Category Archives: Orthopedics

How Active Can I Be After Spine Surgery?

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OSC’s Dr Jeffrey R. Carlson, MD Explains What You Can Do After Surgery on Your Spine

Patients often ask about the activities that they will be allowed to participate in after they have spine surgery. Many fear that they will not be able to return to their previous level of activity and are doomed to a miserable future as an overweight couch-potato. Spine surgery can be concerning enough without the patient worrying about the consequences of the surgery itself.

OSC Spine Surgeon Dr Jeffrey Carlson MD

Dr Jeffrey Carlson preps for surgery

There was a school of thought that suggested that patients who undergo spinal surgery should never participate in sports and should change jobs to less heavy labor positions. Now, there are several studies that show professional football players are able to return to their original starting positions on the field after disc removal, or microdiskectomy. Obviously, these are some of the top athletes in the country who should have better pre-operative fitness than the average patient. There is currently a study in the journal SPINE, which looks at patient’s perceptions of spinal surgery and their post-operative activities. As the physicians in this study found, patients who were more fearful of moving after surgery, had more pain and dysfunction after surgery than those patients who were more confident in their attitudes about moving.

OSC spinal surgery center

Evaluation for Spine Surgery

One of the goals for most spine surgeries is to restore the patient’s activity levels to normal. The spine specialist should address any expected limitations after surgery, before the surgery is performed. This conversation should include the ability to walk, bend, lift, turn and any type of brace that will be needed. For example, after a typical spinal fusion, there will be some limitation in lifting and exercise for the first 6 weeks from surgery. After the first 6 weeks, patients should be allowed to return to their normal activities. Depending on the patient’s pre-operative health and fitness, physical therapy may be needed to get the patient back to their normal routines and exercise.

As a practical matter, if the spine surgeon does not present a surgery that will return you to your previous level of activities, the surgery should not be performed.

Dr. Jeffrey R. Carlson attended medical school at George Washington University, completed his residency at Harvard University Combined Orthopaedic Program in Boston, MA and has fellowships in Orthopaedic Spine Surgery and Orthopaedic Trauma Surgery. Dr. Carlson currently practices as an Orthopaedic Spine Specialist at the Orthopaedic & Spine Center in Newport News, VA.

E (Epidural) Day – Interventional Pain Management

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Pain Relief through an Epidural

Following from my last post, with much fear and trembling, I checked in to the OSC MRI and Fluoroscopy Waiting Room for my Cervical Epidural.  I was taken into the Fluroscopy Suite by Mary, Dr. Sureja’s nurse and by one of our Radiology techs, Debbie.  They gave me a gown to change into (although I could keep on my bra and everything from the waist down), put on a surgical cap (kind of like a shower cap) to hold my hair, and helped me to get situated on the procedure table.

OSC Orthopedic Practice

The procedure table is very comfortable.  I was told to lay on my stomach with my face in a round cushion, which was open so that I could breathe and see.  Kind of like a massage or PT table.  Dr. Raj Sureja came into the room and started talking to me and he was so kind and reassuring.  He explained every step of the procedure and told me exactly what to expect.  He told me that he would talk to me to keep my mind off of what was going on OR that he would be quiet, if that would help me get through my fear.  I told him to talk to me, so he did.

First, he injected numbing medication into the area where he would do the epidural.  My injection area was in the back of my neck, near the intersection of my neck and shoulders.  This shot barely hurt at all and only for a moment, but I still started to feel hot and faint.  Mary and Debbie turned on a fan and blew it on me to cool me off.  Dr. Sureja took pictures of my spine and herniated disc with the fluoroscopy machine and then inserted the catheter into my neck, through which he would place the steriod medication.  He continually took pictures of my spine to make sure he was placing the medication correctly.  He was very gentle and I cannot say this enough, patient and kind.  Although, at this point, the epidural did not hurt, I must say it felt weird.

It was over very quickly and unfortunately, I was very faint feeling, so it took me a while to sit up and feel better.  They got me some water and let me sit awhile until I started to feel better.  They were concerned because my blood pressure dropped and that was why I was feeling so light-headed.  They put me in a room and continued checking on me and taking my blood pressure until I felt normal.  Then they released me to go home, with an instruction sheet and into the custody of my in-laws, who drove me home.  When you have an epidural, you have to have someone to drive you home, because you may experience dizziness or headache or just feeling funny.  It was nice to have someone to worry about the driving.  All I wanted to do was go home and rest.  Even though I got faint and felt silly, I made it through the procedure!  Hopefully, it will help!

Next time, the day after!

How OSC’s Orthopedic Associates Helped my Pain in the Neck – Follow my Journey….

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Orthopaedic & Spine Center at the Cutting Edge of Pain Management

Hello! I work for OSC and have been battling neck and shoulder pain for almost three years. I decided to share my experience in hope that someone else could benefit and find answers. I also would love to start a conversation among folks who might have similar stories about neck pain and disc problems, so that we can compare notes about treatment, what works and what hasn’t, prognosis and actual outcomes.

OSC Orthopaedic surgery center

OSC's Orthopedic Associates Center of Excellence

I have always carried my stress in my shoulders. In fact, when someone would try to rub my shoulders as a kind gesture, it would always hurt instead of feeling good. Back in my twenties, I noticed that I would develop neck pain when I worked for a long time doing data entry at a computer, but that pain quickly went away as soon as I changed my activity.

Fast forward to about 3 years ago, when I was 44 years old. I began noticing pain in my neck, spine, in my shoulder and in the area between. The pain would move around some, but it was almost always a nagging, burning pain, punctuated by bouts of more severe stabbing pain. It started as an occasional problem, but after a business trip where I slept on squishy, non-supportive pillows for five days, it became a constant painful part of my life.  Ever since that time, I have been nursing this pain and doing everything that I can to make it go away.  My examinations and Xrays only showed mild arthritis in the neck, nothing extreme.

Yet, I hurt all of the time!

I have tried Physical Therapy (hot packs, E-Stim, a TENS unit, traction and exercises), at home exercises (performed every night, religiously) anti-inflammatory, non-narcotic muscle relaxers as well as steroid injections into the painful trigger points in my trapezoid area.  I have worn out two heating pads, gotten deep tissue massage and used every type of analgesic rub known to mankind.  None of these have ever provided more than passing relief.

Orthopaedic surgery by Jeffrey Carlosn MD

Dr Carlson Head of Orthopaedic & Spine Center

A few weeks ago, after trying to sleep with the pain, tossing and turning at night and hoping that the heating pad would somehow “heal” me, I noticed a strange stiffness up the back of my head, which made it very uncomfortable to sleep or turn my head.  I waited a few days, hoping it was temporary, but the stiffness and soreness continued and was getting worse.  I decided to take action and talk to one of our Orthopaedic Spine Surgeons here at OSC.  I told him my symptoms and he referred me immediately for an MRI.

Next time…the results of the MRI!

Don Hollomon Hip Replacement

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If you haven’t heard already, the Orthopaedic & Spine Center is now offering outpatient total joint replacement.  Recently, Dr. Mark McFarland performed an outpatient hip replacement on Mr. Don Holllomon.  14 days later, here’s Mr. Hollomon going up and down his stairs.

Pretty impressive.  If you’re interested in outpatient total joint replacement, please contact us to schedule a consult.

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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