Your SlideShare is downloading. ×
OHSU Spine Center
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

OHSU Spine Center

724

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
724
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. OHSU Spine Center Low Back Pain: Myth vs. Reality
  • 2. OHSU Spine Center
  • 3. OHSU Spine Center • Orthopaedic Spine Surgeons
  • 4. OHSU Spine Center • Orthopaedic Spine Surgeons • Neurosurgeons
  • 5. OHSU Spine Center • Orthopaedic Spine Surgeons • Neurosurgeons • Physical Medicine & Rehabilitation Specialists
  • 6. OHSU Spine Center • Orthopaedic Spine Surgeons • Neurosurgeons • Physical Medicine & Rehabilitation Specialists • Pain Management Specialists
  • 7. OHSU Spine Center • Orthopaedic Spine Surgeons • Neurosurgeons • Physical Medicine & Rehabilitation Specialists • Pain Management Specialists • Spine Physical Therapists
  • 8. OHSU Spine Center • Orthopaedic Spine Surgeons • Neurosurgeons • Physical Medicine & Rehabilitation Specialists • Pain Management Specialists • Spine Physical Therapists • Spine Center Gym
  • 9. OHSU Spine Center • Orthopaedic Spine Surgeons • Neurosurgeons • Physical Medicine & Rehabilitation Specialists • Pain Management Specialists • Spine Physical Therapists • Spine Center Gym • Spine Center
  • 10. Identifying the Source of Low Back Pain Diagnostic Tools: – History – Physical Exam – Diagnostic Studies • Imaging • Labs • Electrodiagnostic Studies – Spinal Injections Diagnoses: • Radiculopathy • Spinal Stenosis • Non-Specific Benign LBP • Disc Degeneration • Myofascial Pain • Piriformis Syndrome • Sacroiliac Pain • Malalignment
  • 11. Myth vs. Reality? Back pain … • Affects everybody at some point
  • 12. Myth vs. Reality? Back pain …affects everybody – Individual lifetime occurrence rate – 60-90% – Yearly prevalence rate – 15-20%
  • 13. Myth vs. Reality? Back pain …affects everybody and gets better! – Individual lifetime occurrence rate – 60-90% – Yearly prevalence rate – 15-20% – 50% better at 1 week – 90% better at 6-12 weeks – Dillane, Brit Med J, 1966 – Waddell, Spine, 1987 – Berquist, 1977
  • 14. Myth vs. Reality? Back pain … • Affects everybody at some point • Is result of poor design of the spine
  • 15. Myth vs. Reality? Back pain …is result of poor design of the spine
  • 16. Myth vs. Reality? Back pain … • Affects everybody at some point • Is result of poor design of the spine • Is caused by disk degeneration
  • 17. Myth vs. Reality? Back pain …is caused by disk degeneration • 98 asymptomatic L- Spine MRIs – 52% bulges, 27% protrusions, 1% extrusion – 14% ALT, 8% facet – 38% with multilevel abnormalities » Jensen, NEJM 1994
  • 18. Myth vs. Reality? Back pain … • Affects everybody at some point • Is result of poor design of the spine • Is caused by disk degeneration • Requires activity limitations
  • 19. Myth vs. Reality? Back pain …requires activity limitations • Earlier resumption of work and activities did not have an effect on pain and was associated with improved function – Gilbert, Deyo, Malmivaara
  • 20. Myth vs. Reality? Back pain … • Affects everybody at some point • Is result of poor design of the spine • Is caused by disk degeneration • Requires activity limitations • Implies damage to the spine
  • 21. Myth vs. Reality? Back pain …implies damage to the spine
  • 22. Myth vs. Reality? Back pain … • Affects everybody at some point • Is result of poor design of the spine • Is caused by disk degeneration • Requires activity limitations • Implies damage to the spine • Is better with rest
  • 23. • Bedrest trials – 0 vs 4 days (n=125) – 2 vs 7 days (n=203) • Shorter bedrest – 45% fewer lost workdays – 42% fewer days of decreased activity – No difference in pain » Deyo, 1986 » Gilbert, 1985 Myth vs. Reality? Back pain …is better with rest
  • 24. WHAT ABOUT MY ACTIVITIES? Golfing? Running? Yardwork? Backpacking? Skiing? Firewood? Hunting? Fishing? Camping? Driving? Horseback Riding? Marathons? Lifting? Bending? Weight Training? Biking? Bowling? Working? Basketball? Softball? Grandkids? Kids? Hiking? Climbing? Woodworking? Painting? Kayaking? Mountain Biking?
  • 25. Myth vs. Reality? Exercise/Activity… • Is bad for your back
  • 26. Myth vs. Reality? Exercise/Activity…is bad for your back – Exercise: • Focused on identifying and improving impairments in flexibility and strength. – Results: • People with chronic LBP can substantially improve back flexibility and strength through exercise. This frequently translates into improved ability to function and less daily pain. » Mayer et al. JAMA 1987; Hazard et al. Spine 1989; Estlander et al. Scan J Rehab Med 1991; Manniche et al. Pain 1991; Rainville et al. Spine 1992; Nelson et al. Orthopedics 1995;
  • 27. Myth vs. Reality? Exercise/Activity… • Is bad for your back • Is associated with spine degeneration
  • 28. Myth vs. Reality? Exercise/Activity…is associated with spine degeneration • 67 asymptomatic L- Spine MRIs – 20-39 y.o.: • 35% Disc degeneration – <60 y.o.: • 20% Disc herniation – >60 y.o.: • 36% Disc herniation • 21% stenosis » Boden, JBJS 1990
  • 29. Myth vs. Reality? Exercise/Activity… • Is bad for your back • Is associated with spine degeneration • Should be avoided with back problems
  • 30. Myth vs. Reality? Exercise/Activity…should be avoided with back problems • “Proper Mechanics” – “… learn to sit, stand, lie, and do ADLs with LB in proper position” – Grant, 1975 • Increased LBP risk? – “… difficult recovery in patients using the wrong muscles to bend, lift” – Marras, Spine 2001
  • 31. NO PAIN ----- NO GAIN and the role of common sense
  • 32. Myth vs. Reality? Exercise/Activity… • Myths (traditional advice) – avoid activity, be passive – spine easily damaged – often damage is permanent – focus on pain • Reality – no serious disease – spine is strong, rarely damaged – pain does not mean harm – activity is important to recovery – focus on function Burton, Waddell et al; Spine 1999
  • 33. Exercise and Back Pain… • Degenerative changes are inevitable
  • 34. Exercise and Back Pain… degenerative changes are inevitable • Degenerative changes increase with age • Back pain levels off with age • McNab 1977
  • 35. Exercise and Back Pain… • Degenerative changes are inevitable • Muscle are shock absorbers
  • 36. Exercise and Back Pain… muscle are shock absorbers • Restore – Strength – Flexibility – Endurance
  • 37. Exercise and Back Pain… muscle are shock absorbers • Restore – Strength – Flexibility – Endurance
  • 38. Exercise and Back Pain… muscle are shock absorbers • Restore – Strength – Flexibility – Endurance
  • 39. Exercise and Back Pain… • Degenerative changes are inevitable • Muscle are shock absorbers • Muscles are modifiable and measurable
  • 40. Exercise and Back Pain… muscles are modifiable and measurable
  • 41. Reality! Exercise and back pain… • Back pain is common • Degenerative changes don’t correlate well to pain • Any activity is better than no activity for the back
  • 42. TREATMENT OPTIONS Therapy Medications Injections Surgery
  • 43. Myth vs. Reality? Spinal Surgery… • Spine surgery won’t help me because I know too many people who still have pain after surgery
  • 44. Myth of Spine Surgery Jung U. Yoo, M.D.
  • 45. Upright Balance
  • 46. Provide Motion
  • 47. Shock Absorption
  • 48. House Neural Elements
  • 49. Myths • Minimally invasive surgery is better • Those who have surgery have more pain after the surgery than before • Latest technology is better • Doctors will make me better
  • 50. Arthroscopic or laser surgery?
  • 51. Exposure • Minimally invasive may require longer surgery • Surgeon may have limited view • Small incision does not mean small surgery • There are many type of minimally invasive surgery
  • 52. Laser Discectomy
  • 53. Thermal Disc Coagulation
  • 54. Protein Denaturation
  • 55. THOSE WHO HAVE SURGERY HAV Those who have surgery have more pain after the surgery than before.
  • 56. Why things fail • Wrong diagnosis • Wrong patient • Wrong surgery • Life is a percentage
  • 57. • Conditions that we have to fix • Conditions that we can fix • Conditions that we cannot fix
  • 58. Broken
  • 59. Cancer
  • 60. Herniated Disc
  • 61. Spinal Stenosis
  • 62. Deteriorated
  • 63. I I want the latest technology.TECHNOLO
  • 64. Wrong Surgery
  • 65. Increased Stability
  • 66. Artificial Disc
  • 67. salvage
  • 68. Thank you

×