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>> Well hello and welcome to help find this Tuesday evening.

I'm Jennifer Bloomquist.

I have the great fortune of being able to host the program tonight in case you're new to help line this is a live show we're here in the studio right now.

We do have a guest tonight who is an orthopedic spine surgeon and he's going to be here to answer any questions you may have regarding issues of the back and who doesn't back pain.

I think just about everybody at some point in their life has experienced back discomfort.

So don't be shy.

Give us a call any time now through about eight o'clock when the show ends it's (969) 27 two zero.

You can ask the doctor a call live if you want by calling that number or if you're a little shy or you want me to ask a question for him that's or for you to him that's fine.

You can talk to the call screener, give him your question and I will ask the doctor for you.

I'll call sooner rather than later especially when it comes to show specializing in back problems.

We do tend to get a lot of calls so we'll leave that phone number up for you.

Call any time and let's go ahead meet our guest tonight.

First time he's done a show with us and he seems very relaxed so I told him not to be scared.

>> This is Dr. Alan McGee Jr. and he is an orthopedic surgeon .

>> Yes.

Thank you.

Thank you so much for letting me be here and I'm glad to be a part of the show.

Yeah.

Thank you so much.

And he brought a prop too.

So that's always helpful especially if we've had people call for back shows before where they're talking a very specific disc or area of the back so that the prop of the spine right there will help us out a lot.

Well in the meantime, before we get any calls, we wanted to talk about something called lumbar spinal stenosis.

>> That sounds kind of scary.

Yeah, it can be especially because there's so much verbiage around the spine specifically in regards to the anatomy as well as the different procedures, techniques, different conditions.

>> So lumbar spinal stenosis is essentially just an abnormal narrowing of the spinal canal or certain canals in the spine because low back pain is such a very broad general topic.

I wanted to kind of hone in a little bit and talk about this specific condition which affects millions of people across the country and that can be very much so associated with back pain.

>> So this is if you've got this issue is going to be lower back pain, lower back in general stenosis is just the term just means an abnormal narrowing.

>> It can happen anywhere in the neck or the cervical spine but specifically for the lumbar spine.

We do see it manifest itself as back pain very commonly it's actually the most common symptom of lumbar spinal stenosis is back pain.

>> Does this something that you would experience after doing maybe strenuous work?

Does it tend to be something that's genetic or are you predisposed to it stem from maybe I don't want to say an injury but you know, sometimes over use or you're out mulching or mowing or whatever lifting and then you experience some discomfort.

>> It can be a combination of all of those things but you actually see it most commonly in patients in later years or middle age more fifties, sixties or so or you start to have degenerative conditions like arthritis of some of the joints in the back disc bulging as well which from down the spinal canal you have the nerves themselves, the spinal cord itself as well as the spinal column that can get pinched because of the bone spurs on the joints or the disc bulging in pressure on those nerves can manifest itself in back pain possibly leg pain, leg weakness like fatigue all of those different ways.

>> Now I've had bulging disks and it was excruciating.

I mean I had to crawl in to the emergency room so that is it.

But are other types like is it more like a dull ache that maybe gets worse or because sometimes people just say I and I'll take a little ibuprofen, it'll be fine and they kind of put off going to see a doctor about you usually see when it comes from degenerative conditions or arthritis or broad based these bones in the back usually do so with a slow onset, usually with some general aching some general pains, intermittent low back pain.

>> They kind of just presents itself over time but it's still not uncommon even with the arthritis of the degenerative conditions in the back.

>> Where have you moved the wrong way or do a certain position can flare up the condition or essentially cause inflammation in and around those nerves or in and around those joints or disks which can become pretty painful pretty quickly?

>> Yeah, it's scary how bad back pain can be and then you know at the time you just want it to go away.

So I think that's another thing that concerns people is especially with their back they just don't want they don't want surgery.

I think everybody tries to avoid back surgery.

But I know from talking to some of your colleagues in the past, you guys have had anybody in this field has always had a conservative approach.

So if you go see somebody, you're not going to be having surgery more likely the next day.

So you want to talk about some of the things you can do to help somebody.

>> That's most definitely so.

Again, the majority of the patients that I see in clinic even with lumbar stenosis I don't jump to surgery.

We again I am a spine surgeon.

I enjoy doing spine surgery.

But if I can heal or help my patients with non-operative treatment modalities, that's the way I'm going to go about it.

OK, so ways to go ahead and say treat the condition of lumbar spinal stenosis is things like physical therapy, medications like anti inflammatories or non story related inflammatories like Aleve ibuprofen.

There's prescription medications like Mbalax ACAM or Naproxen.

We also can use other medications like muscle relaxants which can be very helpful because along with back the general conditions of the bones, the joints, the actual discs you can have the associate muscle spasms, muscle tightening and just changes in the biomechanics of your back because of the pain that you're experiencing.

So muscle relaxers can also be pretty helpful.

And again, talking a little bit more about the stenosis component where we're talking about the nerve pinching we actually have nerve medications or neuropathic medications like Gabapentin or Pregabalin otherwise known as Neurontin or Lyrica.

>> Now would would some of those I mean in some cases can people just take these medications or even something over the counter?

They can be profound and it would go away.

Does that happen or I guess what's the other scenario?

>> What do you do if that doesn't provide any relief?

Most definitely and actually the most common how do you say prognosis for patients with a flare up of acute back pain or even chronic back pain is for it to get better with these non-operative treatments?

>> I also say if you do have a flare up of back pain or some of this leg pain, you can actually have a short course of anti inflammatory medications if your doctor allows that just wanted to put a precursor there because sometimes with these antiinflammatory medicines the nonsteroidal anti inflammatory medicines like the ibuprofen or leaves they can cause an increase in your blood pressure.

They are processed through your kidney.

>> So there's kidney issues.

You have to be wary and then sometimes even with stomach issues like upset stomach ulcers, things like that, you have to be very wary.

>> But in the patients that are able to take these medications I do like to do a short course of this medicine from anywhere from four to six weeks consistently even though you may say it's been a flare up, it's been about a week and it's on and off pain.

I want you to take their medicine consistently to get to at least a full month or six weeks so we can calm down that inflammatory process as much as possible so your body can actually reset and that's something that's kind of difficult for some people just understand they talk to me and say well, my disk is still bulging.

I still have arthritis.

What what are we going to do about that again if we're able to treat those symptoms?

>> I don't worry about the anatomy.

I don't treat my x rays are MRI as I treat my patients their symptoms, OK?

>> And I imagine everybody's different and everybody probably has a different pain tolerance to so that probably makes it it's not a cookie cutter solution.

>> There is not anybody infinitely and that's the thing is just taking in consideration in patients aged comorbidities.

The what I see on my imaging studies like my MRI or my x rays, I take that into consideration as well as whether they're having primarily back pain or primarily buttock pain or leg pain isn't even associated.

Sometimes they have the weakness or heaviness in the legs.

>> I take that all into consideration when I'm trying to formulate my plan to treat patients with those symptoms.

So what if the therapies of medication just don't provide relief?

You said you would try that for four to six weeks at that point if it's still an issue affecting daily you know, just daily tasks, what would a patient's options be at that patient's options depending on how much imaging we have because sometimes patients come to my clinic again just with those symptoms.

>> They don't have any imaging like x rays which we get and can show us things like arthritis of the back or degenerative disease.

>> It also shows us interesting component of possible slips of the vertebrae and I can kind of just give you a little show about what I mean by that over here is that a slipped disk?

>> Is that the slip disk?

It can mean one or two things sometimes they talk about here where we're looking at the disks themselves and an example here is a herniation where you can actually have some of the content slip out and can cause pressure on some of the nerves that come from the nerve tunnels here or essentially where you're having pain in this from the spinal cord itself.

But there's another component where we turn it this way where this vertebrae or one of the vertebrates on top are adjacent to the other slips forward or backward.

>> OK, they can be kind of confusing because why would it do that right when you have degenerative processes in the back of these Forsett joints here where they're becoming incompetent are not able to do their job that can put extra wear and tear on the disk because gravity pushes everything down.

>> You can have a slip whether it's four or backwards depending on the patient's anatomy and then that can also cause pressure on the joints themselves which can precipitate some of that low back pain and it can cause pressure in and around those nerve tunnels which can cause the spinal stenosis.

So when you're saying that it would move I mean is it a matter of centimeters or even I don't know like how great of a distance the the disk would have to move?

>> Most definitely.

And that's the thing is it can differ from each person to person.

Sometimes you can have a small a few millimeters or so and then even up to a centimeter to that degree that little bit would make a difference just that little bit can cause different degrees of nerve pain and nerve symptoms because the stenosis can be more significant.

So usually the cases when you have a further slip you make less space for the nerve tunnel here as well as less space for the spinal canal in the nerves that are transverse going across that segment.

And again the bigger the slip usually more significant stenosis and again this is the other caveat not necessarily does that mean you have worse symptoms?

>> Oh, all right.

And how much it moves in going back to again not having the worst symptoms it goes back to my excuse the discussion or the statement.

I said that even if you have a big slip or have these the degree of stenosis that could be pretty significant or severe which patients may see this on their imaging studies like an X-ray or an MRI which no severe stenosis again that does not have to correlate with symptoms because we're able to treat you with those non-operative treatments such as physical therapy or medications.

>> We are happy to have you in a good place.

Yeah.

Now that's good.

I like that philosophy of just not relying on if it looks this way you have to you only have certain options that you kind of keep it open based on other things regarding the patient.

So we're going to continue to talk about spinal stenosis but Dr. MCG's only here till eight o'clock and what typically happens on these shows is people call later rather than sooner and we hate to miss your call.

I can't hurt to get some free advice even if it's somebody maybe in your family, maybe not yourself but a friend or an acquaintance or something that is having some issues it can't hurt to give them some sense of direction as to maybe what they could do to get some relief.

So again, we keep that phone number up for you.

It's (969) 27 two zero.

Think I forgot to tell you that earlier.

If you're outside of Fort Wayne it's still is a free call.

You just put an 866- in front of there and again two options when you call you can ask the question live and the other the other option is you can talk to the call screener and give them the question and then I'll ask Dr. Begi for you so well we're going to go ahead and keep talking about this so at what point after you're working with a patient that's having this condition is something more extreme needed?

Definitely.

I mean I realize physical therapy and things so I mean they could maybe try that even for a few months before giving up on that.

>> Yeah, definitely.

And again we look at the tools in our toolbox to address spinal stenosis.

We'd start with those things that are the least risky which are the physical therapies, the medicines, the next step after that which can be beneficial for both myself as the doctor and as well as the patient or things like injections.

>> So I know you know everyone probably has someone who's had some back pain had an injection that you do well or maybe it doesn't help too much but the next treatment modality are these epidural spinal injections and there's different flavors of those specifically when we're thinking about lumbar spinal stenosis and we're thinking about symptoms causing the back pain or the pain or the leg pain.

>> We like to sometimes be a little bit more specific versus general.

So for example, some people have a general epidural steroid injection.

That's where we would have one of my either myself or one of my pain colleagues which again the pain physicians who are specialized in these injections would use a needle.

They would go in between these two bones in the back again this is from the back and this is called the intra laminar space and they would use the needle and or catheter to place the medication in and around all of the nerves that we think are having the problem that the medication that they use would be something either and or a numbing medication like lidocaine remarking on end as well as a steroid medication, something like Kinlaw about prednisone or methylprednisolone that just would numb just that specific area and depending on how specific they would like to be, this could get multiple nerves which exit multiple different nerve tunnels as well as nerves that cross down and can also get in and around some of those joints as well as the disk where you're also having that stenosis again with those two medications.

>> One like I said we would we would say that the benefit for myself would be from the numbing medication the numbing medication could give me an idea of is this helpful in that short term period where a patient would take note within the first minutes to hours?

>> Oh OK. That passed and that would give me information that I'd like my patient to say.

>> Let's remember how you feel after the injection.

Let's see how how how much pain relief you had and how significant it was that second medication would be that steroid the steroid could take effect anywhere from a day up to a week and could provide anywhere from indefinite pain control or up to a few months which I've heard a few months then it can wear off for some people that right it can wear off the big benefit or the big hope is that we're seeing the symptoms again be alleviated as long as possible if that's not the case, the steroid wears off, the symptoms return.

We could continue down the same non-operative path or consider other treatments such as surgical management.

>> All right.

We're we're going to talk more about that in a little bit if we can get to but we did have a couple of folks call in so shy folks are going to have me ask the question for them.

So we heard from someone named Megan and this is an interesting question she wanted to know Dr. Magee, how often do you see scoliosis in adults with scoliosis?

>> Is curvature of the spine?

>> Yes, most definitely.

So I can see I see scoliosis in adults not fairly uncommonly honestly in usually you see a different number of reasons.

One of we would say say some young adult patients in their say 20s or 30s I could see patients who would have a curve either in their lower back the lumbar spine or up into the thoracic spine.

>> OK, when they have this and I see this in these younger patients it's likely usually due to something called idiopathic scoliosis which happens during the time of maximal growth as a young adult usually in your early teen years, sometimes mid teen years.

>> OK, sometimes this goes undiagnosed of the curves not that significant or it's not caught on any sort of physical or if the patient's not having any sort of significant pain until later in their adult years that is one flavor.

The second flavor you can see in older patients which comes with time something called degenerative scoliosis where as essentially time arthritic changes gravity has its effects on the body.

>> It can start to cause curvature in the spine usually in the lumbar region.

So you can see curves to the left to the right, even a rotational component here that can start causing pain in the back as well as some stenosis or pressure on some of those existing nerves.

>> Now I remember in grade school growing up course this is in the seventies and eighties they used to come into the school and screen the kids for it.

But now I think it's kind of a routine thing for kids to have at a yearly doctor's check.

Yeah, but but yeah, I don't as an adult I don't ever remember, you know, at a doctor's appointment having checked.

So I guess it's really up to the patient to ask the doctor if they like would you have some kind of symptom maybe make you think you have scoliosis and that's the things a lot of the times symptomatic scoliosis usually in the young adult isn't all that common unless this was missed for the most part when we said that test called the Adams for had been tests which you can do or it's usually performed in younger patients preteens, teenagers a little bit younger than that that's able to catch the potential curve because it progresses as you are growing.

>> You don't usually see it so much because once you've reached your full growth potential the likely for that to progress is very minimal unless it's a pretty significant curve.

>> All right.

Good to know.

Thank you so much backing for us for that question.

Good question.

Also another interesting question from Paul.

He wanted to know why people get shooting pain down their back and buttocks when they have back pain.

>> Perfect.

So this actually goes in hand with lumbar spinal stenosis.

So even though back pain is the most common symptom of lumbar spinal stenosis, the second most common is that deep buttock pain or shooting pains down the legs.

>> So to give you an example, most people know the shooting pain or call the shooting pain sciatica.

So if you look to the model, I'll talk a little bit about what that means and where that term comes from.

>> OK, so in the back if we say we look from talk with the front, see the sacrum here we have your L5 vertebrae in your L4 vertebrae.

The nerves that come out of these levels are the Forner between four and five the L5 nerve which comes out between L5 and the sacrum and then the S1 which comes out from a little small hole for Raymont in the front of the sacrum as I turn to the back those three nerves come up and make the sciatic nerve.

The sciatic nerve comes down to the back of the sciatic notch and goes down the leg and provides motor and sensory function to mostly the post your part of your leg as well as some of the motions in your leg like lifting your foot, lifting your great toe and then pushing down your foot.

>> OK, when you're having stenosis particularly at these levels of four or five or I'll five and one you can have those symptoms affecting one or maybe more of those nerves and that pressure on those nerves causes dysfunction down into the nerve itself down the back of the leg.

OK, and that is something the two terms another medical term is called lumbar ridicule apathy or we could say ridiculous that the of a specific nerve like four or five or us one.

>> But the more general term is sciatica that would that normally only happen on one side?

>> I mean if somebody had an extreme case could you have it on both sides?

>> You definitely could you definitely simultaneously simultaneously is usually most seen unilaterally just because it's more common just to have it on one side or the other.

>> But again with things such as arthritis on both sides of the joints or a very broad disc bulge that pushes back, you could have it on both sides.

Also when we talk about that slip forward from one bone on top of the other that makes those nerve tunnels even more narrow and it's more common that you would see it on both sides in that case.

>> OK, yeah, I think we people have heard of sciatica but probably didn't know the details behind it.

So this model is coming in great use tonight.

I'm glad you brought it with you.

Let's see we have another question from an AI apologize.

I don't know if this is Maya or Maya but the question was do posture characters actually help prevent bad posture?

>> I don't really think and what exactly is a posture?

Correct.

That's that's but there are some things like braces some examples are something we call a figure eight brace some of the same symbols.

>> Something is a cloth that goes around the back that pulls your shoulders back and keeps your head neck your back in a better better quote unquote position in regards to correcting posture, I don't think there's any strong evidence saying that this actually completely corrects the posture it holds you in a position where again ideally your head is above your pelvis, shoulders are back and that can help that position.

>> But in the long term don't think there's any strong evidence showing that that does ultimately help you correction of posture without wearing that brace.

>> Is that something that is a prescription from a doctor or is that something people can just go buy?

>> You can buy them over the counter sometimes you can have prescriptions usually that that particular race usually is to keep your back straight and has to do mostly when my training when you have to say clavicle fracture that you want to treat not actively can make you feel a little bit more comfortable.

>> There are braces particularly that can help you with better posture itself.

>> Something that are called RTLS braces is kind of the example or thoracic lumbar sacral or ptosis.

>> So that's a brace that goes up up to the ribcage.

Told you in a position we use those we're not really for the posture for say but we will use those first fracture elderly patients where we have concern where we're going to have a kyphosis or a forward bend from that fracture.

>> We also will use those in patients who have lumbar spine surgery, whether it's for a fusion usually we need to use screws or rods or have to do a long construct where we have to do very long rods and multiple screws.

>> All right.

Yeah, that's why we were saving the best for last the surgery.

We only have a few minutes left unfortunately.

But I was amazed before the show you said some of these back surgeries are done outpatient.

I am shocked.

I mean I figured that would definitely be at least an overnight stay at a hospital but it sounds like you try and make it as is noninvasive as possible.

Most definitely.

And that's where everything's moving right now in the world of spine surgeries to the least invasive as possible.

Our people here are minimally invasive.

>> So say for example, we're talking about lumbar spinal stenosis.

We found essentially the offending agent, whether it's the joint that has arthritis or some of the disc and we see the nerves that are the problem nerves and we figure that out with the injections.

We figure out that with the MRI what can we do next to definitively treat this?

>> So if you look to the model here the most straightforward surgery that we would do is called a lumbar decompression.

>> There's many names such Hemi laminectomy nerve clean out.

>> There's a lot of different terms but it's generally the same thing where we're looking here at the EL faunal five level which is the most common area to decompress.

We make a small incision a few centimeters to an inch or so and we're able to remove the remove the muscle that attaches to this post your bony prominence here in here to sweep that out the way we then would take about a dime sized section of nonstructural bone called the lamina here, the lamina here and then as needed we would be able to take a small portion of the joint not to destabilize it to be able to free up space for the nerve that exists as the well as the nerve that traverses down if necessary we would be able to remove any disk material that's causing pressure and we're able to do this relatively short order and means of anywhere from 20 minutes to an hour if we're doing a single level again, patients usually come to the hospital for a few hours before stay for a few hours later essentially can be done in an afternoon or a morning.

>> So don't get scared if you talk to somebody like a grandparent or great grandparent because maybe what they would have experienced years ago is completely different from from what they do today.

>> Most definitely amazing.

Well, thank you so much as the doctor again Dr. Alan McGee Jr.

I appreciate you coming on and thank so much to all the folks who called in ask questions tonight.

So I know we helped out a lot of people and that model was very helpful.

I hope you guys enjoyed that as much as I did.

We want to remind you that there is another health again next week Mark Evans will be hosting that one in the meantime, have a great week.

Stay safe and we'll see you back here next Tuesday.

Take care.

>> And again, Doctor, thank you so much.

Thank you so much.

Please be here.

Thank you.

Have a good night.

Bye bye.