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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.

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.

How many times have you heard or said: “New year, new you”? Probably too many times to count. About this time of year, many have started their New Year resolutions. But research shows that only 19 percent of people who make resolutions are successful. Since one of the most common resolutions involves exercising, I am here to give you a little insight into how we use resolutions in sports medicine.

In rehabilitation of injuries, the sports medicine team works with the patient to create goals for returning to function and activity. We never just say, “Your goal is to return to sport.” That is not specific. Likewise, you should never set nonspecific goals such as “I am going to exercise more” or “I am going to lose weight.” In rehabilitation, we use the SMART framework to formulate goals for our patients. It is an acronym for the following components of a goal:

Specific – Keep goals simple. They should clearly define what you plan to do.
Measurable – How are you going to determine progress? How are you going to determine if you achieved the goal?
Achievable – The goal is realistic given the timing, conditions, and environment.
Relevant – You actually care about the goal. It directly relates to your life and well-being.
Time-Bound – Set very specific timelines to meet your goal. Remember it is okay for those timelines to adapt and change. Focus on the progress.

An example of a SMART goal for an injured basketball player: Return to basketball with no limitations or restrictions within 6 months, so he is ready in time for varsity tryouts.

This goal is much more specific and measurable. It also sets us up to create hundreds of short-term goals along the way, such as “patient will gain 10 degrees of active range of motion of knee flexion within 2 weeks following surgery.” The SMART framework provides the athlete with actionable steps and enhanced motivation.

Here are a few additional points that are important when making goals for injured athletes. They're also applicable to your resolutions.

  1. Form a tribe.
    When our patients are recovering from injuries, they have a support team behind them here at MUSC. Find your support team and encourage it to keep you motivated.
     
  2. Don’t be restrictive.
    During rehabilitation, we focus on the abilities of the patient, rather than the disabilities. Focus on all the abilities you are creating for yourself with your new resolution. If you focus on the restrictions (“I can’t eat sweets,” “I can’t watch TV because I’m exercising”), you are setting yourself up for failure.
     
  3. Be passionate.
    Athletes are generally very motivated people. Why is that? It’s because they love what they do. If your resolution is to incorporate more cardio into your exercise routine, find a cardio-based activity that you love. Don’t spend hours on the treadmill, if it is not something that gets you fired up.

It’s not too late! If you have a resolution in this new year, stop what you are doing right now, and ask yourself: Is it a SMART goal? If not, get out your pen and paper and make a plan by writing down the S-M-A-R-T of your goal. Make sure you are truly passionate about this goal and go find your tribe. Like our athletes at MUSC Health do every day, you too, can accomplish your goals.

Special guests visit Health Sports Human Physiology, Psychology Classes

Alecia Good and Savior
Athletic trainer Alecia Good and Saviour

November 14 was, for Pinewood's Head Athletic Trainer Alecia Good, a member of the MUSC Health Sports Medicine Team, "a wonderful reminder" of why she is a teacher. Good scheduled her friend Maurice Johnson, CO, BOCO, C.Ped, a certified orthotist and certified pedorthist from Floyd Brace Company (and Pinewood parent), to guest lecture in her Human Physiology and Psychology classes. Johnson asked to bring a model to help explain what he does for a living. The model was Saviour, a 10-year old boy from Ghana, Africa, who was born with cerebral palsy.

In Saviour's tribe, if babies are born with an anomaly (birth defect, maternal death, disease, or even twins or triplets), these babies are considered "spirit children" and are thought to have evil spirits that will be bad for the rest of the tribe. The parents are forced to make a difficult decision of moving the entire family to a "witch camp," where food and water are scarce, or getting rid of the "spirit child" and poisoning the baby.

Saviour was rescued by a local nun, Sister Stan, who cares for 57 other spirit children. Saviour could not walk or talk and got around by dragging himself by his hands. The scars on his knuckles mark the daily struggle he endured.

Sister Stan, through her charity, reached out to a retired nurse, Joan Tucker, who traveled to Ghana and advocated for surgery for Saviour. A long and difficult process finally brought Saviour to Shriners Hospital in Greenville, where he underwent a major reconstructive surgery at the end of June. He worked with a physical therapist to help build his strength and mobility. The physical therapist then referred him to Johnson for ankle foot orthotics.

Johnson, his assistant, Tucker, and Saviour all visited Good's classes that day. "Saviour spoke few words, but his smile lit up the room," said Good. He donned traditional attire as worn by chiefs in his tribe. He also had specially made New Balance shoes that provided a lift for a shorter leg. He had some orthosis on, but Johnson wanted to mold him for a new pair.

During Physiology class, Johnson explained the process of fitting, fabricating, and molding orthoses. He made casts on the ever-smiling Saviour and explained how they would help him walk. Saviour demonstrated his ability to walk across the room with one crutch and assistance from Tucker.

During Psychology class Johnson talked about the ability to allow his patients to participate more fully in life. Through the orthosis and a crutch, Saviour would now be able to move around and will not have to be carried or crawl.

Saviour's smile got even bigger when Tucker spoke about how excited he was to show his brothers and sisters in the orphanage how he could walk. Saviour plans to head home to Ghana in January, and Tucker will stay with him for a month while he learns to transition back into his regular life.

During the visit, the class also discussed the challenges Saviour will face after returning home. He will continue to grow, which creates the need for new shoes, braces, and longer crutches. Saviour and his team are hopeful these needs will all be met in time.

Said Good of the experience, "I'm not sure who learned more yesterday, my students or me. I thought that I was bringing in a guest lecturer to talk about a healthcare profession, but it was so much more. Instead of being the model, Saviour became the teacher.

"His story moved many of us to tears. His smile spoke volumes. His faith that has been instilled in him through Sister Stan was unshakable. The few words that he did speak brought joy to all our hearts. Saviour's presence was more impactful than any textbook could ever describe, any guest lecturer could ever explain, or any lesson I could ever plan."

Anna King, '18, also reflected on the visit: "It was an eye-opening experience that I will never forget. It was awesome to see how the things we are learning right now can help so many people in need."

For more information about Sister Stan's work, visit www.sisterstanschildren.org.

Every new year, many people are tempted to try the newest fad diet to either help lose weight or enhance athletic performance or both. Many of these diets call to restrict certain food groups such as carbohydrates. While this may help with weight loss temporarily, if not monitored carefully, a low-carb diet can lead to decreased energy and athletic performance. Carbohydrates are the primary energy source for the body, and thus are important especially in an athlete’s diet. Once the body depletes its stores of carbohydrates, the body switches to use alternate fuels such as protein or fats.

Carbohydrates often get a bad name because they are often found in simple form in processed foods including refined sugars and white flour. These commonly are seen in cookies, sodas, pasta and white bread. These foods are generally not satisfying to the appetite and cause spikes in blood sugar. Complex carbohydrates, however, are digested more slowly, leaving you feeling fuller and having less effect on blood sugar levels.  Complex carbohydrates include whole grains, vegetables, fruits, nuts and legumes (beans, lentils and peas).

Dietary Guidelines for Americans recommends that carbohydrates make up 45 to 65 percent of a daily calorie intake. For an individual on a 2000 calorie per day diet, that would mean 900 to 1300 calories in the form of carbohydrates. Rather than having these calories come from “empty sources” such as processed foods, carbohydrates should come from nutrient-dense foods that are naturally occurring. My favorite diet tip is to stay to the outside of the grocery store when I am food shopping. On the outside you will find the fresh produce, meats, and dairy. Most processed food is in the center aisles. Natural foods will provide a better fuel for the body, improving overall health and athletic performance.

Rather than limiting a certain food group, the best nutrition advice is to ensure that your diet has variety, balance and moderation. A diet rich in nutrient-dense foods from all food groups will allow for the best result in the New Year and for many years to come.

For more information:

https://www.choosemyplate.gov
https://health.gov/dietaryguidelines/2015/

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