bahamas talk

Spine Center of Miami Spine Center of Miami

The Spine Center of Miami

John C. Nordt, M.D.

http://www.spinecentermiami.com/


Pain is a symptom…

Not a diagnosis!

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Diagnosis is the reason for the problem

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Back pain

80% of population

Resolves in 3 months

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Causes of back pain

Muscle

Ligament

Disc

Nerve

Bone

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tumor

infection

fracture

instability


Pain generator

That which causes pain is more clearly understood now…

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Improved tests clarify source/origin

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Over zealous physician can push treatment plan without clear

diagnoses

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History

Back pain?

Leg pain?

Combination? 50/50

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Positional or postural exacerbation

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Careful & thoughtful history

• Back Pain?

• Leg Pain?

• Combination?


Alf Nachemson

Disc Pressure measurements

In the 1960’s at L-3-4

Sitting caused 2-3 x body weight pressure


• Positional Exacerbation

Back Pain

Leg Pain


Sitting

Exacerbates

• Degenerative Disc

• Herniated Disc


Standing

Exacerbates

• Central Stenosis or

• Dynamic Foraminal Stenosis


Supine

Awaken from sleep with rolling over

Rotation is least stable in spine

with degenerative disc.


Diagnostic tests

• Selective Foraminal Root Injection

• Facet Injection

• Discography


Dynamic Examination LS Spine to assess:

• Canal stenosis

• Foraminal stenosis or

• Instability


Gold Standard

• Standing Flex/Extmyelogram


Magnetic Resonance Imaging

• Since 1988

• Significant source of information


Improved resolution of image

• Magnet Strength

• Software


Diagnosis?

• Degenerated Disc

• Foraminal Stenosis

• PARS Defect

• Central Stenosis

• Lateral Disc or Foraminal Disc

• Herniated Disc


• If your car won’t start-

• You don’t just change the battery


False positives with evaluative tests

Are eliminated with Clinical Correlation


• Abnormal MRI’s in Normal Subjects

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


• 100 normal subjects 17-70 yrs.

• 37% + MRI that would require surgery


Outline mutually agreed upon expectation of surgery clearly

• Leg pain

• Back pain


• Incorrect or Incomplete Diagnosis

Discordant Symptom


Instability of the Degenerative Disc

• Pain with sitting-Relief Standing

• Pain awakens at night


• Inconclusive Radiologic Criteria

• Therefore need to assess within the clinical context


Flex/Ext. MRI

• Pain Relief Supine

• Supine MRI

• Demonstrates?


Back Surgery wonderful tool to help


• Accurate Diagnosis

• Accurate Surgery


• Remember:

• A second surgery with clear correctable problem will be successful


Thank You

SPINE CENTER OF MIAMI

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