Hip-Spine Syndrome: It’s Complicated (and Often Overlooked)

Posted by Brigham and Women's Hospital November 18, 2016

A patient with hip arthritis may experience hip or groin pain as well as trouble walking, while a patient with lumbar spinal stenosis may have pain down their leg, or neurologic symptoms such as numbness, tingling or weakness.

3d rendered illustration of a man having backache

Hip-spine syndrome is a condition where both hip and spine problems are occurring in tandem.

“Hip-spine syndrome is a distinct syndrome where both hip and spinal problems are occurring together,” said James D. Kang, MD, Chairman of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital (BWH).

And yet, because hip and spine disorders have overlapping presentations and symptoms, it can often be challenging for physicians to determine if a patient’s symptoms originate from the hip, spine or both. This can delay diagnosis and treatment, and many patients with hip-spine syndrome have seen several physicians and therapists, or may have undergone various procedures that did not relieve their pain. Read More »

Finding Relief from Pain

Posted by Brigham and Women's Hospital September 6, 2016

Among the many reasons why patients go to see a doctor, pain is often a primary complaint. Whether it is acute or chronic, pain can be debilitating. In recognition of Pain Awareness Month, we have compiled some of our blog posts featuring ways to address pain.

 

PainInnovations in Chronic Pain Management

Treating chronic pain often requires different approaches than those used for acute pain. In this post, Dr. Edgar L. Ross, Director of the Brigham and Women’s Hospital Pain Management Center, talks about the importance of playing an active role in your treatment plan and the benefits of having a multidisciplinary, collaborative care team that specializes in pain management.

 

 

 

Senior African descent woman grabs lower back in painTips on Managing Back Pain

Managing back pain can be challenging because it is often non-specific and may be the result of many different conditions. In this post, Dr. Jason Yong, an anesthesiologist and pain management specialist in the Comprehensive Spine Center at Brigham and Women’s Hospital (BWH), offers some guidance for people suffering from back pain.

 

 

 

Hip painYoung and Active? Don’t Ignore Hip Pain.

 Many young and active adults who experience hip pain during exercise attribute the discomfort to overdoing it during a workout. In this post, Dr. Scott Martin, an orthopedic specialist at Brigham and Women’s Hospital, explains why it is important to be evaluated for a condition called femoroacetabular impingement if you are young and experiencing repeat hip pain, stiffness, or a catching sensation in the hip during movement.

 

 

gel pack on kneeTreating Injury and Pain: Ice or Heat?

Often when someone gets injured or feels pain, they wonder whether to treat it with cold or heat. This post by Dr. Elizabeth Matzkin, Surgical Director of the Women’s Sports Medicine Program at Brigham and Women’s Hospital, offers a few simple guidelines to help you determine which approach to take.

 

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Herniated Discs: New Treatment Option Relieves Pain, Preserves Mobility

Posted by Brigham and Women's Hospital July 19, 2016

ProDisc_ProDiscC_main_03

In artificial disc replacement (ADR), the damaged disc is removed and replaced with an artificial one that moves and shifts like a real disc.

Contributor: John H. Chi, MD, MPH, Director of Neurosurgical Spine Cancer and a spine surgeon in the Department of Neurosurgery at Brigham and Women’s Hospital. Dr. Chi is also an Assistant Professor of Neurosurgery at Harvard Medical School.

If you are experiencing numbness and pain in your arms and shoulder, it may be a sign of a herniated disc in your neck (the cervical region of the spine).

“A herniated disc occurs when the soft inner gel that cushions the spine’s vertebrae protrudes into the spinal canal, placing pressure on nearby nerves. This pressure can lead to pain, tingling, numbness or weakness in the shoulders and arms,” says Dr. Chi.

A herniated cervical disc may be managed with medication, physical therapy, and pain management. When patients continue to experience symptoms, surgery may be recommended .

Balancing Pain Relief versus Mobility

Until recently, patients requiring surgery for cervical disc herniation had one option, anterior cervical disc fusion (ACDF), in which the damaged disc is removed and repaired to help relieve pressure on the nerves and the spinal cord. The ACDF procedure also requires the bones above and below the repaired disc to be fused together.

Though ACDF relieves the pain caused by a herniated cervical disc, some patients may experience a reduction in their range of motion due to the fusion of discs in the neck. Furthermore, there is a chance that discs adjacent to the fusion may later herniate, requiring a second surgery.

 Artificial Disc Replacement to Preserve Range of Motion

Today, spine surgeons can offer certain patients with cervical disc herniation another option – artificial disc replacement (ADR). During the ADR procedure, the damaged disc is removed and replaced with an artificial one that moves and shifts like a real disc, preserving a patient’s range of motion.

Recently, Dr. Chi performed an ADR procedure on a patient who had previously undergone disc fusion (ACDF). Though the disc fusion initially relieved the patient’s pain, a disc adjacent to the fusion also herniated. The patient started experiencing significant pain again. This time, the patient opted to undergo ADR. Compared to his first surgery, Dr. Chi’s patient had a shorter hospital stay, a faster recovery, and maintained his full range of motion while finding relief from his chronic pain.

Are You a Candidate for Artificial Disc Replacement?

Artificial disc replacement is not for everyone. You may be a candidate for ADR if you are younger than 55 years and have been experiencing symptoms for at least three months but not longer than 18 months.

It’s not known how long artificial discs will last; however, they have been in worldwide use for almost 20 years and for 12 years in the U.S. So far, there has been no evidence to suggest that artificial discs will require replacement after a certain period of time.  Research also indicates that ADRs may lead to better outcomes than fusion.  Dr. Chi advises checking with your insurer to verify coverage if you are considering ADR.

Learn more about the Comprehensive Spine Center at Brigham and Women’s Hospital.

-Jamie R.

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Defying the Odds: Neurosurgery Patient Walks Again

Posted by Brigham and Women's Hospital April 21, 2016

Anthony Hodges is walking again after a car accident left him paralyzed.

Dr. Yi Lu, a neurosurgeon at Brigham and Women’s Hospital (BWH), was moved to tears when 23-year-old Anthony Hodges walked into the Neurosurgery clinic for a follow-up appointment.

“I couldn’t believe it,” says Dr. Lu, who performed emergency spine surgery on Anthony after a car accident left him paralyzed. “With his type of complete spinal cord injury, Anthony had less than a five percent chance of ever walking again. His case was a miracle.”

In July 2015, Anthony, the former captain of the Salem State University basketball team, was riding in the passenger seat during a car accident. The crash left Anthony unable to move his hands, legs, or feet. He was rushed to BWH for surgery, where doctors determined that he had a complete spinal cord injury – an injury that often results in the permanent loss of function below the injury site, which, in Anthony’s case, was a spinal disc near the back of his neck. During surgery, which occurred just six hours after the accident, a surgical team removed a broken vertebra that was pressing on Anthony’s spinal cord and replaced it with a bone graft that was stabilized with a titanium plate.

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Why Should You See a Physiatrist?

Posted by Brigham and Women's Hospital May 27, 2014

Physiatrist Zacharia Isaac, MD, specializes in conservative spine care.

Don’t be embarrassed if you don’t know what a physiatrist does. In the context of the medical world, physiatry is a relatively new discipline.

Recognition of the practice was heightened during World War II, when physiatrists were asked to supervise the rehabilitation of U.S. soldiers returning home with severe musculoskeletal disabilities. Soon afterward, in 1947, physiatry was formally approved as a medical specialty by the American Board of Medical Specialties.

Physiatrists (also known as physical medicine and rehabilitation physicians) specialize in non-surgical care for conditions – particularly neuromuscular (nerve, muscle, and bone) disorders – that cause pain and impair normal, everyday functions. Along with their standard medical training, many physiatrists also pursue additional training in one or more of the following subspecialties: musculoskeletal rehabilitation, pediatrics, spinal cord injury, sports medicine, traumatic brain injury, and pain medicine. Brigham and Women’s Hospital physiatrists focus on caring for pain related to spine and sports conditions.

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Spine Surgery: When Nothing Else Will Do

Posted by Brigham and Women's Hospital February 11, 2014

Cervical spine surgery patient - Diane Daigneau

Diane is back to work and play after cervical spine surgery.

For many years, Diane Daigneau of Woburn, MA, was able to successfully manage her back and neck pain. Through occasional chiropractic treatments and mild pain relief medications, she was able to continue to work and play.

A few years ago, however, she discovered that circumstances can change dramatically, to the point where even the best non-surgical care fails to provide adequate relief. Such was the case during the summer of 2013, when the pain radiating through Diane’s back, neck, and arms had become so debilitating and persistent that no physician was recommending anything other than cervical spine (neck) surgery.

From Manageable to Intolerable

Diane likes making things pretty. More than that, it’s her job.

She often spends several hours hovering over a single piece of furniture while meticulously applying delicate gold or silver leafing, or some other type of elegant exterior. It’s a mentally and physically demanding job, particularly for someone who has struggled with back and neck pain. But Diane’s pain was never so bad that she ever worried about not being able to do her job or any other enjoyable pursuits. That changed suddenly during a family vacation at the end of July 2013.

Read More »

Navigating Treatment Options for Back Pain

Posted by Brigham and Women's Hospital July 1, 2013

Matthew Kowalski, DC, a chiropractor at the Osher Center, provides non-surgical care for patients with back pain.

Today’s blog post is written by Dr. Donald B. Levy, Medical Director of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Matthew H. Kowalski, DC, a chiropractor at the Osher Center.

You have many choices when seeking options for treatment of low back pain; however, many people become overwhelmed trying to identify the most appropriate health care provider. So when should you seek treatment for low back pain and who should you see?  This post discusses how to navigate the health care system to get proper care if you are suffering from back pain.

Getting Started

Not all back pain actually requires treatment. Consider a dose of self-care as your first treatment choice. Often, a combination of patience, over-the-counter medications, ice and/or heat, avoidance of injurious activities, and remaining active will relieve uncomplicated low back pain. (Uncomplicated low back pain is an episode of pain without other health concerns or “red flags.”)

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Myths and Facts About Low Back Pain

Posted by Brigham and Women's Hospital June 27, 2013

Eighty percent of us will experience a significant episode of back pain during our lifetime.

Today’s blog post is written by Dr. Donald B. Levy, Medical Director of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital, and Matthew H. Kowalski, DC, chiropractor at the Osher Center.

There is a good chance that you will experience low back pain at some point during your lifetime. In fact, 80 percent of us will experience a significant episode of back pain. It may be a mild strain, such as after a day of yard work, or it may come on for no apparent reason and be quite severe.

If you suffer from back pain, your first temptation may be to search the Internet. In fact, most patients come to their doctor only after they have consulted online information. Unfortunately, there is a lot of misinformation available online. This post will help you distinguish between the myths and facts about low back pain.

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Spine Surgery — When Is It Right for You?

Posted by Blog Administrator May 16, 2012

 

spine specialist with patient

Dr. Bono (right) and his spine surgeon team strive to ease back pain with the least amount of surgery possible.

Dr. Christopher Bono, Chief of the Department of Orthopedic Surgery’s Spine Service, has a habit of talking patients out of spine surgery. It’s not that he doesn’t want to help you – quite the contrary.

Spine surgeons in Dr. Bono’s practice end up performing surgery on less than 25 percent of the more than 800 patients that they see each year. Dr. Bono is proud of that low rate, as his team’s goal, as ironic as it may seem, is to perform the least amount of surgery possible. His rationales for this objective are that spine surgery, even in the hands of its best surgeons, is a very risky proposition, and the vast majority of patients with back pain can be treated effectively without surgery.

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