“Is this a model or is it the real thing?”


I had the pleasure of meeting with one of our local orthopedic surgeons, Dr. Benjamin Bjerke, and the Zimmer-Biomet rep, Christina Escobar, to talk Mobi-C Disc Replacement technology and surgical technique developed by Zimmer-Biomet. Incredibly interesting.

Seeing the prosthesis, my first question was, “Is this a model or the real thing you are showing me?” It was much smaller than I anticipated!

Mobi-C_neck image_9-2016.pngMobi-C_hand-image_1_2016.png

Secondly, I found the specificity of the patient suitable for this intervention impressive – someone with neck pain and or radiculopathy (pain down the arm originating from nerve root compression in the neck) without much cervical spondylosis (degeneration of the discs and joints in the neck) and good vertebral alignment. The Mobi-C can replace discs at one or two levels of the cervical spine between the third and seventh cervical vertebrae.

So lets take a look in more detail.

Anatomy and Pathology of the Neck

  • The cervical spine has discs between each bone that provide cushioning for movements and body loads. The discs and bones in a healthy neck allow bending from side-to-side and front-to-back, and turning left-to-right. Disc problems can start from over-use, an accident, or just the wear and tear of daily life.  When a disc degenerates it becomes thinner and provides less padding to absorb movement.  Degenerated discs can also bulge (herniate) and pinch the spinal cord or nerves, which causes loss of feeling, weakness, pain, or tingling down the arms and hands. Below  you can see the normal cervical spine anatomy and adjacent is a graphic of what a spine with pathology may look like:

1.jpg2.jpg

Treatment Options

  • Before artificial discs were available, patients would traditionally receive an Anterior Cervical Discectomy and Fusion procedure to alleviate the pain from a herniated disc. In a fusion surgery, the disc is removed and either a bone spacer or a plastic implant is placed in the disc space to restore disc height and remove pressure on the pinched nerves or spinal cord.   A metal plate and screws is placed on the front of the vertebral column to hold the implant in place.  The result – a segment that no longer moves, or is “fused”.  The potential downside of a fusion procedure, in addition to the loss of motion, is that it can create additional stress on the spinal levels above and below it.  This can cause degeneration at those levels and potentially result in another future surgery.
  • An artificial disc like Mobi-C is an option instead of a fusion that will also be placed inside the disc space to restore height and remove pressure on the pinched nerves. However, the Mobi-C device is designed to allow the neck to maintain normal motion and thus limit adjacent levels from degenerating, possibly preventing future surgeries.

Image_40a_v02_2016.pngImage_61b_20pct_2016.png

 

Since Mobi-C cervical disc replacements are preferred over fusions because they preserve movement in the spine, lets take a look at this video to see what happens in the spine when a patient with the Mob- C implanted flexes and extends his/her neck versus a two level fusion:

Cervical disc replacement procedures are anticipated to experience rapid growth in the near future, due to multiple factors:

  • A growing library of clinical evidence demonstrating the long term safety and efficacy of cervical disc replacement.
  • Cervical disc replacement is being shown as a superior treatment to fusion for use at two cervical levels.
  • Better outcomes of cervical disc replacement over fusion such as reduced re-operation rates, reduced adjacent segment degeneration rates and surgeries, as well as a faster return to work.
  • Most patients return to work within six weeks of surgery. In the U.S. Mobi-C clinical trial, the return to work time was 20.9 days shorter for Mobi-C patients compared to fusion patients for two-level surgery and 7.5 days shorter for Mobi-C patients compared to fusion for one-level surgery.

What about physical therapy after the Mobi-C disc replacement?

  • Wear a neck collar to lessen neck movement for around a week after the surgery.
  • Avoid heavy lifting, repetitive bending, and prolonged or strenuous activity for up to 6 weeks after surgery.
  • When your surgeon releases you to start physical therapy the physical therapist will do a comprehensive evaluation to assess your cervical, scapular and shoulder range of motion as well as cervical, arm and trunk strength. Based on the data collected, you will be given specific exercises to address any deficits to ultimately improve your function. You may start of with cervical isometrics and progress to upper thoracic and arm strengthening exercises as well as neuromuscular reeducation of the deep neck muscles. The physical therapist will also utilize soft tissue mobilization techniques to limit scar formation and address any myofascial pain and muscle trigger points, present from inactivity. You will need to participate fully by being totally compliant with the home exercise program you are given by the physical therapist at your very first visit.

Successful outcomes are determined by multiple factors which include choosing the right surgical procedure done by a skilled surgeon, following post operative activity limitations and brace use as well as being totally compliant with physical therapy instructions and exercises. It is a 3 person team that makes your recovery work: you (and your home supporters), the surgeon (and their staff) and the physical therapist (and their clinical team members).

Thank you to Zimmer-Biomet for help with supplying me with information and photographs.

The Custom Physical Therapy Challenge Rules


If you dare ….. get fitter, stronger and healthier with the monthly Custom Physical Therapy Challenge.

Every month we will have a daily series of exercises to do for anyone and all who would like to join us. Employees, friends and family may join in.

Here are the rules:

  1. You complete all repetitions of each exercise every day and check it off the schedule of exercises.
  2. If you miss a day you may double up the next day – not advisable particularly towards the end of the series.
  3. It is purely the honor system.
  4. If you complete all exercises for the entire month you let us know by faxing the checked schedule to Custom Physical Therapy (775-331-1180) or emailing it to us with your name on it and contact number: customptchallenge@gmail.com
  5. Prize: $50-$75 gift certificate from a local business (Previously: Great Full Gardens Restaurant, 1 hour massage).

Exercise technique can be seen on our Youtube Custom Physical Therapy Challenge Channel. Here is the URL:

Let us know how you like it and what you would like to challenge in future months. For example, an arm challenge, butt challenge, core challenge, chest challenge, aerobic challenge, rope jump challenge.

If you have any concerns about doing the exercises and need help modifying them feel free to call us at the Sparks location: 775-331-1199. You can also email us with questions: customptchallenge@gmail.com

Have fun, be safe and get strong!

The Custom Physical Therapy Challenge Department

www.custom-pt.com

http://www.customphysicaltherapy.wordpress.com/

Antibiotic treatment of Low Back Pain


I recently came across an interesting pair of research papers in which low back pain was treated with antibiotics successfully.  This research is published in the European Spine Journal April 2013, volume 22, Issue 4, pages 690-696 and 697-707.

This concept took me by surprise.  Dic herniations can apparently become infected with the bacteria from plaque in your teeth and from acne.  The link between dental hygene and cardiovascular disease, and I think diabetes (not sure), has previously been documented so I do not think this premise is a far stretch.  The authors investigated nuclear disc material from patients who underwent surgery for annular tears and removal of visible nuclear tissue.  43% of patients had evidence of infections.

They then treated patients with chronic low back pain and vertebral bone edema with antibiotics for 100 days (that’s a long time).  The antibiotic treatment significantly improved the chronic low back pain when compared to placebo.

Well!  I am somewhat taken aback but realize this is very interesting and may explain some cases of low back pain that do not progress as well as they should.

Your call to Action:

  1. What do you think of this?
  2. If you are a healthcare provider, post your comments please.
  3. Forward this onto someone who may have some comments and have them post their thoughts to our blog.
  4. Have an incredible week!

Pain? What is it really?


The International Association for the Study of Pain defines pain as follows:

“Pain is an unpleasant sensory and emotional experience associated with actual or potential damage, or described in terms of such damage.”

So what does that mean anyway?

  1. Pain doesn’t feel good.
  2. Pain is influenced by our emotional status.
  3. There may or may not be any trauma to the body.

Put differently, per Dr. Lorimer Moseley, Ph.D., a world-renowned pain researcher and clinician at the Prince of Wales Medical Research Institute in Sydney, Australia:

“Pain is the conscious correlate of the implicit perception of threat to body tissue.”

Huh?!

This suggests that pain does not originate in the tissue due to injury or a degenerative process.  Instead, it is a very complex interaction between the peripheral tissues (e.g. torn muscle, knee arthritis, lumbar disc herniation, whiplash injury, broken bone) and the brain. The brain processes information as follows:

  1. From your experiences in life – how did your family deal with pain when you were growing up?
  2. Cultural factors – Italian men have been shown to be stimulated by a blue placebo pill and sedated by a red one while men of other cultures in the study experienced the opposite.
  3. Social and work environments – if you enjoy your job and like your boss then less pain may be experienced than if you don’t.
  4. Your expectations as to what might happen as a consequence of the pain – if you do not have an adequate understanding of a particular injury you have sustained you might be concerned as to how you will return to work or your hobby/sport and thus experience more pain.

So pain is an output from the brain after the brain has processed all the above information as well as the nerve impulses coming from the injured area, called sensory input.  Once it has synthesized the need for an output you will then “be told by your brain” if something is painful or not. Think about the person I spoke to a few years ago who had a motor cycle accident and felt minimal pain when she stopped skidding along the highway and noticed her leg 20 feet away from her!  Why no pain then? The brain had compiled an appropriate response at that time that suggested she had more important survival needs and thus did not feel pain. When she was loaded into the ambulance and the emergency personnel took over (they were in charge of survival now) she began to feel pain.

So what kind of output from the brain results once it has decided there needs to be a response to the “painful situation?”

  1. Pain is produced which makes us do something to address the “dangerous”  position we are in.
  2. The sympathetic nervous system causes the fight or flight reflex.  Increases in heart rate occur.  Energy systems are stimulated.  We sweat. We are ready to take evasive action!
  3. Muscles are reactive and are set to fight or run away as well as protect the damaged area. If you have torn a hamstring muscle you know you cannot move due to spasms – a physiological brace per se!
  4. The endocrine system is mobilized and in so doing hormones circulate in the blood stream to help mobilize energy for use by the muscles and reduce other nonessential body functions such as intestinal motility.

The most recent research into pain has changed the viewpoint from one of a noxious stimulus causing pain (i.e. a peripheral origin of pain) to one of the brain being the decision maker as to what is painful and what is not (i.e. a central origin of pain). How complicated is that! It is not as simple as treating the injured tissue to relieve the pain. Pain needs to be treated from multiple angles with a multi-disciplinary approach.

YOU CALL TO ACTION!

  1. Check out Dr. Lorimer Moseley’s blog at : http://bodyinmind.org/resources/journal-articles/full-text-articles/reconceptualising-pain-according-to-modern-pain-science/
  2. What do you think of this new concept of how pain is generated? Post your ideas on this blog for others to read.
  3. Invite a friend who is struggling with pain to read this.
  4. Call us at any of our three clinics if you have any questions:

Sparks location: 775-331-1199

South Reno location: 775-853-9966

Northwest location: 775-746-9222

Interesting video on back pain.


I thought these two videos from Europe are well done and provide a good description of back pain and how you can control it at a basic level.  Watch Part 1 then Part II. Anyone with back pain must make lifestyle changes to control the symptoms. This includes getting in better shape through correcting any imbalances there may be in flexibility, strength, proprioception, balance and core control. A physical therapist can start you in the right direction but then you have to run with it and stay on the program designed for you. What have you found most helpful in addressing your back pain? If you have had physical therapy for back pain and it was not as successful as you would have liked, what do you think was missing?

Click on “Leave a Reply” located below in blue writing at the very end of the “Tags.”