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Spine Center of Miami Spine Center of Miami

The Spine Center of Miami

John C. Nordt, M.D.

Spine Center of Miami Spine Center of Miami

Pain is a symptom…

Not a diagnosis!

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Spine Center of Miami Spine Center of Miami

Diagnosis is the reason for the problem

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Spine Center of Miami Spine Center of Miami

Back pain

80% of population

Resolves in 3 months

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Spine Center of Miami Spine Center of Miami

Causes of back pain

Muscle

Ligament

Disc

Nerve

Bone

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tumor

infection

fracture

instability

Spine Center of Miami Spine Center of Miami

Pain generator

That which causes pain is more clearly understood now…

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Spine Center of Miami Spine Center of Miami

Improved tests clarify source/origin

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Spine Center of Miami Spine Center of Miami

Over zealous physician can push treatment plan without clear

diagnoses

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Spine Center of Miami Spine Center of Miami

History

Back pain?

Leg pain?

Combination? 50/50

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Spine Center of Miami Spine Center of Miami

Positional or postural exacerbation

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Spine Center of Miami Spine Center of Miami

Careful & thoughtful history

• Back Pain?

• Leg Pain?

• Combination?

Spine Center of Miami Spine Center of Miami

Alf Nachemson

Disc Pressure measurements

In the 1960’s at L-3-4

Sitting caused 2-3 x body weight pressure

Spine Center of Miami Spine Center of Miami

• Positional Exacerbation

Back Pain

Leg Pain

Spine Center of Miami Spine Center of Miami

Sitting

Exacerbates

• Degenerative Disc

• Herniated Disc

Spine Center of Miami Spine Center of Miami

Standing

Exacerbates

• Central Stenosis or

• Dynamic Foraminal Stenosis

Spine Center of Miami Spine Center of Miami

Supine

Awaken from sleep with rolling over

Rotation is least stable in spine

with degenerative disc.

Spine Center of Miami Spine Center of Miami

Diagnostic tests

• Selective Foraminal Root Injection

• Facet Injection

• Discography

Spine Center of Miami Spine Center of Miami

Dynamic Examination LS Spine to assess:

• Canal stenosis

• Foraminal stenosis or

• Instability

Spine Center of Miami Spine Center of Miami

Gold Standard

• Standing Flex/Extmyelogram

Spine Center of Miami Spine Center of Miami

Magnetic Resonance Imaging

• Since 1988

• Significant source of information

Spine Center of Miami Spine Center of Miami

Improved resolution of image

• Magnet Strength

• Software

Spine Center of Miami Spine Center of Miami

Diagnosis?

• Degenerated Disc

• Foraminal Stenosis

• PARS Defect

• Central Stenosis

• Lateral Disc or Foraminal Disc

• Herniated Disc

Spine Center of Miami Spine Center of Miami

• If your car won’t start-

• You don’t just change the battery

Spine Center of Miami Spine Center of Miami

False positives with evaluative tests

Are eliminated with Clinical Correlation

Spine Center of Miami Spine Center of Miami

• Abnormal MRI’s in Normal Subjects

Scott Boden, M.D., etal JBJS March 1990

Spine Center of Miami Spine Center of Miami

• 100 normal subjects 17-70 yrs.

• 37% + MRI that would require surgery

Spine Center of Miami Spine Center of Miami

Outline mutually agreed upon expectation of surgery clearly

• Leg pain

• Back pain

Spine Center of Miami Spine Center of Miami

• Incorrect or Incomplete Diagnosis

Discordant Symptom

Spine Center of Miami Spine Center of Miami

Instability of the Degenerative Disc

• Pain with sitting-Relief Standing

• Pain awakens at night

Spine Center of Miami Spine Center of Miami

• Inconclusive Radiologic Criteria

• Therefore need to assess within the clinical context

Spine Center of Miami Spine Center of Miami

Flex/Ext. MRI

• Pain Relief Supine

• Supine MRI

• Demonstrates?

Spine Center of Miami Spine Center of Miami

Back Surgery wonderful tool to help

Spine Center of Miami Spine Center of Miami

• Accurate Diagnosis

• Accurate Surgery

Spine Center of Miami Spine Center of Miami

• Remember:

• A second surgery with clear correctable problem will be successful

Spine Center of Miami Spine Center of Miami

Thank You

SPINE CENTER OF MIAMI