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Spine Center of Miami Spine Center of Miami
The Spine Center of Miami
John C. Nordt, M.D.
Spine Center of Miami Spine Center of Miami
Pain is a symptom…
Not a diagnosis!
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Spine Center of Miami Spine Center of Miami
Diagnosis is the reason for the problem
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Spine Center of Miami Spine Center of Miami
Back pain
80% of population
Resolves in 3 months
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Spine Center of Miami Spine Center of Miami
Causes of back pain
Muscle
Ligament
Disc
Nerve
Bone
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tumor
infection
fracture
instability
Spine Center of Miami Spine Center of Miami
Pain generator
That which causes pain is more clearly understood now…
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Spine Center of Miami Spine Center of Miami
Improved tests clarify source/origin
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Spine Center of Miami Spine Center of Miami
Over zealous physician can push treatment plan without clear
diagnoses
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Spine Center of Miami Spine Center of Miami
History
Back pain?
Leg pain?
Combination? 50/50
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Spine Center of Miami Spine Center of Miami
Positional or postural exacerbation
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Spine Center of Miami Spine Center of Miami
Careful & thoughtful history
• Back Pain?
• Leg Pain?
• Combination?
Spine Center of Miami Spine Center of Miami
Alf Nachemson
Disc Pressure measurements
In the 1960’s at L-3-4
Sitting caused 2-3 x body weight pressure
Spine Center of Miami Spine Center of Miami
• Positional Exacerbation
Back Pain
Leg Pain
Spine Center of Miami Spine Center of Miami
Sitting
Exacerbates
• Degenerative Disc
• Herniated Disc
Spine Center of Miami Spine Center of Miami
Standing
Exacerbates
• Central Stenosis or
• Dynamic Foraminal Stenosis
Spine Center of Miami Spine Center of Miami
Supine
Awaken from sleep with rolling over
Rotation is least stable in spine
with degenerative disc.
Spine Center of Miami Spine Center of Miami
Diagnostic tests
• Selective Foraminal Root Injection
• Facet Injection
• Discography
Spine Center of Miami Spine Center of Miami
Dynamic Examination LS Spine to assess:
• Canal stenosis
• Foraminal stenosis or
• Instability
Spine Center of Miami Spine Center of Miami
Gold Standard
• Standing Flex/Extmyelogram
Spine Center of Miami Spine Center of Miami
Magnetic Resonance Imaging
• Since 1988
• Significant source of information
Spine Center of Miami Spine Center of Miami
Improved resolution of image
• Magnet Strength
• Software
Spine Center of Miami Spine Center of Miami
Diagnosis?
• Degenerated Disc
• Foraminal Stenosis
• PARS Defect
• Central Stenosis
• Lateral Disc or Foraminal Disc
• Herniated Disc
Spine Center of Miami Spine Center of Miami
• If your car won’t start-
• You don’t just change the battery
Spine Center of Miami Spine Center of Miami
False positives with evaluative tests
Are eliminated with Clinical Correlation
Spine Center of Miami Spine Center of Miami
• Abnormal MRI’s in Normal Subjects
Scott Boden, M.D., etal JBJS March 1990
Spine Center of Miami Spine Center of Miami
• 100 normal subjects 17-70 yrs.
• 37% + MRI that would require surgery
Spine Center of Miami Spine Center of Miami
Outline mutually agreed upon expectation of surgery clearly
• Leg pain
• Back pain
Spine Center of Miami Spine Center of Miami
• Incorrect or Incomplete Diagnosis
Discordant Symptom
Spine Center of Miami Spine Center of Miami
Instability of the Degenerative Disc
• Pain with sitting-Relief Standing
• Pain awakens at night
Spine Center of Miami Spine Center of Miami
• Inconclusive Radiologic Criteria
• Therefore need to assess within the clinical context
Spine Center of Miami Spine Center of Miami
Flex/Ext. MRI
• Pain Relief Supine
• Supine MRI
• Demonstrates?
Spine Center of Miami Spine Center of Miami
Back Surgery wonderful tool to help
Spine Center of Miami Spine Center of Miami
• Accurate Diagnosis
• Accurate Surgery
Spine Center of Miami Spine Center of Miami
• Remember:
• A second surgery with clear correctable problem will be successful
Spine Center of Miami Spine Center of Miami
Thank You
SPINE CENTER OF MIAMI