1. ILYA KUPERSHTEIN, MD
Spine Surgery
Summit Medical Group
MAINTAINING A HEALTHY BACK
AND TREATMENT OF
DISC HERNIATIONS.
DISC HERNIATIONS

2. Background
 N O l
New Orleans

3. Training
 C
Cornell/ Hospital for Special Surgery
ll/ H i l f S i l S

4. Outline
 I
Introduction
d i
 Prevention
 Injuries
 Conclusion

5. Looking at the Spine
 Li
Linear
 Parts
 Cervical
 Thoracic
 Lumbar

6. Looking from the Side
 N
Normal Curves of the Spine
l C f h S i
 Cervical lordosis
 Thoracic kyphosis
 Lumbar lordosis
b l d

7. Abnormal Curves
 K h i
Kyphosis
 G
Genetics
i
 F t
Fractures
 Osteoporosis

8. Abnormal Curves Cont
 S li i
Scoliosis
 Kids/adolescents
 Genetics
 Adults
 Arthritis
 Degenerative changes

9. Anatomy
 A
Anatomy
 V
Vertebral body
b l b d
 Di
Disc
 Facet joints

10. Spine Anatomy
 Cervical
 C1‐C7
 Thoracic
 T1‐T12
 Lumbar
 L1‐L5
L1 L5
 Sacrum
 S1‐S5 (fused)

11. Anatomy Cont.
 Spinal cord
 N
Nerve roots
t
 Disc

12. Prevention
 St t hi
Stretching
 St
Strengthening
th i
 P
Posture
 Lif i h i
Lifting techniques
 Ergonomics

13. Stretching
 I
Improves Flexibility
Fl ibili
 Decreases Muscle Stiffness
 Decreases Injuries

14. Stretching cont.
 S i M l
Spine Muscles
 T k i
Takes time
 Lifetime Benefits
f f

15. Other Muscles
 Q di
Quadriceps

16. Other Muscles
 H
Hamstrings
i

17. Core Muscles
 Abd i l
Abdominal

18. Strengthening
 S bili h S i
Stabilizes the Spine
 Lifetime commitment
 Start Slow and Build Gradually

19. Importance of Abdominals
 Lower Back
 Ring concept
g co cept
 Components
 Spinal muscles
 Abdominal muscles
 Weak parts

20. Strengthening
 S i l M l
Spinal Muscles
 Core Body
 Balance

21. Abdominal

22. Other Muscles
 H
Hamstrings
i
 Quadriceps

23. Recommendations
 H
Have a professional
f i l
 teach you the exercises
h h i
 P id i iti l
Provide initial supervision
i i
 Ensure the exercises are done correctly
 To minimize injury
j y

24. Recommendations Cont.
 D
Develop a Home Exercise program
l H E i
 Have a healthy nutrition (Calcium and Vitamin D)
 I
Increases bone strength
b t th
 Decreases the chances of getting osteoporosis as you
get older
 Decreases the chances of getting a fracture

25. Prevention Cont.
 G d P t
Good Posture
 Balance
 Joint Flexibility
 Muscle Strength
 Bad Posture
 Muscle fatigue
 Increase joint wear
 Pain
 Stiffness

26. Proper Lifting
 Lif l
Lift close to your body
b d
 Feet shoulder width apart
 Bend the knees and keep your back straight
 Use your stomach muscles

27. Lifting
 Lift ith
Lift with your legs
l
 T k
Take small steps
ll t
 A id
Avoid turning or twisting your body while
i i i b d hil
holding something heavy
 IF THE OBJECT IS TOO HEAVY, ASK FOR
HELP.
HELP

28. Ergonomics
 I
Interaction between the user and the
i b h d h
equipment
 Avoids repetitive strain injuries
 Proper Seating
p g
 Back support

29. Injuries
 Di h i i
Disc herniation
 Trauma
 Aging
 Genetics
 Multifactorial

30. Disc Herniation

31. Disc Herniations
 C i l
Cervical
 N k
Neck
 Sh ld
Shoulder
 Arm
 Hand

32. Disc Herniation
 L b
Lumbar
 L
Lower Back
B k
 B tt k
Buttock
 Leg
 Feet

33. Lumbar Spine
 M
Most common
 L4‐L5
 L S
L5‐S1
 Symptoms
 Pain
 Sensation
 Strength

34. Symptoms
 Pain
 Shooting
 Dull/achy
 S
Sensation
ti
 Numbness
 Pi /ti li
Pins/tingling
 Burning

35. Symptoms
 S
Strength
h
 Weakness
 F
Foot drop
d
 Unable to stand on tip toes/heels
 U t bl it
Unstable gait
 B
Bowel/Bladder
l/Bl dd
 Incontinence
 I bili id
Inability to void

36. Disc Herniation
 Red Flags
 Increasing pain
 Weakness
 B
Bowel or Bladder changes
l Bl dd h
 Problems Walking
 Effecting Activities of Daily Living
 Pain lasting longer then a few weeks

37. Diagnosis
 Hi t
History
 Onset
 Duration
 Location
 Quality/Quantity
y/ y
 Physical Exam
y
 Strength
 Reflexes
 Special Tests

38. Diagnostic Imaging
 MRI
 Open
 Closed
 Xrays
 CT/Cat scans
 CT myelogram

39. Disc Herniation Treatment
 Conservative Management
 Medications
ed cat o s
 Physical Therapy
 Acupuncture
 Chiropractic
 Time

40. Medications
 Over the Counter
 Non Steroidal Anti inflammatory(NSAIDs)
o Ste o da t a ato y( S s)
 Over the counter
 Aleve ®
 Motrin ®
 Ibuprofen
 Ad il ®
Advil ®

41. Medication
 P
Prescription
i i
 NSAIDs
NNaproxen
 Mobic
 Ibuprofen
 Steroids taper
 Prednisone
 M d
Medrose d k
dose pack

42. Medication Cont.
 Muscle relaxers (flexeril ®)
 sedative
 groggy
 Narcotic (percocet, vicodin, oxycodone)
 Sleepy
py
 Can’t drive
 Addictive
 Tolerance
 Constipation
 Oth (t
Others (tramadol)
d l)

43. Physical Therapy
 Stretching
 Flexibility
 Strengthening
 Postural training
l i i
 Core body strengthening
 Aquatic Therapy
 Reduce the inflammation

44. Modalities
 Icing
 Heating
 Ultrasound
 Manual techniques
 Massage

45. Injections
 M l
Muscle
 Nerve
 Joint

46. Disc Herniation Treatment
 I j i
Injections
 Trigger Point
 Epidural
 Transforaminal
 Facet

47. Disc Herniation
 Mi di
Microdiscetomy

48. Recovery
 P
Procedure Duration:
d D i ~ 1 hour
h
 Hospital stay: less then 23 hours
 Start activities: couple of weeks
 Prognosis: good

49. Other Conditions
 S li i
Scoliosis
 Kids
 Ad l
Adults
 S
Stenosis
i
 Fractures
 Compression fractures

50. Other Conditions
 D
Degenerative Disc Disease(Arthritis)
i Di Di (A h i i )
 Instability
 Spondylolisthesis

51. Degenerative Disc Disease
g
and Instability
 N k P i
Neck Pain
 Lower Back Pain
 Pinched nerve
 Instability

52. Conclusion
 C ti
Continue to stay active
t t ti
 W
Warm up prior to exercise
i t i
 H
Have a strengthening routine
h i i
 M i i
Maintain a good posture
d
 Develop an ergonomic workspace
l k

53. See professional evaluation
 Have an injury
 Pain
 Around your neck or lower back
 shooting pain in the arms or legs
gp g
 Have weakness in the arms or legs
g
 Start having numbness or tingling sensation in
the arms or legs.