Category Archives: Uncategorized

How Did My Child Get Scoliosis?

There are lots of different types of scoliosis. Congenital scoliosis is when a baby’s spine vertebrae don’t fully form while they’re in the womb. Early onset scoliosis can have a variety of causes, but this kind of scoliosis is when a curve in the spine happens between birth and age 10. Degenerative scoliosis happens in adults, either because of a family history of scoliosis or simply wear and tear on the spine. Certain neurological disorders result in neuromuscular scoliosis (cerebral palsy, spina bifida, muscular dystrophy). But the kind of scoliosis I’m talking about today is called adolescent idiopathic scoliosis (AIS).

adolescent idiopathic scoliosis What Is It?

Out of all the different kinds of scoliosis, AIS is the most common today; about 4% of adolescents have it. It affects more girls than boys (in fact, girls are treated 10 times more often). The word “idiopathic” means that the cause is unknown. Researchers are still working to figure out the specifics, but here are some of the more popular theories:

Family history. Family genetics might play a role, since 30% of adolescents with AIS have a family history of scoliosis. Several researchers have suggested that a mutated gene on the X chromosome may play a role. Other scientists think that AIS may have to do with several chromosomes.

Muscle disorders. One study suggests a relationship between AIS and a primary muscle disorder involving platelet calmodulin (proteins that help with cellular metabolism). The researchers found that individuals with AIS had statistically higher levels of platelet calmodulin. If researchers conducted additional studies like this one on a larger scale and found similar results, doctors might be able to monitor platelet calmodulin levels and identify individuals who are at risk for AIS before its onset.

Growth anomalies. Another theory points at osteopenia (i.e., lower-than-average bone density) and the genes involved with skeletal growth.

Again, no one has definitive answers yet, but science is still searching. The good news is that if AIS is caught, there are treatments available to help.

Watch for These Red Flags

With AIS, there are some physical symptoms that can indicate its onset. You can easily see these symptoms either while the child is standing up straight or if they do a standard Adam’s Forward Bend Test (when the child bends at their waist to touch their toes, keeping their arms and legs straight). Here’s what to look out for:

  • One shoulder is higher than the other
  • One shoulder blade sticks out more prominently than the other
  • One hip is higher than the other
  • The waist looks uneven (one side looks more curved)
  • The body leans to one side
  • The head isn’t centered over the pelvis

If you think your child has AIS, schedule an appointment today with 360 Back and Spine by calling 682-223-1406. We’ll determine whether or not they have scoliosis and help you figure out the next steps.

Sources:

http://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/adolescent-idiopathic-scoliosis

http://www.sauk.org.uk/types-of-scoliosis/idiopathic-scoliosis

http://emedicine.medscape.com/article/1265794-overview#a4

Ankylosing Spondylitis: What You Should Know

Spondylitis

Did you know that back pain is one of the leading causes of missed work days? And over 80% of adults seek treatment for back pain at some point in their lives? It may be a relatively common condition, but sometimes it’s more than a strained back or a pulled muscle. Sometimes it’s an indicator of ankylosing spondylitis (AS).

What Is AS?

In short, AS is a form of arthritis. While it can affect multiple areas in the body, it mostly affects the vertebrae in the spine. The vertebrae become inflamed and, after an extended period of time, they can actually fuse together, resulting in a deformed spine.

It affects men and women alike, and although it can occur at any age, it often starts in the teenage years and when people are in their twenties.

There is no known cause, but there seems to be a strong genetic factor that scientists are still trying to explain. Several genes are said to potentially play a role, but one gene mentioned in particular is HLA-B27. Not everyone with this gene gets AS, and not everyone with AS has this gene, but there is a strong correlation.

Warning Signs and Symptoms

Symptoms of AS will vary depending on the individual, but some of them include:

  • Stiffness or pain in your lower back
  • Progressively worsening back pain
  • Stiffness or pain in your hips
  • Neck pain
  • Fatigue
  • Pain that improves with exercise
  • Pain that worsens with rest
  • Short, painful episodes of pain (called “flares”)
  • Eye inflammation

The only way to know for sure is to meet with a health care provider and have a detailed physical exam. The provider will also probably order some sort of imaging test, like an X-ray or an MRI.

Treatment Options

At this time, there’s no cure for AS, but there are things you can do to make yourself more comfortable.

Physical therapy. This can help you in multiple ways, like maintaining good posture, increasing flexibility, and helping with pain relief. Therapists can create specific stretches and exercises for you and your situation.

Exercise. Daily exercise can really help reduce stiffness and strengthen your muscles. Swimming is one of the best forms of exercise for individuals with AS.

Pain management. Using nonsteroidal anti-inflammatory drugs (NSAIDs) is a popular choice, but these drugs can hurt your GI tract. Luckily, NSAIDs aren’t your only option. Certain pain management injections, like transforaminal nerve root blocks or caudal epidural injections, are incredibly effective. Transforaminal nerve root blocks will target the specific nerves around the vertebrae that are causing pain. Caudal epidural injections work in two ways: first, an anesthetic blocks the pain signals going to the brain, and then a steroid reduces the inflammation. For more information on the medical injections we offer at 360 Back and Spine Center, click here [link to blog on injections].

If you’ve been experiencing back pain, schedule an appointment today with 360 Back and Spine at 682-223-1406 to get your questions answered! Remember, AS is a chronic disease that only worsens over time. Getting the appropriate treatment early on will help you manage its progression.

Can Pain Management Injections Help Me?

At 360 Back and Spine Center, we now offer medical injections that can help with pain management. Check out what they’re for and how they work:

Lumbar (Lower Back) Epidural for Sciatica

Sciatica is the term used to describe pain that shoots down the back of your leg and into your foot or your calf muscle. The pain is usually triggered by certain positions, like sitting a particular way, or certain activities, like walking. A lumbar epidural can effectively and quickly provide pain relief. This is a short-term solution that can significantly help someone experiencing an episode of lower back/leg pain or someone trying to do rehabilitative exercises and stretching.

Facet Injections

There are two facet joints on each level of your vertebrae, and they’re positioned on opposite sides of the cartilage. Facet injections can help us with two aspects of pain: they help us determine which facet joint is the source of pain (based on whether the patient feels relief after numbing that specific facet joint), and then the injection helps alleviate the pain.

Medial Branch Blocks

Medial branch nerves connect to your facet joints and then carry pain signals to the brain. A medial branch block disrupts these pain signals, so they can also help us diagnose the source of pain and provide pain relief. Whereas a facet injection inserts the anesthetic into the joint itself, a medial branch block puts the medication just outside of the joint, right next to the medial branch nerves.

Rhizotomy

This procedure also relates to the facet joint. If the relief provided by a facet injection is only temporary, a rhizotomy injection could provide lasting relief. Similar to a medial branch block, the needle is placed outside of the joint instead of in it. Radio waves then disable the sensory nerve attached to the facet joint, stopping pain signals from reaching the brain.

Sacroiliac (SI) Joint Injections

You have two sacroiliac (SI) joints; these connect your sacrum to your hips. If you have joint inflammation or dysfunction in this area, it can be the source of a lot of pain. Like facet injections, SI joint injections help us determine where the pain is coming from and if SI joint dysfunction is the culprit.

Transforaminal Nerve Root Blocks

This injection is typically used when a specific nerve has been identified as the source of pain. The medication is then injected around that particular nerve root, relieving the pain.

Caudal Epidural Injection

This injection is generally meant to help with lower back pain. The medicine is injected into the lowest part of the spine and typically involves both an anesthetic (which blocks pain signals from going to the brain) and a steroid (which helps reduce irritation and inflammation).

Spinal Cord Stimulators

This is a method that’s been used for decades for a variety of conditions. Spinal cord stimulation involves sending mild electric pulses along the spinal cord. These electric pulses modify or stop pain messages from reaching the brain. This is a popular option for individuals with back pain that have tried surgery or other treatments, but weren’t able to find relief.

If you’ve been suffering from back, neck, joint, or leg pain, know that you have options. We understand that each person’s circumstances are unique. If you’d like to discuss the best treatment options for your situation, give us a call at 682-223-1406 to schedule an appointment.

What Is Bloodless Surgery?

bloodless surgeriesBloodless surgeries do not incorporate blood transfusions. When surgeons use specialized medical equipment, procedures, and meticulous technique, patients do not need their blood supplemented by outside blood sources.

For many surgical procedures, surgeons will utilize blood transfusions (transfer of donor blood to a patient through an IV) to restore blood that is being or was lost during the procedure. Patients can donate their own blood ahead of time to be used during the surgery, or a blood bank can also match and supply the blood instead. Other times only certain components of the blood may be used, depending on the patient’s needs. For example, red blood cells can help to increase the amount of oxygen carried to different tissues in the body, and platelets can help blood to clot better to control bleeding. Rather than receiving whole blood, the patient only receives the part they need.

Reasons for Bloodless Surgery

Health benefits include a faster recovery rate, a decreased risk of infection, and an eliminated risk of a transfusion reaction or receiving contaminated blood from the transfusion. Though these risks are small, they aren’t zero. Additionally, the greater time and care spent during the surgery minimize trauma to the tissues, making it less likely that patients will need blood during and after surgery.

Additionally, people of certain religions, including Jehovah’s Witnesses, consider the blood sacred and do not wish to have it removed or added to their system if their blood count drops as a result of the surgery. It is important for physicians to recognize and be respectful of their patient’s beliefs, even if they don’t match their own.

In this scenario, Dr. Kinchen plans the surgery with the patient and the religious leader who can serve as the patient’s advocate. The risk of blood loss and the options of prevention or minimization are discussed in detail. Other potentially viable options to increase blood volume are discussed. It is important that the patient feels comfortable with the plan prior to surgery. Dr. Kinchen respects every patient’s wishes and wants to make sure that her procedures meet the guidelines of each individual.

Some viable options may include:

  1. Staging the procedure (e.g., dividing the surgery into two days instead of one)
  2. Using the Cell Saver (which recycles the blood removed during the surgery and then gives it back through an IV)
  3. Using Epogen (a synthetic product that helps the body rejuvenate blood cells)
  4. Increasing iron intake pre- and post-operatively (this helps build up the blood count over several weeks)
  5. Using special tables that position the patient so that there is less pressure on the major blood vessels in the abdomen (this decreases blood loss)
  6. Using meticulous surgical technique, avoiding significant tissue trauma, using materials to help decrease blood loss during the surgery, and performing minimally invasive surgeries when possible (all of these things help to decrease blood loss during the procedure and during the post-operative period, as well)

Types of Scoliosis and Treatments for Adolescents

scoliosis treatmentDo you know someone who has a child with scoliosis, or do you have one yourself? Finding the best treatment for your child’s particular type of scoliosis can be a complicated process. Many patients who don’t meet the requirements for surgery are left to see only a nurse, leaving them with inadequate information to treat their child’s unique situation.

The Types of Scoliosis

Many parents don’t know that they have different options for treatment of scoliosis. Those left in the dark tend to take the first option suggested to them, but not every treatment is equal. Let’s explore some of the different types of scoliosis 360 Back and Spine treats and treatment options for adolescents.

What Is Scoliosis?

Scoliosis is a condition in which the spine is curved sideways. Children are most at risk for scoliosis because it typically occurs just before a child’s growth spurt/puberty, and the child’s growth plates will still be open and susceptible to spinal abnormalities. Scoliosis is typically caught during school-mandated physical screenings, but in many cases this condition slips by unnoticed and is dismissed as normal growth.

Idiopathic Scoliosis

The onset of idiopathic scoliosis can happen with very little warning, and the progression of this condition can be fast-moving between screenings. Idiopathic scoliosis is most common in adolescents (preteens and teenagers), and in children it can be grouped by age into three different types with the adolescent type being the most common by far.

  • Infantile (ages 0-3)
  • Juvenile (ages 3-9)
  • Adolescent (ages 10-18)

A lot of scoliosis cases in children don’t require any treatment. If a curvature is detected, a spinal surgeon will use an X-ray to determine the degree of curvature and the child’s skeletal maturity level, also known as the Risser sign. This will help determine the course of treatment.

If untreated, major issues can arise from the progression of scoliosis, such as reduced lung function. Issues like this can be quite debilitating, so it’s important for regular checkups to occur for children with scoliosis. There is, however, a silver lining: the risk of developing scoliosis drops dramatically after a child has gone through puberty. In boys, this refers to the age where they must shave regularly; for girls, it’s two years after their first menstruation.

Treatments For Adolescent Scoliosis

Detecting scoliosis and its symptoms is a simple task for an orthopedic surgeon, but it’s helpful to know the signs of scoliosis when you’re a parent. Symptoms of adolescent scoliosis include uneven shoulders, waist or hips, as well as ribs that stick out. Early signs of scoliosis don’t usually include pain, but more advanced scoliosis patients can experience soreness and more acute pain. After scoliosis is diagnosed by your doctor, there are several treatment options your doctor may suggest to you.

Treatment For Mild Scoliosis

Chances that your child with mild scoliosis will need a back brace are minimal, but the possibility still exists. Most children with mild scoliosis are given checkups with X-Rays every four to six months. Girls in particular are more at risk for a greater progression of scoliosis, so they’ll probably have more frequent checkups than boys. More frequent checkups are also recommended for those with S-curves and thoracic scoliosis, because of the natural rate of progression.

Treatment For Moderate Scoliosis

Children with moderate scoliosis may be given back braces to stop progression of a curved spine. Although back braces won’t reverse or cure scoliosis, they may prevent the curvature from increasing. Most braces will be made of a durable plastic that is worn majority of the time and can be taken off if necessary. The brace’s effectiveness increases the more it’s worn, so strict adherence to wearing it day and night is best. Most braces can be discarded when the child is no longer growing.

Surgery can be an option for young children with fast-progressing moderate scoliosis. If a child’s curvature is greater than 40 degrees, surgery is the most likely option, whereas children with curvatures in the 20–30 degree range are more often prescribed back braces.

Treatment For Severe Scoliosis

Adolescents with severe scoliosis will most likely need surgery to correct it. Spinal fusion is the most common form of surgery used on scoliosis patients and involves rotating the spine and placing it in a more anatomic position. Bone graft and hardware are added to maintain the correction.

What preventative measures can people take when sitting at a desk for prolonged periods of time?

360 Back and spine

Dr. Melanie Kinchen was recently asked to contribute to The American Academy of Orthopaedic Surgeons on-going campaign called A Nation in Motion. This campaign features several articles called Ortho-pinions that highlight the opinions of orthopaedic surgeons on common injuries, conditions, and treatments.

The Dangers of Desks

The Effect of Sitting

The modern work environment isn’t exactly forgiving when it comes to encouraging a stress-free lifestyle. Many careers include being glued to a desk for several hours at a time while staring at a computer screen. This kind of sedentary behavior can cause both neck and back pain. Poor posture contributes to the problem as well. Back pain is the most common issue associated with sitting at a desk.

How to minimize pain/stress

  • Get up from your desk and stretch every so often. Try to walk around from time to time. According to researchers from the University of Utah School of Medicine, data revealed that there was a 33 percent decreased risk of dying when people got up to move around for about two minutes each hour.
  • A chair with lumbar support for your back is ideal.
  • Place your feet firmly on the ground and keep your knees at a 90 degree angle.
  • In order to lessen stress in your neck, I would recommend that you keep your computer screen higher up so you’re not constantly looking down.
  • Most often, back pain is caused by excessive strain of the back muscles and ligaments. Engage in a more active exercise program once the initial pain subsides that includes walking, swimming, bicycling and strength training with light weights.

What can be done today

Many patients report only mild neck and back pain, and when that happens I recommend using a nonsteroidal anti-inflammatory drug (NSAID). Try taking something over-the-counter, twice-a-day, for a week. If the pain is severe or lasts for many weeks, see a physician. Stronger medication that might be prescribed is muscle relaxants. If there is just isolated neck and back pain, it will resolve with medication. An MRI can be performed if pain still persists after medication.

Is surgery ever necessary?

Surgery can be an option for people who experience pain over a long period of time, but that can sometimes be caused by arthritis. People with arthritis who sit for long hours are also more likely to get aggravated by back pain. Unfortunately, surgery for back pain is not nearly as effective on arthritis patients. In extreme cases, spinal fusion will be offered, but surgery for back pain should be the last resort.

Many patients who experience severe neck and back pain think that it is incredibly significant. Most of the time, back pain isn’t caused by a slipped disk or tumor. Just because there is pain, it doesn’t mean that it calls for surgical intervention. There’s really no quick fix. Once habits and lifestyles are changed, the pain should subside.

If you suffer from chronic back pain or have been diagnosed with a slipped disk or tumor and wish to get a second opinion, call our Grapevine or Richardson office to schedule an appointment at 682-223-1346

360 BACK AND SPINE CENTER

360 Back and Spine Center is located in Grapevine, TX on the Baylor Grapevine Hospital Campus. We provide comprehensive treatment for the entire back and neck. Specializing in:

  • Scoliosis (adult and pediatric)
  • Failed back surgery
  • Tumor removal
  • Cervical and lumbar disc replacement
  • Fusions
  • Decompression
  • Micro Disc Surgery
  • Bloodless Surgery- Non-Blood Medical Management

We take a conservative approach to treatment and will partner with you to inform you of all your options so you can make an educated decision.

360 BACK AND SPINE CENTER

360 Back and Spine Center is located in Grapevine, TX on the Baylor Grapevine Hospital Campus. We provide comprehensive treatment for the entire back and neck. Specializing in:

  • Scoliosis (adult and pediatric)
  • Failed back surgery
  • Tumor removal
  • Cervical and lumbar disc replacement
  • Fusions (Cervical and Lumbar)
  • Decompression
  • Micro Disc Surgery
  • Bloodless Surgery- Non-Blood Medical Management

We take a conservative approach to treatment and will partner with you to inform you of all your options so you can make an educated decision.

MELANIE B. KINCHEN, MD, PA

Orthopaedic Spine Surgeon

  • Yale University Bachelors of Psychology
  • Harvard Medical School M.D.
  • Johns Hopkins Hospital, Orthopaedic Surgery Residency
  • Johns Hopkins Hospital, Fellowship in Spine and Deformity

Dr. Kinchen is an Orthopaedic Spine Surgeon and the founding partner of 360 Back and Spine Center. With more than 15 years of experience in spinal surgery, she is well trained in both anterior and minimally invasive surgical approaches to the cervical thoracic and lumbar spine. She is widely recognized by her peers as the expert in adult spinal deformity, reconstruction, failed back surgery and is considered one of the best doctors in her field.