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.”

Motorcyclist Breaks Record after Cervical Spine Surgery by Dr. Frank Phillips

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Dave Siebert, 62, of Grayslake, IL, is up for just about any physical challenge. Two of his favorite activities are wreck diving (scuba diving among shipwrecks) and racing motorcycles which he builds himself.

With a life full of adventure and high physical demands, Dave is used to orthopedic conditions. Over the past ten years, he has undergone two hip replacements, a shoulder replacement, and a broken arm. Each of these he took in stride and has experienced successful recoveries.

However, a new, gradual pain crept into Dan’s body last spring that concerned him in a different way. He could feel the strength slowly drifting from his left hand; something he called a “frostbite” effect. He could barely hold the clutch of his motorcycle. The weakness and loss of control spread to his leg, leading him to stumble and trip. “I remember falling off a chair trying to tie my shoe,” he recalls. “That’s when I knew it was bad.”

Dave consulted his orthopedic physician who told that this time the problem was a cervical spine (neck) nerve impingement. His doctor recommended that he see a specialist, specifically Dr. Frank Phillips, director of the minimally invasive spine surgery specialty at Midwest Orthopaedics at Rush.

After a visit to examine Dave and discuss his MRI, Dr. Phillips recommended a minimally invasive cervical fusion, which would eliminate his neck pain and restore his sensory perception, coordination, and balance issues.

Dave agreed to the procedure at Rush University Medical Center and was pleased to be home and walking within 48 hours.

“I didn’t like feeling unable to do something. Being able to walk was the first thing on my mind. Since I’ve had the surgery, I’ve been better and better.” As part of his healing, he focused on building strength and flexibility by practicing piano and yoga, and then swimming.

Just two months after surgery, Dave was even able to walk comfortably in his son’s wedding. Since then, he has graduated to the activities he loves most: wreck diving, building and racing motorcycles.

Just a year after surgery, Dave broke a national record: 15.3 seconds in a quarter mile race while riding a 1972 2-stroke Suzuki motorcycle that he rebuilt himself. He is thankful to be active again and is looking forward to a diving trip in Cozumel, Mexico this winter.

“Dr. Phillips really knew what he needed to do and he did it,” he explains. “It’s comforting when you have a doctor who is really on his game. I was very impressed with the whole experience.”

Learn more about minimally invasive spine surgery

Featured Body Part: Core

By ATI Physical Therapy

Featured Body Part: Core

Your ‘core’ is a complex series of muscles, extending far beyond your abs, including everything besides your arms and legs. It is incorporated in almost every movement of the human body. The core is comprised of several muscle groups including the local muscles (lumbar multifidus & transverse abdominis), global muscles (erector spinae, quadratus lumborum, external and internal oblique abdominis, rectus abdominis), and other muscle groups such as the psoas major, pelvic floor musculature and the diaphragm. Specifically, the transverse abdominis performs an anticipatory contraction prior to extremity movement in order to contribute to core stabilization.

The function of the core is to stabilize the spine from potentially harmful forces and to create and transfer forces through the body. Think of your core like the foundation of a house. A nice strong foundation lets you build a stable house. A nice strong core lets you absorb and create forces for meaningful movement. Poor core strength can contribute to injuries ranging from your ankle all the way up to your hips, back, shoulders, and neck.

Signs of a Weak Core
These common symptoms can be signs that you have a weak core:

  • Lower Back Pain – Since the core is incorporated in almost every movement of the human body, muscular weakness can be a sign of a weak core.
  • Poor Posture – The core muscles hold your spine and pelvis in place. If these muscles are weak, your body will be unstable, causing an inability to stand up straight or sit properly.
  • Bad Balance – Since your core muscles stabilize your entire body, a weak core will affect your ability to balance.
  • General Weakness – Since the core is incorporated in almost every movement of the human body, muscular weakness can be a sign of a weak core.
  • Inability to Hollow Your Stomach – The inability to hollow your stomach is another potential sign of core weakness. Can you do it? Take a natural breath and pully your bellybutton toward your spine. Hold this position for a count of 10 and then release. If you were unable to hold this position for the full count, you may have a weak core.

Injury Prevention
John Duncombe, PT, DPT, OCS, CIMT, CSCS, GCS, gives us some tips to help prevent core weakness and injury:

  • Warm Up – Perform at least 5 minutes of cardiovascular activity or dynamic total body warm up activity prior to initiating core exercises. Dynamic total body warm up activities may include jumping rope, jumping jacks, dynamic squats and lunges, inchworms, walking knees to chest, hip rotations, and gluteal kicks. See a trained ATI clinician for assistance with these exercises if needed.
  • Stay Tall – Make sure to try to keep your chest up, shoulders stacked on top of your hips, and stomach muscles turned ‘On’ as often as possible. No matter the activity, sitting/standing/walking, this position helps to alleviate unneeded stress to your spine and specifically your lower back.
  • Isometrics – Stronger muscles provide greater stability to the spine to help establish and maintain proper body mechanics during prolonged activities and lifting. Common examples include various plank positions, the Pallof Press, and abdominal bracing.
  • Active Range of Motion – Maintaining good flexibility in your hips (primarily your hamstrings, hip flexors, and piriformis) as well as your lower back will allow for your pelvis and lumbar spine to move freely during your day.

John Duncombe, PT, DPT, OCS, CIMT, CSCS, GCS, also gives us some tips to help rehabilitate the core:

  • A Strong Trunk Leads to a Healthy Spine – Work on strengthening both the local and global muscles (see above for which ones these are) to help maintain proper body positions as you move throughout your day.
  • Be Balanced – Work on dynamic flexibility exercises for your Hips and Shoulders. Lacking mobility in your extremities will put more stress on your trunk to complete dynamic movements and lifts while at home or work.
  • Suck in the Gut – Sitting/standing tall and slightly sucking in your lower abdominals (just below your belt or waistline) towards your spine will activate not only your inner core, but all necessary trunk muscles for optimal functional movements.
  • Check your Chair – Many of us sit for the majority of our day. In our car to/from work, while at work, relaxing at home, etc. Make sure your spine is upright and you have good support for your back. Consider a small pillow or rolled up towel in the small of your back to remind you to not slouch and stress your lower back.

When weighing your treatment options for injury rehabilitation, consider physical therapy. Physical therapy offers a wide variety of treatment options including strengthening, stretching, and sustainable home exercise programs. Stop in or call any ATI location for a complimentary injury screen or to learn more about how physical therapy can help you overcome your pain.

Work with ATI to get to the core of your issues!