For a young athlete, she knew it all too well. She had significantly herniated her disc in her spine and undergone surgery to seek relief. However, she was still in agony post-surgery, and because the pain kept her inactive, she gained weight. To make matters worse, she started walking differently, her body’s way of protecting itself from discomfort. The altered gait, in turn, created anguish in her sacroiliac joint and piriformis muscle. Dejected but hopeful, the young woman turned to The Christ Hospital Joint & Spine Center. She came to the right place!
Travis McClain, D.O. is a physical medicine and rehabilitation specialist certified in musculoskeletal sonography. He gave her an epidural for pain control. Then he recommended a physical therapy program for lower back pain as well as hip pain, performed several ultrasound-guided hip injections focused on the hip and knee region, and also performed an ultrasound evaluation of the other painful
joints in her body. Over five months, the combination of treatments allowed the pain to subside, and the patient began exercising again. She eventually lost 30 pounds.
“Because of what we were doing, her body healed itself,” says McClain. “We were able to help reduce her pain and facilitate healing so that she could become more active.”
McClain uses ultrasound for most of his cases, both for injections and diagnostics. “Patients really like that because they can see the whole process. It’s all live. When I’m doing the ultrasound, I can walk them through the anatomy and show them the areas where they might have either fluid on the joint, impingement or something that’s torn. When I actually do the injection, it’s done under ultrasound. You’d see the needle pass into the shoulder joint, see the medication flow, you’d see the removal of the needle. It gives you that feedback as the patient, too.”
“No one comes into a back doctor’s office wanting spine surgery,” says John Roberts, M.D., musculoskeletal medical director at The Christ Hospital. “That’s why the starting point is with our rehab specialists like Dr. McClain, who can make determinations about therapy versus Pilates, yoga versus epidurals, spinal injections, and so on.”
The Christ Hospital Joint & Spine Center is designed to be a team approach to healing. Patients have nonsurgical options, including physical therapy, dry needling, ultrasound treatments, acupuncture, and medical massage. If a patient has a herniated disc or nerve pressure, and it’s not an urgent scenario, an injection can be helpful.
Ryan Seal, M.D., an orthopedic spine surgeon at The Christ Hospital, says surgery is not the only option. “The data tells us that a large majority of those patients can have definitive, nonsurgical care providing complete resolution of the problem with an injection and subsequent therapy.”
But sometimes surgery is necessary. According to Seal, some cases require surgical intervention as the first line of treatment — for instance, if there is pressure on the spinal cord.
“It’s almost counterintuitive, but sometimes that’s actually the safest and most conservative thing to do,” Seal says. Individuals do not always present with significant spinal cord injuries in the emergency room. It may be a subtle presentation, which is why it’s vital to have a team of doctors who can evaluate and diagnose the problem. The goal is to give the best result to the patient with the least inconvenience. That means trying to limit the length of a hospital stay or a long recovery.
“It’s interesting to me that what would be a two-week hospitalization 15 years ago requires no more than a three-day hospitalization now. You’re driving your car within two weeks!” Roberts says. “It’s astonishing the improvements that have been made along the way.”
One of those improvements is robotic assistance in the operating room. Robotics help make the insertion of the instrumentation more accurate. They also help calculate how much curvature of the spine needs to be corrected. Perhaps the best reason to use robotics is their ability to speed up surgeries, enabling surgeons to do extensive surgeries in a shorter time. “This is one of the main reasons we can attack big deformities with relative ease and relatively short hospitalizations,” says Roberts.
Spinal surgery can be due to a single issue, such as a disc herniation or spinal stenosis. Roberts describes these issues as static, where one doesn’t have to worry about skeletal alignment. In these cases, surgeons can go in and decompress the nerve, whether it’s removing a fragment of a disc, a bone spur or bone overgrowth.
Monir Tabbosha, M.D., FAANS, is a neurosurgeon and spine surgeon at The Christ Hospital who specializes in complex spine disorders. “I love doing complex spine and deformity correction surgeries because it not only improves the patients appearance and mental health, but also improves their functionality and their ability to do the things they enjoy without the distracting pain and suffering.”
More challenging cases involve postural deformities, such as walking in a forward stooped posture. Any number of things can cause spinal changes to occur. It may be due to a genetic predisposition, aging, or it can be because of heavy physical labor. Roberts calculated that if a worker picks up something weighing 10 pounds 10 times per hour throughout the working day, the worker will have lifted an equivalent of an aircraft carrier over the course of her career. Many laborers carry much more than 10 pounds at a time daily.
“The amount of stress that can be put on one’s back through a working career is extraordinary,” Roberts says. “It’s amazing how well the human spine stands up to that, particularly knowing that the discs between our vertebrae are relatively inert. They don’t have a lot of metabolic activity and almost no repair process.”
While some people are born with robust spinal discs, others have diminutive discs. The latter category doesn’t do well in heavy manual labor; those are the patients who end up in more pain earlier in life. “If we could ever match a person’s physical attributes to the type of work they are employed to do, I think we could circumvent a lot of back injuries in the long run,” says Roberts.
The most proactive thing to ward off back pain is to remain active, Roberts says. “Everyone needs to double up on their physical activity to maintain as much muscle strength, cardiac health and flexibility as possible. Pilates and yoga are wonderfully helpful in maintaining all of that and can be practiced by older patients. I’ve got 80-year-old patients who still carry their golf bag for nine holes and don’t think twice about it.”
Doctors can provide diagnoses and make suggestions for treatment. Ultimately, it’s up to patients to decide their course of action. Roberts asks them to consider the following questions:
Are you meeting all of your goals? Are you living life to the fullest?Everyone’s answers are different. Even the perception of what constitutes “old” has evolved. It seems that 70 really is the new 50, and 80 is the new 60.
“It’s a wonderful shift in our society towards activity and achievement,” says Roberts. “Thank goodness technology has evolved greatly, too!”
The Christ Hospital has developed an impressive continuum of care with a full roster of experienced specialists who work together touring the best healing to their patients. The team includes physical medicine and rehabilitation specialists: Jennifer Chung, M.D.; Rachel Heberling, M.D.; Travis McClain, D.O., RMSK;
Jonathan Warford, M.D.; and spine surgeons Michael Kramer, M.D.; John Roberts, M.D.; Ryan Seal, M.D.; and Monir Tabbosha, M.D., FAANS. You don’t have to live with pain that limits your daily life. The Christ Hospital Joint & Spine Center can help.
“No one comes into a back doctor’s office wanting spine surgery. That’s why the starting point is with our physical medicine and rehabilitation specialists like Dr. McClain, who can make determinations about non-surgical treatments first.”
~Dr. John M. Roberts
The Christ Hospital Joint & Spine Center is located at 2139 Auburn Ave. Cincinnati, Ohio 45219. For more information, visit thechristhospital.com/back or call 513-792-7441.