Facebook Live Interview: Dr. Zachary Kalb, D.O. on Non-Operative Spinal Procedures

Can you give a brief introduction of yourself?

I’m originally from Toledo, OH. I did my undergraduate studies at Miami University in Ohio, then went on and did medical school at Virginia School of Osteopathic Medicine at Virginia Tech. I then did my residency training in South Florida at Larkin Community Hospital and an interventional spine fellowship with OrthoCarolina in Charlotte, NC. I started here at the Bone and Joint Institute of Tennessee in September of 2019.

Please give some detail on the spine program at the Bone and Joint Institute of Tennessee.

Our three excellent spine surgeons are Dr. John Klekamp, Dr. Michael McNamara, and Dr. Casey Davidson. There’s also two Physician’s Assistants – Jon Tisdale, PA-C with Dr. Klekamp and Cara Bohrman, PA-C with Dr. McNamara. We also have a large staff that helps us out, and we wouldn’t be able to do what we do without them. They’re specifically trained to treat spine patients as well. Then there’s myself who treats a lot of the non-operative spine patients.

What types of conditions do you treat?

I treat pretty much any nerve, joint, or tendon in the body – but since we’re talking about spine today, I’ll focus there. My spine treatments are generally targeted towards the intervertebral discs in the spine and the nerve roots, as well as the joints in the spine. These treatments are minimally invasive. The surgeons can provide that next step in treatments in surgery, if necessary.

Can you explain what non-operative procedures can be performed at the Bone and Joint Institute?

The most common procedures we do from a non-surgical standpoint are epidurals. Those are performed anywhere from the top of the neck, all the way down to the tailbone. They’re generally aimed at treating pain in the spinal nerve roots, as well as pain in the discs, often related to stenosis-type problems. We also perform facet injections for the joints in the back, which usually treats axial back pain. Then there’s another segment of treatment for facet pain, when patients aren’t getting significant relief from the injection, we can do what’s called a medial branch block, which essentially numbs out the facet joints in the low back. They can also be performed throughout the spine, but the low back and the neck are the most common areas. Once we’ve numbed those out and determined and diagnosed  that those were the source of the problems in the back, we can do another treatment called radiofrequency ablation where we essentially apply heat to those nerve roots and numb them out for six months to a year – that can really help patients’ back pain.  

How do you determine surgical vs. non-surgical care that is best for the patient?

There’s a series of steps that we go through. Generally, neck and back pain is going to get better in the first 4-6 weeks of onset. So we want to make sure the patient has tried anti-inflammatories – things like Tylenol, Ibuprofen, Aleve – and also a course of physical therapy. Once they’ve tried those for about 4-6 weeks, if it hasn’t improved, we’ll often progress to some further imaging, beyond just x-rays, which provide more detailed pictures of the soft tissue, and at least around the spine can show us the nerve roots and the discs better, to see if there’s any other treatments, like some of these non-operative treatments, to proceed with. If I’ve been seeing a patient and we’ve tried non-surgical options, or if I’m presented with a patient who has specifically progressive numbness and weakness, those things I will usually will at least have a surgeon see them, prior to spending time on non-surgical options. But if you don’t have progressive weakness or significant numbness, it’s not an absolute necessity to go through with surgical means. 

Can you describe the technology used in your procedure suite?

My procedures, at least around the spine, cannot be performed safely without a fluoroscope. A  fluoroscope is essentially an x-ray machine that provides a focused beam x-ray picture for me in real time while I’m performing my procedures and allows me to be very precise with where I place my needle. There’s not a whole lot of room for error with the spine, so you need exact locating with the fluoroscope. That’s an invaluable piece of equipment that I use on all my procedures. The other notable piece of equipment that we have in the suite is an RFA generator. That assists me with the facet joint radiofrequency ablation that I spoke of earlier.

How does this add to the comprehensive services that the Bone and Joint Institute of Tennessee offers?

That’s a huge benefit and pretty rare – it’s something you won’t be able to get at many other clinics – is having a surgical team working alongside a non-surgical team. If I see a patient and I feel maybe I need a surgical opinion on the case, I can walk down the hallway while the patient is in the room that day, speak with a surgeon, and get their opinion. It’s invaluable to have two sets of eyes who can look at their images, hear what the patient is feeling, then we can formulate a plan going forward. Another significant benefit to having us all in the same place together is if one of the surgeons sees a patient and feels they’re in a lot of pain and they may not be able to wait for a referral from me or a procedure from me, they can send the patient over and I usually can get them an injection or a non-surgical treatment option that same day. And same thing with a surgical referral – if I feel that non-surgical treatments aren’t the best option, I can walk down the hallway – and this probably happens once or twice a day – I’m able to get a patient referred in and seen that same day that they were scheduled for an appointment with me. Another thing that not many people think about is that pain often changes – patients’ conditions change from one week to the next. You hear patients say, “my pain was good for a week, then I went for a run and it came back”. At other clinics if you’re scheduled, but then have to go elsewhere to another provider to get that treatment, if your pains change from when you saw that surgeon initially and when you present for the procedure, you’re kind of in a bind. Your options are either get the procedure that might not be the best for your problem at that time, or get referred back to the original physician. Whereas here, if I get a shot ordered for a patient of mine and they come in and see me, and in that time that it’s taken for them to get ordered for the procedure and come see me, their pain has significantly changed, I can walk right down the hallway to any of the providers, talk to them, look through the MRI, see if there’s another option, and potentially change that treatment plan right there on the spot, which you can’t do that at other places. Even outside the spine program, spine pain mimics foot, knee, and hip pain, as well as shoulder, elbow, and hand pain, so having all of us in the same building is invaluable because I can talk to any one of them and either change the treatment plan or expedite a treatment plan for the patient.


For more information about non-surgical spine treatments, call Bone and Joint Institute of Tennessee at (615) 791-2630. You can also schedule an appointment online.