and explain what treatment options are available.
If a person twists or pulls a muscle in the lower back as a result of a sudden movement or injury, they may feel a pop or tear as it happens.
Symptoms of a pulled lower back include:
- loss of function and restricted movement
- difficulty walking, bending, or standing straight
- swelling and bruising
- muscle cramping or spasms
- sudden pain in the lower back
Overstretching or tearing ligaments, which are bands of tissue that hold the vertebrae of the spine in place, can cause a sprain. A strain is a tear in either a muscle itself or one of the tendons that attach the muscles to the spinal column.
Strains happen when a person stretches the muscles or muscle fibers beyond their normal range of movement.
Causes may include:
- lifting heavy objects
- sports that require pushing and pulling, such as football or soccer
Other risk factors include:
- having overweight or obesity
- bending the lower back excessively
- a weak back or abdominal muscles
- poor posture
- tight hamstrings
Anyone who strains a muscle in the lower back should rest to avoid further damage. However, they should not stop moving altogether. Gentle movements that cause no pain can help expedite the healing process.
Ice packs and anti-inflammatory medicines can help relieve swelling and pain, and a doctor may also prescribe muscle relaxants.
According to Johns Hopkins Medicine, after a person pulls their lower back, they should:
- apply an ice pack for the first few days for 15–20 minutes, multiple times a day, to reduce any swelling
- switch to a heat pack after a few days, using it for 15 minutes at a time to help reduce the pain
- take aspirin or ibuprofen to help with the pain and swelling
The following exercises might also help.
However, it is essential to avoid moving any further than is comfortable and to stop the exercise if it puts pressure on any other part of the body.
- Kneel on all fours with the knees under the hips and the hands under the shoulders.
- Keep the back and neck straight and bend the elbows slightly.
- Move the buttocks slowly back toward the heels.
- Hold the stretch while taking one deep breath in and out and then return to the starting position.
- Repeat 8–10 times.
- Lie on the back with a flat cushion under the head.
- Bend the knees, keeping the feet straight and hip-width apart.
- Keep the upper body relaxed with the chin tucked in.
- Slowly flatten the lower back into the floor and lift the tailbone.
- Slowly perform the reverse movement, tilting the pelvis toward the heels.
- Repeat 10–15 times.
- Lie on the front with the chest flat on the floor, taking the weight of the body on the forearms.
- Slowly push through the forearms to lift the chest and then the belly off the floor. Keep the hips and pelvis on the floor.
- Relax the back and use the arms to do the pushing.
- Hold at the top for 5–10 seconds and then return to the starting position.
- Repeat 8–10 times.
If the pain has not eased after 1–2 weeks, a person should see a doctor.
In some circumstances, a person may need to go to the emergency department or call 911. It is important to seek medical help if:
- a person hears a crack when they sustain the injury
- the injured part of the back is numb, discolored, or cold to the touch
- a fever of 101°F (38.3°C) accompanies the pain
- a person has lost control over the bladder or bowels
- a person is unable to stand
- urinating is painful or produces bloody urine
- there is severe pain in the abdomen
Most lower back strains and sprains should recover in 2 weeks, and according to the American Association of Neurological Surgeons (AANS), more than 90% of people recover fully in 1 month.
A person should avoid vigorous exercise for 8 weeks to reduce the risk of damaging the back further.
To avoid putting strain on the back, a person should:
- stretch before exercising
- avoid slouching or hunching over
- wear comfortable, low-heeled shoes
- maintain a moderate weight
- sit in a chair with lumbar support
The following tips may also be beneficial:
Lift objects carefully
A person can help avoid pulling the muscles in the lower back by ensuring that they take care when lifting heavy objects.
To lift objects safely, a person should:
- Keep the object close to the waist: This positioning can reduce the amount of pressure on the back.
- Maintain a stable position: Keeping the feet apart with one leg slightly forward can help with balance.
- Avoid bending the back when lifting: A person should not bend their back when lifting an object.
- Avoid twisting: A person should avoid twisting the back while lifting heavy objects.
Yoga may also help relieve pain and strengthen the back. According to a 2016 systematic review, yoga may be an effective treatment option for chronic lower back pain.
By strengthening the back and improving flexibility, this practice may help prevent a person from pulling the muscles in the lower back.
A person can try the following yoga exercises:
A doctor is ly to perform a physical examination to diagnose a lumbar strain.
If they need to do further tests to examine the cause of the lumbar strain, the doctor may request:
- an X-ray
- a CT scan
- an MRI scan
They might also order an electromyogram to examine the muscle and nerve function or a radionuclide bone scan to look at the blood flow to the bone, as well as cell activity.
A pulled muscle in the lower back can be painful. However, with the right treatment at home, most strains get better after a few weeks.
A person should see a doctor if they hear a crack when the injury occurs, or if they develop a fever or experience incontinence afterward.
Factors such as carrying extra weight and having weak muscles can make a person more ly to experience sprains or strains. It is important to lift heavy objects carefully and warm up before doing exercise.
Recent News Articles
The field of medicine, and especially spine surgery, is definitely not static. The body of knowledge is constantly growing and sometimes changing. One must always be looking for new ways and techniques to achieve better outcomes and patient care.
A surgeon needs to stay up-to-date with the newest findings, technologies and techniques. Reading peer-reviewed journals and attending conferences is probably the easiest way to achieve it.
Collaborating with colleagues to share from each other's experiences and findings is also invaluable.
The paths of two area residents led to the same local team of medical experts last year. They came to Suburban Hospital, where neurosurgeons and orthopaedic spine surgeons worked together to treat them using an exciting new tool that helped return both to a high quality of life.
This type of collaboration is what we do every day—what our physicians are trained to do— because our patients benefit from it and we enjoy it,” says Dr. Khanna.
“Strong and frequent collaboration between neurosurgery and orthopaedic surgery for patients needing complex and even simple spine surgery here at Suburban and throughout Johns Hopkins Medicine, along with the newest technology for intraoperative navigation in our operating rooms, enables us to provide what we feel is the best care for patients with complex conditions of the spine. This collaboration and our new technology allows us to provide what we believe is world-class spine care right here in the National Capital Region.
Taking the American Board of Orthopaedic Surgery board examination can be an intimidating experience for orthopaedic surgery residents. Recently, David Hamilton, MD, a PGY-5 resident at the University of Kentucky, spoke on behalf of AAOS Nowwith A. Jay Khanna, MD, of Johns Hopkins Medicine, on how to best prepare for the exam.
Jay Khanna, MD is honored to be listed in Becker's Spine Review publication's List of 65 orthopedic surgeons recommended by other orthopedic surgeons.
Spinal stenosis affects millions of Americans. It is a narrowing of the space around the spinal cord and nerve roots that can cause pain, numbness and/or weakness in the arms and legs. Spinal stenosis often occurs due to age-related degeneration of the spine in middle-aged to older people and herniated discs in younger patients.
Over the course of almost 20 years at Johns Hopkins, spine surgeon A. Jay Khanna has charted a path in the Department of Orthopaedic Surgery that melds clinical expertise with business and professional development skills. In 2008, while maintaining a busy clinical practice and meeting academic demands, he earned
By the time Susan Whitehouse was diagnosed with scoliosis at 16, she had reached her full height and wasn’t eligible for bracing.
Her scoliosis wasn’t severe enough to warrant surgery, but the curve in her spine was pronounced enough to trigger sciatica (pain that radiates from the lower back through the hips and down the legs), especially while sitting and twisting her torso in a chair as she treated dental patients.
SAN FRANCISCO — A. Jay Khanna, MD, discusses what spine surgeons need to know regarding the systemic approach to spine imaging studies at the North American Spine Society Annual Meeting.
Dr. A. Jay Khanna, an orthopaedic surgeon specializing in back and spine diseases and disorders at Johns Hopkins Medicine, answers a viewer’s question: Can arthritis on neck and shoulder be surgically treated?
Akhil Jay Khanna, MD, MBA, is division chief of Johns Hopkins Orthopaedic and Spine Surgery in the National Capital Region and his practice is based in Bethesda, Md.
He also serves as vice chairman of professional development in the department of orthopedic surgery at Baltimore-based Johns Hopkins University.
Additionally, he is a professor of orthopedic surgery and biomedical engineering at the Johns Hopkins University School of Medicine.
Monitor and minimize the number of seconds of fluoroscopy used for each case.
System engineers commonly say that any system improves if it is merely monitored; there is often not a need for a specific intervention. This is true in the case of fluoroscopy time.
A. Jay Khanna, MD, MBA of Johns Hopkins Orthopaedic and Spine Surgery in the Greater Washington Region, and Associate Professor of Orthopaedic Surgery, Neurosurgery and Biomedical Engineering at the Johns Hopkins University, discusses radiation exposure for spine surgeons. He also serves as clinical director of the Johns Hopkins Center for Bioengineering, Innovation and Design.
1. Minimally invasive spine surgery
Much of the spine surgery that we currently perform — and that has been developed by generations of surgeons before us — is relatively invasive. The spine is a deep structure and somewhat difficult to access.
We often end up creating a great deal of collateral tissue damage to get down to the area of interest. For surgery on the lumbar spine, for example, we may have to make an 8- to 12-inch incision to get down to a much smaller region in the spine.
That additional exposure creates a substantial amount of risk, potential morbidity and cost.
This list is sponsored by joimax®.
joimax® is an innovative medical technology company dedicates itself to combined surgical technologies, particularly to minimally invasive spinal procedures (“joined minimal access technologies”).
joimax® focuses on development, manufacturing and marketing of the technology and methods for integrated endoscopic surgical access to the spinal column, with optimized visualization
Frank Acosta Jr., MD (Cedars-Sinai Medical Center, Los Angeles). Dr. Acosta is the director of spine deformity in the department of neurosurgery at Cedars-Sinai. His research focuses on the diagnosis and treatment of spine disorders, and he has received funding from the National Institutes of Health, Harvard Medical School and Howard Hughes Medical Institute grants and fellowships.
Low Back Pain
Linkedin Pinterest Pain and Palliative Care Chronic Pain
Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning.
What causes low back pain?
The exact cause of low back pain can be hard to determine. In most cases, back pain may be a symptom of many different causes, including any of the following:
Overuse, strenuous activity, or improper use (such as repetitive or heavy lifting, exposure to vibration for prolonged periods of time)
Degeneration of vertebrae (often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging)
Abnormal growth (tumor)
Obesity (often increases weight on the spine and pressure on the disks)
Poor muscle tone in the back
Muscle tension or spasm
Sprain or strain
Ligament or muscle tears
Joint problems (such as spinal stenosis)
Protruding or herniated (slipped) disk
Disease (such as osteoarthritis, spondylitis, compression fractures)
Do you have lower back pain? You are not alone. You can experience lower back pain at any time, even if you don’t have a prior injury or any of the risk factors. Learn more about lower back pain and what causes it from rehabilitation physician and back pain specialist Akhil Chhatre, M.D.
Low back pain is classified as acute (or short term) and chronic. Acute low back pain lasts from a few days to a few weeks. Most acute low back pain will resolve on its own. Chronic low back pain lasts for more than 3 months and often gets worse. The cause of chronic low back pain can be hard to find.
These are the most common symptoms of low back pain. Symptoms may include discomfort or pain in the lower back that is:
Sharp or dull
Well-defined or vague
The pain may radiate into one or both buttocks or even into the thigh or hip area.
The symptoms of low back pain may look other conditions or medical problems. Always see your healthcare provider for a diagnosis.
How is low back pain diagnosed?
Along with a complete medical history and physical exam, tests for low back pain may include:
X-ray. A test which uses electromagnetic energy beams to make images of bones onto film.
CT scan. An imaging test that uses X-rays and computer technology to make horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
MRI. A test that uses large magnets and a computer to make detailed images of organs and structures in the body.
Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient's bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
Electromyogram (EMG). A test to check nerve and muscle function.
How is low back pain treated?
Treatment may include:
Physical rehabilitation, therapy, or both
Weight loss (if overweight)
Following a prevention program (as directed by your doctor)
Assistive devices (such as mechanical back supports)
Rehabilitation is often a part of treatment for low back pain. Generally, there are 3 phases of low back pain rehabilitation.
Acute phase. During this initial phase, the physiatrist (a doctor who specializes in rehabilitation medicine) and treatment team develop a plan to reduce the initial low back pain and source of inflammation. This may include using ultrasound, electrical stimulation, or specialized injections.
Recovery phase. Once the initial pain and inflammation are better managed, the rehab team focuses on helping you return to normal daily activities while starting a specialized exercise program to regain flexibility and strength.
Maintenance phase. In this phase, you will learn ways to prevent further injury and strain to the back, and how to start a fitness program to help further increase strength and endurance.
Can low back pain be prevented?
The following may help to prevent low back pain:
Use correct lifting techniques
Maintain correct posture while sitting, standing, and sleeping
Exercise regularly (with proper stretching beforehand)
Maintain a healthy weight
Reduce stress which may cause muscle tension
When should I call my healthcare provider?
Call your healthcare provider if:
Your pain becomes worse or spreads to your hips, thighs, or legs
Your pain medicine no longer works well for you
Your pain begins to interfere with your daily activities, or interferes with activities more than usual
Living with low back pain
Most back pain will ease in a few days to a few weeks. If the pain lasts longer than 3 months, it is considered chronic and you should talk with your healthcare provider. Recovery from low back pain can take time. To prevent back pain from coming back, it's important to follow good health practices, such as:
Maintaining a healthy weight
Practicing good lifting techniques
Maintaining good posture while sitting, standing, and sleeping
Key points about low back pain
Specific treatment for low back pain depends on the cause of the pain and the severity, but often includes pain medicines and muscle relaxers, physical therapy, and lifestyle changes such as stress reduction, weight loss, increased physical activity, and assistive devices such as a back support.
A back rehabilitation program may be used as part of the treatment for low back pain.
Measures to prevent back pain include using safe lifting techniques, correct posture, maintaining a healthy weight, not smoking, and stress reduction.