Dr. McNamara on Lumbar spine

Dr. McNamara, tell us a little bit about yourself.

I am an orthopaedic surgeon.  I do spine surgery as a specialty and did my undergraduate degree at Johns Hopkins University in Baltimore, and then went down to Duke University where I did my medical school and residency.  I then came to Vanderbilt in the early 1990s to do a fellowship in spine.  I’ve been practicing orthopaedics in Franklin since 1995 when I joined the Franklin Bone and Joint.

What are common causes of some low back pain?

Basically, the most common causes are overdoing simple things- such as overdoing yard work or over lifting things that stress the lower back and cause some spine conditions. The other conditions are aging.  Age-related changes occur by no fault of the patient- they just happen- such as degenerative disc disease.  It  just occurs and can become a very painful condition, sometimes requiring surgery.

What are some non-surgical treatments for low back pain? What do you try first?

With every patient that comes in, we start with some type of non-surgical intervention, except in very rare instances, which would be emergencies.  We use a lot of physical therapy, anti-inflammatory medications, and injections.  Zach Kalb is our physiatrist and he does a lot of our radiology-guided injections, so we have that as an option to treat people as well. Physical therapy is our mainstay. As you’ve heard me before on Facebook, I’m a big fan of core strengthening and I think it really can help. It’s not easy, and it’s not fun, but it does work really well.

When do you get to the point where surgery is an option?

To me, my evaluation is when we can either say they have dysfunction, their muscles are weak, or their pain is uncontrollable after all the things we just talked about. Once we get to the point where the pain is not controllable, and it’s a significant impact on their quality of life, then surgery can become an option in the treatment of the patient. 

There are different types of surgery. What leads you to make a decision for one type of surgery over another?

The decision can be between a discectomy, or just decompressing (getting pressure off) a nerve or a laminotomy. When adding the fusion to that operation, if the spine is unstable or it’s out of alignment, we’re going to have to do a fusion to make the bones grow together; I call it bone welding- which is what we want to do with a fusion. A fusion takes longer to recover. It’s a slower process and it’s more surgery which usually involves some type of widgets- screws, rods, spacers- to help stabilize the spine. While the healing is faster with the widgets, it’s still there and it still takes time, so we have to wait for the biology of the bone to heal.

Is a lumbar fusion surgery where you’d be an inpatient in the hospital and spend the night or would it be an outpatient surgery?

Some spine fusions we do as outpatients, but the lumbar spine fusions in general, in our practice, stay overnight.

What does spine fusion recovery look like? When does physical therapy come into play?

In the lumbar fusion, which is what we’re talking about, the mainstay of recovery is going to be walking. I’m going to get my patients up walking the day of surgery, and they’re going to continue to work on that walking. I don’t use physical therapy after they get discharged from the hospital for a while. I want them to go at their own pace and just increase that walking.  If they get to a point where they get stuck or if there’s a problem, we will then refer them to physical therapy.

Talk a little bit about the importance of the core and how it can lead to long-term spine health.

The core is critical to long-term spine health. If you think about it, your body comes with a built-in brace that’s better than anything that’s ever been made. All we have to do is work on developing that brace, which are the muscles to the core- the abdominal muscles. I always tell people that the core goes from the neck to the knees.  It’s all of the muscles involved and it’s important to do core strengthening exercises.

What would be a good example of core strengthening?  Would it be a plank or are there other exercises that you recommend?

I like planks and I recommend planks to patients.  I think it’s easier and lowers stress on the back. On the internet, there are several programs to get to a two-minute plank. Once you get to about two minutes, that’s when you really start to see the benefit.  It can be very difficult, but you have to start slow so you don’t get hurt. Once you build up to a two-minute plank, it’s a very effective way of building your core strength. You don’t have to join a gym. You don’t have to have fancy shoes or outfits. You can do them at home on a mat and that doesn’t take any equipment.

Can you describe the comprehensive care that Bone and Joint Institute offers?

Bone and Joint has been here in Franklin since 1979. Since it was started, it’s now grown to 16 doctors and four locations. We can provide orthopaedic care for about every type of orthopaedic injury. We have fellowship-trained specialists in all aspects, and we’re able to cover any major issue completely.