Guest: Dr. Bart Sachs – Orthopedic Surgery
Host: Dr. Linda Austin – Psychiatry
Linda Austin: One of the most exciting
areas of new surgical techniques is in the treatment of conditions of the back
and spine. Dr. Bart Sachs is Professor
of Orthopedic Surgery at MUSC and has been a pioneer in spine surgery, using
both traditional and minimally invasive techniques. In this podcast, he describes the common
conditions of chronic spinal deformity, kyphosis and scoliosis, as well as the
traditional surgical approach to treatment which is still commonly used.
Bart Sachs: Really, the easiest way to
think about scoliosis and kyphosis, in that order, is that when anyone looks at
a person’s body, directly from the front or directly from the back, we should
have a straight posture. The shoulders
should be level and even, waistline is even.
The pelvis is level. People
should be standing, pretty much, straight.
And the head should be balanced over the center of the body, right in
the middle of the hips, viewing from the front or the back.
scoliosis involves a structural change of the spinal column, which is the
foundation. And what happens with the
spine is, it starts to bend sideways and, at the same time, it twists around
and turns. One shoulder blade might
stick out more than another. The
waistline of an individual changes and becomes asymmetric, sticks out on one
side and is flatter on the other side.
One hip is usually higher than the other. And people start to realize they’re out of
balance. Their head starts to shift and
they start to lean to one side. That’s
what scoliosis is.
is, basically, looking from the side of the person’s body, where, again,
structurally, we should all be balanced.
Our head should be centered right over our legs and we could drop a
plumb line down, and that’s what allows us to stand straight. And, within range, we have a normal slight
curve to our shoulders as we look from the side, and a little sway in the
lumbar, lower back, area. Again, those
balance out. A kyphosis is an
exaggerated forward bend and forward hump of the upper part of the back where,
looking from the side, an individual’s head is thrust forward and their
shoulder blades stick out.
are not only common conditions, but they’re becoming more common
conditions. The reason that we’re seeing
them more often is, it’s simple, people are living much longer. We see people living a more full and active
life and wanting to remain active as they age.
Linda Austin: Since kyphosis and
scoliosis progress over time, it’s no wonder that they are often conditions
most common in the elderly. The elderly
spine may be especially fragile, posing extra surgical challenges.
Bart Sachs: I can tell you an example of
what brings people, finally, to treatment.
A very nice lady who I treated just within the last six to eight months
was in her mid-eighties. She happened to
be one of the oldest people that I had treated for an elective scoliosis
operation. She came into my office and,
before I went into the room, I saw her age and, inappropriately, made a
determination that this person is too old.
So, I was going to have a discussion on how to live with this condition
and accommodate your lifestyle. And I
walked in and found this very pleasant, energetic patient in her mid-eighties
who told me that she had lost her husband.
She was there with her two daughters.
her joys in life was to participate and be a ballroom dancer. She used to go out ballroom dancing Friday
and Saturday night every weekend. Her
problem: she was developing increasing
pain, which was starting to limit her.
And, because of her scoliosis, it was advancing and getting much
worse. She was starting to lose her
balance and lean. Her biggest complaint
was, she kept leaning on her partners, and her partners kept pushing her away,
so she was losing her ability to dance.
She said she wanted to get back to dancing, whatever it took. That’s what brought her in. She came across three states. She convinced me that she was a good
candidate for surgery, underwent surgery and within two weeks, when I saw her
return, she was standing straighter and walking. And when I saw her four weeks after that, she
was back to dancing.
Linda Austin: To understand how the
orthopedic surgeon treats back problems, Dr. Sachs describes a little about the
anatomy of the spine.
Bart Sachs: Our vertebral spine is
composed of multiple small building blocks of bone, which are, in essence,
stacked on top of one another. And all
of those building blocks are connected by soft tissue ligaments which tie the
bones together, and then muscles which help to support those building blocks
and allow continuous motion. Then, there
are spaces between the building blocks, called the disc spaces, and, obviously,
the nerves, the spinal cord, runs within the space of the bony segments.
building blocks have collapsed. They’ve
lost their alignment. They’ve twisted
and they’re falling out of position.
Linda Austin: In order to straighten and
stabilize the spine, sometimes it’s necessary to perform open surgery.
Bart Sachs: The operation involves
exposing and opening up areas of the spine, loosening up all of the contracted
and scarred tissue around the building blocks so that each building block can
be moved individually and separately, realigning those building blocks, putting
them in the position they should be in, while protecting the nerves, of course,
and then locking them together and holding them there.
technique of locking them together is with implants that we use in the spine,
those implants being metallic implants, at this point, where we’ll place hooks,
screws, or rods. And, once the spine is
lined up in the position we’d like for the patient, we attach to each
particular building block, segmentally.
Then, once we’ve fixed to the bone, we take a rod, two rods, usually,
and align the rods into the position the spine should be in and, in turn, place
the rod attached to each of the building blocks and hold it there.
Linda Austin: After the spine has been
stabilized, or fixated, the body takes over, providing stabilization through
the normal process of bone regeneration after injury.
Bart Sachs: The body will lay down bone,
and a fusion is really creating an underlying physiologic scenario in the body
where the interpretation of the body is that there is a broken bone. And, anytime there’s a broken bone, a natural
tendency is for our bodies to heal that broken bone. These are complex operations. They’re long operations. We’re detaching and moving each segment
apart. We have to do that very carefully
and very delicately, and it takes time.
So, an operation, that I’ve just described, might be anywhere from 6 to
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