.

>> Well hello and welcome to Help Line this Tuesday evening.

I'm Jennifer Blomquist.

I have the privilege of hosting the program tonight.

If you're one of our regulars you probably know the routine but in case you're new let me go over kind of the whole strategy so that you know what is going on.

>> We are live in the studio and that's why we keep our phone number up at the bottom of the screen so that you can call in or you can text in a question to our guest.

We have an orthopedic surgeon here tonight.

He has been with us before, is a wonderful guest and is more than happy to answer any questions you may have.

His specialty is the back.

So we're going to be talking about spine surgery but if you have something kind of related to that, please don't don't hesitate to give us a call or a text.

So real quickly, the phone number if you want to call is (969) 27 two zero.

It is a free call if you're outside of Fort Wayne.

Just put 866- in front of there and we'll get you through.

We don't throw you on the air.

You talk to a very nice call screener and they can either put you on live to ask your question which is I would say the better way to go because maybe Dr.

Smith needs more information from you to give you a better answer.

So if you're if you're up for it, if you're brave enough, it's really easy to do it that way or if you prefer you can tell the call.

Ask me to your question and they'll relay it to me and we'll get it answer that way the text number is a little different.

It's (969) 27 three zero and I want to assure you that it's we'll keep your phone number private so you don't have to worry about that if you feel comfortable giving us your name maybe and where you're calling from or texting from that would be great and that's a really easy way to get your question answered to just text to us and we'll get that answered.

So why don't you just keep you aware of all that in the meantime, as I said, Dr.

Michael Smith is our guest tonight so we're going to go ahead and introduce you to him.

So thank you so much for coming back.

I appreciate apps is always a pleasure and you've been doing this quite a while so you know you know he knows at all so we're going to talk about different kinds of spinal surgeries that are available.

>> We'll start that conversation.

But like I said, feel free to interrupt at any time with a question.

So I think in general because we we do a lot of spinn we've done a lot of spinal shows over the years because there's almost always somebody in your circle of friends or family that you know that oh, they have chronic back issues or they're always having something going on with their back.

>> So it's a pretty common issue for people.

It is and surgery is scary.

>> I mean most people that's the last kind of surgery they'd want to have.

Yeah, but you guys don't jump into the surgery.

>> No.

You try minimally invasive techniques first.

Exactly.

So we always try conservative management first.

OK, so whenever you see somebody in the office where they have neck pain or back pain or anything like that, you know the first thing is to try medications, maybe some physical therapy and see if we can manage it considerably from there.

You know, depending what the issue is to recommend a lot of people see a chiropractor sometimes depending on what it is.

They're also very helpful too.

So a lot of times the mixture of medicines, chiropractic care and physical therapy works wonders for people and then if that's not working then we look at getting an MRI and then we try to figure out what what truly is going on from a pathology standpoint and then there are some things we can try like some injections and things like that before going on to surgery.

>> If you get to the point where you know, surgery is really maybe your best or maybe even your only option, it's still you gave me a list of of things and the the first one was outpatient spine surgery and my thought was OK, is that a real thing?

>> So it's hard to imagine having some surgery on your spine, such a sensitive part of your body and so important it's hard to imagine doing that outpatient.

So I could you is it done in a hospital setting or more like an ambulatory surgery center?

>> Yeah, So it's actually done both.

OK, so we do a lot of the surgery now that we do is predominantly either outpatient so stay home same day or some people they usually one night or overnight in the hospital and then they're able to go home the next day.

So our our techniques, the the nursing care, the anesthesia care with pain blocks and things like that are, you know, emerged so much of the last several years to where we can really get people up and moving a lot quicker and so so much of that kind of the roadblock so to say initially right after surgery is just a lot of it's that fear of the unknown until you know, I think you know, you have pain.

You've never had this before.

You had your your neck pain, your back pain.

But this is a different type of pain and you're not sure what that means or what you know, you don't want to hurt something you don't want to do damage whatever we've done.

>> And so if we can make you comfortable not that I can understand here's the normal biomechanics.

What you can and can't do.

Yeah.

Then you know now it's all about rehabbing.

You know, we've done this intricate surgery, the implants it's not that we place in there are very stable and so now it truly is just getting you back to life .

>> Does is age play a factor with that?

I wonder if I mean my daughter had back surgery, you know, about a year and a half ago and she did great.

I mean the pain was bad but but you know, they they kind of give you a whole team now most places I mean you have places you can call it 3:00 in the morning and a live person will talk to you so that that has changed the whole medical culture is like that.

But I mean her being younger I felt like she handled it really well.

But then I thought gosh, I don't know if I would be you know, somebody my age you know, I'm in my 50s, you know, as does age play a factor and I wonder if you know, if there are certain kinds of conditions that would prevent it from being able to do the outpatients.

>> Yeah.

So age does play some sort of factor.

I think some of it has to do with the extensiveness of the surgery itself.

OK, so for instance a lot of the next year's surgeries we do we actually go into the front.

>> That's what I've heard.

OK and I actually had surgery myself a couple of years ago so actually the majority I would say ninety seven percent of the neck surgeries we do for the cervical spine we go in through the front, we just kind of move things over so there's not really any muscle dissection or anything like that.

So you don't have that that is as much of that pain.

You do have some pain and kind of your back of the neck in your trapezius muscles just from stretching things back out to normal lineman's.

But again that's kind of managed with you know, I'm seeing it and some muscle relaxers and things like that.

You can go back to most of it pretty quickly so even you know, I even do up the three level fusions the neck and people can still go home the same day.

Yeah, you know, most a lot of things now are understanding of cervical spine surgery especially has really changed the last several years.

We do a lot more disk replacements at least in my practice than fusions.

>> OK, and so the whole idea is to maintain that neural, you know, motion of the neck in the mobility and you know, the fear of people coming in and saying oh I don't have a fusion because you know, that next level may break down or I may have an issue at.

>> So we before with a lot of our studies they're always on like predominately younger patients that have a lot of wear and tear but is now some of our other studies have come out.

We're understanding that even patients with pretty degenerative necks we can still do motion preserving surgery disk replacements on them and they still do really well long term.

>> So we don't have to do fusions on these people and so we can do a one or two level, you know, disk replacement and get the patients home the same day within a couple hours of surgery I was going to say is it require even the outpatient surgeries?

Is it a situation where you would need to have somebody at home to help you?

I mean I'm just thinking of you as an older person maybe live by themselves.

>> We'd have to have somebody.

Yeah.

So especially if you have a general anesthetic you need to have somebody with you for the first 24 hours.

Yes.

You know somebody who's older you may need help you know, making meals at first I will say there's there's also the difference between neck surgery, cervical spine surgery a lot easier to recover from and a lumbar surgery.

Oh sure.

OK so that's one of the things to is having somebody help you around, you know, getting to the bathroom up and off the toilet, you know, things that we take so for granted in our daily life that sort of becomes, you know, a challenge and that goes into even like I said, so much of what we do is a multi team approach, you know.

>> So even with with what we do is if someone has a humble surgery, you know, when we sign up for surgery, send them back to physical therapy.

But the therapy then is designed with a different approach.

>> So it's not just oh, here's your exercise that you do now for those first couple of weeks before surgery they're teaching you how to get on and off the toilet.

>> Yeah, how to get in out of bed all these things that we want you practicing beforehand so that you are accustomed to it and you're kind of well aware of all right, this is what I need to do so I don't end up having a bunch of extra back pain and all that stuff.

>> So that's some of these things that really makes recovery a lot better.

>> And I was going to say years ago my mother in law I mean she's passed away now unfortunately.

But this is like twenty years ago she had back surgery and my father in law went with her.

I mean I remember them going to classes at the time because he had to learn how to help her as well.

So it can be you know, you definitely if you can recruit help if it's a spouse, if you have you still have your spouse around or maybe a child or a neighbor.

>> Yeah, it's it's definitely you need that team help when you get Yeah it is it's yes.

Either your spouse and if they can go to the classes you know because we have a spinning class our joint surgeons have a joint replacement class these are all things that to have that person who's your person after surgery to be there with you to really help make sure that you have the best possible recovery because if they're there learning they know how to kind of help you and all that and if you do stay overnight, it's great to have them stay in the hospital with you so they can meet physical therapists.

>> Understand what the physical therapists are showing you.

Yes.

So that this all leads to a better recovery afterwards.

>> What does it matter?

I think I made a big difference for them a different our family we went through everything with our daughter too.

So we did get a call doctor.

Somebody wanted me to ask for them.

So Roger called from Fort Wayne and he wants to know what to do for pain from a broken tailbone and I've always heard you can't do anything but I don't know if that's true.

>> Yeah.

So when I look when I think of like what are the most challenging things that I take care of in my practice coccyx pain which is the tailbone.

>> Yeah.

So that is one of the most challenging because we don't have great answers.

>> Yeah we wouldn't even be sir would you ever need to do surgery.

>> Very very rarely.

There's sometimes sometimes we can take it out.

Oh God we just got the call it cost me so you go in he actually exercise that portion of the tailbone the very bottom portion OK and take it out but even doing that it's it's not a very hygienic area to go in for surgery because it's right by where you're you know ,taking care of yourself after the bathroom the so there's a lot of risk for the infected and things like that.

>> So after if you have a broken tailbone it's a lot of anti inflammatories, maybe some muscle relaxers using a you know, inflatable donut the sit on to kind of help pad that area and trying to give it time and then if we can get you doing some physical therapy, there's some exercise that the physical therapist can show you and sometimes we even just have our intervention list.

They do some injections and things like that to kind of combat inflammation down.

>> Yeah.

So I think around here with the ice that's what most people have told me.

They're like I think I broke my tailbone because I slipped on a slip on the ice which you know and then most of them say, you know, I'm just I read online that you can't do anything so they just kind of weigh it out.

>> But at least yeah, like you said, the antiinflammatory to stay comfortable and so forth.

>> So you kind of went over the motion preservation spine surgery.

But can you kind of explain a little more about what that is?

Is that because you talked disc replacement versus fusion so yeah.

>> So in my mind we have kind of two forms of motion preservation surgery.

OK, so one of them is disc replacements.

So I said, you know, we're doing a lot more in the cervical spine and now we're getting much better.

>> The technology is better, the approaches are better for lumbar disc replacements.

So there's still some things that we're still very picky on those because we have to have the right indications in the right patients their anatomy is we have to go into the front line basically through the belly so their blood vessel anatomy has to be right because the big blood is a feed.

>> Your legs are right there and so we have to make sure they're in the right places so it's safe to do the surgery.

>> So those are kind of like from an implant standpoint motion preservation surgery and then the other part is we're getting much better at just doing decompressions.

>> So going in kind of cleaning out the arthritis without having to do a fusion or replace any implants and so we can do that with different techniques.

>> There are certain ones where we can actually preserve the we'll call the midline structure.

So the the the ligaments, everything in the middle.

So we go and we can clean that out without having to do a fusion and so then that means that those other structures still are still there for stability.

OK and then there's also I'm I've been doing a lot more endoscopically surgery so kind you think of like a sports medicine surgeon would do a knee scope or a shoulder scope so I can go in you know, surgeons going through a two centimeter incision.

>> We used two of them and we can literally go in clean some of the muscle off the bone and we can go in and clean up the arthritis special tools where we can go in.

We can move the nurse back over.

We can take out a disc herniation and kind, just pluck it out very elegantly, get the pressure off the nerve and then it's just a couple of stitches in close it up.

What would that be?

I would assume that's OK.

Yes.

So that's our patient.

That's amazing.

It's hard to imagine when you talk about an incision that little I mean obviously the patient's glad to hear it's not going to be like a six inch incision but is that robotic done robotically then is that so?

>> That's a great question.

So when we do those types of surgeries yeah.

That's not robotic because we're actively kind of doing everything there.

>> There are times where we do use a robot in spine surgery.

>> It's a little different than general surgery.

You probably heard of using the robot for like The Da Vinci robot or heard of that cholecystectomy or appendectomies, things like that.

>> So that's used because we're not you know, you're not around the spinal cord and so like you're literally within like.

>> Injuring things and so we're going to try and get there at some point.

Yeah.

The robotics that that we use today is more for placing the implants.

So if we're going to place screws throughout the spine we can do a scan of the spine and then know exactly where in space then our instruments are and so through small incisions we can go and we put the screws we can retract things and then we can very we can literally in space I can literally take an instrument and you can follow it all over the screen because it can see it in space.

>> So then through a small incision I can go ahead you this far down into the body and scrape out the cartilage and take out things that we need to get out of there and then we can put our cages, our implants in there through much smaller incision so so allows surgery with less distraction, less disruption of the muscle and all that and much very, very precise way.

>> Yeah.

Which becomes a very safe surgery for the patients and say it's amazing to Stephen just to have in my lifetime I remember people you know I was younger older relatives having hip and spine surgery and things like that and it was a huge deal.

>> I mean they were in the hospital for over a week a lot of times, you know, that just doesn't happen anymore.

Yeah, I even you know, I've been in practice for thirteen years and it was routine for one of effusions a you know, three days now 90 percent of them are home within the next day.

Yeah.

So you know, the things that we're able to do now is it's amazing.

>> Well, and just from hospitals days we've had for ourselves and for our children the worst place to try and get rest is the hospital.

You would think that would be a real it's not they have to come check on you constantly and it's I think most people would agree if they've experienced it in the hospital they'd rather recover at home.

>> Yeah, there's a lot of monitoring that the nurses have to do checks and all these things.

>> I mean God bless them.

That's great.

You know, you appreciate that they're on top of it but yeah, you try and sleep for like twenty minutes here and there.

So we do have another gentleman who called wanted me to ask the question form.

So this is Lewis from Fort Wayne so thanks for calling Lewis.

He's asking if spine compresses the spine compresses during the day are shorter than during the evening time so I'm not sure.

>> Yeah so actually I believe that what they're alluding to is so actually is kind of a sometimes that's not a grade school science fair project.

>> Oh OK.

You know schedule do like if you measure yourself in the morning you're actually taller than at the end of the day.

>> That's interesting.

OK, yeah and so the whole reason behind that is because with when we lay down so our desks are just full of water OK so they're full of like protein and protein structure that absorbs water so we lay down our body kind of decompresses itself and so you don't have gravity and so it fills the desks with water.

>> Yeah.

And then as soon as you got up in the morning the next day now gravity is kind of pushing on each of those desks and so you have you know we have seven cervical vertebrae to twelve thoracic vertebrae and five of our vertebrates now gravy's pushing and all those desks in between and so slowly, slowly that the water the hydration kind of goes out and so you are a little bit shorter at the end of the day and that's why that's interesting.

>> I got to tell you I'm done with science fair.

I know your youngest graduated high school.

My youngest is starting high school and we're done with the science fair but that is for maybe for my grandkids.

I'll pass that along someday they can do that.

So all right.

We have another question coming in.

Got a lot of I think shy folks tonight.

So they're having to ask for Doris from Fort Wayne so she knows three people who had the front like you mentioned the front facing neck surgery and they had they had daily migraines for the rest of their lives as a result according to her.

>> So she's wondering if there was a connection.

Yeah, one of the things actually we've a lot of studies have actually shown that when people have neck surgery their neck or their their headaches actually go away or improve so a lot of headaches end up being what we call cervical genic.

>> So they related to a lot of the arthritis.

I don't know why it would be related to after surgery unless they've developed significant arthritis at some the other levels and so it could still be that if they've had, you know, multiple other levels fuzed and they have some really severe arthritis in other levels that are still mobile that that could be causing neck pain.

A lot of people have what we call occipital neuralgia so this kind of stems from like one of the top nerves and that can actually kind of radiates up the back of their head around the front.

It can be very, very debilitating and so sometimes their pain is actually occipital neuralgia that's causing the headaches and things like that.

>> Can they get any relief from I mean I know some people get migraines that they would have to give.

There was a medication they would have to give themselves an injection they would get so bad I don't know if it yeah.

>> So sometimes it's it's still some therapy and then depending on what their x rays or imaging look like it would be probably a shot with one of the interventionists and sometimes just that those joints in the back and sometimes is at that nerve and that's what we rely heavily on the intervention was for some of those very specific injections.

>> All right.

Well, I just want to remind people they just showed me the five minute card so we've got a few minutes left that will still be plenty of time to get some questions answered again if you want to text.

So that's a really easy way.

This is probably the first show where nobody has texted.

So we've had I appreciate everyone is called in but do you want to text that's so easy (969) 27 three zero do you want to just give us a quick question that way and again we keep your phone number private or the other way of course (969) 27 two zero call and ask a question live during the show or have me ask it for you so we're going to go ahead.

>> I just want to ask you about one other type of surgery that you mentioned was the muscle preserving surgery?

>> Yeah, because I think people don't realize how much you have to you cut through muscle to get to where you need to work.

>> It's not really the most pleasant to think about but I mean it can be it can be a lot for a patient to handle.

>> Yeah.

So depending on the patient's pathology they have their certain approaches that we can do instead of stripping all the muscle off the spine to get in there to get the access what we need to do we can go and kind of split the muscle which ends up with a lot less scarring and so the muscle still works functions better after surgery .

A lot of this has to do with like some minimally invasive techniques where we can go in like I said, we can split the muscle.

>> There's times where we can actually go in through people's side and avoid tearing apart all that muscle pretty much all together so we can go in through the side, split your Hyflux a muscle and go into the disk space in place implants to go in like a cardiac or ashim he goes in and pushes the bones apart and when that happens when a nerve is being pinched, when she pushed the bones part it relieves that pinched nerve and so it's the pressure off the nerve and then for instance like I use a lot of robotics we can go in then through a couple of small incisions in place the screws much less disruption to the muscles, a lot less pain afterwards, quicker mobility and all that.

>> Wow.

All right.

>> That sounds like a much better deal than probably what it used to be so.

Oh, thank you so much, Mike.

You texted Mike from Roanoke.

He's the man tonight.

He asks says seventy three year old asking about a seventy three year old has sciatica.

He's used a steroid kind of steroid that hasn't helped.

>> What else could help to ease the pain?

You just can't say the brand name.

Unfortunately.

>> But it's a very common commonly prescribed steroid.

Yeah.

So sometimes it could be depending on the medical issues you have just regular anti inflammatories.

OK, there's what we call neuromodulators medicines so there's some nerve pain type medicines that we can use a lot in patients and in physical therapy and if needed the injections then obviously if that's not taken care of it then surgery.

>> So and a steroid use is is only temporary is that correct?

I mean you can't I mean I just know that I've heard doctors say you can only maybe three or four weeks.

>> Yeah.

We typically do what we call dose packs and a smaller one that's like you know, around three or five days the larger one that's about seven days seven to ten days that's pretty much it because after that it starts to potentially affect your adrenal glands.

>> It can affect your hips, the bones and things like that.

OK, so that's kind of a temporary correct fix.

>> So yeah, good to know.

Well we are just about out of time so I appreciate everybody calling in and asking questions.

I don't know if you have any advice for people over the summer months for that might be doing activities we're not used to and sometimes you feel it the next day, you know so I don't know if you have I know my kids were out doing a lot of exercises and things they hadn't done for a while and now they they were asking for pain reliever.

>> So yeah, I mean the biggest thing is like it's the old adage lift with your legs now with your back use good ergonomics is is huge you know, so that you're truly you know, stay with your limits, use your legs.

And I tell you a lot of times like if you know you're doing something that's going to aggravate it, take an antiinflammatory if medically it's OK ahead of time to kind of get ahead of that you prevent some of that information stuff for you instead of waiting and then you're behind the ball and don't make the mistake my husband made thinking he could just jump on a trampoline like like he was ten years old again it doesn't it doesn't end well the next day.

>> So that's my advice.

So thank you so much, Dr.

Michael Smith.

My pleasure.

Orthopedic surgeons so glad to have him back.

I hope hopefully you'll come back soon.

In the meantime, want to remind you we do have another program next week.

I don't know the topic yet but I will be here and we'll have a live guest and I'm sure it'll be a great show and you'll learn a lot.

So please tune in next Tuesday night as well.

Take care.

Have a good evening and we'll here next week.

>> Bye bye