Nearly 90% of Americans will suffer from back pain during their life. While it often resolves itself, there are many patients whose pain impacts their quality of life, and they are unable to do the things they love. Two of Bone and Joint Institute of Tennessee’s spine specialists John Klekamp, M.D., and Zachary Kalb, D.O., recently sat down to discuss advancements in technology and minimally invasive treatment options that are changing how back and neck issues are treated. Dr. Klekamp, a spine surgeon, is the former chief of Surgery at Williamson Medical Center, and Dr. Kalb is a physiatrist with a focus on interventional spine medicine.

Q: SPINE IS A PRETTY BROAD CATEGORY. CAN YOU TELL US MORE ABOUT YOUR SPECIALTY?

Kalb: My specialty is physical medicine and rehabilitation, and my sub-specialty is interventional spine medicine. First, I diagnose spine and various other musculoskeletal pathologies. I formulate a conservative treatment plan that usually involves physical therapy, modalities such as dry needling, and medications. For the patients who fail to improve with these conservative measures. I offer minimally invasive procedures such as injections and radiofrequency ablation, which can help patients avoid or delay progression to surgery. These procedure also help further diagnose the specific problem and aide in directing surgical management should it progress to that. We perform all of the injections and procedures on the third floor of our facility.

Klekamp: I began my orthopaedic training at Vanderbilt and then completed a spine fellowship at Emory University School Medicine. My practice primarily entails the evaluation and treatment of maladies of the spine from the top of the skull to the tip of the tailbone. I also operate at Williamson Medical Center, where I was the chief of Surgery for several years.

Q: WHAT ARE SOME OF THE MOST COMMON CONDITIONS THAT YOU TREAT?

Klekamp: Most of the disorders I treat are degenerative in nature. Some patients come in with issues like trauma or tumors, but mostly conditions such as wear and tear, like arthritis that occur naturally with age. Other common conditions include bone spurs, stenosis, scoliosis and instability.

Q: ARE THERE NON-INVASIVE TREATMENTS FOR MOST SPINE CONDITIONS?

Kalb: There are a variety of conservative treatment options that are considered before doing anything invasive. These include, but are not limited to diet modification, medications, physical therapy and Modalities such as dry needling, manual manipulation, Transcutaneous electrical nerve stimulation (TENS), phonophoresis, etc. If your pain hasn’t subsided in four weeks, we may consider minimally invasive treatment options such as epidural steroid injections, facet injections, radiofrequency ablation techniques.

“THERE ARE A VARIETY OF CONSERVATIVE TREATMENT OPTIONS THAT ARE CONSIDERED BEFORE DOING ANYTHING INVASIVE.”

Q: WHAT IS YOUR PROCESS FOR DETERMINING IF A PATIENT NEEDS SURGERY? ARE THERE OTHER LESS INVASIVE OPTIONS YOU TRY FIRST?

Klekamp: It completely depends on the presentation. Back pain in general is very common – about 80% to 90% of the general population will experience some kind of back pain at some point during their life. However, about 90% tends to get better on its own with basic home remedies. These include:

• Anti-inflammatory medications
• Ice and heat
• Stretching exercises
• Rest

If pain persists, or if you’re in a significant amount of pain, then you’ll want to come and see us. We will usually start off with some initial x-rays and talk with you about your pain and how it’s impacting your quality of life. We will then do a physical exam and go over your x-rays, and from there we will develop a conservative treatment plan. Usually, we recommend physical therapy, non-invasive methods, anti-inflammatories and activity modification. If this doesn’t work, we will move to more advanced diagnostic imaging such as CT scans, CT myelograms, and MRIs. We have access to all of this technology on the Williamson Medical Center campus, which is just across the parking lot. It really is a team approach here, and we work together to develop the best plan for our patient. After more conservative methods and more complicated diagnostic tests, we will determine our best course of action.

Q: HOW HAVE TECHNOLOGICAL ADVANCES IMPACTED HOW YOU DO YOUR WORK?

Klekamp: Advances in tech have impacted our work in both the office and the operating room. In the office, we have access to digital x-ray as well as access to multiple imaging facilities in Middle Tennessee. Access to imaging, including EMG, is key once you get past the initial conservative treatment options. We have our own neurologist in the building, Dr. Miller, who performs our EMGs in-house. This technology only improves at Williamson Medical Center. We utilize cutting-edge technology for spine care, including disc arthroplasty, minimally invasive approaches called oblique lumbar interbody fusion or OLIF, microscopic approaches, and more recent biological techniques that are advanced bone graft techniques that are capable of stabilizing the spine without the use of bone grafts.

“ADVANCES IN TECH HAVE IMPACTED OUR WORK IN BOTH THE OFFICE AND THE OPERATING ROOM.”

Kalb: Specifically in the procedure suite, I use a state of the art fluoroscope. It is a modern x-ray machine that I use for many of my procedures. It provides an instant image of the bony anatomy at any angle I need while minimizing radiation to the patient. The radiofrequency generator is another technological advancement I use frequently to ablate nerves in the back. It allows me to run electrical current along nerves, denaturing them and taking away their ability to transmit pain. Radiofrequency ablation has become very popular due to its ability to treat facet joint pain.

Q: CAN YOU EXPLAIN THE TEAM APPROACH TO PATIENT CARE AT THE BONE AND JOINT INSTITUTE?

Kalb: I work together with my physician partners, physical therapists and nurses here at Bone and Joint Institute to ensure that we have taken the proper conservative steps before progressing a patient to more invasive treatment options. My partners and I frequently discuss and refer patients to one another. The spine is so integral to the rest of the body. A problem in the back can present as pain anywhere in the body from the fingers to the toes.   I collaborate daily with my partners who specialize in upper and lower extremity orthopedics to determine the cause of pain and the correct course of action.

Klekamp: We have 16 physicians working at Bone and Joint Institute, and each of us relies on one another. We truly have a comprehensive, team approach to care. I frequently visit my partners’ clinics to present patients and ask questions to learn more and keep each other up to date on the newest technologies in each other’s fields. We attend conferences every other month where we discuss patient problems. Our referrals move very quickly because we recognize that we do need help in order to provide the best treatment. It really is a team effort.