All posts by Legacy Neurosurgery

Fall, A Season? Or A Safety Concern?

Fall, A Season? Or a Safety Concern?

With the leaves changing and seasons turning it is time to talk about “Fall”, but perhaps not in the way you are thinking.  As the weather changes and the temperature outdoors starts to decrease the incidence of fall related injuries has been noted to increased1. A good working definition for the context of fall that we will be discussing is any event that leads to an unplanned, unexpected contact with a supporting surface2 . Here at Legacy we have an interconnected team of specialists that can identify risk factors that may predispose a patient for falls then provide timely intervention and recommendations on how to decrease the risk of falling.

A few quick statistics to emphasize the importance of intervention in patients with poor balance:

  • 25-35% of people 65 and older experience 1 or more falls per year2-4
  • 40% of hospital admissions for 65 and older are the result of a fall-related injury5
  • Average hospital stay for fall injury for ages 65 and up = 11.6 days5
  • Approximately 50% of older adults hospitalized for falls are discharged to a nursing home5

If you are feeling unsteady on your feet, constantly worrying that a fall is imminent, or pain has started limiting your mobility then reach out to your local medical doctor, someone from the Legacy Team, or your local physical therapist for a treatment plan that will have you ready for Spring!

1 Pui-Yee, et al. Higher incidence of falls in winter among older people in Hong Kong.

2 Tinetti ME, Ginter SF. Identifying mobility dysfunctions in elderly patients: standard neuromuscular examination or direct assessment? JAMA. 1988;259:1190-1193.

3 Tinetti ME, Speechley M Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1989:319: 1701-1707.

4 Nevitt MC, Cummings SR. Risk factors for recurrent non-syncopal falls: a prospective study. JAMA. 1989;261:266.7-2668.

5 Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-dwelling elders. J Gerontology. 1994;49:M140-M147.

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Cervicogenic Headaches: A Real Pain In The Neck

Cervicogenic headaches are an often-overlooked headache type. These headaches cause pain in the back of the head, the temporal areas, and behind the eyes and are often mistaken for—or co-exist with—tension headaches, migraine headaches and neck pain. Often patients with cervicogenic headaches will have a history of a neck injury such as whiplash, or participate in activities that cause excess stress to the upper neck such as working on computers or looking down at smart phones. Poor posture is also a factor.

The treatment for this type of headache starts with physical therapy which helps most people. Sometimes medications like muscle relaxers, gabapentin or Lyrica are used to help treat the pain. For people whose headaches are refractory to conservative treatments, procedures like occipital nerve blocks, steroid injections or percutaneous radiofrequency neurotomy can provide lasting relief.

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Migraines

Many migraine patients recognize specific triggers to their headaches. Migraine patients are more sensitive to certain substances in their foods and environments as well as changes to their routine. Too much or too little sleep, changes in exercise routines, and processed foods can worsen migraine headaches. Heavy, flowery scents or cigarette smoke are frequent triggers. Keeping a headache journal can help identify migraine triggers and eliminate them. Elimination diets that target artificial sweeteners, food dyes, chocolate, processed meats, and/or certain alcohols can help find food triggers. In general, migraine patients are encouraged to eat a diet consisting of whole foods, stay hydrated, avoid caffeine, have a regular sleep schedule, and exercise regularly.

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Trigeminal Neuralgia

Trigeminal Neuralgia is a facial pain disorder caused by compression of the 5th Cranial nerve deep in the brain by an adjacent artery. This condition, also know as Tic douloureux or “Suicide disease” is often misdiagnosed and mistreated. It is the most painful neurological disorder that exists. The disorder causes horrific electrical shocking pains on one side of the face that come and go very rapidly like a machine gun of taser strikes. If properly diagnosed it can be readily cured with a low recurrence rate and low risk of complications by experienced surgeons for those that fail medical treatment. For all, to learn more about TN please visit https://youtu.be/pOV3EC3lpJw for our educational video.

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Keep Your Pain Under Control While on the GO

Keep Your Pain Under Control While on the GO

Get comfortable
Eliminate any items that could potentially alter your spinal alignment while seated. Remove any objects from your back pocket like a wallet or cell phone. If you are the driver, make sure your seat position is close enough to the steering wheel to avoid reaching.

 

Get out and move around
Sitting for prolonged periods of time will cause your muscles to tighten and can even lead to spasms. If driving, try to stop every 30-45 minutes for a brief stretch. If you will be on a long flight, make a conscious effort to get up every 30 minutes. Below are a few quick stretches you can do on your short break.

 

 

Bring along cold or hot packs
Back pain is often accompanied by inflammation. Ice can help to decrease inflammation and numb any soreness that is a result of prolonged sitting. Some individuals find heat to be more soothing to sore and tight muscles so utilizing heated seats or quick use hot packs can help to ease the ache as well.


 

 

 

 

 

 

 

 

 

 

 

 

Support your back with your feet
Good support for your back can be strongly influence by foot positioning. Your feet should both be positioned on the floor. Ideally you would like your knees to be at a right ankle in relation to your hips. You may have to modify your seat or utilize a foot rest to achieve optimal positioning.

 

 

 

 

 

 

 

Have a Diversion
The mind is a powerful thing, so if you are not the driver then use a book or movie to occupy your time. If you are the driver, try music or an audiobook to keep you mind off any pain that may arise from a long trip.

 

 

 

 

 

 

 

Image credit: https://www.pakwheels.com/forums/t/tips-for-maintaining-pain-free-posture-when-driving-a-car/442532

Image credit: https://wellness-centre.com.au/why-you-should-never-sit-on-your-wallet/

Image credit: https://praktispartners.com.au/latest-news/turn-t-rex-work/

 

 

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Sports Injuries

Well, we are in full swing of the summer! Speaking of swings, I hope most of you are enjoying my favorite game golf! I hope your swing looks as good as my daughters Maci’s after playing for only three months! I wish mine did as well, unfortunately, with the game of golf comes back and neck injuries all too frequently. To learn more about preventative measures stay tuned in the coming weeks we will post important steps to use to attempt to avoid injury.

Common injuries include musculoskeletal back pain and neck pain that can be treated with anti-inflammatories and physical therapy. More significant injuries can cause herniated discs in the neck or back. This can produce severe back and neck pain with or without radicular pain down the leg or arm. If the pain is down the leg or arm this is called sciatica. We can often treat these more significant injuries with the above and often with the addition of epidural steroid injections. These are outpatient procedures often done a couple of weeks apart for 2 to 3 injections. Of course, neural imaging is important to be obtained first. We perform these procedures and potential surgical intervention if needed at our outpatient spine facility- Legacy Surgery Center. Our team has vast experience with the performance of these and other spinal procedures which to be effective requires experience as well as fluoroscopic guidance.

Lastly, if a disc herniation causes intractable radicular (radiating) pain in the arm or leg (sciatica) refractory to the conservative care above then minimally invasive spinal surgery could be needed. At Legacy Spine and Neurological Specialists, we offer the most minimally invasive surgical solutions available anywhere in the world. These solutions range from micro decompression and discectomy surgery to the minimally invasive standalone lumbar fusion operations without the need for pedicle screws. These surgeries are performed through keyhole incisions less than 1 inch completely outpatient when medically appropriate.

To Learn more visit www.LegacyNeuro.com. Stay tuned for upcoming posts on prevention of golf and other sports -related back and neck injuries.

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Effects of Chronic Pain

Effects of Chronic Pain

Anyone that has experienced pain, whether acute or chronic, knows that it can affect multiple aspects of daily living.

The feeling that “I hurt everywhere” or “I have no energy” are common complaints associated with pain scenarios that are treated regularly here at Legacy.

Persistent pain is truly its own disease regardless of its underlying cause.1-3 This type of pain, which is also often characterized as chronic or intractable, has all the ramifications of a disease in that it may have pre-clinical and overt phases.4-6 Many recent and emerging studies clearly document that persistent pain exerts profound impacts on the body’s endocrine, cardiovascular, immune, neurologic and musculo-skeletal systems.7

According to an article on the complications of uncontrolled pain, there are three major classifications of complications associated with chronic pain.8

Deconditioning

“Overuse” of ancillary musculoskeletal tissue with degeneration

Decreased mobility

Obesity

Muscle atrophy

Contractures

Neuropathies

 

Hormonal

1.       Excess catecholamine production with hypertension and tachycardia

2.       Glucocorticoid excess or deficiency

3.       Hypotestosteronemia

4.       Insulin – Lipid abnormalities

5.       Immune suppression

 

Neuropsychiatric

1.       Nerve – Spinal cord degeneration

2.       Cerebral atrophy

3.       Depression/suicide

4.       Insomnia

5.       Attention deficit

6.       Memory loss

7.       Cognitive decline

 

 

Knowledge and understanding of pain complications only aides in better treatment of the entire patient instead of treating just the active pain site. Here at Legacy we always strive to provide comprehensive care by offering services from skilled and experienced healthcare professionals. There are many treatment options offered at our facility that have the ability to encompass multiple body systems that could be affected by chronic pain. Whether the patient’s needs are medication therapies, minimally invasive surgical intervention, spinal injections, diagnostic studies, or physical therapy ▬▬ the Legacy Team is well-equipped to assist their patients back to a better, more functional way of living

 

  1. Brookoff D. Chronic pain: A new disease? Hosp Prac. 2000. 7:1-13.
  2. Murphy K. Chronic pain syndrome: What is it: And how can we help? Am Pain J Management. 1994. 4:129-31.
  3. Carver A and Foley K. Facts and an open mind should guide clinical practice. Curr Neurol Neurosci Rep. 2001. 1:97-8.
  4. Curlje O, Von Kostt M, Simon CE, et al. Persistent pain and well-being: a WHO study in primary care. JAMA. 1998. 280:147-151.
  5. Liebeskind JC. Pain can kill. Pain. 1991. 44:3-4.
  6. Mantyselka BT, Turennen J, Ahonen RS, and Rumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003. 290:2435-2447.
  7. Chapman RC and Gavin J. Suffering: The contributions of persistent pain. Lancet. 1999. 353:2233-7.
  8. https://www.practicalpainmanagement.com/pain/other/co-morbidities/complications-uncontrolled-persistent-pain?page=0,1
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Sciatica

Sciatica is a painful condition of the nerves in the lower back that is associated with a variable degree of pain, numbness, tingling and weakness of one or both legs. Often it is self limited and resolves on its on. However, it can be persistent and need treatment. It is usually due to a ruptured or herniated or bulging disc. Discs are the cushions between our vertebrae of the spine. Normally these function as shock absorbers of the spine but over time the normal covering of the disc- the annulus- can become weak and allow the central part of the disc- the nucleus- to become displaced outside its normal location. If this displacement is adjacent to one of the nerves that run from the lower back into the legs it can produce sciatic pain.

Non-operative Treatment can consist of any or all of these options for those cases that do not spontaneously resolve:

* Spinal Exercises, Traction and other forms of spinal therapy

* NSAIDS

* Neuropathic medications such as Gabapentin

* Course of oral steroid medications

* Spinal Epidural injections In refractory cases minimally invasive microsurgical decompression and/or discectomy is a very safe and effective treatment.

 

At Legacy we offer this surgery for most patients at the outpatient surgery center through a MIS (minimally invasive) 1 inch or less incision. The success rate in terms of pain relief, return to work, return to ones sports or other activities of life are outstanding. Usually within 4-6 weeks most patients are able to resume normal activities. Patients with sedentary type work can usually return to their job in 2-5 days.

 

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Cell Phones and Neck Pain

Cell phones and neck pain

A new catchphrase in the health care world is Text Neck. It is a term that describes neck pain and damage sustained from looking down at a cell phone, tablet, or other electronic device for too long. In today’s society the cell phone is very much a necessity to most people and as a result, individuals begin to experience pain from overuse of these handy little devices.

 

Symptoms of Text Neck

  • Upper back pain (nagging pain to sharp, with or without muscle spasms)
  • Shoulder pain
  • Radiating pain in the arms or hands due to poor postural alignment

Treatment of Text Neck

  • Use handheld devices at eye level as much as possible
  • Take frequent breaks every 20-30 minutes
  • Physical Therapy
    • Core strengthening/stabilization exercises
    • Cervical musculature stretching
    • Soft Tissue Mobilization
    • Modalities for pain

 

The link below does an excellent job of explaining cervical spine anatomy and how it relates with neck pain, including “text neck”: https://www.spine-health.com/conditions/spine-anatomy/cervical-spine-anatomy-and-neck-pain

 

Image courtesy of: Always Connected. How Smartphones and Social Keep US Engaged\

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Cervical Radiculopathy

See below for some common symptoms and treatments for cervical radiculopathy.

  • Radiating arm pain and/or numbness and tingling
  • Usually due to a ruptured or herniated disc in the cervical spine or narrowing of the exit hole for the nerve also called neural foramen stenosis
  • May be also associated with cervical spinal stenosis which can lead to spinal cord damage or cervical myelopathy
  • If not associated with spinal cord compression can be initially treated with conservative care
  • Conservative options include: Neuropathic medications, physical therapy and manipulation therapy, Cervical Epidural Injections
  • Surgery is usually via an ACDF or anterior cervical discectomy and fusion from the front of the neck for refractory cases and/or those with severe neurological issues including spinal canal stenosis.
  • When indicated surgery is usually very successful and the benefits far outweigh the risks
  • Other causes less common of this type of pain may include shoulder disease, neuropathy, CTS, brachial plexopathy, vascular disease

Images obtained via google

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