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.

We have one of our returning as he's been coming here off and on for many years.

So it's Dr. Michael Smith who is an orthopedic surgeon and he is here to answer your questions, give you some free advice.

Maybe it's a question you have about yourself or maybe it's about a loved one or friend.

Please give us a call.

That's why we keep that phone number up at the bottom of the screen throughout the show.

So it's (969) 27 two zero.

In case you're outside of Fort Wayne it is a toll free call.

Just put an 866- in front of there and we will get you through and you have two options when you call in.

My favorite one is if you call and ask the question live and what's nice about that is that Dr. Smith can converse with you.

Maybe he needs to get more information from you to give you a better answer.

So that one's great.

But I completely understand if you would prefer to just call in the question and I can relate it to the doctor that's another option you have as well.

So please give us a call again.

We keep that number for you up at the bottom of the screen.

So let's go ahead and you can see Dr. Smith again again Dr. Michael Smith and you came with props which is always helpful when you bring the spine.

I think definitely we are going to talk about a bunch of different surgeries but please feel free to interrupt us.

Maybe your question isn't exactly what we're talking about that specific moment but that is fine.

Please call anyway and then we'll get you get your question answered.

>> So I know one of the things we wanted to talk about was cervical and lumbar disc replacement.

>> So I don't know if you want to talk about that.

I think a lot of people will they've heard of the terms you know, a slipped disc herniated disc.

So is that if you're dealing with an issue like that, is that why you're going to need disc replacement or.

>> Yeah, so typically somebody who has a disc has an issue with the disc you start to get wear and tear just like in your cars OK and the disc is like the pad the job having between all the different vertebrae, each of the individual pieces of the spine and as the disc was out this the area where the nerve comes out that's area gets smaller and so if say if the nerves mean like this and it goes comes through the hole between the vertebrae now a sudden that area is pinching a nerve and so people are in pain in the neck it's rising pain and numbness going down their arm is extremely uncomfortable.

>> I actually I am about my own patients.

>> I live with this replacement about two and a half years ago so I know exactly what people are going through when they're dealing with something like this.

>> So we've had a lot advances over the last several years in terms of the technology that we have for patients can do disk replacements now to where we are able to keep the motion or mobility of the spine.

We're more advanced in the cervical spine than we are in the lumbar spine.

Oh my cervical spine disc replacements are becoming very, very common.

I came into practice five years ago.

>> We are very selective on who we could do a disk replacement on and as the technology's gotten better and our understanding and our ability to place the implants better we're able to widen indication.

So before it was like people that basically had a pristine spine, just the disc herniation and so we were taking out the bad discus pinch on the nerve and then we replacing it.

Now we're doing this replacement.

Some patients have much more arthritic spines and things like that in the neck and it it's a game changer and I know people or is it a relief after the city's like oh I had mine I woke up immediately, my pain was gone.

>> I still had some numbness.

Yeah, but the pain was like immediately better.

>> That's always nice to hear.

Yeah.

And it kind of helps it kind of replaces that, you know, fear of the fusion because we've you know over the years we've done a lot of fusions and people and so now our indications are we're doing less fusions and some more disc replacements in patients so we're able to keep the mobility of the spine and hopefully prevent the next level in their neck from breaking down and have an issue we are doing in a lumbar spine much more selective.

The surgeons are much more technically challenging.

>> There's a lot of other issues like with the blood vasculature and all the stuff around that makes the surgery a little more challenging and less I would say safe but it's more challenging our parts.

>> We're much more selective.

So when you have a surgery like that, is there any kind of physical therapy or anything you have to do afterward or you like antiinflammatory for a while or.

>> Yeah, so a lot of people you know, I have some pain meds and we try to obviously people off of narcotics as soon as we can and onto and I just really anti inflammatories or Tylenol then obviously the goal surgery is to be off the medications that you're on.

We do have people in physical therapy our practice.

>> We get people in the physical therapy about two weeks after surgery because now that we've done the surgery to mobilize you want to get you back to life .

>> That's whole goal a surgery.

Right.

And so the physical therapy is there to help strengthen the muscles that have been kind of weakened with the surgery and help decrease inflammation and start improving that mobility and everything gets you back to enjoying life .

>> Yeah, I know many of your colleagues and yourself have come out over the years with a lot of surgeries whether it's back knee a lot of times I'll hear the doctors, you know, respond to a patient when they say well when do I need surgery?

And the doctor will say it's up to kind of up to you.

>> You know, when when is it impeding on your everyday life and get to the point where you feel like you're just not functioning, you know?

>> Yeah.

I tell people, you know, like you you can tell me, you know, unless there's like a severe neurologic deficit or something like that.

>> Yeah.

It's really, you know, up to you when you say I've had enough because are you especially with this when you're doing replacing the disk, are you at risk if you put it off longer that other disks will be impacted or not necessarily.

>> Not necessarily.

OK, you know, in terms of you know, there's just general wear and tear that occurs and so, you know, putting off a certain business I mean the other ones are going to go I was just mostly a matter of time.

>> All right.

Good to know.

I'm sure some of you out there have a question who doesn't have back pain or knows somebody who's back pain?

So please don't be shy.

Give us a call.

That's why we keep that phone number up at the bottom of the screen throughout the program.

Again, it's (969) seven two zero still toll free if you're outside of Fort Wayne just put an 866- in front of their eye.

And I guess I also wanted to address the issue that a lot of people get nervous they don't want surgery.

But I don't know if you want to reiterate maybe some of the conservative steps that I know that you don't just throw people in surgery unless it's a dire situation.

>> So yeah.

So we have a whole kind of protocol, a regimen of things that we do to obviously try to avoid surgery in patients.

You know, there's various medications like I said earlier, we really try to stay away from any narcotic medicines.

You know, people especially with bad muscle strains in the neck in the lower back we'll try and muscle relaxant.

But even then like you know, it's usually a temporary thing.

Yeah, we try anti inflammatory medicines, you know, some other we call neuro modulatory medicines that help with the nerve pain and things like that just to kind of get things to calm down because most part a lot of it is it's a process of time.

There's some arthritic changes on this happened and you know, if it's just not bother you but six months ago it wasn't the whole idea as each one the other side effects back to where it wasn't bothering you.

So antiinflammatory medicines and things like that we'll try some physical therapy, improve the core strength, get your and your leg muscles, your pelvic muscles, your abdominal muscles, your back muscles all working together.

>> I tell people it's kind of like a concert or an orchestra.

>> OK, if one muscle groups more developed than the other then they start to fight with each other, you know, and even professional athletes I mean basketball players and football players do physical therapy for things so people oftentimes don't want to go to physical therapy.

>> But if professional athletes do you know you may have to yeah.

>> A lot of my daughter had physical therapy and they gave her exercises and they said you know, she said well how long should I do those?

>> And they said you should do all the time.

>> I mean you just make it part of your everyday life , you know, like part of you it's like part of the exercise routine and you know yeah.

>> I mean I think it's beneficial for people to achieve it by the time you know, they're out there two years off from surgery and they're doing great and I just reiterate keep up the exercises two , three, four times a week.

Keep doing them.

Yeah, the whole goal is not to have to have this do this again.

Right.

And so hopefully if you keep up those exercises, you know it'll help prevent it.

>> Yeah.

Now in the long run if I look the big picture be a good idea for sure.

So I know another topic you wanted to discuss was minimally invasive spine surgery.

>> So we hear a lot is that the same as robotic surgery or is that so so there's a lot of things that go into invasive surgery.

>> OK, the goal of minimally invasive surgery is to decrease the trauma that occurs to the body when you have a surgery because surgery is still just a controlled trauma to the body.

>> It's a purposeful it's you know, direct we're going to fix this problem.

>> But you know, the body still has endured some trauma and so anything we can do to kind of lessen that is you know, it's beneficial.

>> So there's a lot of new techniques where we do what we call muscle sparing muscle splitting approaches to decrease that muscle pain and things like that after surgery there's ways that we can access different parts of the spine, especially in the front to where we're able to not going through the back muscles so much and so we're able to do that and it was a lot less bleeding, less discomfort and usually you can back back to normal life a little bit quicker.

OK, so there are things I used I procedure robotics you know my other partners we use navigation systems and all these other things that help us plans our surgeries more efficiently which then decreases the trauma.

>> So robotic surgery is just one of those tools that I used to help do minimally invasive surgery.

Yeah.

Now I mean anything you do to make it I guess easier and the recovery process I'm sure a lot of people fans of that.

So full disclosure my eyesight spazz I'm going to turn here and look at the I forget what my contacts in again.

All right.

That's another issue I have.

So we did get a call doctor from a gentleman name one and he said that he had surgery on his back and he says his hands are always tingling and cold now and he's wondering if that's normal.

>> I wouldn't say it's normal but sometimes it's actually related, you know, do I didn't know if be like a nerve.

>> Yeah.

So if it's my hands it's either could be carpal tunnel, it could be a pinched nerve in the elbow or it could be cervical by related something from the neck.

So it was actually you know surgery on the on the lower back itself.

It has nothing to do with the actual surgery other than sometimes just other things that happen and sometimes it's just a coincidence that you may have some neck pathology that now has kind of evolved.

You coincidentally around that time.

>> Is that some I mean would you be alarmed about that?

Should he get that checked out or is that maybe I think it's wise, you know, to get checked out if both his hands are numb ,you know, especially if if you're having some issues with dropping things you kind of feel clumsy with your hands if your balance is off, then I think it's very reasonable to get checked out by one of us professionals.

>> OK, all right.

Well thank you for calling in.

I appreciate it and good luck to you.

Let's see we had another call.

This is from Lois and she said her brother is having back surgery and they told him to stop smoking so she was asking about which you know, smoking and recovering from surgery that probably doesn't make for a good mix.

>> Yeah.

So it's so the smoking issue has always been there.

It's becoming a more and more issue to life really especially the insurance companies lately are very cognizant of the issues of smoking related to surgery.

>> Oh so in and of itself smoking especially have to have a general anesthetic your risk for respiratory issues pneumonia is things like that you know, go up you know, related to smoking.

>> Smokers have a higher risk of having a so blood clot.

So if you have the blood clot and you're on a blood thinner for , you know, months, you know, if that breaks off, if you go to your heart lungs, it can kill you.

>> So those are significant risks and then specifically to spine surgery neck it's the nicotine is not always the the smoking.

So even chewing tobacco vaping anything that has nicotine in it actually causes what we call vasoconstriction.

So it causes blood vessels to tighten down and when that happens there's less blood flow to the tissues.

>> So there's less oxygen being delivered, less nutrients.

So your risk for an infection goes way up if it's spine's surgery and you're having fusion your risk for it not Fuze, not the heal goes way up .

>> And so if that happens, that's when you hear of screws loosening oh rods breaking you all those things that you don't want to see happen.

>> So there's true things that are like it's a it's a patient safety issue and we're trying to avoid complications so it's in the patient's best interest.

>> Well in general just a good lifestyle change.

I mean I've never smoked but I've heard that it's horrendously difficult to stop.

So I mean I do sympathize especially if you're somebody who's been doing it for a really long time.

Right.

But I can I can understand that I didn't realize it was an issue with the insurance companies either.

>> Yes, they're there insurance now company or companies are being very protective of , you know, the cost for surgeries and so if there is a modifiable risk factor then we want to try to, you know, work on that.

It's just like patients who are diabetic if the blood sugars are uncontrolled and their hemoglobin A1 seems very high, their risk for complications not healing wounds manage infections go up.

So these are things that we want to limit patient that the best outcome possible.

Yeah.

And so there's something we can modify.

We want to do that before putting a patient the risk of a surgery.

>> I mean I guess if you think about it it's an investment in yourself.

So I mean there's a lot that goes into it beforehand and afterwards.

>> Yeah.

And there's a lot of people that we've got to stop smoking and they're like Dr. Smith, I'm doing great after my surgery.

But you know what the best thing was I stopped smoking just so much better now I stop smoking.

>> Yeah.

And so I've heard that time and time again I said kudos to people who can do it and it saves you money.

So a good good move.

OK, again I have to look over here because I can't read the other monitor so we had somebody who called in I think was Wessely.

I wanted to know what is the treatment for arthritis in the back and how common is leg pain in the front leg from the back.

>> So if you'd have I guess could you have leg pain that was associated?

Yeah, So I can actually kind of show you on the model so what we get when we get arthritis in the back either both either the the disc is kind of this kind of wear down but ultimately the arthritis occurs by these joints here in the back.

OK and so as these joints arthritic they start to get bigger.

If you've ever seen anything like a patient has actually their hip and they start having big bone spurs and things like that, the bone spurs then grow in the canal where the nerves are OK so the space for the nerve becomes much smaller, starts the pinched nerve and starts causing pain down the leg the most like a pinch pinched nerve pinched nerve.

>> OK, the most common level's are these kind of bottom here so I'll four down to S one typically those are caused pain down the back side of a patient's leg.

OK, as we move higher up into the spine it can kind of start to cause pain in the front of the thigh or into the groin.

Another common thing that can cause groin pain or front of the thigh pain is hip arthritis.

So those two kind of things sometimes start to kind of mimic each other and that's what we need to do appropriate physical exam and kind of take over our history and kind of understand what's going on.

But so those are the two most common.

It's either a hip arthritis or arthritis in the back now and I really hear people who have that nerve pain I think do they do epidural?

I mean I used to know somebody who would get one every few months.

Yeah.

But I mean at some point is it futile to keep doing that or is that could that be a long term solution?

>> Yeah, you know I tell people as you know you get two or three injections a year and you do great with them.

>> Yeah.

And if you avoid a surgery especially if you need a big surgery.

>> Right.

That's great.

You know, again, it's some people are like at some point they just kind of get tired of getting the shots and they want some that's more more permanent.

Yeah but again that's depends on your risk factors.

Depends on how much it's affecting your life .

So there's a lot for things go in with that.

>> Sure.

Right.

Well while we've got the model right there, the next question was in particular it was Karen calling and she wanted to know if you could point out where t nine ten and eleven are on there.

And I think there was a second part to her question but I'm not sure I don't see it on screen.

Oh, she wants to know what what could possibly cause that to collapse on the spinal cord.

>> Yeah.

So is that something that happens is so what can happen is it won't be the disk that to be collapsed causing issues on the spinal cord, the disk collapse and a T nine ten eleven.

So this is kind of l five four three two one 11 10 nine so it was kind of B right in here so it's kind of a mini mid back.

>> Yeah OK. And so yes it can if people have bad arthritis or if they have a big discrimination that comes from this you know in the front it can kind of start to pinch the spinal cord and so it can start to really kind of narrow that space around there.

>> OK, is that how do you address that then for treatment?

>> Yeah.

So it depends on if it is arthritis is coming from the back of the spine versus if it's a discrimination coming from the front that kind of dictates what type of surgery it would be.

>> Typically though if patients have impinge on the spinal cord so anywhere in the thoracic spine they're actually having typically issues with their balance.

They can't walk very straight sometimes they have just kind of global numbness of their legs or their feet that can be hard to delineate between if it's neuropathy or spinal cord issue.

And so that's one of our jobs have making sure we get proper imaging of the spine getting a nerve test to see if it is neuropathy and there's some physical exam things that we can check to kind of see if there's pressure on the spinal cord versus something else.

>> Yeah, that sounds really miserable to to have that kind of pain I would imagine that's pretty pretty bad.

Absolutely.

All right.

All right.

>> Well thank you to everybody for all the questions that we actually have some more let's see Stephen called or I is Jill still on the line?

>> I guess I'll get some more.

OK, there you go.

There you are.

Jill, thank you for your patience.

I wasn't sure if you were still there.

>> You wanted to ask a question about was it lowered neck pain?

Yes.

Musculoskeletal neck pain.

It says M5 four point two it says osteoarthritis of cervical spine, unspecified spinal osteoarthritis complication status.

Is there something that can help relieve the pain that I get on the lower right side of the back of my neck because of the osteoarthritis of the spine of cervical spine?

>> Yeah, so great question.

So a lot of times so you're going to have some muscle pain and also pain from the joint kind of down in the lower part of that neck there you typically that's inflammatory medicines, maybe a muscle relaxer sometimes you talk about a steroid injections we can do a trigger point injection just real quick in the office into that muscle that may help calm it down and then really work with physical therapy on that area sometimes if it's causing deeper issue especially was going down the arm, then we may talk about the epidural and if it truly is the lower part of the cervical spine and it's causing that pain or numbness and things like that, the arm eventually after you've kind of gone through that whole gamut then we may discuss a surgery if it's appropriate.

But those are kind of the early things that I would I would talk about.

You know, it's hard that area red the base, the neck it's a transition between your mobile cervical spine.

You know, we were moving our necks and then our thoracic spine which is very stiff and stop because you have the ribcage and everything.

So it's a transition from fixed to mobile and so a lot people end up with some pain there and it's just you know, it's just a consequence of kind of the design of our bodies.

>> All right.

Jill, did you want to ask Dr. Smith something else?

Yes, I was wondering how effective do you think the physical therapy is and also do you have to go through about six weeks of that before you can get a cortisone injection?

>> Yes, and usually we can do a cortisone injection pretty routinely and easily in the office I would call a trigger point injection into that muscle.

Physical therapy does really work well.

I see sleep all the time.

You know they come in they're like oh I'm so surprised of how well physical therapy worked.

So there's a lot of things they can do that can help calm that information down, get the muscles relax especially if it's you know, when people wake up and they're like I have a crack in my neck and then two , three, four weeks later it's still there.

And I said if it's not going down the arm then it's usually just it's more of a muscle or an arthritis flare.

And so that's really what we're trying to work through all those things and then yes, if needed and we into a deeper injection epidural which the spine interventionists do are also known as pain management specialists.

>> It's all right.

Thank you for your time tonight.

You're welcome.

Absolutely.

Thank hope you're feeling better.

Thank you for calling.

I know she was talking about physical therapy as if it was kind of a downer but it can be fun.

I mean if any of you watching have had physical therapy my daughter had to go a lot this past year for some back issues.

They are so not they are some of the happiest people I mean they they post jokes they each day like they were different colors.

They play different music depending on what I mean.

Some people will schedule their physical therapy because they want to be there on Country Music Day versus you know, the eighties rock songs for the eighties.

So you know yeah.

It's I mean if you think about it it's kind of a that you have to go and sometimes I saw some people who were in a lot of pain but I think they try and make the best.

>> They absolutely do.

Yeah.

We have made a lot of good friends doing that.

So let's say I do have one more question for you and this was a gentleman who called it in so Steven wanted to know about his wife because she is a lower Phusion and three and four in her lower back.

I guess her screws have become loose.

>> So she was he was wondering is there a minimally invasive surgery that can repair that?

>> Yeah.

So some of it depends on on how close they are if there's any other deformities to the spine it's like that especially L3 for there's a minimally invasive techniques that we can actually do.

We can access the spine.

So going back in through the back sometimes we can actually come in through the side through an incision like this and we can kind of just put the muscle and we can kind of come in to the disk space here.

This would be three four right here.

We take this disk out and we can put in what we call we call it a cage but really a cage is just it's an empty box that we fill with bone graft and it basically kind of fills and takes up that space of the disk so people think of a cage it's like here like a fence like you're wrapping the spine.

It is not like that.

It's just literally a box then kind of comes in and then get that area to Fuze and then depending on what it's like, you know, we could still make a couple of small incisions, take those screws out, put new ones in.

But it also depends on how much bone's worn away from the loose screws and things like that.

They're definitely usually some options especially at all three or four.

>> That's one of the easier levels to repair in a minimally invasive fashion is to say most people probably want to try and after if you go through a pretty major back surgery probably want to avoid anything major.

I mean most of the screws and the hardware you use are they typically I know you've brought some things on before and I couldn't believe how heavy and solid they were.

>> I mean they're built to last.

They are yeah.

>> Yeah.

They're usually strong titanium.

Yeah.

Between the rise and the screws is most common metal use.

>> Do they put a year on it like do they is there ever a guarantee like all these will definitely last for ten years they won't do that ok I didn't know if they give you a ballpark promise like that so all right we only have about 30 seconds left unfortunately but I do want to thank everybody I know the show always goes so fast it's flies by.

We had wonderful calls tonight.

Thank you so much everybody for calling in and many, many thanks to Dr. Smith.

Sure.

He's got a very busy schedule and we appreciate him giving us his time once again.

So we will have another live show coming up next week at Mark Evans will be hosting that one.

So please tune in for that next Tuesday evening.

In the meantime, I'm Jennifer Bloomquist.

Take care.

Have a great rest of your week.

>> We'll see you next next Tuesday