Spine: Chronic Conditions and Motion-Sparing Techniques

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Spine: Chronic Conditions and Motion-Sparing Techniques




Guest:  Dr. Bart Sachs – Orthopedic Surgery

Host:  Dr. Linda Austin - Psychiatry


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 motion-sparing. 


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 following surgery.


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.


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