Spinal Surgery

Airport Security and Metal Implants

“Will the metal in my device set off metal detectors at the airport?” Especially since September 11, 2001, when airport security measures increased significantly, it’s been a common question for spinal implant patients. They’re concerned they may set off detectors, be subjected to more screening than their fellow travelers, and, of course, delay their travel. Metal implants can include knee replacements, hip replacements, and other orthopedic implants. Implants are usually made of cobalt chrome, stainless steel, or titanium. The location of your implant, and what it’s made of, can both affect whether you set off a metal detector. While there are some reports of airport metal detection rates of orthopedic implants generally, there have been few data regarding spinal implants specifically. A recent study of pediatric spinal fusion patients found that cobalt chrome implants set off metal detectors 24% of the time, while stainless steel implants went undetected. Past studies have also found that implants with cannulated screws and implants with high iron content are more likely to be detected. A 2012 study showed that archway metal detectors do not detect modern spinal implants. Handheld metal detectors, on the other hand, detected all modern posterior spinal implants and anterior cervical

April 23, 2015

Pain Management Cheat Sheet

Pain management is one of the oldest areas of medicine. And just as there are many different causes of pain, there are many different treatment options. One of the most controversial options is pain-relieving drugs, especially the long-term use of opioids for chronic pain. One thing is for sure – all patients should have access to a variety of pain management options. Pain-relieving drugs may be the right choice in some cases, but they should never be the only option on the table. A recent bill sponsored by Wisconsin congressman Ron Kind serves to highlight this issue. Many veterans receive only drug therapy for their chronic pain. The bill, called the Chiropractic Care Available to All Veterans Act, would make chiropractic care a standard benefit of Veterans Affairs health care, and require chiropractic care and services at every VA medical center by the end of 2016. The bill is also supported by the Veterans of Foreign Wars, Paralyzed Veterans of America, the American Legion, Vietnam Veterans of America, National Chiropractic Leadership Conference, and the American Chiropractic Association. Pain management is a major health care issue in America. According to the National Institutes of Health (NIH), pain affects more Americans than

April 14, 2015

9+1: Derrek’s Patient Experience

Derrek is a patient of mine who has left a lasting impression – he recently ran his first half marathon after having a 2 level spinal fusion (see his xray to the left). He is a great example of patients who become more physically active after a spinal fusion than they were before, which is a common experience in our practice. Derrek’s back pain began eleven years before his surgery, when one day he woke up with terrible pain in his back. Over the course of the eleven years, after all else failed, his condition deteriorated to the point where he considered surgery. Failing to get the answers he was looking for after speaking to a doctor specializing in psychosomatic symptoms, Derrek came to my office. Here’s what he had to say about his experience: “Dr. McCance really did a great job explaining everything to me and my wife. He told us that surgery is what needs to happen now, or something much worse will happen later. “What I’m most impressed by is that Dr. McCance even explained the differences between psychosomatic therapy and surgery to my wife. He answered all of our questions and gave us two solid options.” Derrek’s options were

March 17, 2015

AARP’s Surgeries to Avoid

An AARP article that discusses common surgeries to avoid – including spinal fusion – has recently made its way back into the headlines. Specifically, it cites studies that show the frequency of this procedure has increased 1,400 percent between 2002 and 2007, and does not appear to be slowing down. The article suggests that the surgery is dangerous and is no more effective than physical therapy, which is inaccurate and misleading. Spinal fusion involves the joining of two or more vertebrae together, using screws and rods along with bone graft material, and sometimes cages (devices that support the vertebra). These techniques provide strong support for the spine, as well as correction of alignment and protection of the spinal canal and nerves. While spinal fusion has increased in frequency, in my experience it is a safe and highly effective treatment for patients when performed properly and for the right diagnosis. The key to success is careful selection of the patients who need a fusion (i.e., performing the procedure for the correct diagnosis), and also performing the surgery carefully to achieve maximal success (i.e., achieving a solid fusion). Where patients and doctors get into problems is when the procedure is performed for a

March 10, 2015

10 Years Later: James’ Patient Experience

Meet James, a former patient of mine. James’ story began when he was lifting paving stones and felt a sudden shooting pain in his back, eventually traveling to his legs and toes. Knowing something was wrong, he immediately consulted a physician, but doctor after doctor couldn’t figure it out. He had undergone prior surgery for a herniated disk about 15 years ago. After receiving five different opinions with no clear answer, James was left with more uncertainty: “Five different guys didn’t seem clear on where my problem was. They thought it was scar tissue from a previous surgery I had 15 years ago or a herniated disc. Three of the doctors consulted each other and thought some kind of implant would be best for me.” James continued to look for someone who could provide a better answer. He didn’t want rods put in his back. When a friend recommended my services, James did his research and made his appointment the next day. What I did differently from the previous doctors was to get a high quality MRI and special Xray views. Once I got the results back, I assured him that the pain was not due to scar tissue left

March 3, 2015

Back on the Dance Floor: Kathryn’s Patient Experience

Kathryn is a former patient of mine who has left a lasting impression. Her back pain began when she hurt her L3/L4 disc after a spinning class, and she believes she aggravated the injury during a subsequent game of golf. Initially, Kathryn told me she didn’t think too much of it because she’s athletic and used to pushing herself outside her comfort zone. Kathryn thought this was something she could deal with – so she sought a massage treatment, iced her lower back area, and rested. Afterwards, she continued to play golf and attend spinning class. Unfortunately, what Kathryn didn’t do was listen to her body and get help when she needed it. I see this in a lot of patients; a good rule of thumb is if the pain persists, starts to travel down your arm or leg, and/or keeps you up at night, it’s time to see a physician. Unfortunately, the pain took a turn for the worse when Kathryn further exacerbated her injury lifting a mattress while vacuuming. Kathryn contacted my office and met with me to discuss different options that would work for her injury. Because she had severe nerve compression in her lower back due

February 3, 2015

What is a Lumbar Herniated Disc? Causes, Symptoms, and Treatment Options

With nearly 80 percent of the general population experiencing back pain at some point in their lives, it is important for patients to understand the source of their discomfort in order to expedite relief. Herniated discs—sometimes referred to as slipped or ruptured discs—are one of the more serious causes of lower back pain. Herniated discs can lead to severe pain, and even to numbness and weakness in the legs, if left untreated. Today, I will further explain the root causes of the pain associated with herniated discs, common symptoms, and a few simple treatment options. What is a herniated disc? In between your spinal vertebrae are discs that work to absorb the shock created from day-to-day tasks. These round discs are composed of a tough outer ring and a soft, jelly-like center. Either injury or general wear and tear from aging can cause these discs to tear, or herniate, and allow the soft center to rupture and displace into the spinal canal. This shift can irritate spinal nerves and causes the discomfort and pain common known as sciatica. Who is most at risk? Herniated discs are most commonly seen in males ages 30 to 50. As you many remember, Tiger

July 15, 2014

From Scoliosis to the Marines: An Inspiring Patient Testimonial

A few years back, I met an inspiring young patient named Manuel Rivas. He was a determined young man, but his advanced scoliosis was holding him back from fully participating in all of the activities he loved. He recently came back into my office and shared his incredible plans to join the Marines this year. I was so taken by his bravery and recovery that I wanted to share his story with you today. As a kid, Manny was incredibly active and loved playing baseball with his friends. However, around the age of 13, he began experiencing severe pain that reduced his ability to participate in his favorite activities. He recalls, “It was so painful that if I was running around or training, I would have to sit or even lay down on the ground right afterward.” The most debilitating side effect of this pain was his inability to get enough good quality rest. Manny struggled to fall asleep and stay asleep nearly every night because of his immense pain and discomfort. Understandably, 13-year-old Manny considered sleepless nights the “worst part” of his condition. Manuel Rivas’s pre- and post-operative x-rays Concerned for their son, Manny’s parents initially brought him to

July 2, 2014

What is Scoliosis? Causes, Symptoms, and Treatment Options

Scoliosis is a somewhat common condition that affects approximately 6 million Americans or 2-3% of the general population. Many people are familiar with back braces that sometimes accompany the treatment of scoliosis. However, from varying degrees of spinal curvature to different treatment options, there’s more to it than just back braces – and I’m sharing a brief guide to understanding what scoliosis is, who it affects, and how it is treated. What is scoliosis? Scoliosis, simply put, is an abnormal curvature of the spine. While a normal spine forms a straight line from the neck to the buttocks, spines with scoliosis curve to form a C or S shape. Who has scoliosis? Scoliosis can begin at any age. Most commonly, it develops in adolescents between the ages of 10 and 15. Juvenile scoliosis occurs when spinal curvature develops in children under the age of 10. Adult onset scoliosis, or degenerative scoliosis, most often develops in adults over the age of 60. Degenerative scoliosis can be caused by a gradual deterioration of discs from a lifetime of wear and tear. While adolescent scoliosis occurs equally among both genders, females are eight times more likely to progress to a degree serious enough

May 6, 2014

Advancements in Robotic Spine Surgery: Weighing the Pros and Cons

There are incredible achievements happening in technology and science every day, especially in the world of spinal surgery. One of the most recent developments in spine surgery, using robotic technology in the operating room, has been up for debate among surgeons and spinal specialists, and I’ve been considering the pros and cons of these new treatment options myself. Robotic surgery is considered a minimally invasive procedure in which the surgeon controls the camera and instruments using a console. The surgeon operates the robot while looking through a monitor that allows him to see inside the patient. Every movement made by the surgeon is mimicked by the robot, allowing for unprecedented control, precision, and access to the human body. Numerous studies have shown the advantages of robotic technology and the implications it has for the future of medicine. Overall, the average length of hospital stay for patients undergoing robotic surgery was reduced by 27 percent, and complication rates were reduced by 48 percent. A recent study published in Head and Neck Oncology shows that a robotic arm can reduce unavoidable tremors in the human hand by filtering out hand movement. And finally, robotic technology is ergonomically desirable, allowing cosmetic benefits

February 19, 2014

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