Charles Edwards II, M.D., Medical Director of the Maryland Spine Center at Mercy Medical Center in Baltimore, Maryland, talks about a new-cutting edge way to get back pain patients back on their feet faster than ever.
Interview conducted by Ivanhoe Broadcast News in October 2016.
Tell me a little bit about the problems with the lumbar disc. When you’re talking about back pain is the disc, are the discs in the back the majority of the problems that a lot of patients come to you or no?
Dr. Edwards: Back pain is very common in adults. Seventy percent of people will experience a significant episode of back pain during their lifetime. The source of that pain can vary ranging from muscle strains to ligament injury or disc problems such as a disc herniation.
The cause of that pain is it sometimes age, sometimes injury, a combination of both?
Dr. Edwards: The spine is a very complex part of our body with muscles, ligaments, discs and bones all working together typically in wonderful harmony. Injury, however, to any one of those structures can cause a flare up of back pain. Often times it’s hard to sort out which one of those structures is the precise source. Fortunately, ninety percent of back pain episodes get better within a few weeks on their own.
For the ten percent where the pain becomes persistent and chronic what are the options?
Dr. Edwards: When appropriate non-operative measures like anti-inflammatories, limited activities and time do not provide significant improvement in their pain, then surgery is often a good option.
Are we talking about this being a problem of the middle age mostly, people in their forties, fifties, early sixties?
Dr. Edwards: Disc and arthritic problems causing back pain that benefit from surgery typically occur in middle to later age. Sometimes we see a disc herniation in teenagers and individuals in their twenties but that is the exception.
You’re talking about disc related pain and surgical options what has been the gold standard for a number of years?
Dr. Edwards: There is a spectrum of disc problems that can cause back and radiating leg pain from a degenerative or aging disc versus a disc herniation. Depending on the specific problem, the appropriate surgical solution will vary. For individuals with pressure on the nerves, a minimally invasive decompression is often the best option. When there is instability in the spine, a fusion operation should be considered.
We were talking about the disc problems and the radiating pain, what are the surgical options, what have they been and the best option of the past?
Dr. Edwards: When people have pain radiating down their legs we call that sciatica. Typically that’s arising from pressure on the nerves within the spine. The purpose of the surgery is to take the pressure off the nerves; we call that decompression. Historically that’s done with an incision and exposure of the spine. During the decompression surgery, we remove the bone spurs or the disc herniation which is putting pressure on the nerves. In recent years, with the advent of microscopic techniques, the decompression surgery is performed through a much smaller incision.
Would that be considered major surgery, when you’re doing that are you talking about opening up the back?
Dr. Edwards: Historically, ‘open’ decompression surgeries would involve a several inch long incision on the back to expose the spine so that the surgeon can see the nerves and remove the disc herniation or the bone spurs. That involves dissection of the muscles and some removal of the bone to allow better visualization of the nerves.
When doctors are performing that surgery how long does it take usually before the patient can recover and go back to normal function?
Dr. Edwards: With a traditional ‘open’ decompression, surgery patients are often up and walking either the same day or in the days ahead with muscle soreness lasting several weeks. Often times, however, the nerve pain gets better rather quickly as the nerve is relieved by not having pressure upon it.
Can we talk about the micro decompression surgery, how is this different, what is new about this?
Dr. Edwards: Over the past two decades there have been significant advances in microscopic visualization, surgical instruments and also in operative techniques that allow us to do the same decompression surgery through a much smaller incision with less muscle dissection. This leads to a shorter surgery, less injury to tissues and a faster recovery and an overall improved result.
Can you walk me through how the surgery is done now, the micro-decompression?
Dr. Edwards: During the surgery the patient is face down, we take an x-ray to make sure that we are at the proper location and then we make a one-inch incision. I dissect the muscles over that area of the spine so that I can see the nerves themselves. I then gently move the nerves off of the disc herniation or the bone spurs, and then remove the portion of the disc which is pressing on the nerves and confirm that the nerve is nice and free.
And from there what are you able to do?
Dr. Edwards: At the end of the surgery we typically inject numbing medicine around the muscles and underneath the skin to minimize the pain. We sew the skin together and put glue on the surface so that the patient can go home and shower either the same day or the next day.
So, does the microscopic decompression provide for a much faster recovery?
Dr. Edwards: With microscopic decompression techniques a majority of patients do go home the same day. They are able to get back to life, including driving and back to work much faster than was possible even a few years ago.
I want to talk about the patient Mr. Ryan, avid runner, avid competitor and it was really important for him to get back to his life. If you could speak a little bit to what you were able to do for him with this surgery.
Dr. Edwards: Our body is an amazing machine requiring the cooperation of the bones, the ligaments and the muscles to work together in tremendous harmony. A big surgery can disrupt that harmony and prevent an individual such as Mr. Ryan from getting back to high performance athletes. By keeping the surgery very focused and the dissection limited we therefore preserve the natural function of the muscles, the bones and the ligaments to allow him to get back to that high level of function.
Does he have restrictions after this surgery?
Dr. Edwards: During the first six weeks after the surgery I want my patients to be active with walking, gentle bending, and limited twisting. As the soreness and inflammation of surgery subside, they can get back to a full range of activities without restrictions.
So honestly, is it surprising for someone who is in Mr. Ryan’s shape before surgery to be able to go back out and compete in a triathlon and do the things he wants to do?
Dr. Edwards: Once the nerve has been decompressed then the source of the pain is gone. And once the surgery is healed then people can get back to a full range of activities without restrictions.
How long has the microscopic decompression surgery been used? For the last couple of year, five years, three years, two years?
Dr. Edwards: While microscopic techniques in the spine have been around since the nineteen eighties, significant advances in the microscopes themselves, the instrumentation available, and the surgeon familiarity with these techniques has brought forth a much more widespread application of microscopic lumbar decompression in recent years.
So it has been done but not widely done, would it be correct to say that?
Dr. Edwards: As with any advancement, refinements are needed, and those refinements have occurred gradually over the past twenty years. Decompression procedures are now done through a much smaller incision with a much faster recovery and much better overall results than were available even ten to fifteen years ago.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Dan Collins
Public Relations
410-332-9714
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here.
