Spinal surgery is a complicated and daunting subject that, as recommended, should be left to the professionals. Despite the availability of information, patients can still be left questioning their treatment options and potential next steps on their road to recovery. In order to combat this issue, Bone and Joint Institute of Tennessee’s spine specialists Michael McNamara, M.D., and Casey Davidson, M.D., sat down to answer and discuss patients’ questions concerning the world of spine health and surgery. Topics included common back and neck conditions such as arthritis and herniated discs, when to seek help, and preventive measures we can all take to avoid pain.
Q: What are the most common things that you treat?
Davidson: Arthritis and herniated discs are some of the more common conditions we treat at Bone and Joint Institute. We see a lot of arthritis that creates tightness around the nerve roots through the spinal cord, which usually warrants some decompression or removing of the element that’s causing pressure on the nerve root and spinal cord. Degenerative and acute disc herniation are two of the most common things we deal with. We do treat spine fractures, usually with bracing and some medical management. We also do some deformity correction and treatment of infection and tumors, but it’s much less common.
Q: At what point should someone see a spine specialist?
McNamara: We tend to see patients in every spectrum of treatment. We see some patients with acute issues as new patients, some patients we see as a type of primary care provider, and some patients come to us through their primary care physician. We’ll see patients in any aspect of the spine care element. We also have some mid-level providers to provide care upfront if somebody has an acute problem that we can’t get to immediately.
Conservative management is what we’re going to initially default to almost every time, unless there’s some type of major red flag about a neurologic problem. So 99% of the time, we get started with conservative treatment and progress from there. Most people who come in to see us are not going to have spine surgery, and that’s just the nature of what we do.
“WE TEND TO SEE PATIENTS IN EVERY SPECTRUM OF TREATMENT.” – DR. MCNAMARA
Q: What types of conservative measures do you take before surgery?
McNamara: The big buckets are:
Q: What types of surgeries do you perform, and what is the recovery process like?
Davidson: Typically our first approach to any of the conditions is usually decompression. That can be anything from taking a little bit of bone off of the back of the spine to access the nerve root(s) to a fusion. Those are the bread-and-butter things we do, but we can also do a micro-discectomy through a very small incision and a relatively minimally invasive procedure. In the neck, we do cervical disc replacements to try to maintain and preserve motion.
From a recovery standpoint, there are varying degrees of recovery; but a four- to six-week period is typical. For 95–99% of the procedures we do, we have you up and walking on either day one or day two, and the length of stay in the hospital is usually around one to two days, as well.
McNamara: For most minimally invasive procedures, you’re going home same day. Some cervical spine fusions, you’re going home same day. Most cervical disc arthroplasties, you’re going home same day. It has moved to a much shorter hospital stay, and the patients do better when they’re home, so we try to get them home as quickly as possible.
Q: Are there restrictions for spine surgery candidates?
McNamara: Yes. The biggest restriction has to do with putting the patients to sleep, because most of what we do is done under general anesthesia. Things that can preclude the opportunity for spine surgery are:
Q: What is your niche within the spine specialty?
McNamara: We perform most spine surgeries with the exception of complex pediatric deformity work. That deformity work goes up to the pediatric children’s hospital. We do everything from the top of the neck all the way down to the bottom of the sacrum. We are able to do lumbar instrumentations, thoracic instrumentations and all the decompressive work.
Some people use a neurosurgeon and an orthopedic surgeon in Nashville; but we’re trained to do all of the work ourselves, and we intend to do it that way. There’s nothing wrong with having a team approach in general, and we do team together if we have complex issues in the operating room; but we find that we have better control of what we’re doing this way.
Davidson: I agree. We handle everything from the upper neck, down through the lower neck and the middle of the back, and all the way down to the lowest levels of the lumbar spine and down to the sacrum. We treat everything from:
Q: Can you go into more detail about kyphoplasty?
Davidson: Kyphoplasty is a procedure we utilize for patients who suffer from a fracture of the lumbar or thoracic vertebrae, usually something called a compression fracture. This can be related to a fall, or it can be related to osteoporosis or metastatic tumors.
When the patient experiences ongoing pain in spite of attempted non-operative management for approximately three to six weeks, then we take them to the operating room. Here, we use X-ray guidance to place percutaneous balloons into the fractured vertebrae and inflate the balloons to recreate the arterial body height, and then insert some bio-compatible cement into the fractured vertebrae. This typically gives very good relief of pain, almost immediately, as well as long-term.
Q: Are there any preventive measures to keep a healthy back and spine?
Davidson: I definitely think there are a number of different things you can do from a preventive standpoint. One would be to maintain a healthy body weight. Carrying around extra weight on a day-to-day basis puts extra stress through the mid- and lower back, and that can predispose you to having significant degeneration on an accelerated basis.
Smoking and smokeless tobacco have both been proved to cause deterioration of the tissues and deterioration of the microvascular vessels that provides blood supply to the nerves. Monitoring medical conditions, such as diabetes and high blood pressure, and exercising on a day-to-day basis are also very important, and that goes hand in hand with the first thing that I mentioned. Maintaining flexibility of the neck, back and hips can help prevent you from having back issues.
McNamara: As Dr. Davidson said, keeping a healthy diet and healthy weight are key. I’m always preaching core strengthening, especially to my lumbar patients. One single exercise I tell patients to do is a plank. It requires no equipment, no gym membership, and it’s significantly more difficult than it looks; but it seems to work.
“KEEPING A HEALTHY DIET AND HEALTHY WEIGHT ARE KEY.” – DR. DAVIDSON
As far as nutrition, a lot of people ask about whether glucosamine and chondroitin sulfate help with joints. The jury is still out on that. It certainly will not hurt, but it will hurt your wallet. So I tell patients, if their wallet doesn’t mind and they want to try it, they should, because for some people it does work really well.