Category Archives: Orthopedics Articles

Spinal Stenosis: A Painful Condition Prevalent in the Senior Population

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A recent study  published by Boston University has determined that lumbar spinal stenosis affects 4.71% of the general population, seemingly a very low number.  However, 47.2%   of individuals in the 60-69 age group have lumbar spinal stenosis on their MRI scan, which is a significant number.  The individuals  that actually  are diagnosed with severe stenosis will approach 20%.  These patients with significant spinal stenosis have a 3 times higher incidence of back pain than the general population.  As our population continues to live longer, spinal stenosis will certainly be  a significant health problem.

Spinal stenosis is the progression of arthritis in the spine occurring in the neck, as well as in the lower back.   As we age, the cartilage in the discs of our spine will lose their ability to hold water.  The water in the discs is what helps the disc move and remain flexible to bending and compression.  As the discs lose their water content, they become more fragile.  If the  fragile cartilage breaks, the condition is called degenerative disc disease.  As discs degenerate, they will begin to bulge and put pressure on the spinal canal and nerve roots.  This disc bulging will decrease the diameter of the spinal canal,a condition referred to as spinal stenosis.  The spinal stenosis slows the information that flows between the brain and the extremities.  The arms will be affected by spinal stenosis in the neck and the legs will be affected by lower back (lumbar) spinal stenosis.

Patients with lumbar spinal stenosis will feel back pain, as well as leg pain or fatigue.  Because of the fatigue in the legs, patients will have to sit frequently during walks.  Lumbar spinal stenosis will also cause patients to find benches in the mall and grab the cart at the grocery store, in order to make it through their errands.  Some patients may attribute their fatigue to age and as they continue to remain active later in life, this may severely limit their ability to join in their families activities.  The leg fatigue can cause significant pain and cramping during activity, but dissipates when the patient sits down.  The act of sitting  opens the spinal canal by decreasing the curve in the lower back,which also occurs while the patient is leaning on the grocery cart. Continue reading →

Spondylolisthesis – A Fancy Name for a Common Spine Problem

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Did you know that back pain and leg pain will cause about 20% of our population to see a physician each year? Although most back pain is minor and will usually resolve on its own,  there are many different diagnoses that can cause lingering lower back pain.  About 10% of the patients that see an orthopaedic spine specialist for their back pain are diagnosed with a condition where the bones in the spine have slipped or changed position slightly.  In medical terminology, this is called spondylolisthesis.

There are several different reasons that the bones may slide or change position.  The most common is degenerative disease of the discs that cause the bones of the spine to sit more loosely on each other and allows shifting to occur.  Children may also have a failure to form a complete connection in the spine.  This lack of connection allows the bones to slip on each other.

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Anterior Hip Replacement – What is it all about?

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As a Fellowship Trained Joint Replacement Surgeon, I am often asked about the latest developments in arthritis surgery.  With the advent of minimally invasive techniques in orthopedic surgery there has been a renewed interest in performing hip replacement through the front (anterior) of the hip as opposed to the more traditional posterior, or backside approach.  The logic behind anterior hip replacement is to try to minimize muscle damage by separating muscles to gain access to the front of the hip as opposed to releasing and repairing the muscles to gain access to the hip joint form behind.  In short, there is no perfect way to deliver implants to the hip joint.  If there were, we would all be performing that approach only for hip replacement surgery. Having given you this background, these are the most frequently asked questions encountered in my office:

Is anterior hip replacement a new technique?

No. The anterior hip approach was first described by Smith-Petersen in 1917.  It was used by the French surgeon, Robert Judet, in 1947 to perform an isolated femoral head replacement.  This later evolved into other French surgeons performing complete hip joint replacements through an anterior exposure in the 1960’s.

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Interventional Pain Management Providing Innovative Pain Relief

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More than 75 million Americans suffer from chronic, debilitating pain, according to the National Pain Foundation. In 2003, Research America released the results of a survey of 1,000 people in the United States that showed that 57% of all adults have had chronic or recurrent pain in the last year and that 75% of people currently in pain had to make adjustments to their lifestyle due to their pain. Chronic pain also accounts for more than 80% of all physician visits and leads to time off work and billions of dollars in lost productivity. With the prevalence and the exorbitant cost involved, it would seem only natural that health care workers would be clambering to find better ways to treat this epidemic problem. Unfortunately, this is not the case, and thus pain remains poorly understood and grossly under-treated. The complex mechanisms of pain transmission coupled with its inherent subjective nature creates an intimidating battle and requires physicians who are both comfortable with its diagnosis and more importantly who have an appreciation for the art of treating those in pain.

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