hello and welcome to HealthLine this Tuesday evening.

>> I'm Jennifer Blomquist.

I have the privilege of hosting a show tonight and I sure hope you'll call us during the show to get some free advice.

There's nothing that's really free anymore but I guarantee this is free advice here won't even cost you a penny to call us.

So if you're in Fort Wayne it's toll free eight nine six nine two seven two zero outside of Fort Wayne.

Still it's a free call as long as you put an 866- in front of there.

So call that number any time from now up until about eight o'clock and you have two options when you call in you can either ask the question live during the show which is great.

We love that you can interact with the doctor.

Maybe he wants to get more information from you or it's just a really nice experience if you can call in live.

But I understand some people might not want to do that and I'm more than happy to ask the question for you so they don't just throw you on the air when you call in you'll talk to a call screener and tell them which way you'd like to do that and we'll get your question answered.

So we do have a returning guest tonight.

I'm very happy to see Dr. Smith.

So thank you.

This is probably third or fourth time at least I think I think third time.

Yeah.

All right.

Great having me.

Sure.

And Dr. Mike Dr. Smith is a spine surgeon.

So if you have anything related to spine back issues, he's your guy tonight.

You want to give him a call.

So again, I'll remind you throughout the show about that phone number but we'll keep it up at the bottom of the screen.

So I think Dr. Smith, people here owe back surgery or spine surgery that just sounds horrible or you know and I know from talking to you in the past as well as many of your colleagues that you always take a conservative approach.

I think people get scared they don't want to do surgery but it typically is the last resort.

>> Yeah, absolutely.

So you know, when I see a patient unless they truly have some sort of neurological deficit where it's like we really need a tie with no surgery, we always address the pathology and try to treat things conservatively.

So we pretty much always start with either physical therapy and medications and things like that and we can even do that before you even get an MRI even just a simple X-ray is what time is all we need to make sure that there's nothing really, really bad going on after we do have good physical exam and kind of take a good history and figure out kind of what's going on.

And I said most time medicines and physical therapies all that's needed for most neck and back issues and then that's when we talk about getting an MRI and then it's OK. What do we do from here and is there something to address?

And that's when we talk about doing either maybe an injection, an epidural steroid injection or something like that or we talk about doing surgery and do you find that I mean I feel like I know young people and older people who have back issues, you know, range of of things and it's not necessary.

I mean I understand if somebody had some kind of an accident or you know, some type of trauma but sometimes these are just folks that you know, they really are they look pretty healthy.

>> You know, I can understand too if somebody is really obese that could pose an issue.

>> But so do you feel like if your back is kind of sore here and there, is that normal I mean do even healthy people have to deal with that?

Yeah, absolutely.

You know, a lot of people say oh, I just have a bad back.

Yeah.

You know, a lot of people say oh my dad had a bad back.

>> I have a bad back.

It's you know, it's very common as we get older as we just age the the disks which kind of go between the vertebrae is like the cushions for a spine and just as we get older they get a little worn out the a little dehydrated and so they kind of collapse and it stresses the disc stresses that the joints in the back and it can just kind of lead to some aches and pains and it's not uncommon you know you hear all the time there's a professional athletes that have to sit out a game or two because you know, they twisted you know, straighten their back or have some sort of other issue and so it's very common and so that's why, you know, having an active lifestyle is very important eating healthy and maintaining a good strong core and that's really where physical therapy is.

Why it's so important is helping people have a good strong core getting their abdominal muscles balanced and working with their back muscles and their pelvic muscles and all that.

Yeah.

And I you know, I was just thinking today, you know, saw a lot of people out mulching and doing yard work and I know that's what gets me when I mulch I feel like I'm never going to be able to walk again and I do end up having to take like an ibuprofen or acetaminophen.

But you know, just to for a few days I don't know if you have advice for folks that if we should be maybe I should be stretching or something before I go.

>> Yeah.

So I think one of the big things with doing this is that time of year right where people can be a little bit more active.

>> Yeah.

They're doing household chores, spring cleaning, getting the flower beds and gardens ready, starting to mow sometimes you know doing that last rake of leaves that had fallen after the fall and so we're not meant to be in a forward position and that's actually that Ford Flex position is actually the where the disc's of your back and your neck are the most stressed and that's why you're sitting there.

>> Bend over.

You're in all day long you've been stressing loading that part of your spine more than it's used to.

And so I just in general I mean, you know, taking a little walk and stretching before you do you know, activities outside probably a good idea as long as your physician says it's OK to take ibuprofen or leave some sort of other antiinflammatory medicine, take it before you even start an activity is probably good kind of free trading, OK?

>> Yeah because otherwise yeah.

You know within a couple hours you're probably going to start to feel yeah yeah.

>> So I always recommend kind of getting ahead of the curve if you know it's going to bother you then do it especially the day too well and I recommend having your kids help you too.

>> Oh yeah that's how I like it.

Doesn't the neighbor kid yeah yeah.

>> Oh yeah a lot of for summer jobs so absolutely.

All right well I don't want to forget to remind everybody if you're watching you're welcome to call Dr. Smith any time now up until about eight o'clock I will say a lot of times our phone lines get jammed up toward the end of the show.

People tend to wait toward the end and we'd hate for you to miss an opportunity to ask him something.

So there's the phone number again it's (969) 27 two zero.

If you're outside of Fort Wayne it's still toll free call as long as you tak and 866- in front of there and again we're talking about spine surgery.

So you know, you've talked about taking the conservative approach medications, injections, physical therapy.

If for some patients that's not going to work again.

People always think of spine surgery as being so invasive but even that going that route you can do things that are minimally invasive.

>> Yeah, absolutely.

So I love what I do and one of the very cool parts about this time and spine surgery is we're kind of finally at that point where our understanding of the the good alignment and biomechanics of spine and our research and the technology that we have, we're kind of at that at a good time where it's all coming to a head to where our understanding is, you know, much better the technology is there so we can do approaches that are much less invasive.

And so, you know, even though it's surgery and it's minimally invasive surgery, it's still a trauma to your body even though it's a it's a controlled trauma and so anything we can do to minimize that is really important.

>> And so now there is newer techniques that we can use Twitter instead of peeling the muscle back and having really, really long surgeries are techniques so much more efficient, less bleeding, less stretching the muscle which leads to less hurt just there's just it tends to be a kind of a good research.

>> Absolutely.

So what we're able to now has a lot less burden to people after surgery so they are able to get up and out of bed a lot quicker .

>> We're doing a lot more surgeries now is outpatient so same day as a home?

Yeah, I can I mean yeah I was that was my next question was most people walking that night but obviously you're doing outpatient.

We even if you stay overnight we still get you out of bed that that that night and so even working with our anesthesia colleagues we're now able to do certain blocks injecting medicine into muscle bed to help with the pain after surgery because a lot of the hardest thing about it is kind of getting over that initial fear and that initial pain.

And so once you're under stable you're able to understand that you can get up and move your recovery that much quicker.

>> Yeah, I mean that would be you know, I think about when I was in grade school I had a teacher that had back surgery and she was gone for months, you know?

And so now I'm thinking this doesn't sound as bad.

I mean I think you just have to kind of mentally get past oh yeah.

>> You know, the fear which is easier said than done.

I have patients all the time who said oh you know, I had surgery, you know, 15 or 20 years ago and I was in the hospital for five or seven days and I'm like no, that's that's not how we do it today.

>> You know, much, much more efficient techniques to where we can get people up and moving a lot quicker.

That sounds better I think for everybody.

Absolutely.

We did have somebody call in Dr. Smith.

He wanted me to ask the question for them.

So Matthew wants to know is there a difference between a slipped disk and a protruding disk?

>> Yeah, it's a great question.

So typically when we think of a slip disk that actually kind of refers to the vertebrae itself.

>> So if I kind of hold this up here so you can kind of see the alignment of the spine kind of has this natural curve and for some people that spine bone actually translates for it and it's called a fancy name is spondylolisthesis which really means slipped disks.

And so that means that it just kind of literally slides forward so that is one set of pathology and a protruding disk is different.

>> So protruding disk is where I kind of turn this around here maybe we can see it but actually with this material Spetz into the canal where the nerve is and so if the nerve is in a tight space, confined space in this kind of this canal and the disk material butts up into there now that space is a lot smaller so disk is protruding in the canal kind of squeezing it.

>> I tell people at times it's like a pebble in your shoe.

It's very, very annoying.

Yeah.

And if it's if the nerves coming up and over that pebble like that, any time you take a step you're stretching the nerve over it and that's what sends that shooting gnawing pain down your leg or numbness or you get in your arm.

I had surgery from my neck about six months ago because I had some pensioners and so I know exactly what it feels like.

>> I can totally relate that to.

>> So what a slipped disk would that be?

Well, what would cause it both in both cases slipped or protruding?

>> Yeah.

So they're all kind of just a spectrum of kind of wear and tear.

I don't really like the term degenerative disease.

It's kind of in an older antiquated kind of term even though we still use it basically just you know as we get older the disk drive is kind of like a jelly donut leave a jelly donut out the kind of the crust starts to get some cracks right.

And if you put a little bit of pressure on it, the disorder, the jelly squirts that's the same thing like a disc in your back so that material squirts into the canal and that's the protruding disc.

OK, and we can have some people is as at this kind of wears since it's a front stabilizing part stabilizing portion of the spine now it's stressing these kind of back joints back in here.

So if the disc is worn out now the back part of the joints here starting to wear and as the joint capsules get stretched then that that vertebral body can slip and that's really the slipped disk portion of it.

>> Yeah, either either way as you know I mean I've seen I had a crawl on my knees and I had a herniated disc, you know I mean that's how I went into the the hospital and I almost wanted to laugh.

I couldn't because I was in too much pain but when they said well go and get up on the table we're going to do an x ray and I thought I don't know how that's going to happen.

>> It's really it's all it is.

It's scary how painful it can be, you know.

>> Oh yeah.

So it's a pain that few people can describe thankfully.

Yeah.

But when you have you know and then people other people have had I can absolutely sympathize with it makes it makes people grateful when we can find something that gives you relief.

>> Yeah.

Hopefully so another thing that you had sent to me note in the notes was about robotic spine surgery and I know we've talked about that and some of the other specialties we get on the show but I had not heard about it for spying so I said now it's kind of a time where a lot of this technology is kind of catching up and kind of helping advance and making our techniques a whole lot more efficient and safer.

>> And so with robotic surgery we're able to actually do basically a CT scan of the patient's spine either before surgery or during surgery and we're able to put some devices that anchor usually near their pelvis and then we're able to orient that into space and so the robot actually knows where in space all the vertebrae are and so we use it typically for placing the screws in the spine.

>> So it allows us to be much more accurate, much more safer during surgery which then makes patients, you know, surgery outcomes a whole lot better.

>> We're actually able to put retractors in there.

They're sturdier and without taking a bunch of X-ray we're able to actually take a probe and we can kind of follow it live on the screen and exactly where in the body in the spine we are and it helps us just get oriented without having to take a bunch of X-rays to see kind of where everything is.

And so then that allows to make our incisions much smaller so less trauma and disruption to the patient's tissues.

>> So you're you're using some type of device to control the equipment while looking at it all on a screen.

>> Yep.

So we can basically tell it's basically kind of like a really strong arm and hand and it kind of comes in and I'm kind of like right there we can tell you exactly where we wanted to be and so then that allows us to do all of our work right through that in a very small structured spot and that you know, a lot of people do need the hardware and that always seems to now is most most of what they're using today.

Is that something that I mean I realize it could be maybe a person's age could impact this but for most people is that just one and done if you have to have some surgery because I know that that's a really expensive part of the surgery.

>> So yeah.

So usually it's one and done usually the implants we place are staying there forever.

>> OK, pretty much are all for a younger person.

>> That's what I would do if it was somebody younger if maybe I wouldn't last.

Yeah no we use medical usually titanium or sometimes a plastic and even like when we do scoliosis surgery for kids you know that stays in there for all their life and thankfully with the titanium there's no real reactions that the bodies have to that some people have like Niccolr allergies, things like that.

>> So that's not in those implants.

So people have a reaction to them.

OK, OK, good to know.

Yeah well they're just showing me the car that we still have ten minutes left that is plenty of time to get some questions answered so I was just had a few people call in and ask questions if you have something you'd like to find out it's (969) 27 to zero again is a toll free number if you call outside of Fort Wayne put an 866- in front of there again I get some free advice.

You can't beat that.

We're going to keep talking about spine surgery but please feel free to interrupt us at any time.

Another thing I wanted to ask you about was the disc replacement surgery and I know somebody Matthew had called and asked about slipped disk and protruding disk.

>> What kinds of disk issues would require surgery?

Yeah, So if someone has a worn out disk that's kind of use that term degenerative really worn down and kind of collapsed especially in the cervical spine that starts to kind of come down a pinch on the nerves and that causes pain and numbers down the leg.

Certain people at the joints aren't worn out.

We can go in and just take that disk out and then put the disc replacement in there like a shim comes in and pushes the bones apart OK and so holds them open.

>> But with that implant we maintain the motion so they're able to sell Ben through it and twist and turn and it acts more like a normal disk and the theory behind that is then the levels next to it tend to not wear out the concern if you do a fusion is that there's added stress levels next to that spine and so then they can wear out and it leads to subsequent surgery and so like I said before though, some of the things that we're now knowing is that if we're doing a better job of aligning the spine, I think the literature is starting to come out that that risk of what we call adjacent level issues to the level next to it typically doesn't wear out as much if we're able to get you know, the alignment of the spine kind of corrected.

But again, that's we're knowing these things now because we have better technology, better implants and better just overall knowledge of what we need to do.

>> Yeah, I think a lot of times people think about you know, when I think of back surgery like I referred to my grade school teacher, you know, I'm thinking of things from a long time ago and so yeah, a lot of us who aren't in your field or working in your field we don't realize all the advances that have happened.

>> By the way, what is the material made of that they would use to replace the disk?

Yeah, so it's usually a squishy I mean naturally it's squishy, naturally it's squishy and so the implants we use now is a company that makes one kind of has a difference.

Right, because we've patented all that OK but typically they're metal implants and they're either a metal that kind of has a metal to metal articulation or a like a plastic a high grade plastic disk that allows for the motion like most hip replacements have a plastic bearing in there.

But even then some of our different some of them have what we call a ceramic and so everyone has a different theory of what's a better design.

>> OK, did I realize that I thought it was just kind of a universal material so.

>> All right.

Well, we did have a woman named Maria who wanted to wanted me to ask the question for her so she said her back Astarte her back is starting to crack make it probably that cracking noise after she started taking our cholesterol medication.

>> Is there a correlation?

>> I don't think it's necessarily correlated to taking the cholesterol medicine.

OK, you know, I mean Michoac I kind of twist and turn it like the cracks and that's usually just the some of the nitrogen gas is just kind of releasing the joints.

She may just not have ever really noticed it before.

Sure.

But what we do see in a certain subset of some cholesterol medicines they can cause muscle aches and so if you're having some new new muscle back aches ,some people like their thighs or a casual ache that definitely could be related to the to the cholesterol medicine.

>> OK, I mean is that something your family doctor?

Yeah, I was your family doctor who ever prescribed that it's term called myalgia.

>> It is a common kind side effect of certain cholesterol medicines.

>> OK, all right.

Yeah, at least I mean the good thing is sometimes you have choices with these different kind of medications so they may need to try a different one.

>> Right some you work a little bit differently so I'm going to try and squeeze in one more question.

I just have a lot of folks tonight they're wanting me to ask the question for them.

So Leslie wants to know what is a noninvasive way to help being bone spurs?

>> Yeah, so a lot of people have bone spurs that's kind of on the spectrum of arthritis .

>> And so typically, you know, it would be starting with the physical therapy and medications Tylenol, Ibuprofen, Aleve that's usually the stuff that we can treat with just simply bone spurs if it's just kind of a backache.

>> OK, OK. Is that how it starts.

Yeah kind of OK yeah but if you're having you know pain or numbness going down the leg from the bone spurs that's where the Spurs kind of growing in the canal taking up that space for the nerve.

But again most of the time we're able to just rehab that in fact I mean I see people all the time who 70, 80, 90 years old, they have weak bones and so I'm seeing them for a compression fracture because they have osteoporosis because their bones are weak.

And if you look at MRI they're really, really big large bone spurs have taken up the canal, really scrunch the space down for the nerve and having the nerve pain and then have any back pain.

So interesting.

So our understanding of pain and knowing why one person has pain so much kind of like the very same MRI almost and have horrible pain and we don't know why that varies.

>> Yeah that is interesting.

So yeah I always say my husband has no pain tolerance but I do so I don't know different people of different body chemistry ought to try and squeeze in one more real quickly Dr. Smith, John said he just got a cage in his back to help with some pain but the pain has continued and John is saying how long until I start getting results?

Is that right?

Yeah, I've never heard that terminology.

Yeah.

So cages essentially it's an empty box and what we do in spine surgery is we'll take the disk out and put a box in there that's filled with bone graft and that's just basically another surface to get it the Fuze and then a lot of the cages are designed with different configurations to help drive that natural curve of the spine.

>> OK, OK. >> And so a cage just kind of acts like a shim so we kind of go and we put it in at the bones are really really Clapp's.

It helps get that disk in the vertebrae back into better alignment and so sometimes it's a pain just because it hasn't fuzed yet.

I mean it takes anywhere from six months to a year, year and a half to actually Fuze for the biology to go through.

So that can be causes of some pain if the alignment's not ideal, sometimes it can cause some pain.

>> Sometimes people have some pain just because the other joints in their back arthritic .

Some people have S.I.

joint issues so sometimes if they had a cage they have they've had a fusion.

So sometimes now that the side joint which is the joint kind of right here where the spine and pelvis kind of come together this is your S.I.

joint a lot of times after a fusion this joint even doesn't move see some extra stress, OK?

>> And so that can be a source of some pain.

>> And so these are all things that we would kind of , you know, see and try to figure out well and it is it is a recovery process.

It's going to take longer than maybe if you fell and broke your arm when you were ten years old.

>> So it takes a while just I think you've answered this question one time before we've had it on here before the broken tailbone.

>> Is there anything that can be done for that?

I I've heard different answers .

The broken tailbone is it's a very challenging thing to take care of .

It's very painful.

There's not a whole lot we can do for it sometimes depending on what it looks like we can actually go in there and kind of exercise or take out that the bottom portion there.

Oh surgically yeah.

OK, the hard thing is this kind of in an area that's not the cleanest and so they get infected sometimes it doesn't feel very well and so usually it's time and it's an inflatable donut and just trying to let it calm down.

Yeah.

Now I can I know we've had other people call in and say they just assumed there was nothing be done and I think you've answered before but I thought well Sam wanted to know so we are unfortunately are about out of time so thank you so much.

We as usual we got a lot of calls at the end a lot of folks who wanted to ask the questions for them but still so glad that you guys called and got some free advice and expert expert advice I should say so.

Dr. Smith, thank you so much for coming on.

We'll have to make it a fourth time.

So we've done three.

>> We can do that.

We can do for it.

So and thanks again for bringing the it's always helpful to have that prop the spine I think because a lot of us we don't know what it really kind of have a little picture in our head.

But for you to point out that's very helpful.

So thank you so much for bringing that.

>> Thank you.

And I just want to remind everybody there is another HealthLine one week from tonight and Mark Evans will be hosting it and I don't think we've ever done this topic before child abuse awareness.

You know, we hear a lot of sad stories from time to time and maybe just things you don't think about that you should hear that phrase.

You see something, say something.

So I think that should be really helpful.

And again, that's next week.

And again, we welcome your questions.

I'm Jennifer Bloomquist.

Take care for all of you out there.

Have a wonderful Easter.

Sounds like the weather is going to be beautiful for Easter egg hunts so enjoy and take care.

>> Have a great week.

Bye bye