Four Questions to Ask Before Spine Surgery

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If you’ve been told you need spine surgery, it’s smart to get a second opinion. Here are questions to ask any surgeon to help decide where to be treated.

Q: Do they have spine surgery specialists?

A: “For any problem, you want a team that specializes in that surgery, because more experience leads to better success rates,” explains Christopher J. DeWald, MD, spine surgeon. “At Midwest Orthopaedics at Rush, we have the largest team of neck, back and spine specialists in the region. And our surgeons are leaders in their field, teaching the techniques and procedures we have helped pioneer.”

Q: Do they offer less invasive options?

A: “Two-thirds of patients who come here expecting surgery, do not end up having surgery,” says April Fetzer, DO, physiatrist. “At Midwest Orthopaedics at Rush, we have experts in non-surgical alternatives, including injections, pain medicine and rehabilitation options. And, if surgery is needed, many of our spine surgeries are done minimally invasive, because our surgeons invented techniques used throughout the world.”

Q: How experienced are they at this procedure?

A: “Once you know the type of procedure they recommend, the next question is how many have they done?” asks Frank M. Phillips, MD, spine surgeon. “Spine surgery teams at Midwest Orthopaedics at Rush perform the same type of surgeries day in and day out. In fact, no spine surgery team in the region has more experience. And for surgery- especially complex surgeries—the more experience the better.”

Q:What are their success rates?

A: “Hospitals and surgeons are required to report their success rates for every surgical procedure,” explains Kern Singh, MD, spine surgeon. “So, it’s important to ask your surgeon about his or her success rates. The spine surgeons at Midwest Orthopaedics at Rush are very experienced and our success rates are among the best in the country. Which is one of the reasons why the orthopedic program at Rush is ranked among the nation’s best by U.S.News & World Report.”

The section of spine, back, and neck surgery at Midwest Orthopaedics at Rush is comprised of board certified orthopedic doctors, physician assistants and registered orthopedic nurse specialists. Together, this team of leading experts can help diagnose, evaluate and treat patients with varying degrees of neck pain and back pain. Our spine doctors are among the best in Chicago—and the nation—and can help relieve your neck pain or back pain.

5 Reasons Why Outpatient Spine Surgery Is Here To Stay From Dr. Kern Singh

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Dr. Kern Singh, co-founder of the Minimally Invasive Spine Institute at Rush in Chicago, recently penned an article on the safety of outpatient spine surgery for Vertebral Columns, a publication of the International Society for the Advancement of Spine Surgery.

The article responds to a USA Today and Kaiser Health News article highlighting the risk of cervical hematoma after outpatient spine surgery, among other potential complications after outpatient surgery. Here are five key points.

1. As technology advances, it has become safe to perform more complex spine surgeries in the outpatient setting, which is typically a lower cost setting. “Outpatient surgery centers are more easily accessible than large facilities, and the streamlining of services allows for maximum efficiency and minimal wait times,” he wrote. “These advantages have led to outpatient surgery centers achieving an overall patient satisfaction rate of 92 percent.”

2. Spine-focused ASCs have staff who are trained in outpatient spine surgery and focused on providing the high quality care for patients.

3. Complications are a concern for surgeons regardless of the operative setting, but especially for the outpatient setting because the staff are not equipped to handle a life-threatening complication. ASCs and surgeons should have an action plan to transfer patients to the hospital quickly if there are signs a complication occurred.

“Though rare, a cervical hematoma can develop in the first few hours after surgery,” wrote Dr. Singh. “For this reason, patients in the outpatient setting are monitored closely during the immediate postoperative period so emergent treatment can be initiated if needed.”

4. Dr. Singh cited an article published by McClelland et al., showing complication rates among outpatient cervical fusion patients from 1996 to 2016. The complication rate was 1.8 percent and mortality rate was 0.1 percent, much lower than up to 5 percent rates that have been associated with hospital-performed cervical fusions.

5. According to Dr. Singh, most ASCs where surgeons perform outpatient spine procedures are owned and operated by hospitals or health systems; however even among centers owned by surgeons, the surgeons have an obligation to prioritize patient safety.

“Surgeons must rigorously assess a patient’s eligibility for outpatient surgery, as pre-existing conditions may put patients at a higher risk for complications,” he wrote.

He argues that surgeons who are proficient in outpatient spine techniques and responsible patient selection can safely perform the appropriate procedures in the ASC and achieve high patient satisfaction as well as positive outcomes.

Hitting the Slopes? Consider these Expert Recommended Safety Tips

By: Brian Rog and Laura Waller, ATC, LAT for ATI Physical Therapy

Hitting the Slopes? Consider these Expert Recommended Safety Tips

Gasping that brisk winter air as your snowboard seamlessly rips through that freshly-packed powder at supersonic speeds sounds fun, right? Few would argue, but a lesser attractive reality of high-risk winter sports like snowboarding and skiing is assumed well before these euphoric moments on the slopes.

Regardless of skill level, it’s important to know that while activities like snowboarding and skiing vary in technique, they both demand superior agility, strength, balance, response time and endurance. For those thrill seekers destined to conquer the mountain, failing to fuse these physical requisites into your day can land you in serious trouble.

Anyone who’s navigated the slopes, will tell you that the inherent dangers on the slopes can be minimized with a bit of knowledge and preparation. Looking at this deeper, a rider’s physical aptitude, gear and body mechanics such as stances and riding styles ultimately decide a day’s outcome.

Injuries during or after a day on the slopes can happen to anyone, but with a few simple measures, you can consciously assume control of your adventure and work to lessen these risks. As with any sport, the levels of risk, set against reward, teeters on your willingness to establish and commit to a routine.

Common ski and snowboard injuries

It should come as no surprise that within the ATI clinics, injuries credited to skiing typically involve hip arthritis, hip labral tears, and ACL/MCL sprains and tears (knee injuries account for 30 percent of all skiing injuries). Since these areas of the body endure the most load and changes in motion, a blunder in form or technique puts the lower extremities at increased risk.

With snowboarders, since the motions and stances are fundamentally different than skiing, our clinicians see more wrist and back injuries than any other ailments. When a boarder falls, instinctively, the hands are used as a first line of defense to break the fall, ultimately resulting in a fracture or sprain.

With back injuries, this comes with its own grouping of challenges. Since both feet are anchored to the board, you see a lot of falling either directly on the butt or on the stomach, which lead to a menu of conditions.

We are also seeing an increase in tendonitis among snowboarders because of the hopping required just to get moving down the slopes.

And the final, most overlooked ailment, is a concussion. As CTE (Chronic Traumatic Encephalopathy) gains attention among the athletic community, skiers and snowboarders are learning they are also not immune to the effects of this disease. Given the high speeds involved in the sport, that soft, snow-covered surface can wreak major havoc on the body upon impact. While a helmet can help protect the brain from a major impact, it may not completely defend against a concussion.

One final thing to note is that for skiers and boarders who have successfully rehabbed an injury, overuse injuries (specifically of the lower extremities) are leading to more chronic instability. With this, it’s important to recognize the risks and preventive measures to take. You can always reach out to your nearest ATI clinic for next steps in care and assessment.

Leading contributors to ski and snowboard injuries

Injuries in both disciplines commonly result from improper form, fatigue or acting outside your limits – like taking on a more advanced slope. With improper form, weaknesses among certain muscle groups tends to occur, resulting in injury. Conditioning the larger muscle groups is not enough for these sports – it’s important to work on the smaller, more stabilizing muscles to retain peak performance.

Balance is also an important factor. The more stability and body awareness you have, the better your form, and the lower your chances become for muscle soreness and strains.

Ski and snowboard safety gear to consider

Above all else, the most important item to wear when skiing and snowboarding is a helmet. To be most effective, the helmet must be intended for snow sports – not biking, skateboarding, rollerblading, etc.

With the appearance of major concussions and probability of CTE, the industry has stepped up in big ways to produce helmets aimed at protecting the brain from major traumas. Of these advancements, most companies now manufacture helmets that feature the innovative Multi-Directional Impact Protection System (MIPS), which helps to protect against rotational motions transmitted to the brain from angled impacts to the head. So when choosing a helmet, make sure it is MIPS-equipped.

When considering braces and padding, it’s important to remember that while snow is relatively soft, it can still be unforgiving. With this, our specialists recommend wearing knee guards or braces, back protectors, wrist guards and protective shorts to support and cushion the impact of a fall. These items will also help to shield areas of the body that are most susceptible to injury.

Muscle groups deserving attention before hitting the slopes

Stretching before a day on the slopes can be the difference between a more agile and flexible ride or a more stiff and strenuous one. When stretching, be sure to focus on your hamstrings, IT band, hip flexors, calves, glutes, ankles, back and neck. These stretches should be done as dynamically as possible.

More specifically, consider incorporating squats, lunges, side lunges, hip rotations, upper body rotations, donkey kicks and fire hydrants. These exercises target mobility and flexibility, which help to support function, form and performance. If you have your own warm up routine that focuses on the areas of the body listed above, but doesn’t follow our suggested exercises, no problem – stick with it.

If you are planning a full day on the slopes, a good rest period should entail increments amounting to at least two hours. Taking enough time to make sure you can refuel your body correctly with food and possibly a nap (not to mention hydration) will give your body the recharge it needs. Most resorts have a lodge to set your equipment and an area to snack and rest.

A recommended ratio would be 3:1 hours of activity to rest. For those who only spend a few hours on the slope, just be sure to incorporate, at minimum, several 30-minute rest periods.

Stretching after a day on the slopes

You are exhausted, sore and fatigued, and the last thing you want to do is demand more of your muscles. But if you want to reduce soreness in the hours and days to come, stretching after a day on the slopes must be a priority. This will help maintain your mobility and ease muscle soreness during the recovery period.

In doing this, we recommend using a foam or handheld roller and rolling out the lower body to help loosen your muscles and reduce tissue tension. Rolling out to get the massage effect before stretching will allow for a deeper, better stretch. It’s also beneficial to take a warm shower after you roll out as it’ll help to complement your rolling efforts. After a shower is the best time to incorporate your stretches because that is when the deepest stretches will occur due to increased blood flow and muscle warmth.

If these options are readily accessible, just make sure your program targets the hamstrings, calf muscles, glutes, spine, rotators, quadriceps, and thighs. ATI specialists encourage people to stretch out what they feel like they need to stretch out after any activity, but given the lower body demands of these two activities, the lower body takes a lot of strain, so more emphasis is placed on that area.

Recover like an Olympian

Recognizing and assessing an injury is the first step in ensuring a speedy and effective recovery. Most individuals are led to believe that surgery or opioids are their only lines of defense when dealing with an injury. Instead, consider physical therapy as a first course of action, even if it’s only a screening, which are complimentary at all ATI locations. Recent research suggest that people who underwent physical therapy enjoyed faster recovery and less pain than those who chose alternative routes such as surgery and opioids. Give PT a try!


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Cindy suffered from spinal stenosis, a condition causing the open spaces in the spine to narrow, which can put pressure on the nerves. The condition can cause pain, numbness and muscle weakness. She already endured one spinal surgery, but it didn’t correct the issue.

“The spinal stenosis greatly affected my life,” she said. “I had to lay down most of the day, and still was in incredible pain, even though I was on pain medication. I had no quality of life.”

She was unable to work or do many things without help. Because the pain was so severe, she underwent a second spinal fusion procedure.

During the surgery, her doctor used cancellous chips, a type of bone allograft that can be used in a variety of orthopedic procedures.

“The recovery following surgery was difficult, but it was all worth it in the end,” Cindy said. “I went from being unable to function to being able to do anything I want to do. I have no pain and no limitations.”

After her surgery and recovery, Cindy took time to reflect on what it meant to receive donated human tissue in the procedure.

“I feel incredibly blessed that a donor was available to help me in this way. I am sorry someone lost their life, of course, but I am very glad that the donor and the donor’s family were unselfish enough to donate.”

She also thought about what she would say to her donor, if she could.

“I would tell my donor how much they changed my quality of life for the better, and how I would never forget the sacrifice they made. My life has changed 180 degrees because of the transplant made available to me.”