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

Regenerative Cell Therapy

Regenerative cell therapy is a major next step in medical research, with the potential to effectively treat the most complex diseases – including various forms of cancer. Researchers studying regenerative cell therapy look at both how stem cells may be used to replace, repair, reprogram or renew your diseased cells, and at how reprogrammed stem cells may be turned into specialized cells that can repair or regenerate cells. It has the potential to change the outcomes for patients who are left with little time and very few answers. In regenerative cell therapy, function is restored in damaged or destroyed tissues, rather than producing a new organ. This can be done either by intravenously injecting cells into damaged tissue or by inducing self-repair by recruiting from the patient’s own highly functioning tissues. There are a few different types of cells with various effects used in regenerative cell therapy, including: Induced pluripotent stem cells (iPSCs) – Cells that are taken from adult tissue and are genetically altered to behave like an embryonic cell. Embryonic stem cells (ESCs) – Cells that are taken from the inner mass of a blastocyst and have the potential to become any kind of tissue within the body.

February 17, 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

3-D Printing in Spinal Surgery

In spinal surgery, advancements in technology and medicine have given doctors new ways to combat conditions affecting the human body. Minimally invasive procedures use small incision for less complex procedures; in robotics, surgeons use robotic arms to carry out a minimally invasive procedures with potentially more accuracy. So what about 3-D printing? Technically, it’s been around since the 1980s, but hasn’t been used in medicine until recent years. Commonly used to support or replace body parts that don’t enter the bloodstream, 3-D printing has the ability to fabricate prosthetic limbs, layer by layer, from the ground up. What is 3-D printing? What is 3-D printing? In medicine, 3-D printing, also referred as additive manufacturing, is the process of using plastic or metal gel to shape a replacement body part based on a patient’s MRI or CT scan. 3-D printing is allowing prosthetics to be produced and personalized in complex shapes including hands and fingers. No longer will these devices cost thousands of dollars, removing much of the financial burden patients and their families may face. “If a parent wanted to purchase a 3-D printer of their own and produce hands for their own child, the cost of the printer and

January 27, 2015

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

Pregnancy and Back Pain

We’re still in the throes of a frozen winter – which just so happens to be a very popular time to conceive. If you’re pregnant or considering it, there are a few things to be aware of when it comes to your back and spinal health. Women who have experienced chronic back pain or other spine issues and are hoping to become pregnant should visit a spine first. Chronic spinal conditions can worsen during pregnancy due to increased mechanical stress and hormonal changes. This sometimes requires prolonged bed rest toward the end of gestation, or occasionally surgery during the pregnancy. Even if you’ve never experienced major back pain, according to a 2004 study, more than two thirds of pregnant women reported suffering from lower back pain at some point after the first trimester. And it’s no wonder: with weight gain and a surge of hormones relaxing the ligaments in the pelvis, pregnant women often experience strain on their lower back muscles. There are a number of ways to reduce pain by preparing for back strain during pregnancy. 1. Practice perfect posture. As your center of gravity changes, it can be difficult to keep good posture in mind, but slouching is

February 11, 2014

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