Orthospine Academic Presentations

Orthospine.com is an educational resource that includes books, articles, academic presentations and more more. Below is a list of our Academic Presentations.

Academic Presentations

The following presentations are talks given at the indicated meetings, you can see the actual slides by clicking on the title.

1. Idiopathic Scoliosis in the pediatric population. Frank J. Schwab, Jean-Pierre C. Farcy. Pediatric Symposium, Maimonides Medical Center, January, 2001

2. Congenital and Neuromuscular Scoliosis. Jean-Pierre C. Farcy, Frank J. Schwab. Pediatric Symposium, Maimonides Medical Center, January, 2001

3. Pain Predictors in Adult Scoliosis: a quantitative radiographic and clinical analysis. Schwab, F.J.; Gamez, L.; Levine, E.; Farcy, J-P.; Strongwater, A.: Annual Meeting of the Scoliosis Research Society. San Diego. September, 1999.

4. Revision Surgery in Adult Scoliosis; Jean-Pierre C. Farcy, Frank J. Schwab; Contemporary Insights in Spine Surgery, Conference, New York City, NY December, 2000

5. Degenerative Lumbar Spine: Circumferential Treatment: Posterior Route - TLIF; Frank J. Schwab, Jean-Pierre C. Farcy; Contemporary Insights in Spine Surgery, Conference, New York City, NY December, 2000

6. Schwab, F.; Farcy, J-P.; Berven, S.; Bridwell, K.; Ferguson, M.; Glassman, S.; Harrast, J.; Horton, W.: A comprehensive clinical impact classification for Adult Scoliois. Spinal Deformity Study Group meeting San Diego, CA. April, 2005

7. Schwab F, Farcy JP, Bridwell K, Berven S, Glassman S, Harrast J, et al. A clinical impact classification of scoliosis in the adult. A multi-center clinical and radiographic analysis. SRS 2005, October 27-30, Miami, Florida, USA.

8. Virginie Lafage, F. Schwab, F. Rubio and J. P. Farcy. "Impact of sagittal plane spinal deformity on the spino-pelvic relationship and gravity line position in adults." Scoliosis Research Society, Monterey, CA. (2006)

9. Frank Schwab, J.P. Farcy, K. Bridwell, S. Berven, S. Glassman, W. Horton, M. Shainline. " Surgical treatment analysis of 809 thoracolumbar and lumbar major adult deformity cases by a new adult scoliosis classification system". International Society for the study of the Lumbar Spine, Bergen, Norway. (2006)

10. Schwab F: When to operate on Adult Scoliosis patients and when to say No. SRS Course September 13-16, 2006 - Monterey, California

Orthospine.com

Orthospine.com

This is an educational site developed for the understanding of spinal problems and back pain. Get top level, unbiased information from leading experts. Get the inside story about conditions such as a degenerative spine conditions like spinal stenosis, or malalignment issues such as flatback or spondylolisthesis and deformities like scoliosis including idiopathic scoliosis and congenital scoliosis and malformed vertebrae resulting in kyphoscoliosis. See the pros and cons of undergoing spine surgery and other procedures such as spinal fusion. Find out how disc surgery on a herniated disc can change the way you live. Discover what treatment may be available for failed back surgery, what to expect from revision spine surgery, and the role of minimally invasive spine surgery. These top New York City doctors have the authoritative answers to your back pain questions right here. Get your questions answered now. It's time to ask the doctors...

Frank J. Schwab, M.D. and
Jean-Pierre C. Farcy, M.D., F.A.C.S.

Visit our main web site at Orthospine.com

Non Operative Care - Functional Restoration

FUNCTIONAL RESTORATION

As part of non-operative care, your physician may prescribe a program of physical therapy or exercises. The purpose of such treatments is usually to assist you in restoring muscle tone and muscle strength. The muscular supports of the spine are crucial to maintaining good function and stability of the back. With aging, injury or underlying spinal problem it is very common for the back musculature to become weakened, with diminished tone and easy fatigability. In fact, poor muscle condition can be a significant source of disability and pain itself.

Physical Therapy
The principle to most physical therapy approaches in spinal conditions is twofold: pain modality treatment (as described above) and structured guided strengthening programs for restoring good muscle function. There are many different types of exercise programs and particular focus on isometric strengthening appears to be quite beneficial for many patients. Isometric exercises involve activities that stimulate contraction of a muscle (working the muscle) while maintaining the length of that muscle (ie. no significant motion across the span of the muscle). Vigorous movements or extremes of motion are often avoided in physical therapy approaches to spinal care.

Exercise
Most patients that see benefit with a physical therapy program are advised to maintain some form of regular exercise on a long-term basis. Even patients with mild or intermittent back pain and no severe underlying problem can receive benefits with regular exercise. A number of studies have shown that regular aerobic activity reduces the chance of developing repeated back injuries. Clear advantages of one type of sport over another have not been shown and it therefore may be most important to find some activity that is enjoyable and easy to maintain on a regular schedule (ex. swimming, fast walking, running…).

Visit our main web site for more articles on Non Operative Care

Non Operative Care - Bracing

BRACING

There are a wide variety of collars, binders, belts, braces and other devices designed to offer relief from neck and back pain. Their effectiveness in most cases has not been clearly proven, and yet many patients do feel some relief from their pain with some of these applied devices. Long-term wear of back braces may however lead to gradual weakening of the supportive muscles due to an effect of unloading and may therefore not be desireable.

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Non Operative Care - Treatment of Pain

TREATMENT OF PAIN

Back pain is the third most common reason for patient visits to physicians' offices, and affects up to 80% of the adult population at some time. The precise cause of low back pain is poorly understood and only 10-20% of all patients have their pain attributed to an accepted, definable diagnosis. In the majority of cases low back pain tends to disappear with time. In about 90% of patients symptoms resolve within 3 months of onset.

True low back pain is defined as pain located between the lower rib cage and the buttocks. This pain may occasionally extend down to the level of the knee but not beyond. If back pain is associated with numbness, tingling or weakness in the legs then it is possible that irritation of neurologic structures is present (see herniated disc, spinal stenosis). Leg pain with symptoms that extend to the feet is thus usually a separate condition from back pain and may require a different treatment program than for back pain alone.

Conservative treatment (non-operative) for back and leg pain varies greatly depending upon the cause and severity of the pain. There are a number of common treatment approaches available including the following:

Medications — Pain Management

This is a brief outline of common medications that are prescribed by a physician as part of the treatment in back or leg pain. A thorough evaluation and discussions with a physician are necessary to properly guide treatment. It is important to note that any medication can lead to allergic reactions or side effects, this must be discussed in detail with the prescribing physician and pharmacist.

See a listing in the Medication Index

Anti-inflammatories - this is a group of medications which specifically aim to decrease inflammation in tissues, they can be quite effective in mild and moderate pain. Side effects (aside from allergic reactions) may include: stomach upset, gastritis, ulcer problems, kidney and liver problems.

Analgesics - this group of medications aims at reducing the sensation of pain without any specific action at the source of the pain. In a sense, this covers, or dampens the pain feeling but does not actually treat the site of the problem.

Muscle relaxants - these medications aim to loosen the tension and irritability of muscle tissue. By relaxing a very tense muscle, the pain due to spasm and cramping can be reduced. Some patients become very drowsy with these medications.

Combination drugs - these combine different types of medications to offer, for example, pain relief and anti-inflammatory effects.

Narcotics - these are pain medications, which are quite strong, and act on the brain and spinal cord to decrease the sensation of pain. Due to addiction potential and risks of overdosage, these medications are restricted in use and require special prescriptions from a physician.

Antidepressants - in some cases mild doses of antidepressant medication may offer added relief from chronic pain and nerve related pain.

Visit our web site to read entire article.

Orthospine.com - Treatment of Pain

TREATMENT OF PAIN

Back pain is the third most common reason for patient visits to physicians' offices, and affects up to 80% of the adult population at some time. The precise cause of low back pain is poorly understood and only 10-20% of all patients have their pain attributed to an accepted, definable diagnosis. In the majority of cases low back pain tends to disappear with time. In about 90% of patients symptoms resolve within 3 months of onset.

True low back pain is defined as pain located between the lower rib cage and the buttocks. This pain may occasionally extend down to the level of the knee but not beyond. If back pain is associated with numbness, tingling or weakness in the legs then it is possible that irritation of neurologic structures is present (see herniated disc, spinal stenosis). Leg pain with symptoms that extend to the feet is thus usually a separate condition from back pain and may require a different treatment program than for back pain alone.

Conservative treatment (non-operative) for back and leg pain varies greatly depending upon the cause and severity of the pain. There are a number of common treatment approaches available including the following:

Medications — Pain Management

This is a brief outline of common medications that are prescribed by a physician as part of the treatment in back or leg pain. A thorough evaluation and discussions with a physician are necessary to properly guide treatment. It is important to note that any medication can lead to allergic reactions or side effects, this must be discussed in detail with the prescribing physician and pharmacist.

www.Orthospine.com is the number resource online for questions about Flatback, scoliosis, adult scoliosis, spinal stenosis, revision spine surgery, and non operative care.

Herniated Disc - Orthospine.com - New York, NY

Herniated Disc- Orthospine.com

The spinal canal is like a tunnel which runs down the entire length of the spine from the skull to the sacrum (portion of the pelvis). This canal sits directly behind the bony blocks which make up the spine (vertebrae) and contains the nerves (spinal cord and nerve roots) running from the brain to all areas of the body. When something causes a narrowing of this canal then the nerves can become irritated or squeezed. This can lead to a variety of symptoms ranging from tingling, numbness, and weakness to severe pain and paralysis. Common conditions which can narrow the spinal canal include a herniated disc (often called a slipped disc), fracture of the spine, tumor, infection and degeneration (spinal stenosis). The intervertebral disc is a complex spongy structure which consists of a central sticky gelatinous portion (nucleus pulposus) and an outer fibrous ring of tissue (annulus fibrosus). These discs are found along the entire spine from the neck all the way down to the lowest part of the back. The function of this disc is to permit motion of the spine while also acting as a shock absorber and a connecting link between the vertebrae. With aging this disc gradually looses some of its height and sponginess (decreasing water content). This explains partially why people shorten with aging. Young adults (20-45 years) are at risk for the disc to loose its normal structure and develop tears in the annulus fibrosus. Although injuries may cause disc problems, in many cases no direct trauma is responsible for disc problems. When a disc begins to deform or a portion of the nucleus pulposus squeezes through a disc tear, then a bulge into the area of the spinal canal can develop. When a disc is noted to bulge into the area of nerves, this can lead to irritation of the nerves and is commonly called a "slipped disc". Nerve irritation may result from chemical irritation of the disc material in addition to compression from the disc itself. If an actual piece of disc separates off from the remainder of the disc and sits freely in the spinal canal, this is called a disc extrusion or sequestered disc fragment. The symptoms from a disc herniation or extrusion will depend upon a number of factors including: size of disc herniation/extrusion, the location, the amount of room for the nerves, the time course?The type of symptoms can vary from numbness, tingling and pain (in arms or legs) to bladder and bowel dysfunction, weakness and even partial paralysis (in arms and legs). Treatment of a herniated disc must be individualized to each patient and is dependant upon the size and type of disc herniation as well as symptoms and degree of nerve irritation or dysfunction. Most herniated discs will not cause severe problems and most symptoms will improve with time and do not require surgical treatment. Unfortunately, in a small group of patients the herniated disc continues to cause significant pain and disability. In those patients surgically removing the offending piece of disc material (a discectomy) can be very successful in removing pain. Prior to considering surgery a thorough examination and several test are essential to clearly identify the problem. Common tests include MRI, CT scan, myelogram and plain X-rays. A decision to operate should only be made after careful consideration of the different treatment options as well as the risks and benefits associated with the procedure. It should be noted that even in the best of hands, a severe nerve irritation due to a disc problem may cause permanent problems. Furthermore, after a discectomy, another portion of disc material may come out from the treated disc at some later time causing a recurrence of symptoms.