hello there.

>> You're watching for Wayne and the name of our show is LIFE Ahead.

We air this show every Wednesday night at seven thirty .

I love it because every week we have different topics and different guests and all very professional in their field.

And I do want to remind you all if you're a regular viewer or a new viewer, this is really your show too.

I will be asking the guests some questions but we also have the opportunity for you to call in and ask our professionals for some complimentary advice.

>> We'll put it that way.

And our topic tonight I think many of you might identify with it is about spine and neck pain.

What about treatments?

Are there some non-surgical treatments?

What are some experience that you might want some opinions on?

Well, we have the guy here who can answer those questions.

He's been in the business a very long time and if you watch us regularly on LIFE Ahead, you've met Dr. David Lutz before.

>> Welcome.

Well, thank you.

It's always great to be here.

It's been a little while since Koven and I know that we were talking right before the show of whether that's affected the medical field or not.

>> But are things getting kind of back to normal?

Yes, things are getting back to normal at this point.

Well, people are going to have their pains regardless of covid I'm sure.

>> Right?

That's true.

>> Yeah.

And I think that I read a statistic I don't know how many million it was but millions of people in the United States are affected by some sort of back pain or neck pain at some point in their life , right?

>> Oh, absolutely.

At least 80 percent of us at one point or another will have neck pain or low back and at some point and it's one of the most common reasons why patients even come to the family doctor's office, they go to the family doctor and then he'll maybe give some preliminary diagnosis and say go see a professional to get some treatment for this because you need it.

You know, whether it's a young person that has a maybe a sports injury or it's an older person who just has arthritis or something that's beginning to affect seems to happen to everybody.

>> Yeah.

All right.

Well again, remember you can call in and ask doctor let your questions but we have a whole series of graphics we want to show to you to better explain about our topic this evening.

Dr. Lutz is going to be describing what's happening here as we look at those images, images.

>> Doctor, let's let's just start out talking about the spine.

If you're if you guys can pull up image number one, I think it's important for our viewers to understand aspects about the spine so we can understand the reasons why there's pain or other problems.

Here's a picture of the spine and it's basically a long chain of bones and the purpose of that is to allow us to walk upright, allows us to bend and twist but most importantly protect the spinal cord and the nerves in the spinal cord.

Is that within the actual spine itself or attached to it is within this within OK, OK. >> And this is I'm assuming a normal spine we should all want to have spinal with a normal spine, right?

>> Yeah but slide two can show us a little bit closer up and we can see that we have the bones that are lighter in color the more pale color and in between the bones we have the disks and the disks can act like a shock absorber between the bones in the disc is often where people have an issue isn't it?

>> It is a lot of times those disks can bulge out or herniate and we'll see a little bit later how that can push on the nerve and we can see even on this slide the nerve is right next to that disk and that's yellow.

>> The nerve would be yellow on this picture and the disk would be the same and.

>> Yeah, exactly right in the middle a lot of times maybe people refer that it's like a donut, right?

>> Sometimes you can think of the just kind of akin to a jelly donut because on the inside there's a softer gel like material.

On the outside there's something called the annulus and that's stiffer.

>> So sometimes what is on the inside can actually herniate to the outside and that can cause a lot of pain and a lot of discomfort and that can cause back pain like pain, numbness, tingling, even weakness.

>> So if if you had an issue with a disc maybe it's actually in your upper spine but that could affect your different parts of your body.

>> It's not necessarily right where the disc is.

Is that correct?

And that is correct because the nerve is affected or nerve is pinched that can cause pain that can refer down from the neck to the arm even to the hand.

For example, if there's a disc herniation in the lower back that can actually even radiate down all the way to the foot and toes.

So it's real interesting how those pain patterns can radiate and sometimes we'll have a patient who has a pinched nerve in the lower back and they have like symptoms but they'll say I don't even have any back pain at this point.

So it's important to, you know, take a good history, do a good physical exam, do the right imaging and heisting to put it all together.

>> Well, let's continue with our graphics here too.

Graphic number three, are we still talking about a disk here?

>> Yes, this is just a cross-section of what we just talked about.

You had asked is the disk like a jelly donut so you can see on the inside the lighter color would be that inside more gel like substance and the outside is the firmer substance and when those disks can bulge out that can go towards those yellow nerves that we can see on the picture here.

>> So that would like potentially touch on the nerve and you're thinking about well what's a slipped disk?

>> I hear a lot of people saying I had a slipped disk.

What's that?

>> Well, that's another synonymous term for like a herniated disk in the disk goes out of position and if it's out of position then it can go where the nerve structures can travel in the spine whether that's more in the middle or up to the sides.

It just goes where there's open space.

>> So it I mean we had the picture of the spine and you have the vertebrae and the disk here between two .

So if it slips out of its place ,where can it go?

>> Well, sometimes it can go towards the spinal nerve roots and that is a little bit more off to the side like we saw in the picture.

Sometimes it can go towards the spinal canal itself and it could even push up against the spinal cord depending on where that is.

It could cause crowding where the nerves run through and that can cause a lot of trouble based on the severity of it.

>> Well, it sounds to me are so many ways that you could certainly have issues with this.

>> OK, what are we seeing here, Dr. Well here is another picture but it's pointing towards the joints.

>> It says Forsett joint right behind the nerve on this picture and there are joints in the back and the joints allow us also to, you know, move and bend and twist and extend and so forth.

And it's important for us to understand what is going on because sometimes there can be pain caused by a disc issue like we mentioned already a slipped disc herniated disc but sometimes the discs and nerves really aren't affected and the joints can also cause pain so if we can go on to the next slide we'll look at a couple more things.

>> For example, we talked about a herniated disc so you can see the jellylike material on the inside going towards that nerve at the five o'clock position.

>> What would cause that?

I mean how can it start leaking, if you will, in the leg sometimes there can be an acute injury that can cause problems.

>> Sometimes there can be just a wear and tear degenerative problem that just gets to the point where weekends and weekends and that can crack and happen.

I you know, sometimes it can be due to repetitive trauma and so forth.

>> So there's a lot of different reasons why that can happen.

>> Car accident again our our spine is pretty important, isn't it?

Oh absolutely.

>> Yes.

We take it for granted if it's not hurting.

I think so.

OK, Allan Banks is back in the control room and he's controlling all of our graphics for us and always does such a great job.

>> Alan, if you can take us on to number six.

OK, there we go.

So this is a situation where the nerve is irritated.

As we mentioned before, the disk is close by that can bulge or protrude and it irritates that nerve.

>> Sometimes there can be physical compression where the nerve is compressed and it can cause numbness, tingling, pain, weakness whether that's down the leg if there's a back issue it could be down the arm if it's a neck issue and that's what this slide is showing.

But sometimes there can be just a lot of inflammation in that region and even though the disk may not be physically touching the nerve, there can be so much inflammation going on that that can irritate the nerves and still cause symptoms.

So that's a total different type of treatment you can do.

If there was an inflammation then yeah, it depends you know, how bad it is, what's going on.

But a lot of times if there's inflammation, even if there's some types bulges or protrusions, we can try something like injections for example to try to help calm that because we'll use some cortisone or steroid to do that.

>> Yeah, and we want to talk about that in a little bit too as well because I know that in addition to that compression table where we want to address the injections oh a lot of people are familiar with that.

>> OK, let's go on to number seven, Alan and what are we looking at?

>> So we talked about earlier the joints of the back.

>> This is another picture of an irritated Forsett joints, for example.

>> We put more pressure on those joints when we are bending backwards and twisting when we're bending forwards we're putting more pressure on the disc.

So that's one of the physical exam maneuvers we'll do in the office when we're examining the patient to try to understand what pain generators are going on because we obviously want to put together our treatment plan to go after the right pain generator.

>> Sometimes there's more than one also when you're doing imaging of someone a patient that comes in and you know you're talking about their issue or whatever.

>> Right.

Do you look at x rays or how can you actually see what the problem is?

>> Sure, it's a combination of things.

Sometimes we'll start off with some x rays to make sure there's not any type of acute injury or broken bone or other degenerative process.

A lot of times we'll use MRI imaging to try to understand what's going on with the soft tissues because the discs in the nerves or soft tissues and that can be seen best on an MRI studies so we can determine if the disk is bulging out and pushing on the nerve.

We can even see if there's a lot of arthritis in that region.

We can see if the spinal cord which is another soft tissue structure is being pinched off as well.

So it's really important for us to couple the imaging as well as the examination and sometimes I'll also do EMG or nerve conduction studies and that's a test to look for nerve damage.

So we put all of these tests together others as well at times to try to figure out the source and the cause of our patients problems.

>> What if you have nerve damage?

Is that fixable?

Sometimes it is.

Sometimes it can be more chronic and long lasting in nature.

So that depends on how long the problem has been present.

What the pathology is and so forth.

There are different types of nerve damage that we'll look for and then try to treat it, uh, accordingly.

>> All right.

Let's keep moving along here at number eight in our graphic against the slide.

>> Um, just a picture of some bones of the neck and the purpose is to show that there are some smaller nerves that run up and down the side the areas places yeah.

>> This is a side view of the neck.

>> Um, it's not an x ray.

It's just, you know, pictorial here.

But the purpose of this is to show that there are even small little hair like nerves that can transmit pain and sometimes when we're doing interventions to try to help improve patients pain from the joints will block these nerves sometimes burn these nerves caused called radiofrequency ablation.

>> Huh?

That's very interesting.

Is this next one here?

Is this the neck also and this number nine coming up is um a picture of a Lobach model?

>> Well, we're at the opposite end of the spine at this point.

OK, so it's a Lobach model and what that is showing is the provider is providing Neidl to the interspace there for an epidural steroid injection.

>> They're showing where that needle will go for the procedure.

So what we do is we have our patient come to the procedure room and you can move on to slide ten if you'd like to show the cartoon.

Basically we'll have our patients lie down will wash off the area with antiseptic scrub um and then we'll take X-ray pictures.

>> So in the options like what we just looked at, that's what the physician here in this picture will be seeing.

>> Right.

He'll be seeing an X-ray of that spine model we just saw in the prior and is this so that if he's going to do a steroid or cortisone injection he knows exactly where to put it, where it is.

>> So we'll see our patients for example, in the office and we'll examine them.

We'll look at their imaging and say look, OK, you have a problem at the L four or five disc.

OK, so then we will take our patient to the uh, surgical center, our procedure room and then perform an injection.

We want to certainly target the space the interspace that is causing the problem.

So that's why we take the pictures.

So it's not a blind injection.

It's much better tolerated.

We can numb up the area, offer a mild sedation as well and then we'll slowly direct the needle to the target on live X-ray so it minimizes discomfort and focuses our creative that I mean patients that come in are they they nervous about it or how can you assure them that this is customary and this is a very safe procedure?

>> It is and everybody is different risks are very, very low but we certainly have a conversation with our patients ahead of time.

We try to explain what's going to be taking place and during the procedure we'll talk our patients through it as well.

>> I mean so they're awake they're not sedated during the injection.

>> They're done different ways.

I will offer a mild sedation if you would like it again, that's kind of like going to the dentist depends on what you're going to have done, you know, and what your tolerance is for .

>> All right.

Let's move on then to 13.

Is this imaging or no I guess eleven is this imaging?

>> Sure.

So this is a picture of an X-ray of the back and as mentioned before, while we're doing the injections we first see and have to number the levels and we have already decided what level we'll go after and then we will move forward and we can move on to slide number 12 and that will show the needle at the appropriate inner space where we're going to inject and you really do see exactly what's going on in there.

Right.

And then we can inject a little bit of contrast dye to make sure that the needle is in the right space and then we can look at that and different views to make sure we're in the right space before we actually inject the medication.

>> OK, I see.

Wow.

>> Is this a pretty common thing to do injections it is.

I do it every day on patients.

You know?

>> Well, you know, I think that's like a lot of people are getting some sort of a cortisone or steroid injection for a lot of different things.

I mean I remember a time when I had a rotator cuff issue and got a couple of injections, you know, certainly alleviates some pain.

>> Right.

And I'll do those in the office for joints as well in the spine and those types of areas we'll do those under X-ray.

>> Others can be done right in the office without that let's let's say somebody comes into you as a new patient and they have some back pain or shooting pain down their legs or whatever kind of what's the process of you doing the diagnosis?

>> Well, again, it's important to get a good history to find out when the pain started.

It's important to find out what makes the pain worse, what makes the pain better.

It's important for us to know what types of treatments have already been attempted because sometimes sure patients have already come to us, have tried anti inflammatories or tried therapy or tried, you know, chiropractic rehab a lot of times our patients have already tried certain things so it kind of depends where they are in the process as to what we do next.

>> OK, what if somebody doesn't seek treatment?

>> They just keep living with the pain?

Well, it's not going to go away on its own is what I'm saying.

Correct.

It depends how long it's been going on.

It depends what the problem is.

But if there has been a condition problem that's been going on for quite some time, it certainly makes sense for um our patients to be referred to a specialist to take a look into it because the longer it occurs the harder it is to treat it and get rid of it over time.

>> OK, all right.

So good recommendation and seek some medical assistance right early on you have a better chance of getting it taken care of .

All right.

Where are we here are we on fourteen what is that we can go to thirteen.

>> Thirteen OK this is just another type of procedure we do where I mentioned how we will treat the joints of the back.

This is showing some treatments directed towards the joint regions of the back where we can first inject anesthetic ultimately if it helps but doesn't last we can move on to the next slide and sometimes we'll even burn patients nerves in the back to try to get longer lasting relief again.

These are the small nerves that transmit pain in the back.

It's up the major nerves that allow us to we aren't going to miss them miss having those burn those no no.

>> They can actually the little ones can grow back after time.

>> Oh all right.

That's interesting.

Would they be in the same condition or would they be healthy ones that grow back?

>> Well, those same nerves can regenerate and then they can do their job of transmitting the pain.

So you know, if we've burned a patient's nerves and they've been doing well for a year or so and they come to my office and say Doc, the pain's back just how it was a year ago then we can burn it again.

>> I see.

OK, so maybe an ongoing treatment.

All right, let's move on to thirteen fifteen.

>> We're moving right along here.

There are other treatments that are beyond just injections and so forth and as mentioned before, um, disks can bulge and protrude and some treatments can help patients without the needle without the knife and this is a non-surgical spine that table decompression that's available to help patients as well.

>> And this type of treatments if we move on to the next slide can be helpful to, uh, alleviate pain from bulging disks or herniated discs.

This generation the Forsett syndrome we talked about even the sciatica radiating leg pain or even neck and arm pain.

So you know, over time discs can bulge and protrude and become degenerative.

This type of treatment can zone in and focus on a specific and just level and reduce the pressure inside the disks trying to draw unnecessary necessary oxygen fluids and nutrients so that we can help the body naturally heal and reduce the pain and bulging and often the sciatica too.

>> What kind of a process is this like using this uh do you chair bad whatever this is a table spine spine mid table decompression program is that it like a series of it is typically a twenty visit program where patients come every day for four weeks.

>> I see.

OK got it.

I didn't think that could solve it in one treatment right.

Yes.

>> Three years to build up so this picture here just shows how it can zone in hold on to that pelvis so it can do the job.

It's really a remarkable treatment that's helped countless numbers of patients struggling with back pain, leg pain, neck pain, arm pain and again it's great because it's a natural type of treatment no knives, no needles, no meds and we have seen great results over the years.

>> That's good because I know a lot of people would be fearful of going straight into surgery for a back issue.

>> Right.

Maybe their friends or other family members say oh yeah, that happened to me fifteen years ago and I had this surgery and whatever.

>> But with new developments you can say let's try this first, right?

Absolutely surgical way.

>> All right.

What about the leads?

Are they are these used in conjunction with the compression treatment?

>> Well, this is a type of treatment spinal cord or neurostimulation.

>> If we have a patient let's say who's you know, had surgery, who's tried injections, who've tried different medications and still struggling with chronic nerve pain, there is an implant that we can offer to help patients who are struggling with their excruciating daily pain.

So these are pictures of neurostimulator leads that can be implanted like a pacemaker to try to help kind of cover up the pain and reduce the discomfort.

>> I'm so fascinated by this every time when we talk about this I think what a wonderful revolutionary thing.

You've brought an example with you, Doctor.

If you would show that to our viewers.

>> Sure.

This is the neurostimulator and the lead, if you will, that goes up into the spine.

>> Is that correct?

Yes, it is.

We can see right here the battery device is what is ultimately implanted to provide the power and then we have a lead as you can see right here that is put into the spine itself often through a needle and is advanced towards the target and this is in the epidural space of the spine and stays there and ultimately this wires connected to the battery as you can see and that can provide ongoing pain relief and that's implanted below the skin.

>> Nobody knows you have it and it helps our patients who are struggling with that type of chronic chronic pain.

>> Is this as you told me once, is that like above your hip it's often placed and that um where you have plenty of material to cover it that's good with this stay in your body then.

>> ARBERG It can but over time depending on the usage the battery almost like a pacemaker would have to be replaced from time to time because of the battery life .

I understand that that kind of like a halfling.

Yeah right.

What are these trials we're talking about here?

The yeah.

>> The spinal cord stimulator trial is just a cartoon of a provider um placing these lead wires into the spine so we'll do a test drive or a trial first and if the trial helps then we can ultimately implant the permanent uh which is certainly comforting to know that you can try it out for exactly.

>> A lot of times our patients uh, don't want the leads removed because they're feeling so much better.

>> Uh, there you go.

It's that nonsurgical but certainly a new and improved way.

Well, Dr. Lutz is always appreciated here on LIFE Ahead.

Thank you for all the information for having me.

I appreciate it.

And the medical knowledge that you all have now from listening to him?

Well, we appreciate all of you watching us here on LIFE Ahead and of course next Wednesday night we'll have another show here.

We hope that you'll join us for that.

We'll see you then.

Good night.

Night