All posts by b36xc7

Bone Autograft

I know it’s been over a month since I posted a new blog but I had to write something about an article I just read in one of my Orthopedic journals talking about the trends of bone graft and what we can expect in the future.

Let’s face it, as medicine continues to conduct research and we find out more and more about the human body and it’s properties, there’s a fascination for trying to mimic or imitate what Mother Nature has given us.

Take for instance in our discussion of bone and bone properties.  Bone is very dynamic – meaning constantly building and constantly breaking down.  In simple terms, the rate and quality of bone being deposited is largely effected by a number of different factors – these include nutrition status, baseline bone integrity, co-morbid conditions or more simply – underlying medical issues, just to name a few.  All of these variables are put together and this in turn determines how your bone scaffolding will be put down during a fracture, broken bone, or iatrogenic trauma.

There are 3 main types of bone graft.  The first and gold standard (always will be the gold standard) is Autograft Bone – “Auto – meaning your own” bone.  There are multiple different areas to get your own bone from including your pelvis(iliac crest), leg (proximal tibia) and other areas too like your rib or your spine.

AUTOGRAFT = AUTOLOGOUS = AUTOGENOUS BONE

“THE GOLD STANDARD”

Autograft can be taken from a number of different areas called “Harvesting” and can be transferred from the same area of the body to another part of the body.  This graft contains your own body’s proteins, antibodies, and other properties that help to minimize the risk of rejection and can provide a solid ridge of bone especially in spine fusions.

Advantages to Autograft:

It contains osteophytes or bone-growing cells and proteins to help        develop new bone growth.
It provides a calcium scaffolding or matrix for new bone growth to grow on.
There is a greater chance for Spinal Fusion Success versus other substitutes
Minimizes disease transmission and rejection

 Disadvantages to Autograft:

There are few risks associated with autograft and although they are rare, it is worth mentioning that they can sometimes occur.  Mainly, surgical wound problems like infection and depending on the site of harvesting, nerve injury, and sometimes excessive bleeding from the site.

One complaint that I occasionally hear of is about pain at the bone graft harvest site.  This is a subjective measurement of course and there are a certain number of surgical techniques that can used to minimize the amount of pain at the donor site.   It has been estimated that up to 25% of patients will experience temporary discomfort at these sites although the actual number is likely a lot less than that.

Allograft (Cadaver) Bone Graft

Allograft is bone tissue that has been harvested from a cadaver.  This is usually done by very strict regulations and monitoring to ensure the potential risk of disease transmission and in my opinion, lower fusion rates.

It should be noted that allograft bone does provide the calcium scaffolding needed for bone ingrowth but it lacks the bone-producing proteins and growth cells required for new bone growth stimulation.

This in turn theoretically leads to a lower chance of fusion compared to autograft but there are some studies that suggest that it is comparable to the gold standard of autograft.

Bone Growth Substitutes or Commercial Products

This has been an area in spine surgery that is what we call a “hot topic” but it often leads to many unwanted side effects that do not work in favor of spinal fusion like we would hope.  I will admit that there are some times where there it can be advantageous for a surgeon to use these substitutes but in my opinion, nothing is better than your own bone.

As you can tell, I am not a big fan of this category and often like to call this category “Silly Putty” as it is often made of synthetic or naturally-occuring products that have been manipulated to help mimic natural bone.  These agents are usually very expensive and often imitate to a certain degree our own bone.

There are 3 main types or variations to these substitutes and they are:

Demineralized Bone Matrix (DBM)
Synthetic bone graft extenders
Bone Morphogenetic Proteins (BMP)

I only mention these substitutes to let you know that there are alternatives to autograft and allograft bone.    I will not spend much time here on their discussion because these various agents can be discussed for hours sometimes days with often minimal advantages.

For more information, please feel free to send me a comment so that I can further provide you with the information you need.

 

 

First Day of School – Back Packs

Today – marks the first day of Kindergarten for my son.  He’s been looking forward to going to the “big school” and now that day has finally arrived.  I and like most parents, have not been looking forward to this day – as it reminds us of days and milestones being passed….

As I was watching my son get on the school bus today, I couldn’t help but notice the amount of children that had large backpacks, loaded to the gills, pulling them backwards, and thus altering their posture and gaits.

Check out this page on KnowYourBack.Org – brought to you by the North American Spine Society

Back Pack Safety

 

Have a Safe School Year!!

Considering Spine Surgery? Ask These Questions First

While looking through my email, I came upon an article title “40 questions to ask your surgeon before you have spine surgery” and often get asked many of the same questions.

I encourage patients to ask and seek out as much information before any type of surgery whether it be spine surgery, joint replacement surgery, hand surgery, etc. so that they are aware of everything going on from start to finish.

Although this article highlights 40 Questions to ask your surgeon, it ultimately will benefit your current medical condition and outcomes for the procedure.  Just remember to “Do Your Due Diligence”

40 Questions To Ask Your Surgeon Before Your Back Surgery 

Prior Authorizations for Care

A few times a week, I’m on the phone during office hours (and sometimes after-hours) working with insurance companies through pre-authorizations or peer-to-peer reviews advocating for the need and necessity for my patients as to why we need this test or this procedure.

Often, both my patients and myself get frustrated by the way insurance companies and “the system” work to approve or deny these much needed interventions.

Below is a good article from Medical Economics highlighting the process of prior authorizations with particular emphasis on the patient and physician side.  Let me know what you think?

Prior Authorizations Predicament

The New Digital Age

imagesI just read an interesting article about a new coined term called “Digital Immigrants” and “Digital Natives”.   The article highlights many differences between the key date of 1985 with anyone born before 1985 being an “immigrant” and anyone after being a “native”.

I like to think that I’m a digital savvy “digital immigrant” when it comes to devices.  I do have a Facebook page, a twitter account, and a whole bunch of online accounts with every password under the sun.  But what is most interesting to me is the speed at which the natives can speed along through the digital media catalogs without any thought.    I don’t know about you but after a little while of staring at the screen, my eyes begin to see spots. This is when I highly encourage paper articles, tangible objects, and newspapers.

There are some “core”    principles that must be known whether its a generation from 50 years + to our most recent generations.  One of my common examples has to do with The Beatles – I’ll simply ask some of the people in the OR, “who were the 4 Beatles?”  You would be surprised by the results that I get!  Anesthesia usually waits to hear what the answers are and it usually sparks an entertaining discussion.

You can read this article here.  SpineLine

Anyways, hope you enjoy this article as much as I did. 🙂

Top Five Travel Tips for Your Back on Car Trips

Since we are at the height of travel season during these hot summer months, I thought it would be a good reminder to think about your back during long car trips,  especially if you suffer from chronic back pain or have had  previous back surgery.

Below is a list of my Top Five Travel Tips for Your Back on Long Car Trips!

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DRIVING AND SEAT POSTURE

Let’s start with simple things first.  Before you even get in the car, make sure that you have adequate support from your car seat and/or sometimes the necessary lumbar supports or pillows that you usually use.

It is important to note that you should be comfortable enough for the long trips but also that you can SAFELY visualize all directions and operate all of the features your vehicle has to offer.  This can be as simple as be able to adjust the pedals to the right height, appropriate seating posture i.e. sitting up straight, and also being able to simply reach the pedals without putting undue strain on your back where you could potentially introduce a back spasm rending your starting and stopping ability useless.

**Some cars are equipped with heated seats that you may traditionally think of using during the winter months, but they can also come in handy during the summer months too.

WEAR COMFORTABLE CLOTHING 

You would be surprised as to how often in the office as we’re going through why things happened and what triggered your back pain,  that I hear about people having things in the their back pockets i.e. wallets, cell phones, and the occasional sandwich (yes, it’s true!) that caused the back pain.

With all joking aside, this can seriously alter your spine’s alignment and when you add in your driving position for an extended period of time, your body will become accustomed to that position.  Tilting one hip higher than the other can cause issues like this.  As soon as you adjust, the back spasms and pains begin.

I highly recommend you avoid having anything in your pockets, both front and back, to avoid any back pain triggers that may occur.

GET OUT AND “SMELL THE FLOWERS”

Occasionally during my office visits, I’ll hear someone telling me about their trip and that “I made it in such and such hours” from point A to point B.   Although, I’m often surprised that someone can make a trip from New York to Los Angeles by car in 6 hours, that’s usually not a good thing.  Besides obviously speeding or I like to call “flying low”, from a Spine Surgeon’s perspective, this means that you broke a cardinal rule of NOT getting out to walk around and stretch every 1 to 2 hours.

Not only can getting out of the car and giving your back a rest from the long trip, but you can also sometimes discover new things.   One of more iconic discoveries was a large blue whale on Route 66 during a cross country trip a few years back.

BlueWhale-590x421

 Besides, getting out every fews hours on a road trip will allow you to   stretch your back, help circulate your blood (preventing blood clots) and just stopping to “smell the flowers”

STRETCHING

Stretching your back is very important on long car trips.  I’m not talking about getting out and doing a full aerobic routine (but you can if you want to) but rather take a few minutes to  stretch your back so that things remain limber.  It is also usually good practice to stretch before your trip, during your trip, and after your trip.

Usually some variation of forward and side-to-side bending can usually “work the kinks out” of your back.  This can make your trip much more enjoyable and comfortable while simultaneously keeping your back flexible to prevent those unexpected muscle spasms and pain.

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HYDRATION

Staying hydrated on the road is one of the most important things you can do your back as it will feed your muscles with the appropriate amount of fluids it requires.  We often times (I’m guilty of this too) drink lots of coffee or tea during these excursions but the reality is, the caffeine content from these  beverages although provide the stimulation we crave, also can accelerate the dehydration process during these trips.

Try to limit the amount of caffeinated beverages, especially carbonated beverages during these trips.  Water is usually the best remedy for hydration and your body will love you for it!

Consider using these Five Travel Tips for Your Back on Car Trips can go a long way in making your trip much more enjoyable and memorable.  Please be safe in your journeys!