Low Back pain - Whose domain does it come under?.pptx

Whose domain does the management of Low Back Pain come under- the orthopaedic spine surgeon or the neurosurgeon?

1. Low Back pain: whose domain?? Indranil B haduri

2. Low back pain L ow back pain is second only to the cold as the most common affliction of humankind. The lifetime prevalence of low back pain exceeds 86% in most industrialized countries. The highest prevalence is in persons aged 45-64 years, a highly productive and vital age group.

3. Low back pain Most common causes: Acute LBA - most commonly – muscle sprains and strained ligaments Lifting a heavy object, or twisting the spine while lifting Sudden movements that place too much stress on the low back, such as a fall Poor posture over time Sports injuries, especially in sports that involve twisting or large forces of impact Chronic LBA - Pain is considered chronic once it lasts for more than three months and exceeds the body’s natural healing process . Chronic pain in the low back often involves a disc problem, a joint problem, and/or an irritated nerve root . Lumbar herniated disc Degen . Disc disease Facet joint dysfunction SI joint dysfunction Spinal stenosis Spondylolisthesis OA & Deformity Infection and Auto-immune disorders Tumour ≤ 2% > 90%

4. Where do I go?? Who do I show??

5. Unfortunately the answer is sometimes hard to find ! Surely neurosurgeons traditionally operating on the brain, spinal cord, nerve and cervical (upper) spine should be able to deal with the lower lumbar spine as well?

6. BUT… IS THAT THE WHOLE TRUTH??!!

7. WHAT DOES THE Neurosurgeon do? A neurosurgeon treats diseases and dysfunctions of the central nervous system—more specifically, the brain and spinal cord—as well as its dense network of nerves. As such, a neurosurgeon is highly qualified to address certain types of brain and spine disorders, including: Brain tumors Intradural tumors (i.e. tumors that originate inside the dural sheath) Birth defects, such as tethered spinal cord syndrome or spina bifida Strokes, aneurysms, and other cerebrovascular events Epilepsy Movement disorders, such as Parkinson’s disease, dystonia, or essential tremor Neurological conditions, such as Multiple Sclerosis or ALS Chronic pain disorders that affect the central or peripheral nervous systems

8. What does an Orthopedic Spine Surgeon do ? In contrast, an orthopedic surgeon is solely concerned with enhancing the everyday function and mechanics of your musculoskeletal system. More specifically, this includes your spine, bones, joints, ligaments, tendons, muscles, and nerves. Although by the very nature of both practices there will be some overlap between orthopedics and neurosurgery, it all boils down to this essential difference: An orthopedist’s primary job is to identify the source of your musculoskeletal pain and to eliminate it.

9. The Orhtopaedic spine specialist Spinal deformities, such as adult and pediatric scoliosis, kyphosis, lordosis, or flatback syndrome Degenerative or age-related spine conditions , such as degenerative disc disease, bulging or herniated discs, spinal stenosis, osteoporosis , spondylolisthesis , etc. Arthritic spine conditions , including osteoarthritis, facet joint disease, and ankylosing spondylitis Radiculopathy or pinched nerve conditions such as sciatica or cervical radiculopathy Sports or traumatic spine injuries , including spinal cord injuries or sprains/strains Spinal infections (e.g. osteomyelitis) and vertebral column tumors (VCTs )

10. The quick answer is that for most types of low back and spine issues, both specially trained orthopedic surgeons and neurosurgeons may be considered . Both neurosurgeons and orthopedic surgeons may specialize in spine surgery, and for most of the typical spine operations both types of surgeons are equally well qualified . In both specialties, the surgeons may subspecialize, such as in the case of surgeons who specialize in pediatrics, cervical spine, lumbar spine, hand and wrist surgery, plastic surgery, or in other areas or procedures .

11. A gifted spine surgeon often focuses his or her talents exclusively on the spine. The Orhtopaedic spine specialist

12. Conclusion!! Neurosurgeons don't really operate on lower back pain ALONE, but neither do many Orthopaedic Spinal Surgeons Most surgeons (Neurosurgeons and Orthopaedic Spinal Surgeons) will operate on a prolapsed intervertebral disc causing nerve root compression ( microdiscectomy or decompression) SOME neurosurgeons, whereas MOST Orthopaedic Spinal Surgeons, also do fusions when patients have an unstable spinal segment with pain or when a long segment of the spine has been decompressed.

13. Neurosurgeons very rarely perform lumbar disc replacements Neurosurgeons are not as well trained and therefore, usually DO NOT do deformity surgery (scoliosis and kyphosis), whereas trained Orthopaedic Spinal Surgeons regularly perform these operations. Orthopaedic surgeons perform endoscopic microdiscectomy to treat herniated discs equally well, if not better, than the Neurosurgeons.

14. Thank you for being with me All the way!

15. Who’s who in spine surgery Lewis Albert Sayre (1820–1900) is considered to be among the founding fathers of orthopaedic surgery in the United States . He is best remembered for advancing non-operative management of scoliosis . Dr . Sayre used Paris Plaster casts, also known as body casts, to realign curvatures of the spine.

16. Who’s who in spine surgery Lawrence G. Lenke , MD Professor of Orthopedic Surgery Columbia University Medical Center Lawrence Lenke , MD is a Board Certified Orthopedic Spine Surgeon World renowned for the surgical treatment of complex spinal disorders affecting pediatric and adult patients. Dr. Lenke is a leading authority with expertise in the treatment of scoliosis, kyphosis, flatback syndrome, high-grade spondylolisthesis, and major coronal and sagittal malalignment.

17. Who’s who in spine surgery Dr. Mark A. Reiley was the person who came up with the idea for the  Kyphoplasty Boca Raton  procedure. He got his undergraduate degree from California's Claremont College before going on to get a medical degree from Washington D.C.'s George Washington University School of Medicine. Then , he attended the University of California San Francisco to receive five years of Orthopedic training.

18. Who’s who in spine surgery Dr. S. Rajasekaran of Ganga Hospital, Coimbatore, He used simple radiological tools for research to transform international methodologies in orthopedics. Rajasekaran’s interests and expertise relate to spinal tuberculosis, open fractures, genetic studies, back pain and disc degeneration, disc diffusion studies, computer-assisted orthopedic surgery, and diffusion imaging of the spinal cord. His research has won him numerous international awards including the prestigious ISSLS (International Society for the Study of Lumbar Spine) Prize for Spine Research for 2004, 2010, and 2013; the EuroSpine Open Paper Award for 2008; the MacNab LaRocca Research Award, Canada, 2005; and the ISSLS Sofamer Danek Award for 1996, 2002, and 2006.

19. why is there any confusion at all!?!? Until recently, surgery to the bony aspects of the spine, i.e. vertebral bodies, was in the exclusive domain of Orthopaedic Spinal Surgeons. This is because Orthopaedic Surgeons spend all their time mending broken bones and are experts in bone fixation and healing, akin to lumbar spinal fusion. The fact is that over the last two decades, and with the advent of stenting of cerebral  aneurysyms , neurosurgeons lost a lot of this work because of the much reduced need to operate on them. They therefore started to venture south from their traditional area of expertise and began to operate on the lower lumbar spine.

20. And… In today's environment, there is quite a lot of crossover, but there is still a general perception that neurosurgeons lack an appreciation of spinal biomechanics and bone biology, e.g. spinal fusion . Orthopaedic Surgeons however, never stop thinking about bone stability and bone healing . In addition, most Orthopaedic Spinal Surgeons work a lot more closely with physiotherapists when treating lower back disorders.