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Minimally Invasive Spine Surgery

MCR — Wed, 24 Feb 2010 22:31:41 +0000

By Dr Fong Shee Yan

Surgery on the spine that once required large incisions, hours in the operating room and extensive blood loss, can, in some cases, be done through an incision less than an inch long.

After the common cold, back and neck pain are the second most frequent reason that Americans visit the doctor, according to the North American Spine Society. Treatment of low-back pain alone costs Americans at least $50 billion each year and is the most common cause of job-related disability and a leading contributor to missed work.

Minimally invasive spine surgery, for the right patient, can make the sometimes difficult decision of whether to undergo surgery a little easier. In traditional spine surgery, a surgeon has to make a large incision and dissect several layers of muscle to access the area of the spinal column he or she is trying to correct. The injury caused by cutting through this muscle and tissue significantly adds to a patient’s recovery time after surgery. In some cases, it can leave long-lasting weakness in the back muscles. Minimally invasive techniques limit injury to surrounding muscle and tissue without compromising results.

A vivid example is a procedure called endoscopic lumbar microdiscectomy, which is used to treat a ruptured or herniated disc in the lower back. The bulging disc compresses nerves in the spine, causing disabling leg pain. Traditional discectomy requires lengthy incisions and the stripping of several levels of muscle to give the surgeon a good view of the area where the disc material compressing the nerve needs to be removed. Now, microdiscectomy can be done through a two-cm incision. A tube is inserted through the incision, creating a tunnel for the surgeon to reach the affected disc with a microscope and surgical instruments with minimal blood loss (Huang 2004, J Orthop Res 23: 406-11). Patients typically can go home the same day or next. This is achieved as post-operative pain is significantly reduced and these often young working adult patients can return to work early. In fact, the average number of disability days was reduced from 49 to 27 days (Hermantin 1999, JBJS 81: 958-65).

Dr. Fong Shee Yan

Qualifications

M.B.B.S, Masters of Medicine (Orthopaedic)
Fellow of the Academy of Medicine, Singapore
Fellow of the Royal College of Surgeons

Professional Highlights

Dr. Fong is a practicing Consultant Orthopaedic Surgeon with Island Orthopaedic Consultants.
Set up Singapore’s first day surgery spine service in Tan Tock Seng Hospital
Winner of the Prestigious N Balachandran Award for Outstanding Orthopaedic Trainee (Singapore Orthopaedic Association)

Other spine procedures that now may benefit from minimally invasive approaches include: lumbar fusion to correct back and radiating leg pain caused by spondylolysis, a defect or fracture of the wing-shaped parts of a vertebrae in the lumbar region or lower back. The fusion procedure, which traditionally required an incision that exposed the vertebrae, can now be done through incision an inch long. Similarly, the rods and screws that hold the spine in place while the fusion heals can be inserted via multiple small incisions even less than an inch. Thoracoscopic instruments — tools that aid in visualization and operation through portal holes in the chest — allow a surgeon to address part and, in some cases, the whole correction of a patient with scoliosis. During kyphoplasty to treat painful vertebrae fractures caused by osteoporosis, the surgeon makes two small incisions and inserts a tube in the centre of the vertebrae. Cement is injected into the weakened vertebrae, creating almost immediate pain relief.

Minimally Invasive Spine Surgery is a post from: Musculoskeletal Consumer Review

Knee Ligament Anatomy Animation

Admin — Wed, 17 Sep 2008 11:58:04 +0000

This is an excellent animation showing the four key ligaments in the knee and their functions in holding the knee joint together.

video

source: MGH Sports Medicine Service

Knee Ligament Anatomy Animation is a post from: Musculoskeletal Consumer Review

I keep getting stress fractures. Why?

Admin — Fri, 15 Aug 2008 01:16:44 +0000

This question was posed to Dr. Lewis G. Maharam. Often getting to the bottom of a problem is about asking the right questions. His answer covered the basic questions that one should ask for recurring stress fractures.

I am experiencing my fifth stress fracture in two years. First my right tibia, then my left hip, my right tibia, and now my fourth metatarsal. I heal fine; my doctor has me rest for eight weeks, and then I go back to run and another problem occurs. I work up slowly to 40 miles per week and then bam!… another stress fracture! Why does this keep happening to me? – Jennifer V., Little Neck, NY

Read about Dr. Maharam’s basic questions here.

Dr. Lewis G. Maharam is the world’s premier running physician. He is medical director of the New York Road Runners, ING New York City Marathon, all of Elite Racing’s Musical Marathons, and The Leukemia & Lymphoma Society’s Team in Training program. Dr. Maharam also serves as Chairman of the Board of Governors, International Marathon Medical Directors Association.

I keep getting stress fractures. Why? is a post from: Musculoskeletal Consumer Review

Mind and Body (III) – Imagination and Self Talk for Sports Injury Rehabilitation

MCR — Fri, 01 Aug 2008 00:30:00 +0000

In the past article in this series, Mind and Body (II) – Mental Goals for Sports Injury Rehabilitation, we looked at goal-setting. Goal-setting is the crucial first step and is the psychological foundation for faster injury recovery. To aid you in achieving your goals, we will look at two other supporting psychological factors – Mental Imagery and Positive Self-Talk. We will cover these two factors along with concrete take-away suggestions and examples that a recovering athlete can use.

Mental Imagery

Mental imagery is the process of using the imagination to rehearse, imagine or replay situations in the "theatre of the mind". Sometimes also known as mental rehearsal, it helps athletes anticipate and deal with the challenges of rehabilitation and to enhance the healing process.

Photo by: tom.snaps

Studies found that athletes that "tried to see or feel their body heal" or "imagine themselves fully recovered and performing their sports again" recovered faster than if they don’t excessively replay their injury.

Levleva and Orlick (1993) suggested this summary of imagery application during rehabilitation to improve the rehabilitation process:

Visualizing the healing taking place to the injured area internally.
Visualizing effectively moving through specific motions and situationsthat put the most demand on the injured area.
Re-experiencing or imagining individual skills required for best performance – to stay sharp mentally.
Calling up the feelings that characterize best performances.
Visualizing returning to competition and performing at one’s best.
Engaging in imagery that involves feeling positive, enthusiastic, and confident about returning to training and competition.

Positive Self-Talk

It is not uncommon to find many athletes having a tendency to dwell on negative or irrational thoughts and beliefs about themselves, their injury, or their return to performance. Performance in sports afterall in part lies in the confidence that the athletes have in themselves. Positive self-talk is the process by which the athlete’s negative thoughts are redirected into positive, task oriented thoughts and affirmations that can help provide direction and motivation to the rehabilitation process.

Researchers Ievleva & Orlick (1991, 1993) provides us with some examples of positive self-talk statements from the fast healing group:

I can do anything.
How can I make the most out of what I can do now.
I can beat this thing.
I told myself “I can do it”. I can beat the odds and recover sooner than normal.
I want to go spring skiing. I will be totally healed by then.
I have to work to get my leg as strong as the other one.
It’s feeling pretty good.
It’s getting better all the time.

In contrast, the slow-healing group will likely to say the following to themselves:

It’s probably going to take forever to get better.
I’ll never make up for the lost time.
Talked to myself about how frustrated I was, and that it would probably take forever to get better
What a stupid thing to do. – Dumb mistake. [tied with excess imagery replay of injury]
What a useless body.
It will never be as strong again.
Stupid fool! Stupid injury. Stupid leg.
I talked to myself about how frustrated I was. There is nothing good about this and there is nothing I can do about it.
Why me?

Reference:

Ievleva, L., & Orlick, T. (1991). Mental links to enhanced healing: An exploratory study. The Sport Psychologist, 5, 25 – 40.
Ievleva, L., & Orlick, T. (1993). Mental paths to enhanced recovery from a sports injury. In J. Heil (Ed.), Psychology of Sport Injury (pp. 219 – 245). Champaign, IL: Human Kinetics Publishers.

Adapted from a technical paper contributed by Poh Yu Khing, a sports and performance psychologist. Poh Yu Khing was formerly the Head of Sport Psychology at the Singapore Sports Council. An ex-national badminton player, he has also taken part in small endurance events such as the half-marathon and mini-triathlons. In his spare time outside of his day job, he enjoys consulting with athletes and performers as a freelance sports & performance psychologist. He was also the author of a regular “Golfing Mind” column in the local GOLF magazine.

Mind and Body (III) – Imagination and Self Talk for Sports Injury Rehabilitation is a post from: Musculoskeletal Consumer Review

Understanding Muscles and How They Contract

MCR — Sun, 27 Jul 2008 01:55:06 +0000

The animation below explains the structural components of skeletal muscles and the mechanism by which they contract.

This animation resource is linked from www.brookscole.com

Understanding Muscles and How They Contract is a post from: Musculoskeletal Consumer Review

Mind and Body (II) – Mental Goals for Sports Injury Rehabilitation

MCR — Thu, 24 Jul 2008 08:15:58 +0000

In the previous article in this series, Mind and Body (I) – Psychological Factors for Sports Injury Rehabilitation,we took a broad overview of the various key psychological factors crucial in enhancing an athlete’s recovery from injury. One of the key factors, goal-setting, was distinct from the other four factors was that it formed the bed-rock on which the rest work off. Without goals, the other factors cannot help drive the athlete in the desired direction and rate of recovery.

Goal-setting is de-rigour in sports training. We aim to swim a little faster by a certain time or jump a little higher in clear, discrete measurable steps. The same works in rehabilitation when recovering from an injury. Perhaps more than anything else, it provides the injured athlete with a sense of control and enhance motivation, persistence and committment.

How does setting goals benefit?

Photo: Lachlan Hardy

Systematic goal-setting gives an athlete an active role in the healing process helping increase self-confidence. It also helps reduce anxiety by focusing the athlete on what needs to be done. Research by Bull, Albinson and Shambrock¹ recommended small but significant daily goals works best to ensure motivation and confidence remain high to enhance the healing process.

The following are guidelines for goal-setting in injury rehabilitation as suggested by Wayda, Armenth-Brothers, & Boyce²:

Goals should be meaningful to both physiotherapist and athlete.
Goals must be performance – not outcome – oriented.
Goals should be individualized for each athlete.
Goals must be objective and measurable.
Goals must be specific.
Goals must include a criterion for success.
Goals must be realistic but challenging.
Goals should be stated in positive terms.
Progressive short-term goals should lead to a long-term goal.
Goals should have a target for completion.
Goals should be few and prioritized.
Goals should be accompanied by strategies for achievement.
Goals must be recorded and monitored.
Goals must hold athletes accountable.
Goals must be reinforced or supported.

In the next article in this series, Mind and Body (III) – Imagination and Self Talk for Sports Injury Rehabilitation , we will have a look at imagery and self-talk in greater detail.

Reference:

Bull, S. J., Albinson, J. G., & Shambrock, C. J. (1996). The mental game plan: Getting psyched for sport. UK: Sports Dynamics.
Wayda, V. K., Armenth-Brothers, F., Boyce, B. A. (1998). Goal-setting: A key to rehabilitation. Athletic Therapy Today, 3(1), 21 – 25.

Mind and Body (II) – Mental Goals for Sports Injury Rehabilitation is a post from: Musculoskeletal Consumer Review

Mind and Body (I) – Psychological Factors for Sports Injury Rehabilitation

MCR — Sat, 19 Jul 2008 03:04:40 +0000

In the past much of our efforts to rehabilitate an injured athlete focused on the physical causes and their treatment options. It leaves out much of the psychological dimensions of the injury and its rehabilitation. Today, psychological factors increasingly plays an important role in rehabilitation, particularly for sports where there are greater time pressures to return the athlete to optimal peak peformance as quickly as posisble. There are five key psychological factors – goal-setting, imagery, positive self-talk, relaxation and social support – that play an integral role in the recovery process.

Goal Setting

click for larger view

Of the five factors, goal-setting is the most first important in that it must first be established clearly and be in place before hand. The remaining four factors are important in that they aid goal attainment.

Studies have shown that injured athletes using goal-setting exhibit greater performance improvement than those not using goal-setting.

Imagery

Mental imagery is the process of using the imagination to rehearse, imagine or replay situations int he "theater of the mind".

Positive-healing and/or sports performance imagery has shown to be correlated to faster recovery times. Unsurprisingly, negative imagery has the opposite effect. Examples of negative imagery includes replaying the injury scene excessively.

Positive Self-talk

Positive self-talk is the process by which the athlete’s negative thoughts are redicted into positive, task-oriented thoughts and affirmations. Many athletes have the tendency to dwell on negative or irrational thoughts and beliefs about themselves, their injury, or their return to performance. Following injury, positive self-talk techniques are useful to help counteract the problem of low self-condifence in athletes.

Relaxation

Relaxation training is a psychological tool that is recommended for use with injured athletes during rehabilitation in conjuction with the other techniques to relieve pain and stress. Staying loose and relaxed facilitates recovery.

Social Support

Social support systems for athletes include family and friends, and relationships with team-mates, coaches, and the therapists. Social support is believe to be effective in helping the athlete make a better appraisal of their situation (towards a positive imagery) and through the emotional adjustment process.

In the next article in this series, Mind and Body (II) – Mental Goals for Sports Injury Rehabilitation , we will have a look at goal setting in greater detail.

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Mind and Body (I) – Psychological Factors for Sports Injury Rehabilitation is a post from: Musculoskeletal Consumer Review