Jason H. Thompson, MD

Stenosis? Arthritis? What is the difference?

 

One of my patients asked me about the difference between Spinal stenosis and Arthritis.
Spinal stenosis is a narrowing of spaces in the spine (backbone) that results in pressure on the spinal cord and/or nerve roots (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Spinal arthritis is the breakdown of the cartilage between the joints in the spine that quite often leads to pain. The joints become inflamed and increased joint degeneration creates more pain. Back motion and flexibility decrease in proportion to the progression of back pain felt while standing, sitting and even walking. 

In Spinal stenosis, bone spurs (small irregular growths on the bone) typically form on the joints and around the spinal vertebrae. These bone spurs are a response to joint instability and are nature’s attempt to help return stability to the joint. The enlargement of the normal bony structure indicates degeneration of the spine. Bone spurs are a normal part of aging and do not directly cause pain, but may become large enough to cause irritation or trap the nerves passing through the spinal structures, and they may result in less room for the nerves to pass (spinal stenosis).

Spinal stenosis can occur as a result of the effects of arthritis, aging, inherited conditions, tumors, injuries, Paget’s disease ( a disease that affects the bones), too much fluoride in the body calcium deposits on the ligaments that run along the spine . (National Institute of Arthritis and Musculoskeletal and Skin Diseases)

When Should Surgery Be Considered and What Is Involved?
In many cases, the conditions causing spinal stenosis cannot be permanently resolved by nonsurgical treatment, even though these measures may relieve pain for a period of time. A doctor may recommend such treatment first, but surgery might be considered immediately if a patient has symptoms including numbness or weakness that interferes with walking or impaired bowel or bladder function. The effectiveness of nonsurgical treatments, the extent of the patient’s pain and the patient’s preferences may all factor into whether or not a physician recommends surgery.

The purpose of surgery is to relieve pressure on the spinal cord or nerves and to restore and maintain the spine’s alignment and strength. This can be done by removing, trimming, or adjusting diseased parts that are causing the pressure or loss of alignment. The most common surgery is called decompressive laminectomy: removal of the lamina (roof) of one or more vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disk. Various devices may be used to enhance fusion and strengthen unstable segments of the spine following decompression surgery. (National Institute of Arthritis and Musculoskeletal and Skin Diseases)

www.niams.nih.gov/Health_Info/Spinal_Stenosis/#spine_e

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Lori Stephens, MBA, OTR/L

Backpack Safety

 

With the incredible summer we experienced this year, chances are many of you were enjoying the great outdoors. In the Puget Sound area, that often includes hiking in the Cascades or the Olympics with a day pack or backpack. August and September signal back to school shopping and the time to buy a new backpack to carry all of those books and school supplies. More than 2,000 backpack related injuries were treated and reported in the United States in 2007. Many students of all ages report discomfort and pain from using a backpack. Incorrect fitting and use of a backpack can impact your posture and your back health.

Many day hikers and students get used to carrying their backpack on one shoulder. However, wearing a back pack on one shoulder impacts the alignment of the spine from side to side as well as from back to front. Distortion of the natural curvature weakens the spine and makes your muscles work harder in an imbalanced way. The spine is strongest when all the curves are lined up correctly and the muscles are working in a balanced way. The most ergonomic way to wear a backpack is to put it on both shoulders and to secure the waist belt if one is present.

Hikers, as well as students, tend to overload their packs and to incorrectly secure the load. Backpack loads should not exceed 10 – 15% of the person’s body weight. For example, if a person weights 150 lbs the loaded backpack should not exceed 15-22 lbs. For a 50 lb elementary aged student, the pack should not exceed 5-7.5 lbs. A lunch box, bottle of water and a book or two can get to this limit quickly. When loading the pack, the heavier items should be loaded closest to the spine with lighter items further away from the spine.

Along with the weight, the size and shape of the backpack should match the user. Women tend to have more narrow shoulders and should select a pack with narrower distance between the shoulder straps. North Face, Jansport and other manufactures make specialized backpacks for women. Children and smaller adults should have smaller packs that match their stature. REI, Big 5 and other sporting goods stores will have a broad selection of backpack sizes, shapes and styles to match your stature and needs. Choose a pack that is lightweight and has two padded straps, a padded back, a waist belt and multiple compartments. Shop around and try them on. It is time well spent!

Whether hiking or heading back to school, pick the backpack that best fits your body type. Pack it correctly to decrease the pull on your spine. Wear it using both arm straps and the waist or chest straps when available. Proper use of a backpack will protect your spine and keep your back healthy for summers and school years to come!

References:
www.aota.org
www.backpacksafety.com
www.rei.com
www.ergonomics.about.com
www.kidshealth.org

 

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Jason H. Thompson, MD

The Relevance of Robotics

 

One of the hot topics in surgery these days – whether it’s for surgery on a spine or anywhere else – is robotic surgery. My patients are often curious about the benefits that the robot manufacturers are claiming, and they want to know if their surgeries might be done with the help of a robot.

According to the web site for the most popular spine surgery robot, Mazor Robotics Renaissance™, using their robot during certain procedures, including operations for scoliosis, degenerative disc disease, or a herniated disc, offers a lot of benefits. They claim that its use increases accuracy and precision, lowers complication rates, reduces pain, enables a faster recovery, and sometimes even allows for minimally-invasive surgery!

It sounds like a great choice, doesn’t it? Unfortunately, it doesn’t really work that way. Even supporters of robotic surgeries are concerned about the lack of consistent training among the surgeons who use them. There’s no standard for training. The companies who sell the robots provide some lessons, but then it can take hundreds of cases before surgeons are considered “consistently good” at using the robots. Those patients who are among the “practice cases” can’t always rely on the surgeon’s expertise at using the robots.

In addition to a lack of consistent training, there just haven’t been enough studies to realistically determine the effectiveness and safety of surgical robots. Although the robots’ popularity is growing quickly, as their use in operating rooms increases, so do the numbers of complications associated with them.

Performing surgery with a robot also requires a set of specialized skills that many surgeons haven’t trained for. When a surgeon operates with a robot, he or she is across the room from the patient, using what amounts to a fancy remote control. It requires a different type of spatial and eye-hand coordination. A surgeon can no longer feel the tissues when cutting, cauterizing, and suturing, and those sensations are, in my opinion, paramount for a skilled surgeon’s ability to operate well.

There may well come a time when robotic surgery is more practical or feasible. Right now, however, the current state of robotic surgery is version 1.0 and I’d prefer to wait until it is more extensively tested and its benefits clearly proven. Until then, we still have lots of great options to minimize the impact of surgery and provide patients with excellent outcomes.

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Lori Stephens, MBA, OTR/L

Keep Your Spine Tuned Up with Body Mechanics

 

Body mechanics, biomechanics, proper lifting or safe lifting are all terms that can be used to describe ways to safely handle materials at work and home. Your body and your spine are designed to handle pressure and movement with lifting, carrying, pushing and pulling. However, when you move something in an awkward way, you risk injuring your back. Twisting in particular is a high-risk activity.

The human spine is at its strongest when in proper alignment from side to side, and with all the curves correctly positioned from top to bottom. When the spine is too curvy, it can buckle against pressure and place more force on each vertebrae and impinge upon spinal nerves and disks. If the spine is too straight, it can be too rigid and lack sufficient give to rebound against pressure. It’s a lot like the story Goldilocks and the Three Bears. The spine is at its strongest and most resilient when the curves and alignment are “just right.”

Safe load handling is about getting your spine “just right” while sitting, standing, walking and while performing tasks in any or all of these positions. It’s not just for lifting heavy items. Using your back efficiently is important for every lift, every carry and every push. Developing a strong core and thinking through the lift before even touching it will reduce the risk of injury.

Proper body mechanics with load handling starts with planning and organizing. Evaluate the situation and determine if moving the object is within your ability. If not or if in doubt, ask someone to help you. If you think it’s within your ability, make sure that the object is stable and that you have a clear path to your destination. Remove any obstacles or obstructions before you lift or move the object.

Bring the object close to your body and keep it as close to your core,* and between hip and shoulder levels, as possible. This is where your best strength is located. Stabilize your core and lift with your legs – leading with your head and shoulders, not your buttocks. Don’t hold your breath, but exhale with exertion. Now move the object. Always watch where you are going. Don’t plant your feet or lock your knees. Always lift your feet and move your body all together rather than twisting; secure the load, and then turn with your whole body. Save the twisting for the dance floor, to your favorite Chubby Checker’s song!

Once you’ve reached your destination, lower or place the load with the same attention to your body’s position as you had when you picked up the object. Activate your core. Lower the object using your legs, this time leading with your buttocks not your head and shoulders. Use your back wisely with all load handling activities and it will continue to hold you up and be there for you when you need to move the next item along.

*Your core muscles are the group of muscles around your body often defined as “core muscles.” The role of the core muscle group is to support your spine and stabilize your posture. A stable posture is a key component of good body mechanics.

Core Muscle Groups

References

osha.gov – Occupational Safety and Health Administration
LNL.wa.gov – Washington State Labor and Industries
aota.org – American Occupational Therapy Association
Four Steps to Proper Lifting: http://www.lni.wa.gov/IPUB/FSP0-918-000.pdf
Lifting Tips: http://www.lni.wa.gov/IPUB/417-055-909.pdf

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Carolyn Salazar, OT

7 Ways to Make Sure Your Office Isn’t Working Against Your Spine

 

Properly positioning your body and using good body mechanics when you’re at your office workstation are important to keep your spine and body healthy, especially if you are returning from an injury or surgery. Here are some simple tips for using good office ergonomics to keep your body healthy.

What is the ideal ergonomics set-up for your workstation?

  • • Shoulders completely relaxed at your side
  • • Elbows at approximately a 90-120 degree angle
  • • Wrists straight
  • • Head level or in-line with the your torso/trunk
  • • Feet flat on floor
  • • Hips slightly higher than knees

Start with your chair. All chairs are different and have a variety of features. Get to know your chair and how to adjust it.

  • 1. Sit all the way back in the chair so your buttocks touch the backrest. The lower curve of your spine should match the curve of the backrest so your spine feels fully supported. If it doesn’t, adjust the backrest height.
  • 2. Adjust the armrests so they are just below your forearms. Ideally, your forearms should be barely resting on the armrests. If the armrests are too high, your forearms will be pushed upward subsequently causing your shoulders to rise. This can cause pain in your shoulders and neck.
  • 3. Position yourself as close to your work as possible to prevent reaching, which can also contribute to shoulder and neck pain. If your armrests interfere with your ability to position yourself close to your work, remove them if possible.

Your keyboard, mouse, phone and monitor can also impact your spine.

  • 4. Ensure that your keyboard and mouse are close to you, immediately next to each other and at the same height. This will prevent reaching.
  • 5. If you use your phone frequently, position it close to you so you don’t have to twist and/or reach to access it. If possible, use a headset.
  • 6. When viewing your monitor or documents, the goal is to maintain a neutral or straight neck position. To ensure this positioning, your monitor should be directly in front of you and at least 20 inches away.  The top of the monitor should be at, or just below, eye level. If you use bifocals, the monitor should be slightly lower.  To prevent excessive neck rotation when viewing documents, keep them close to the monitor. A better option is to place the documents directly in-between the keyboard and monitor on a document holder.

Changing positions throughout the day will help keep your spine healthy.

  • 7. Sitting for a prolonged period and working in the same position is not healthy for your body or spine. Make sure you are changing your position frequently throughout the day by making small adjustments to your chair positioning, stretching and getting up to walk around.

 

Reference: www.osha.gov

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Jason H. Thompson, MD

The Effects of Obesity on Lumbar Disc Herniation Treatment

 

The January 2013 issue of The Journal of Bone & Joint Surgery includes an analysis of the effect of obesity* on lumbar disc herniation treatment. The study examines the results among nearly one thousand patients over a four year period of treatment of lumbar disc herniation, both surgically and non-surgically. Nearly a fourth of those in the group were considered to be obese. The researchers looked for changes or improvements in four different categories: bodily pain, physical function, disability, and mental components. No significant differences were noted in the mental component scores of obese and non-obese patients. Overall, the majority of patients appreciated better results after surgical treatment than after non-operative treatment.  After four years, however, the obese patients enjoyed significantly less improvement than the non-obese patients in the majority of measures, regardless of whether they were treated operatively or non-operatively.

In summary, the long term benefit from treatment of lumbar disc herniation is significantly better for those who maintain a healthy body weight.

*The most commonly used measure of weight status today is the body mass index, or BMI. BMI uses a simple calculation based on the ratio of someone’s height and weight (BMI = kg/m2). For adult men and women, a healthy BMI is between 18.5 and 24.9. Overweight is defined as a BMI between 25.0 and 29.9; and obesity, a BMI of 30 or higher. http://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/

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Jason H. Thompson, MD

Is Your Office a Pain in the Back?

 

The New York Times Well blog recently addressed some concerns about back pain among office workers; specifically, the type of back pain experienced by workers who spend their days hunched over computers at their desks. The article discusses the importance of finding a chair with adequate lumbar support for your lower back. For many people, sitting in an office chair either causes or exacerbates lower back pain. The blog article offers several recommendations for expensive chairs that might help to prevent back pain associated with sitting all day, but concludes that a lumbar chair pillow may be plenty good enough.

You can easily find lumbar pillows at stores like Bed Bath & Beyond, Brookstone, Relax The Back, or even online at Amazon. The article also discusses a few exercises that you can do during the day to avoid back pain. The most important suggestion is to simply make sure you’re moving around and changing your position regularly. 

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Erica Bryant, DPT

Spring Into a Walking Program

 

Hello! My name is Erica Bryant and I am a physical therapist at Valley Medical Center. I am excited to be joining Dr. Lundin and Dr. Thompson as a new contributor to the VMC Spine Blog.

Springtime is here bringing sunshine and warmer temperatures (we hope!), making it the perfect time for you to get started on a walking program. Walking is healthy for the spine because it increases your core and leg strength and improves your endurance. Walking can be part of a conservative treatment plan for low back pain. It’s also a great form of exercise before and after spine surgery because it is low impact on the body.

Before initiating a walking program after surgery, talk with your spine surgeon regarding any precautions. In most cases, it is encouraged to engage in light activity following surgery, as tolerated. I recommend to my patients that they start with short 5-10 minute walks on flat terrain, using an assistive device for support as needed. Then, gradually increase walking time by about 5 minutes, as tolerated and as long as you are pain-free. Multiple short walks throughout the day allow your muscles time to rest and help you build up your endurance. You may be overdoing it if you are feeling a significant increase in pain level following your walk, if you are having any sharp pains around your surgical site, or if you are feeling muscle soreness lasting more than 2 days.

If you have severe back pain, walking outdoors or on a treadmill may not be an option. Water walking at your local pool (forward, sideways, and backward) is a great alternative for you to get the benefits of walking without the pain. Exercising in water decreases the load on your body, including low back, hips, and knees. This allows you to move more freely than you would on land.

Please feel free to post any questions you have about starting a walking program pre- or post-surgery.

Thanks for reading!

Erica Bryant, DPT
Valley Rehabilitation Services

 

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Jason H. Thompson, MD

Smoking and Back Pain

 

A study published in the December 2012 issue of the Journal of Bone and Joint Surgery reported some interesting results regarding smoking and back pain. Previous research has shown that smoking is associated with a higher risk of surgical complications and less satisfying outcomes after surgery, but this particular study focused on the relationship between smoking and patients’ self-assessment of their own back pain.

The researchers compared over 5,000 patients with back pain, looking at their reports of pain over an average period of about eight months. Some of the patients had surgery, but most did not. They found that the patients who were current smokers reported significantly more pain, and significantly less improvement over the treatment period, than patients who had never smoked. What’s more, they found that patients who quit smoking during their course of care also experienced more improvement in their own assessment of pain. In short, they discovered a strong link between the improvement of patient-reported pain and not smoking, even if the patients quit smoking during the course of treatment.

To sum up, if you quit smoking, you may decrease your back pain in addition to saving money and, probably, living longer!

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Jason H. Thompson, MD

Best Surgical Approach Depends on Diagnosis

I’m often asked by patients who are contemplating surgery about my approach: Will the incision be big? Is it arthroscopic? Do I use lasers? My approach is completely dependent on each patient’s diagnosis and what our experience at the Spine Center tells us gives the best result for that diagnosis. I’m interested in outcomes that are lasting and durable, and sometimes that means I have to make major corrections which necessitate long incisions.

For example, last week I had the opportunity to dramatically change a patient’s life for the better. A woman came to see me with kyphoscoliosis (abnormal curvature) of the cervical spine, which, over time, left her chin resting on her chest, slightly askew. She had restricted range of motion in her neck; she was unable to walk or get around much because she couldn’t safely see where she was going, crushing her quality of life. For some conditions of the neck, a short, minimally-invasive procedure done as an outpatient is the perfect solution. But this woman’s extreme condition took eight hours of complex cervical spine reconstruction.

I’m proud to say that today she is walking tall, looking everyone straight in the eye again. When you weigh the vastly improved quality of life with the size of her scar, the length of the incision seems irrelevant to me. So while I often perform small-incision, quick-recovery, outpatient surgery, and I realize this is what many people would prefer, what I love most is relieving your pain and restoring well-being to your life using whatever procedure necessary.

If you are interested in learning more about your own spine condition and what procedure may be warranted, I am happy to meet with you and discuss your options. 

Thanks for reading!
Jason Thompson, MD

Phone: 425-656-5060
Web: seattlespinedoc.com

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