Pablo Pazmi ño, MD

Orthopaedic Surgery American Academy of Orthopaedic Surgeons Clinical Faculty Olympia Medical Center Cedars Sinai Medical Center Century City Doctors Hospital Education The University of California, Los Angeles The University of Michigan, Ann Arbor

Education

The University of California, Los Angeles

The University of Michigan, Ann Arbor

Clincal History Medical History Epidemiology, Natural History Pathophysiology Pathoanatomic Theories New Theories Diagnosis Symptoms Exam Findings Studies Treatment Non Operative Decision Making Process Operative 8. Cases Dr. V.A.H. Horsley (1857-1916)

Clincal History

Medical History

Epidemiology, Natural History

Pathophysiology

Pathoanatomic Theories

New Theories

Diagnosis

Symptoms

Exam Findings

Studies

Treatment

Non Operative

Decision Making Process

Operative

8. Cases

Patient usually younger: 20-50 years of age History of recurring or persistent back pain Occasional buttock pain and referred pain radiating down the posterior thigh with no radiculopathy (Radiating leg pain) Pain: Deep, dull ache in the lower lumbar region Increased pain with : Rotation, Flexion, and side bending, prolonged sitting/standing/walking Is your pain similar to this? You are not alone….

Patient usually younger: 20-50 years of age

History of recurring or persistent back pain

Occasional buttock pain and referred pain radiating down the posterior thigh with no radiculopathy (Radiating leg pain)

Pain: Deep, dull ache in the lower lumbar region

Increased pain with : Rotation, Flexion, and side bending, prolonged sitting/standing/walking

Is your pain similar to this? You are not alone….

A review of early Egyptian (1550 BC), Greek, Roman, and Arabic texts on medicine reveals an ongoing interest in treating spinal disorders. Sciatica and low-back pain were perhaps first mentioned by Hippocrates in 460–377 BC, and later by Galen. Hippocrates

A review of early Egyptian (1550 BC), Greek, Roman, and Arabic texts on medicine reveals an ongoing interest in treating spinal disorders.

Sciatica and low-back pain were perhaps first

mentioned by Hippocrates in 460–377 BC, and later by Galen.

Hippocrates

Galen performed the earliest methodical and research-oriented study of spinal disorders Galen recognized lordosis, kyphosis, and scoliosis, and may have been the first physician to describe back pain. He observed that injuries to the cervical spinal cord caused a certain level of loss of sensation and motor function, whereas injuries in lower areas caused a different level of paralysis. He gave a detailed account of the dissection of the spinal cord.

Galen performed the earliest methodical and research-oriented study of spinal disorders

Galen recognized lordosis, kyphosis, and scoliosis, and may have been the first physician to describe back pain.

He observed that injuries to the cervical spinal cord caused a certain level of loss of sensation and motor function, whereas injuries in lower areas caused a different level of paralysis. He gave a detailed account of the dissection of the spinal cord.

In the seventh century Paulus of Aegina first suggested surgery for spinal column injury in Medical Compendium in Seven Books.

In the seventh century Paulus of Aegina first suggested surgery for spinal column injury in Medical Compendium in Seven Books.

Surgery for disc herniation was first performed by Oppenheim and Kruse (1909);

Surgery for disc herniation was first performed by Oppenheim and Kruse (1909);

It is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. WJ Mixter

It is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice.

Henry Crock coined the term IDD: Internal Disc Disruption in 1970 Painful increase in biologic activity of the disc after injury in patients with normal Xrays, CT scans with abnormal discograms.

Henry Crock coined the term IDD: Internal Disc Disruption in 1970

Painful increase in biologic activity of the disc after injury in patients with normal Xrays, CT scans with abnormal discograms.

80% of population will have back pain, by the age of 60. By the age of 20, 50% of the population have already experienced Low Back Pain. 50% will become disabled at some time Low Back pain is second only to the common cold when it comes to symptoms requiring a physician visit. 4% will become chronic 4% represent 80% of cost to society 1%-3% will undergo surgery

80% of population will have back pain, by the age of 60.

By the age of 20, 50% of the population have already experienced Low Back Pain.

50% will become disabled at some time

Low Back pain is second only to the common cold when it comes to symptoms requiring a physician visit.

4% will become chronic

4% represent 80% of cost to society

1%-3% will undergo surgery

Patient usually younger: 20-50 years of age History of recurring or persistent back pain Occasional buttock pain and referred pain radiating down the posterior thigh with no radiculopathy (Radiating leg pain) Pain: Deep, dull ache in the lower lumbar region Increased pain with : Rotation, Flexion, and side bending, prolonged sitting/standing/walking Relief of pain with : Rest, Lateral recumbent position Leg pains develop as a late finding SLR causes back pain only Pain originates proximally and progresses distally occasionally past the knee

Patient usually younger: 20-50 years of age

History of recurring or persistent back pain

Occasional buttock pain and referred pain radiating down the posterior thigh with no radiculopathy (Radiating leg pain)

Pain: Deep, dull ache in the lower lumbar region

Increased pain with : Rotation, Flexion, and side bending, prolonged sitting/standing/walking

Relief of pain with : Rest, Lateral recumbent position

Leg pains develop as a late finding

SLR causes back pain only

Pain originates proximally and progresses distally occasionally past the knee

Conservative Options Nonsteroidal Anti Inflammatories Narcotic Medications / Muscle Relaxants Heat , Ice Physical Therapy Chiropractor Acupuncture Injections Epidural Steroid Injections Selective Nerve Root Blocks Facet Injections Surgical

Conservative Options

Nonsteroidal Anti Inflammatories

Narcotic Medications / Muscle Relaxants

Heat , Ice

Physical Therapy

Chiropractor

Acupuncture

Injections

Epidural Steroid Injections

Selective Nerve Root Blocks

Facet Injections

Surgical

All our procedures are performed in a minimally invasive manner. All discectomies are performed as a microdiscectomy as opposed to the traditional open discectomy. All patients receive a plastics closure and are followed closely afterwards

All our procedures are performed in a minimally invasive manner.

All discectomies are performed as a microdiscectomy as opposed to the traditional open discectomy.

All patients receive a plastics closure and are followed closely afterwards

Teamwork: All Procedures performed with both an Orthopaedic Spine Surgeon and a Neurological Surgeon

Thank you for your time. If you know someone who could benefit from a consultation for Lumbar Degenerative Disc Disease please refer them to our online website or call toll free to schedule an appointment 1-8SPINECAL-1 www.beverlyspine.com

Thank you for your time.

If you know someone who could benefit from a consultation for Lumbar Degenerative Disc Disease please refer them to our online website or call toll free to schedule an appointment

1-8SPINECAL-1

www.beverlyspine.com