THURSDAY, July 9, 2020 (HealthDay News) — If you have a bad hip and lower back pain, a new study suggests that hip replacement surgery may solve both issues at once.
Researchers at the Hospital for Special Surgery in New York City focused on 500 patients who underwent hip replacement surgery and followed up with them one year after the operation.
Over 40% reported pain in their lower back prior to hip surgery. Of that group, 82% saw their back pain vanish after surgery.
It was “completely gone,” said study author Dr. Jonathan Vigdorchik, a hip and knee surgeon at the hospital.
He said that experts in his field have studied the connection between the hip and back for years.
A hip replacement is a surgical procedure to replace a worn-out or damaged hip joint with an artificial one. On average, it is a highly successful operation, with 95% of patients experiencing pain relief, according to the Hospital for Special Surgery.
“It’s an outstanding procedure,” said Dr. Craig Della Valle, a professor of orthopedic surgery at Rush University Medical Center in Chicago. “There are very few things in medicine that are close to hip replacement in terms of how good of a medical procedure it is.” He wasn’t part of the study.
But Vigdorchik added that patients who have undergone some types of spinal surgery before a hip replacement face five times the rate of complications compared to the general population — for which the complication rate is less than 1%.
This knowledge prompted him to dive deeper into the hip-back interplay.
“We noticed that there are certain conditions where a hip condition can actually put undue stress on the back,” Vigdorchik explained.
He and his fellow researchers wanted to find out how effective a hip replacement can be in eliminating low back pain, and determine which patients are more likely to benefit.
The patients whose low back pain resolved after the surgery were those with “flexible spines,” according to Vigdorchik. When a person’s spine is flexible, a stiff or poorly functioning hip can drive the spine to move more than usual, causing pain.
Those with normal flexibility in their spine were also highly likely to have their pain resolved.
“Those are the patients whose back pain went away completely after their hip replacement, because their back pain was probably caused by their hip not functioning properly to begin with,” said Vigdorchik.
But the back pain in patients with stiff spines did not go away. Patients with stiff spines already have serious arthritis of the spine, and replacing the hip is unlikely to relieve their pain.
But how can you know if your back pain could be resolved with a hip replacement?
It’s not easy to figure that out on your own, according to Vigdorchik. “It really relies on a good physical exam, and then good X-rays,” he said.
Before a patient undergoes a hip replacement, surgeons will typically take an X-ray of the patient lying down.
In this study, researchers took X-rays of their patients standing up and sitting down, both before and after the surgery.
These X-rays allowed them to see how the hip and spine moved in relation to each other, and assessed the flexibility of their spine, as the patient switched from a standing position to a seated position.
Vigdorchik encouraged other surgeons to utilize these X-rays to identify patients whose ailing backs may be relieved by a hip replacement.
He also advised surgeons in the field to “look beyond just the hip.”
“Anytime they’re looking at the hip, they should also look at the back, and anytime they’re looking at the knee, they should also look at the hip,” Vigdorchik said.
The existence of an interplay between the hip and back is well known to experts, but Della Valle said that this study showed how consistent it is.
He said the study gives surgeons in the field “some tools to try to predict which patients you can tell, ‘Yeah, your back pain will get better,’ and others, well, maybe it won’t.”
The study was published online recently during a virtual meeting of the American Academy of Orthopaedic Surgeons.
SOURCES: Jonathan Vigdorchik, M.D., orthopedic surgeon, hip and knee replacement, Hospital for Special Surgery, New York City; Craig Della Valle, M.D., professor, orthopedic surgery, Rush University Medical Center, Chicago; AAOS 2020 Virtual Education Experience, March 26, 2020, online
TUESDAY, June 16, 2020 (HealthDay News) — Patients with lower back problems often worry about how much time they’ll need to recover if they have surgery. A new study finds similar results for two common minimally invasive spine procedures.
Surgery may be recommended for degenerative conditions of the lower spine, such as a herniated disc or spinal stenosis.
Researchers at Hospital for Special Surgery in New York City compared 117 patients who had minimally invasive lumbar decompression surgery and 51 who had minimally invasive lumbar spine fusion surgery. All the procedures were performed by the same orthopedic surgeon.
“Our study is the first of its kind to look at return to activities and discontinuation of narcotic pain medication after single-level lumbar decompression or single-level lumbar spine fusion performed with a minimally invasive technique,” said senior investigator Dr. Sheeraz Qureshi, a spine surgeon at the hospital.
It took the 117 decompression patients a median of three days before they no longer required narcotic pain medication, and seven days for the 51 spinal fusion patients.
Among patients who drove before their surgery, decompression patients took a median of 14 days to resume driving, and 18 days for the fusion patients.
There was no statistically significant difference between the two groups in how long they took to return to work, according to the study.
The findings are important because standard open spinal fusion surgery generally requires a much longer recovery and slower return to activities than standard lumbar decompression, Qureshi noted.
“In our study, all the patients in both groups were able to resume driving and return to work within three weeks of surgery,” he said in a hospital news release.
“When you compare this time frame to that of standard open spinal fusion surgery, it’s really striking. Patients having a standard spinal fusion could take six months or longer for a full recovery,” Qureshi said.
Degenerative conditions of the lower spine are common causes of pain and disability, and surgery may be considered when initial treatments such as medication and physical therapy don’t provide relief.
Lumbar decompression surgery involves removal of a small section of bone or part of a herniated (bulging) disc that is pressing on a nerve. Spinal fusion is a more extensive surgery in which surgeons join two or more vertebrae together, sometimes using screws and connecting rods.
The findings were presented online earlier this year at a virtual meeting of the American Academy of Orthopaedic Surgeons. Data and conclusions released at meetings are usually considered preliminary until peer-reviewed for publication in a medical journal.
The American Academy of Family Physicians has more on low back pain.
SOURCE: Hospital for Special Surgery, news release, June 15, 2020
An MCL tear or rupture can be a debilitating injury, but it often responds well to conservative treatment options like physical therapy.
The medial collateral ligament (MCL) runs along the inside of the knee and connects the shinbone, or tibia, to the femur, or thighbone. This important ligament allows you to rotate your knee. It also stabilizes the joint by preventing it from bending too far inward.
The MCL is susceptible to sprains or tears, especially if a blow to the outside of the knee stretches it beyond its normal range of motion. MCL injuries are seen most often in athletes who play contact sports, but they can also be caused by an accident or a sudden twisting of the knee while skiing.
If you’ve ruptured your MCL, you’ll likely hear a popping sound in the knee. A tear will also cause pain, swelling, and tenderness. The knee may feel stiff, making it painful to straighten or bend the joint. An MCL injury creates a feeling of instability as well, so it may be difficult to put weight on the knee.
MCL injuries are grouped into three grades, each with a different level of severity. Treatment depends on the type of MCL trauma, but most can be successfully overcome with conservative therapies.
The Types of MCL Injuries
The type of MCL injury dictates the treatment and recovery time. Here’s a rundown of three categories of MCL damage:
Grade I: A Grade I MCL injury refers to a sprain of the ligament, but not a tear. This type of MCL injury heals within a few weeks with conservative therapy centered on resting the joint, reducing swelling with ice packs; and taking anti-inflammatory medications. Patients can strengthen the muscles surrounding the knee with exercises, including:
Hamstring Curl: Stand straight on one leg and tighten the stomach muscles. Bend the other knee and slowly raise the heel toward the buttocks. Hold for 30 seconds and repeat with the other leg. You may want to hold onto a chair for balance, if needed.
Wall Slide: With a straight back and feet flat on the floor, stand against a wall. Slide down slowly, ending in a squatting position. Hold for 30 seconds, and then rise. Repeat 10 to 15 times.
Grade 2: In a Grade 2 MCL injury, the ligament is partially torn. Treatment is similar to a Grade I trauma, but patients may be advised to stabilize the knee with a brace while they recover.
Grade 3:The most severe MCL injury, a Grade 3 MCL trauma means the ligament is completely torn. It also requires a longer recovery time, typically about three months. In addition to wearing a brace or taking pressure of the knee with crutches, you’ll undergo physical therapy to increase the joint’s range of motion. You can also start walking and pedaling on a stationary bike when the pain subsides.
Is Surgery Necessary?
A total rupture of the MCL usually doesn’t require surgery. Only in cases where the tear hasn’t healed after conservative therapy or other knee ligaments are damaged is surgery recommended. Surgery to repair a torn MCL involves stitching the ends of the ligament together or re-attaching it to the bone.
If you suspect you’ve injured your MCL, the doctors at Comprehensive Orthopaedics can diagnose your condition with a thorough physical exam. We’ll also take X-rays to check for any broken bones as well as an MRI to get a closer look at the ligaments of the knee. We’ll prescribe a therapy program so you can get back to the activities you enjoy as soon as possible. Contact us today for an appointment.
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People who get prompt physical therapy for pain in the knee, shoulder or lower back may have less need for opioid painkillers, new research suggests.
The study, of nearly 89,000 U.S. patients, found that people given physical therapy for their pain were 7 percent to 16 percent less likely to fill a prescription for an opioid.
The researchers said the findings suggest that early physical therapy is one way to reduce Americans’ use of the risky, potentially addictive painkillers.
“For people dealing with these types of musculoskeletal pain, it may really be worth considering physical therapy — and suggesting that your health care provider give you a referral,” said lead researcher Dr. Eric Sun. He is an assistant professor of anesthesiology, perioperative and pain medicine at Stanford University.
Dr. Houman Danesh, a pain management specialist who was not involved in the study, agreed.
“This study shows how important physical therapy can be,” said Danesh, who directs the division of integrative pain management at Mount Sinai Hospital, in New York City.
Physical therapy does require a much bigger investment than taking pain medication — and, he said, patients may have to travel to find a therapist who is the best fit for them.
“Physical therapy is highly variable,” Danesh said. “Not all physical therapists are equal — just like not all doctors are.”
But the effort can be worth it, according to Danesh, because unlike painkillers, physical therapy can help people get at the root of their pain — such as imbalances in muscle strength.
“You can take an opioid for a month, but if you don’t get at the underlying issue [for the pain], you’ll go back to where you started,” he explained.
The findings, published online Dec. 14 in JAMA Network Open, come amid a growing national opioid epidemic. While many people who abuse opioids are hooked on illegal versions — like heroin and illicitly manufactured fentanyl — prescription opioid abuse remains a major concern.
Medical guidelines, from groups like the American College of Physicians, now urge doctors to first offer non-drug options for muscle and joint pain. Opioids, such as Vicodin and OxyContin, should be reserved as a last resort.
The new findings support those guidelines, according to Sun’s team.
The results are based on insurance records from nearly 89,000 Americans who were diagnosed with pain affecting the lower back, knee, shoulder or neck.
All of the patients had a second doctor visit within a month of the diagnosis, and an opioid prescription within 90 days. So the group included only people with significant pain, the researchers said.
Overall, 29 percent of the patients started physical therapy within 90 days of being diagnosed. Compared with those who did not have physical therapy, the therapy patients were 7 percent to 16 percent less likely to fill an opioid prescription — depending on the type of pain they had.
And when physical therapy patients did use opioids, they tended to use a little less — about 10 percent less, on average, the researchers found.
The findings do not prove that physical therapy directly prevented some opioid use.
Sun explained that, “since physical therapy is more work than simply taking an opioid, patients who are willing to try physical therapy may be patients who are more motivated in general to reduce opioid use.”
But his team did account for some other factors — such as a patient’s age and any chronic medical conditions. And physical therapy was still linked to less opioid use.
While this study focused on physical therapy, Danesh said, there are other opioid alternatives with evidence to support them.
Depending on the cause of the pain, he said, people may find relief from acupuncture; exercises to strengthen particular muscle groups; injections of anti-inflammatory steroids or other medications; platelet-rich plasma — where a patient’s own platelets (a type of blood cell) are injected into an injured tendon or cartilage; and nerve ablation, where precisely controlled heat is used to temporarily disable nerves causing the pain.
It’s also possible that some simple lifestyle adjustments will help, Danesh pointed out. An old worn-out mattress could be part of your back pain woes, for instance. Ill-fitting, non-supportive or worn shoes could be feeding your knee pain.
What’s important, Danesh said, is to get at the underlying issues.
“We have to match patients with the right treatment for them,” he said.
The U.S. National Center for Complementary and Integrative Health has more on managing pain.
SOURCES: Eric Sun, M.D., Ph.D., assistant professor, anesthesiology, perioperative and pain medicine, Stanford University School of Medicine, Stanford, Calif.; Houman Danesh, M.D., assistant professor, anesthesiology, perioperative and pain medicine, and director, division of integrative pain management, Mount Sinai Hospital, New York City; Dec. 14, 2018, JAMA Network Open, online
TUESDAY, Nov. 27, 2018 (HealthDay News) –What if a simple zap to the spine could relieve the debilitating lower back and leg pain brought on by a herniated disk?
Such is the promise of “pulse radiofrequency” therapy (pRF), which sends inflammation-reducing pulses of energy to nerve roots in the spine, a new study claims.
The therapy is not new, having first received U.S. Food and Drug Administration approval in the 1980s.
But recent advances in CT scan technology now enable clinicians to deploy those energy pulses with much more accuracy, experts said. And the new research suggests the treatment could prove a boon to back pain patients for whom standard therapies have failed to do the trick.
“I was amazed with the results of pRF,” said study author Dr. Alessandro Napoli. “Especially having read, as a radiologist, numerous lumbar MRI scans of patients with recurrent hernia after surgery.”
And as a patient himself, Napoli added that “from personal experience I can tell you that the treatment is not painful, and the results are appreciated within days after a single treatment lasting 10 minutes.”
Napoli is a professor of interventional radiology at Sapienza University of Rome in Italy.
He and his colleagues plan to report their findings Tuesday at the Radiological Society of North America annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.
Lower disk herniation results when the insulating disks that sit between spinal vertebrae tear open, allowing jelly-like material to protrude and exert pressure on surrounding nerve roots. Beyond lower back pain, the condition often triggers sciatica, a pain that radiates down a patient’s leg.
Standard therapies include over-the-counter pain meds, corticosteroid spinal injections, and/or invasive spine surgery that sometimes involves disk removal and vertebrae fusion.
The problem, said Napoli, is that such options entail risks without assured relief.
“Steroid injections are effective only in portion of the patients, and generally require more sessions,” he noted. And though surgery safety has “largely improved,” Napoli pointed to the risk for bleeding and infection, the need for a minimum two- to three-day hospital stay, the high cost, and the fact that some patients ultimately realize little benefit.
By contrast, pRF is scalpel-free, delivering radio signals directly to affected nerves via a CT scan-guided electrode. The process, said Napoli, requires no hospital stay, is noninvasive, far cheaper and less risky.
“The rationale for using pRF on disk herniation is that we eliminate the inflammation process of the compromised nerve root,” he explained. “Without inflammation the pain fades, and the body starts a self-healing process that allows for complete resolution of the disk herniation in a large proportion of patients.”
For the study, the Italian investigators compared 128 lumbar herniation patients who underwent a single 10-minute round of CT-guided pRF with 120 patients who received one to three rounds of steroid injections.
All the patients had already undergone standard interventions, with poor results.
By the one-year mark following either treatment, a full “perceived” recovery was reported by 95 percent of the pRF patients, compared with just 61 percent of the steroid injection patients.
Dr. Daniel Park, director of minimally invasive orthopedic spine surgery at William Beaumont Hospital in Royal Oak, Mich., offered some caution on the findings.
He noted that because “the majority of people with back pain improve with time and exercise alone,” it remains an open question as to whether the pRF procedure really cured the condition.
Still, Park noted that diagnostic uncertainty can undermine the ability of surgery to get at the true source of a patient’s pain, given that “the problem with low back pain is that there are many causes of it, and physicians have trouble identifying the cause of pain.”
Nevertheless, he remains unsure if pRF is truly ready for prime time.
“Best case, I think [pRF] could be an option for people if they [have already] failed therapy and medication,” said Park. “It may be a similar option for people if they do not or cannot have steroid injections, but they need more treatment. I think this is experimental, and should not be first-line.”
The American Academy of Orthopaedic Surgeons offers more information on herniated disks.
SOURCES: Alessandro Napoli, M.D., Ph.D., interventional radiologist and professor, interventional radiology, department of radiological, oncological and pathological science, Sapienza University of Rome, Italy; Daniel Park, M.D., orthopedic spine surgeon, associate professor, orthopedic spine surgery, and director, Minimally Invasive Orthopedic Spine Surgery, William Beaumont Hospital, Royal Oak, Mich.; Nov. 27, 2018, Radiological Society of North America annual meeting, Chicago