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Spine surgery can offer patients significant relief for chronic back or leg pain related to disc herniation. Yet traditional surgical approaches require a lengthy recovery that can make many patients hesitant. The endoscopic discectomy procedure uses less invasive techniques, so patients can see relief sooner — with much less downtime.

“Endoscopic spine surgery techniques have been perfected over the last decade. In endoscopic discectomy procedures today, patients can be up and moving (and go home) the same day as the surgery. They experience the same degree of pain relief as they would with an open procedure – but with a shorter and less painful recovery,” says Dr. Bruce M. Frankel, M.D., a neurosurgeon at the MUSC Health Spine Center.

Less Invasive Spine Surgery Offers Multiple Benefits

In an endoscopic discectomy procedure, Dr. Frankel makes a tiny incision in the patient’s back, then introduces a small dilator right next to a disc herniation in the spine. Under direct visualization with an endoscope, he then shaves off the disc herniation to free the pinched nerve that’s causing the pain.

According to Dr. Frankel, patients experience several benefits from this endoscopic approach:

  • Less downtime: “There’s a shorter recovery, with most patients on their feet soon after surgery. Patients experience significantly less postoperative pain than with traditional operations.”
  • Similar outcomes: “Outcomes are similar to those from open procedures. While open procedures work quite well, patients can experience setbacks from the significant pain they experience during their recovery. We eliminate that setback with an endoscopic approach.”
  • Minimal sedation: “Patients don’t need to be intubated like they would during open operations.”
  • Less blood loss: “Most patients have minimal to no blood loss. In an open procedure, blood loss poses a larger concern.”
  • Shorter procedure: “Traditional spine surgeries can last several hours. We can complete an endoscopic discectomy procedure in 30-45 minutes.”
  • Lasting results: “Patients typically see long-term and hopefully permanent leg pain relief.”

Dr. Frankel has seen how chronic nerve pain severely limits patients’ lives. With endoscopic approaches to spine surgery, he hopes to help patients add quality and function back to their day.

“Less invasive spine surgery techniques offer significant benefits with little downside to patients. It’s an alternative to other complicated surgeries such as large back fusion procedures that may have significant downsides and may not offer permanent results. Endoscopic techniques help patients affected by chronic back or leg pain feel better, so they get back to their daily activities without undergoing a complicated surgery,” says Dr. Frankel.

MUSC Spine Center Has a Treatment Option for Everyone

Endoscopic discectomy is just one way specialists at the MUSC Health Spine Center treat chronic back and leg pain. The specialists at the center find the right treatment solution for each patient, including non-operative treatments, such as pain management and physical therapy.

The center’s spine specialists are trained in all types of surgical approaches: They are proficient in open and traditional surgeries, when such an approach will provide the best outcome for patients. And they perform a range of less invasive spine surgeries in addition to endoscopic discectomy, including minimally invasive rhizotomies, fusions and reconstructions.

The multidisciplinary spine center tackles patients’ pain from multiple angles. Depending on individual circumstances, patients may meet with one or more of the following care specialists:

  • Pain physicians
  • Physical therapists
  • Physiatrists
  • Surgeons, specializing in orthopaedics or neurosurgery

“Our approach to back and spine care is both multimodal and collaborative. Our goal is to match every patient with a treatment that offers the relief they seek,” he says.

For more information, contact Dr. Frankel at frankel@musc.edu.

By Ethan Konoza, ATC
Athletic Trainer
MUSC Health Sports Medicine

Post workout muscle soreness? Use these tips to speed up recovery and reduce soreness.

Summer is around the corner, and now it is finally time to get the gym and start chasing that beach body you’ve always wanted! So you’re at the gym crushing your workout feeling great. By the time you wake up in the morning you’re feeling aches, pains, and soreness! This is known as delayed onset muscle soreness (DOMS). DOMS is a common problem for almost anyone who partakes in intense or unaccustomed exercises. Here are some tips you can implement to your post exercise routine that will help combat DOMS and get you back to normal function as rapidly as possible.

Understanding DOMS

Delayed-onset muscle soreness is a common experience for all individuals who partake in exercise at one time or another. There are many types of physical activity that cause delayed soreness.

  • Strength training exercises
  • Running
  • Jumping
  • Walking down inclines/declines

Delayed soreness tends to begin 12 to 24 hours after exercise. This pain and soreness can linger around for days making working out impossible and lifting normal things or taking stairs dreadful tasks. Current literature suggests that eccentric muscle contractions are thought to be the main culprit in resulting soreness.1 Eccentric muscle contractions are those actions in which the muscle is being lengthened. An example would be the lowering phase of a bicep curl or getting into a squat position.

Initially DOMS was thought to be a result of lactic acid build up in the muscle, similar to acute muscle soreness, however we now know that this is not the case. DOMS seems to be a by-product of the repair process occurring after microscopic muscle damage.1,2 While no one enjoys being in pain or feeling sore, it is important to remember that this soreness you are experiencing is temporary and is leading to a stronger you.

Starting slow

When starting a new program, starting slow can help reduce the effects of DOMS. Slow progression in a new program allows your muscles time to adjust to the new demands being placed on them. Allowing this time for adaptation will help in reducing the amount of soreness experienced in the first couple of sessions.

Warm up

Although there is little evidence to suggest that warming up is effective in reducing DOMS, it is always important to prepare your body for stresses that you are about to place upon it. It is important to break a mild to moderate sweat while warming up. Make sure to incorporate dynamic stretching to prepare your muscles and joints for the exercises you are about to perform.

Active recovery

This is a technique used by many athletes to help with recovery time. Active recovery can be extremely beneficial in reducing muscle soreness, but be careful not to over do it. Active recovery can include cross training like bike riding, swimming, or jogging at a lower intensity than normal. The goal with this isn’t to increase strength, power, or endurance. It is to increase blood flow to muscles bringing in necessary nutrients to enhance the recovery process.2,3

Massage

Massage is used to decrease muscle soreness, pain, and stress, and improves circulation and lymphatic flow.2 Massage can help promote and aid in the recovery process, but it is important not to be too aggressive. Easy does it in terms of massage and its role in recovery.

Foam rolling

Foam rolling is a self-myofascial release (SMR) technique that can provide improvements in flexibility, movement efficiency, and muscle recovery.3 During the recovery process our muscle fibers can become knotted and misaligned causing a reduction in muscle elasticity, soreness, and stiffness. SMR can be used to release the knots in the muscle aiding in the recovery process. This can be done prior to exercise as well as post.

Ice

While icing injuries remains a debated topic in the sports medicine world, it can be beneficial for the analgesic effects. While physiologically the literature remains to be seen on ice having any effects on the inflammation process, there is no question that it can be used to help temporarily relieve aches and pains.

Try implementing some of these things into your post exercise regiment to combat DOMS and improve recovery. It is important to remember that some techniques may be more effective than others and each individual may respond differently to the next. It is important to find what works for you and your needs.

For more information visit MUSC Health Sports Medicine

References

  1. https://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf
  2. https://magazine.nasm.org/american-fitness-magazine/issues/american-fitness-magazine-winter-2017/exploring-the-science-of-recovery
  3. Ahmaidi, S., et al. 1996. Effects of active recovery on plasma lactate and anaerobic power following repeated intensive exercise. Medicine and Science in Sports and Exercise, 28 (4), 450–456.
  4. https://www.myofascial-pain-syndrome.org/myofascial-release-as-an-effective-post-workout-recovery/

Dr. Alana Ronnquist and family

Dr. Alana Ronnquist and family 
Photo provided by Abbey Medley Photography

 

My name is Alana (Rojewski) Ronnquist and I currently work as an Assistant Professor in the Department of Public Health Sciences here at MUSC. I am honored to serve as the 2018 March of Dimes Ambassador Family in memory of my son, Nash.

In October of 2015, I went into preterm labor with my first born, Nash, who was delivered by emergency C-section at MUSC, weighing only 1 lb., 10 oz. and only 11.5 inches long. He appeared to be doing well for only 24 weeks and as parents we remained hopeful. We spent every moment at his bedside in the NICU and over the course of the following weeks, the extent of his lung complications became clear.

After being diagnosed with persistent pulmonary hypertension, he was kept on ventilators, prescribed nitric oxide for his symptoms, and received several doses of surfactant. Through it all, he was an amazing little boy - he would look at us when we went to his bedside, grab our fingers, respond to our voices, and loved kangaroo time. His care team of doctors, nurses, and respiratory therapists worked tirelessly to give him the best possible chance given his challenging circumstances. Ultimately, at 55 days old, Nash could not fight anymore and passed away peacefully in our arms.

Dr. Chris Goodier and baby Maia
Dr. Chris Goodier and Maia

Nash is now a big brother! On March 20, 2017 at 37 weeks, we welcomed our beautiful rainbow baby, Maia. She weighed 7 lbs., 12 oz. and was 20 ¼ inches long. Thanks to the preventative care I received by Dr. Chris Goodier and the entire Maternal Fetal Medicine team at MUSC Women's Health, Maia arrived perfectly healthy and full term. She entered the world screaming – a sound we never heard from Nash, as he spent his life on ventilators.

We are so grateful for the care we received from MUSC that allowed us to bring Maia safely into the world. We know that every provider used every resource at their disposal to give Nash the best chance at life, but providers and researchers need more to treat our most fragile babies – research has to progress. That is why we march for Nash – to raise money for March of Dimes that will go towards lifesaving research. Please join our family in the fight against prematurity at the Charleston March for Babies on April 28!

For more formation about the walk or to pledge your donation here, please visit the Charleston March for Babies.

Complex spinal deformities can cause debilitating pain, restricted movement, even low self-worth. MUSC Health Spine Center specialists partner with patients to get them relief – no matter the patient’s age or cause of the pain.

“There's a lot we can do to help people who have back pain related to a complex spinal deformity. With our skilled surgeons and comprehensive support team, we have capabilities today that we didn’t have before,” says Charles Reitman, M.D., an orthopaedic surgeon and co-director of the MUSC Health Spine Center.

Spine surgery can be complex. To avoid complications, Dr. Reitman pays particular attention to patients’ health prior to greenlighting surgery. Working together with patients, he helps improve their symptoms and self-image.

Common Causes of Back Pain From Spinal Deformities

Many adults with spinal deformities suffer from the effects of an untreated childhood ailment. However, spinal deformities may occur at any age and be caused by other factors, including:

  • Injury
  • Cancer
  • Infection
  • Inflammatory conditions, such as rheumatoid arthritis
  • Degenerative disease
  • Postoperative complications

“The main types of spinal deformities include sagittal plane deformities, such as kyphosis, and coronal plane deformities, such as scoliosis. For both these conditions, corrective spine surgery can be pretty complicated,” says Dr. Reitman.

Partnering With Patients to Make Spine Surgery Happen

Because spine surgery can pose so many complications, Dr. Reitman says many spine surgeons may be reluctant to perform surgery on older patients or those in less-than-ideal health.

The team at MUSC Health Spine Center works with patients to make spine surgery possible for them, regardless of their health impediments.

“A patient with a severe sagittal plane or coronal plane deformity, for example, may be in severe pain, unable to stand up straight and may have limited function. That patient shouldn't think twice about getting evaluated for spine surgery — no matter their health or age,” he says.

Dr. Reitman notes the importance of patients taking ownership over their health prior to spine surgery, which helps avoid complications and ensures more effective results. Dr. Reitman works with patients to overcome health hurdles before surgery.

Common roadblocks that can impede healing and recovery include:

  • Smoking
  • Overweight or obesity
  • Heart disease or lung disease
  • Diabetes
  • Low bone density
  • Poor bone quality


Dr. Reitman emphasizes: “If patients commit to tackling any health problems they have (with our support), then we can often get them through surgery safely and effectively. That’s our goal: to find patients relief, safely and help them lead a more fulfilling life.”

Spine Surgery Offers More Than Back Pain Relief

When patients optimize their health prior to surgery, Dr. Reitman says they optimize their chances of success.

“Spine surgery is not a walk in the park for anyone. At MUSC, we have a high-level, coordinated critical care team that can handle complicated cases. For patients who commit to ensuring they can reach their ideal health prior to surgery, it’s more than worth it,” says Dr. Reitman.

“With many complex spinal deformities, the body is in a position that it simply wasn't meant to be in. Corrective surgery does more than relieve pain – it improves patients’ self-image and self-worth. Even though it’s a high-risk surgery with potential complications, the vast majority of patients who have been through it tell me that they’d do it all over again, in a second. Patients say spine surgery gave them their life back. That’s what we’re here to do, for as many patients as we can,” he says.

For more information, contact Dr. Reitman at reitman@musc.edu.

MUSC Children’s Health welcomed Dr. Laura Hollinger in late 2017 as part of the pediatric surgical team and as assistant professor of surgery in the Division of Pediatric Surgery.

The Texas native earned her undergraduate degree from Texas Christian University in Fort Worth, Texas, which is also Dr. Hollinger’s hometown. From there, she earned her doctorate in medicine degree from the University of Texas Health Science Center in Houston at McGovern Medical School.

She also completed a two-year research fellowship at the Methodist Hospital Department of Surgery and Research Institute where she studied critical illness and the distant organ effects of kidney ischemia-reperfusion injury. She completed her fellowship in pediatric surgery at the University of Texas with training in both open and minimally invasive approaches to neonatal and pediatric general surgical diseases.

Her enthusiasm for building and repairing things started at a young age, and she says that she thinks her mother knew before she did that she would ultimately choose to become a surgeon. While in medical school, she was mentored by Dr. Barbara Bass, who is one of the female pioneers in general surgery and president-elect of the American College of Surgeons.

Dr. Hollinger has been recognized for academic excellence and is the recipient of many awards including the Raleigh Ross Scholar Award from the Texas Surgical Society, the American College of Surgeons Resident Award for Exemplary Teaching, The Methodist Hospital Department of Surgery Resident of the Year Award, and the Excellence in Research Award, Critical Care: American College of Surgeons Surgical Forum.

Her surgical interests include pediatric ECMO support during critical illness, congenital diaphragmatic hernia as well as prenatal diagnosis and intervention. She enjoys working with the MUSC Advanced Fetal Care Center multidisciplinary team and team’s ability to diagnose and offer counseling and therapy for babies with prenatal conditions.

Dr. Hollinger said it’s a thrilling opportunity to be at MUSC Children’s Health and the upcoming Shawn Jenkins Children’s Hospital scheduled to open in the fall of 2019. She said it’s nice to be able to focus on pediatric patients and their families and their complex needs while providing them with an environment that can be healing. She added the new children’s hospital reflects on the dedication MUSC has to the children of South Carolina.

 

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