Chronic Conditions and Motion-Sparing Techniques
Guest: Dr. Bart Sachs –
Host: Dr. Linda Austin -
Dr. Linda Austin: Dr. Bart
Sachs is Professor of Orthopedic Surgery at the Medical University of South Carolina. He’s an expert in the surgical treatment of
severe and chronic conditions of the back and spine. He performs traditional surgery but is also a
pioneer in motion-sparing devices that are used not only to reduce pain, but
also to preserve motion in the back.
Dr. Barton Sachs: In the
past, the treatment has been to stabilize the spine, and the word stabilization
meant to do a fusion. Today, we have the
ability to void the fusion, but put in artificial devices back into the spine
which provide stability and support but, at the same time, preserve
motion. It’s much akin to what we
commonly think of, in lay terms, as artificial hip joints, artificial knee
joints, artificial shoulder joints, where patients have degeneration, lose the
motion, and have pain in those parts of the body. The end-stage treatment is to take the
degenerated joint out and replace it with a new joint which provides support,
stability and preserves motion. And,
now, we’re getting to that point, with the new technology, to be able to do
that in the spine.
Dr. Linda Austin: Even
young adults can suffer from serious conditions of the spine, and
motion-sparing surgery can be especially important for those who anticipate a
lot of years ahead of them and really want to stay active.
Dr. Barton Sachs: The
condition is not just limited to an elderly person. This problem might start, actually, where
patients present in their 30s, 40s, sometimes their 50s and 60s, and the
patient will start to talk about back pain.
The back pain is usually more of a generalized diffuse discomfort. It occurs more specifically with activity;
it’s activity-related. So, the
individual will say they feel better when they’re lying down. They feel somewhat worse when they’re
standing up. But the more active they
are, more movement, more walking, the more their back hurts, and then if they
lie down and rest, their back feels better.
They might have episodes with this as a constant low-grade problem, and
then the individual might complain about episodes of severe pain which really
limits them, which, sometimes, can occur every few weeks, through no particular
injury. The individual may just be more
active or playing, say, an extra nine holes round of golf or going out dancing
and staying up later.
Dr. Linda Austin: Dr. Sachs
is often asked to see patients after they have failed to improve with
conservative treatments like physical therapy or medication, and, of course, he
starts with a good evaluation, including an MRI.
Dr. Bart Sachs: We’d be
looking for two things. One is the MRI
can show us deterioration of a disc space, where the disc is the space between
the vertebral building blocks of the spine.
Now, we’re getting to the point where we have new technology. We’ve recognized a bad disc on an MRI
scan. We might even try some injections,
just to verify that that’s the source of the pain for the patient, with an
injection of some lidocaine or novacaine, a local anesthetic, the same thing
that a dentist would do working in the mouth.
And, if, indeed, we’ve localized the pain, we can replace that disc,
now, with an artificial disc. And, in
the future, I think, when we’re talking about the plight of the disc, we’ll
probably be getting to the point where we can use medication or material that
will regenerate the disc.
We actually explain to the patient that if something were to go
wrong, if it works out that, in the middle of the operation, their bone is too
soft or the space is too tight, or the nerves are going to be affected, the
bailout is to perform a fusion. So, the
patient really has to be a candidate for a fusion. The difference is a fusion provides the
support, the stability, for the spine and it also removes the source of pain,
and it protects the nerves, but the fusion eliminates motion. The artificial joint will provide all of the
things that a fusion does but, at the same time, it retains that motion. So, it allows us to be, as living beings,
more the way we came, more the way that the Lord brought us here, with
The beauty of performing an artificial replacement into the spine,
as compared to a fusion, is that the recovery is much faster and much less
painful for the patient. The patient is
in and out of the operating room quickly.
At the most, patients might stay overnight and go home the next morning
from surgery. We have them start to move
and walk around immediately, the same day of surgery, and they can be back at
light-duty activities within a week, and generally back to unrestricted
activities, if it were to be golf or something else, between six to eight weeks
If you have any
questions about the services or programs offered at the Medical
University of South Carolina, or if you’d like to schedule
an appointment with one of our physicians, please call MUSC Health Connection
at (843) 792-1414.