well hello and welcome to HealthLine.

I'm Jennifer Blomquist.

I have the privilege of hosting the program this evening and I'm so glad you joined us.

You know, we have many regulars out there and I so appreciate your patronage and you watch this show every week I run into you at the grocery store or at the gas station and and I know many of you really appreciate this program.

I'm so grateful that we have you viewing tonight and maybe we have some new viewers tonight as well.

So the one thing about this program is we are live in the studio and we welcome your participation if you want to call and ask a question, the phone lines are open so we'll keep that phone number at the bottom of the screen and you can also text us so you've got some different options.

I know the the people who watch us regularly know this been in case you knew the phone number is (969) 27 two zero.

It's a free call if you're outside of Fort Wayne as long as you put an 866- in front of there you have two options when you call in you can answer ask your question live.

They don't just throw you on the air.

By the way, you'll talk to a very nice call screener.

They'll get you situated and then you'll get to ask your question at a few minutes later on the air.

That's a really nice option because maybe the doctor needs to ask you some questions to give you a better answer.

So if you feel up to it that's great or you can just relay your question to the call screener.

They'll let me know and we'll get it answer that way.

And don't forget our texting option which we started out earlier this year and that's a little different phone number though two six zero (969) 27 three zero one to remind you that we keep your phone number private so you don't have to worry about that if you feel up to it, maybe give us your name where you're calling from or texting from and then you can just send your question in that way either way it's a great way to get your answer.

So tonight we have a new guest ,somebody who has not been with us before.

This is Dr.

Garrett Bennett and you are let me get this correct because this is a longer title than I'm used to neuro interventional radiologist.

That sounds like a lot.

>> So thank you so much for joining us, Dr.

Bennett.

Thank you, Jennifer and PBS for having me.

You want to before we even get into we're going to be talking about vertebrate genic, low back pain before we get into that which a lot of people I'm sure experience back pain.

Can you talk about your specialty?

Is it you know, is it something that's kind of unique or give us just kind of the lowdown on that?

>> Yeah.

So I'm a neuro interventionist and I'm also a radiologist so neuro interventionists were a specialty that manages mainly conditions the blood vessels of the head in the neck.

But we also perform minimally invasive procedures on the entire neuro axis or including the spine.

And so some of us are neurosurgeons, some of us are neurologists, some of us are radiologists.

>> OK, you've kind of got a little bit of both.

So all right.

Can you explain to everybody Vertov vertebra genic, low back pain how is that maybe different from you know, most people just say oh I have low back pain.

They maybe don't get as specific as saying Verdie Burgett biogenic.

>> So what what is that specifically?

Yeah, well I'm going to turn to our diagrammatic I appreciate you bringing that.

>> So we're we're just going to talk about some structures first of the back.

So you know, this is the spine the model of the spine and spine includes nerves and bones and other things.

And so if you look at this model, the the vertebra which are these things that stack up on each other are the are the bone parts and then between each one there's a disk which is kind of that gelatinous material the cushion when we move around it kind of absorbs the impact.

These yellow things are nerves that come out and they go down to your body.

It's different at every level.

Some of them go to your legs in this area in particular and then in the back you know, we're talking about the back but the back of the back is these joints and so these are Forsett joints and so every virt roll every vertebrae articulates meaning it has a joint with the vertebrae above and the vertebrae below.

>> And so these are other structures of the back then down here you have the sacrum and there's another joint down there.

So there's a lot of stuff here and back pain is really quite common and so you know, when we talk about vertebrate genic pain that's pain that's specific being caused by these box parts of the vertebrae which are called the vertebral bodies.

So we have all these different things the disks, the vertebral bodies, the facets, the nerves and the sacroiliac joint down there and so back pain can can be caused by any of those things or combinations of those things.

But vertebra, genic, low back pain is pain that is caused by the vertebral bodies being irritated.

>> I was going to ask you is there does it involve influence or is a lot of times is it a just a chronic condition or can it be caused by an injury or overuse all of the above?

>> It certainly is a chronic condition.

It certainly can be caused by trauma.

Oftentimes what happens that starts the whole cascade so to speak is is actually a problem with one of these other things in particular the disk.

So you've probably heard of disc herniation.

Yes.

So these parts between the bone are the discs and what can happen is these discs can squeeze out.

That's what a herniation is.

When that happens then you get information and wear and tear of the bones above and below.

Yeah.

And so that kind of starts the process of vertebra genic low back pain.

>> I've always wondered is there is it the same thing to say herniated disc and bulging disc are those two totally different things?

>> They are overlapping things herniated herniated disc encompasses different types of Bolger's is one of several types of places that ways that the disc can move out that is still herniation so you can have where it where it bulges a little bit or it bulges specifically to one side.

>> Yeah.

And some of those have different medical terms but they're all herniation.

OK I I had a bulging disk years ago and I mean it's excruciating it's you know I couldn't walk I was crawling I had to crawl into the hospital so I just you know they always refer to it as bulging disks but I've heard of other people saying they've had a herniated disc.

>> So how do you what do you do for somebody who has this condition?

You know, I mean I know in general we've had many people in the orthopedic field come in and talk about how you want to start conservatively when you're treating conditions in the back.

You know, maybe you know, medication or injections I don't know is that is that is this beyond that?

You know, can can any of those methods be used to help treat this by this you're talking about vertebra, back pain.

So, um, well they can certainly conservative you know, therapy, physical therapy and you know, medications and in steroid injections you know the the the way the way I kind of think about low back pain is you know, we have different features that can kind of guide us towards what the diagnosis is and then we have treatments a whole a whole bag of treatments, some of them more invasive, some of them less invasive that we can throw at this person in order to try to reduce their pain.

So the tool we try to use all the tools we have.

>> Sure.

So you know, that includes x rays and MRI's in particular are very useful for the lower back and then there's some physical exam tests and characteristics of pain and that kind of thing.

So the depending on the type of low back pain the patient has, they might be candidates for any number of those things.

Some of them may work better in that particular patient depending on what's going.

So you know, we can there's if you can go one of our graphics we have some graphics with them so what you so tell us what we're looking at here.

>> Yeah.

So this is an MRI image where we're kind of looking at this part right here and so you see a couple of those boxes and those are the bones, the vertebral bodies, the black thing, the two black horizontal areas within the box are the discs if you can imagine discs in the bones.

But if you see kind of the white stuff at the bottom of the box.

Yeah, What that is is there MRI changes that are seen in vertebrate genic, low back pain and they indicate inflammation that is potentially a cause of pain in that person.

>> So if that person has low back pain then then that is possibly a cause and there's a treatment for that.

It's essentially burning the nerve that transmits that pain.

And so if you want to pull up that may brought another slide.

You have another one for you guys.

>> There you go.

So what they found on anatomic studies actually is that the the nerves that there are one that there are nerves in the vertebral bodies that sense pain and to the nerves since pain particularly on the end plates.

So the end plates it's kind of the term that we use to describe that the top and the bottom of that box and that's where it meets the disks.

So I know we're kind of really zoomed in on this picture but if you look at the the top of that vertebral body that is where the disk is above that it's white on this picture and then there's another one below it.

Yes, And so that you can see all those nerves that it almost looks like a spider web and those nerves are sensing pain.

And so if you have inflammation at the top and the bottom of that the end plates again then you can kind of imagine the way that those nerves go and they they transmit that pain down that nerve and then back which is to the left on the picture to for you then to feel the pain.

So one of the treatments that you know that we're talking about today is that is the Beezy vertebral nerve.

That's what it's called.

OK, and so one of the treatments that is fairly new treatment certainly I think under utilized in modern medicine is this ablation of that nerve and so essentially burning that nerve will block the pain that's being transmitted there.

>> Now is this how invasive is this procedure?

Would it be done outpatient and what all does it involve an incision or how do you robotics use robotics?

>> Yeah, um, so sorry if I can get you to go back again to the to the to the picture we were just looking at what the nerves are OK.

>> Yeah.

So you can actually see there's a there's a um in the in the left side of the bone there there's a little red thing so what that is is it's a needle in a probe and so you ask how invasive it is so it's essentially putting that probe there but it's a it's a it's a needle procedure that is image guided and then goes through the skin in the back and then goes into the bone to position it where that nerve is to then burn a little area in the bone where that nerve is.

>> So this is nerve that you're looking at is all in the bone.

>> That wasn't clear.

OK, yeah that's I'm glad you brought all the the pictures and also the model.

That's very helpful because most of us don't look at something like this every day.

>> We just know when it hurts and we want it to go away.

When you do that procedure, is it usually kind of a done deal or is the patient at risk of having this recur?

Yeah, I want to answer that but I think I missed part of your last question is you know this is it.

Yeah.

it's done outpatient or it takes about an hour.

>> It's done is now patient.

We have the same day, you know, depending on where if you go back to that MRI picture that we had the one with them yeah.

There they go.

So in this situation, for example, the MRI, you know we're zoomed in again but there are that level right there which is L5.

All these levels are numbered.

But you could see there's the white stuff in the level above it too.

Yeah.

In fact there's some in the level below it.

So you know, in this situation it would be at least, you know, the three levels that you can see they all seem to be affected.

>> So this would be a three level procedure so three needle sticks so to speak, but it would still be an outpatient procedure about an hour and then the patient would go home.

There's there's no I don't know what the recovery was.

>> You know, like if you're sending them home are they on pain medication or are they limited, you know, limited mobility at that point or yeah, usually I tell people I tell people to take it easy for about 24 hours and then slowly increase activity.

People often will take Tylenol and ibuprofen but so some people aren't so sure at all.

I think most people do have some soreness for a few days maybe up to a couple of weeks and then do they feel the effects right away?

>> You know is it or is it something that gradually start the pain goes away or is it instant?

>> Yeah, it's pretty variable.

Some patients you know, they tell me that that they have significant relief early on.

Other patients say that it kind of progressively increases the data on the on it is checked was checked initially at three months.

So from a data standpoint it's hard to know exactly you know, the the time but I do think a lot of people have pretty quick relief.

>> Yeah, I'm just curious when we have a lot of orthopedic doctors on you know, when they're talking about somebody who's back pain or knee pain and unless it's you it was caused by some type of an accident or injury or something like that a lot of times they'll say to the patient you tell me when you want me to do the surgery.

Is that kind of the same thing here?

I mean are people making the situation worse or perhaps hurting themselves by saying I don't really want to do a surgery right now or I don't want to have to deal with this kind of recovery?

I think I can tolerate the pain a little bit longer.

>> How do you handle a question like that like wanting to have the surgery so maybe like saying I don't really want to do this right now.

Can I prolong you know, is there any danger in prolonging it as long as they can tolerate the discomfort?

>> Yeah.

>> For for back surgeries in general or for this for back surgeries in general.

You know, I think it's possible depending on what the actual problem is, you know, everybody's different and their underlying problem you know, it really has to be individualized by by what is at risk.

So from this standpoint, you know, this is this is a procedure that that treats pain .

Yeah.

And is not something that, you know, protects them otherwise other than feeling better.

>> What is what is the likelihood though that they will have a full recovery ?

>> I mean do you I don't know if you have any statistics on that that you know how effective it tends to be in general.

Yeah, the data on the procedure is that about one third of patients will get complete relief one third of patients will have fifty to ninety nine percent relief and one third of patients will have less than 50 percent.

>> OK, so once again it it really does you know, most people will have significant early most people know have some degree of relief, you know, so I think it's really hard to know.

It depends on what actually is causing their pain and that kind of comes back to this idea of , you know, all these different things and and that's why imaging MRI and there's even other advanced imaging that you can do that we won't get into to help tease out, you know, what is actually the cause of this person's pain and yeah and the reality is is that some of it's this and some of it's that and you know, an 80 year old is going to have pain from a lot of different things of course.

But if you know if you can if you can reduce that by 30 percent or 50 percent or you know more hopefully you know that then that's very meaningful often sure that that pain can be debilitating for sure.

>> So I want to talk to you more about who you talk about who is a good candidate for something like this.

But before we do, I want to remind you that we have the phone lines open.

We you can text us so again the phone number is (969) 27 two zero.

It's still a toll free call if you put an 866- in front of there.

I don't want to forget that texting so easy.

>> You're texting all day so take it ten seconds to send us a question that's a little different phone number two six zero (969) 27 three zero again keep your phone number private .

That does not get shown on air and maybe tell us your name and where you're calling from our texting from when you said at him I do want to ask you you know, are there typically is there a typical kind of patient that comes in with this condition with vertebra, genic, low back pain, maybe certain professions or sports or activities that tend to ,you know, leave people with this issue?

>> I'm sorry.

Can you say that again?

Sure.

Are there are there certain kinds of I'm sorry I was reading yeah.

>> Oh that's okay.

We are getting somebody is coming up with a question that's all right.

What what is a typical maybe of a patient who comes in with this vertebra genic back pain is it somebody maybe from a certain kind of profession whether lifting or maybe even sports or different activities?

>> It can be but it's really just anybody you know, the characteristics of the pain it's pain.

It's typically worse when you're bending forward lifting things up and that is pain.

It is you know, you feel in your back it's not pain that is shooting down your legs.

>> So you mentioned was your daughter.

Yeah.

She had scoliosis and head back to head back surgery she had.

>> But yeah I think at some point you mentioned something about shooting down the legs.

You know when you have pain that's shooting down the legs it's usually one of these nerves is being pinched.

>> Yeah.

So what we're talking about with the vertebra hygenic pain it's unrelated to these you know we're talking about burning a nerve but these nerves in this diagram are these big nerves that go down in control your legs sensation and motor.

And so you know, if you have pain that shoots down to the below the knee, certainly that is not pain that you know, this procedure would help because that is something where the nerve might be being compressed and that might need to get fixed.

>> OK, so it's a completely different situation there.

So all right.

We do have a text from David.

He's from New Haven so he wants to ask your doctor if this procedure could help with lower back pain due to arthritis.

>> Hmm.

OK, yeah, that's a really good question.

You know, I think arthritis so arthritis is inflammation of a joint and if we're talking about it depends on what arthritis we're talking about.

>> So if you know when you say arthritis in the lower back, you kind of think about the facet joints.

So the joints are again these joints back here and these are not treated by this procedure nor would be the joints down here which would be the sacroiliac joints.

So if you just say arthritis, I say no because I wouldn't really consider the vertebra genic pain to be arthritis.

>> All right.

Thank you, David.

I appreciate it.

And I want to remind everybody else that was so easy.

I'm sure David it probably took them all of ten seconds to send us that question and maybe that helped them out.

Maybe he's got an issue that he wants to deal with and so now he knows this is not going to be for him.

>> So we have another another question coming in.

But in the meantime, real quickly really quick, can I can I come back?

You know.

Sure.

You know arthritis.

Yeah.

It depends on a little bit on how he got to the idea that he had arthritis because really the you know, when a patient has low back pain it really requires a lot of scrutiny of the imaging and a lot of times the Modak changes which the eponymous name of these that MRI picture if you blow it up again it shows.

>> And so the presence of those is something that you really need to look for and can often be overlooked.

So you know, if you've had an MRI or if you're getting an MRI ,that's something that you should really look as to whether or not it's noted that you have they're called Modig Modeste or degenerative changes of the vertebral bodies because that's the that's kind of what this procedure aims to treat.

>> OK, yeah, it sounds I mean it sounds like a wonderful procedure if even if it reduces your pain by 50 percent I mean that can be life changing I would think for some people.

>> Yeah, it can be really quite dramatic.

I think I want to quickly try and get this other question and somebody had called in with Karl from Fort Wayne .

He is asking can this help with our broken tailbone?

>> I've always been told you can't do anything for a broken tailbone but I don't know what your thoughts are on that.

Certainly not this procedure and this procedure is indicated for L three, four, five and six one pain that's been for more than six months and failed conservative measures tailbone ,a tailbone, a broken tailbone.

Yeah, I think there may be some conservative management strategies for that as well as perhaps some sort of minimally invasive ones but not this procedure.

>> OK, all right.

Sorry we get a lot we get that question a lot.

I will say we've had enough tailbone yeah we had a number so you know and I think and a lot of people will say it happens from a fall.

You know they they fall especially in the winter months we'll get questions from people when we do orthopedic programs and they'll say, you know, they hear a crunch and then it just hurts every time they're trying to get up and down.

>> So I don't even know if it can can they would that yeah.

Would they detect that and since it's bone can they just find diagnose it with an x ray or do you have to use soft tissue.

>> You can it can be seen on an x ray you know a CAT scan is maybe more sensitive.

>> It'll show more that maybe an x ray misses but OK this is the tail bone here the classics and yeah it's kind of what we're talking about here but it's such a small bone and yeah yeah but there are people with broken tail bones that have pain unfortunately does that I it is it usually heal on its own though.

>> I think so but really I'm not sure I don't really manage that to ok yeah OK well we appreciate that Carl.

>> I know a lot of other people have asked about that as well so I was just wondering if some of these if this type of low back pain does it tend to be hereditary?

Do you find that people have it in their family and then there does that put them more at risk?

>> It's a it's a really good question.

>> I'm not sure I've ever thought of that.

OK, I didn't know there are a lot of other conditions that I manage where that is the case and comes up.

>> But for this is such a common problem of low back pain.

Yeah, degenerative low back pain or vertebra genic low back pain that I guess I've just completely overlooked that is something but I think it's possible.

>> Yeah.

And do you find it that it's more men or women or not?

>> Yeah I'm not sure.

I think it seems to me pretty equal demographic in that regard.

>> I don't know if all ages you know I was wondering if I thought maybe it would affect older people older people certainly you know they've earned more degenerative change of their back but young people get it to in young people it's often more obvious what their problem is because they don't have you know, on imaging they don't have a lot of problems everywhere.

Yeah, they may have one thing that is, you know, stands out on imaging and then, you know, you can kind of tailor your approach on that specific pathology.

Right.

Well, unfortunately, Dr.

Bennett, we are out of time.

Appreciate all the things you brought up the images and also the model.

>> Very helpful.

Thank you so much, Doctor Garrett Bennett.

Thank you.

I'm Jennifer Bloomquist.

Take care.

Have a wonderful week.

And we are back here next week with another program same time same place.

Take care.

Bye bye