Custom-Fitted Spine Implants

Personalized rods may improve outcomes, cut surgery time

spine_colman_storyCustom fit is the key when it comes to spinal implant rods, which an estimated 38,000 people need each year. This need is especially great for people who have a spinal deformity such as scoliosis, which causes the spine to twist and turn into complex and sometimes dangerous positions. In 2010 and 2011, an estimated 1.6 million people received treatment for scoliosis according to the Bone and Joint Initiative, a consortium of professional medical societies.

Correcting this deformity involves moving a distorted spine into a different position, which is no simple task. To accomplish it, surgeons attach metal rods to the bones surrounding the spinal column in order to support and straighten the spine.

To perform this demanding procedure, surgeons previously needed to be as much a sculptor as a physician. Over the years, they have mastered the art of cutting, bending and twisting metal rods to fit each patient.

Often, however, this manipulation may create weak spots in the rod where it can break in the future. In addition, the manipulation of the rods traditionally has been done in the operating room during surgery, adding to the time a patient spends in surgery under anesthesia.

Now, however, advances in medical imaging and implant manufacturing are making it possible to tailor an implant to the patient receiving it.

Matthew Colman, MD, has begun using patient-specific rods in reconstructive surgery — giving patients with spinal deformities implants designed to fit their anatomy perfectly. An assistant professor of orthopedic surgery at Rush University Medical Center, Colman is one of few spinal surgeons in the world who also specializes in spine cancer treatment and was one of the first doctors in Chicago to use these patient specific rods.

The customization is done in advance of the operation in cooperation with an implant manufacturer. To create the rods, Colman uploads the patient’s calibrated X-rays to a computer. Then he uses a sophisticated software program to plan the reconstructive surgical procedure.

The software allows him to simulate deformity correction and other surgical maneuvers in order to map out and determine the exact length and shape of the rod. The specifications are sent to the manufacturer, and the finished rod is delivered to Rush.

Because so much of the planning is done before surgery, less time is needed during the operation itself. “When we reduce time operating room we help to decrease the chances for infection and blood loss during surgery — and we decrease potential mistakes with the measurements,” Colman says. “In addition, manipulating the rod by hand-bending them may cause them to break more easily, which is theoretically avoided with the custom manufacturing process.”

In addition to custom-made spinal rods, Colman has also been involved in the design of patient-specific 3-D printed vertebral cages, which are used to provide anterior (frontal) support for spinal reconstructions when the area in front of the spine has been MOR300x250destroyed or removed due to infection, a tumor or trauma. The cages are in the process of receiving U.S. Food and Drug Administration approval for use in the United States.

“The future of implants is in customization,” Colman says. “New technology is streamlining the process, making surgery more efficient and effective by employing faster and better working methods.”

Why is Cheerleading A High-Risk Sport?

In spite of being a highly skilled sport, cheerleading may be dismissed by some as a trivial activity. This misconception is simply dispelled by statistics that cheerleading accounts for 66% of all catastrophic injuries in female US athletes.

Requiring an array of dynamic skills and discipline, cheerleading is not only a highly demanding endeavor but also markedly high-risk, illustrated by research reports that cheerleading is the most statistically dangerous sport for US women.

First and foremost cheerleading is a highly-skilled sport, requiring highly dynamic movement, gymnastic demands and dance elements, and like any athletic endeavour carries a high risk of injury – particularly at the professional end of the spectrum where stunts and performance carry a higher risk of fall and overuse injuries.

In fact, a study by the University of North Carolina (UNC) National Catastrophic Sports Injury Research found cheerleading to be the cause of more injuries to US females than any other sport. The author of the report Frederick Mueller, Ph.D. commented that “A major factor in this increase has been the change in cheerleading activity, which now involves gymnastic-type stunts.” Indeed gymnastics was found to be the second most prolific injury-causing sport in women.

A cheerleader requires the following prerequisite skills and strengths: agility, flexibility, coordination, balance, strength and precision of movement. Timing is also an essential facet in avoiding injury, particularly in terms of regarding the safety of your team mates. Dropping a team mate during a flip or pyramid can have serious repercussions, so a constant mental engagement and awareness is crucial at all times. The requirements for the above mentioned skills obviously intensifies with the proficiency of the team, particularly for cheerleaders performing at a professional or national level.

When considering the specific logistics of certain signature cheerleader stunts – such as ‘basket toss’ stunts, in which cheerleaders are thrown up to 20 feet into the air – the causation of extremely high injury risk statistics are clear.

A notable cheerleading injury incident that made transatlantic headlines was the case of Orlando Magic stunt team cheerleader Jamie Woode. Watched by thousands during the televised event, a treacherous mis-step caused Woode a devastating fall during a the first half of the NBA event between Orlando Magic and the New York Knicks. Landing on her head, the incident resulted in concussion, three broken vertebrae and a broken rib.

While cheerleading is an established sport in American culture, it is also gaining keen momentum in the UK. Recent figures show that 37% of British schools now offer cheerleading as part of the physical education curriculum, and 68 UK universities were represented at the UK University Cheerleading Nationals in 2015. Particularly with an increase in popularity, ensuring the safety of cheerleading participants with informed advice and regulation is crucial.

The importance of a good coach

As with any sport, a good cheerleading coach is fundamental to the pursuit of progressive quality training, the safety of the athlete and the avoidance of injury risk. Dr. Mueller states, “If cheerleading activities are not taught by a competent coach and keep increasing in difficulty, catastrophic injuries will continue to be a part of cheerleading.”

Improved regulation of coaching credentials and cheerleader safety training in the UK and USA have contributed greatly to a recent reduction in reported cheerleader injuries. Bodies such as cheersafe.org also provide cheerleading facilitators, parents and participants with comprehensive cheerleading safety information and checklists for extra-curricular cheerleaders, and those competing within teams in the educational system.

Main causes of injury in cheerleading

The injuries most prevalent in cheerleading are as follows:

  • Falling injuries – A high-risk product of stunt work, falling injuries can cause anything from surface abrasions and brushing, to severe fractures and concussion.
  • ACL injuries – Mis-stepped landings, a sudden change in direction or pivoting of the knee during full extension of the leg, are all contributing factors to the high risk of ACL injuries in cheerleading.
  • Overuse injuries – Common in many sports with intensive training, cheerleaders may be at risk or overuse injuries.

How can injuries be avoided?

A fully accredited and experienced coach providing full supervision and expert guidance is at the heart of safe cheerleading practice. Similarly it is the responsibility of the participating cheerleader to be responsible and fully aware of their own safety, as well as that of their team mates. The individual should ensure they are comfortable with any stunts undertaken, and that they have the sufficient training and ability to perform any given stunt.

Cheerleading regulatory bodies have placed restrictions and regulations on certain stunts, in order to minimize injury risk. A fully accredited coach will always train a squad according to these safety regulations.

As with any athletic endeavor, supporting training exercises are recommended to ensure sufficient levels of fitness and conditioning to help optimise performance, and negate the risk of injury. The recommended training and considerations are as follows:

  • Resistance exercises – This is important to gain and/or maintain sufficient strength in the lower back, shoulders and stomach. Pilates exercises and resistance weight training are excellent exercises for cheerleaders.
  • Stretching exercises – Flexibility is a vital performance requirement for cheerleaders. Dynamic stretching or yoga are excellent options for cheerleaders to improve performance and negate the risk of injury.

Correct injury rehabilitation – As a cheerleader’s performance effects not only their safety but also that of their team mates, it is crucial that cheerleaders do not return to squad training until fully cleared by a sports professional. If injured, seeking the correct treatment and rehabilitation program is essential.

Despite it’s perhaps frivolous depiction in popular culture, cheerleading is a serious sport carrying very severe risks of serious injury. Nonetheless, the correct adherence to regulation, undertaking proper comprehensive training with an experienced and fully-qualified coach and performing supporting exercises all significantly reduce the risk of cheerleading injury.

By SportsInjuryClinic

Return to Play After Spinal Fusion

Dr. Frank Phillips, co-director of the MOR Minimally Invasive Spine Institute, conductedgolf-spine a study on return to play after spinal fusion that was recently published in SportsHealth.  Dr. Phillips found that more than 50 percent of golfers return to play within one year of lumbar fusion surgery and some were even sooner. In general, most golfers returned to preoperative levels of performance (handicap) and frequency of play.

Read Full Study

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No Turning Back: Reduce Back Pain with These Spine- Stabilizing Exercises

Intro by Megan Wilson: In today’s world, technology is king—and it has helped make us more sedentary than at any other time in human history. Is it any wonder that back pain affects 80 percent of us at some point in our lives? The good news is research shows that regular activity can significantly reduce back pain. Taking a few minutes every day for simple, easy stretches and basic core-stabilization exercises can help you feel more comfortable and make you more mobile. Use the infographic below to get started!

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OUR SPINE STRESS FRACTURE MINI-EPIDEMIC

By Dev K. Mishra, M.D., President, Sideline Sports Doc. Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Stress fractures in the low back (lumbar spine) are injuries that can result in months off from sport and in some instances can lead to withdrawal from the sport
  • Many types of low back pain can be managed early on, before anything serious happens
  • Seek qualified medical care for pain that doesn’t improve after a few days of rest and simple treatment, or for pain that is affecting performance

One of the high schools where I’m team physician appears to be having a mini- epidemic low backof low back (lumbar spine) stress fractures. We were going through our fall season injury stats with our athletic trainers this week, and I was surprised to see that low back pain was now the third most common main complaint of the athletes we saw in the training room, and an alarming number of those young athletes turned out to have stress fractures of the lumbar spine.

Stress fractures of the lumbar spine, and stress fractures anywhere in the body are reportedly uncommon. A study published in 2014 by Changstrom and colleagues found that in the high school athlete population, stress fractures accounted for only 0.8% of reported injuries across 8 seasons.

When I first started my orthopedic practice in the early 1990s I’d have to say I didn’t think too much about stress fractures. We simply weren’t trained to put it near the top of our thought processes when evaluating young athletes with pain. Then a series of studies principally focused on military recruits started to raise our suspicions. Furthermore, improved understanding of the role of low bone mineral density, low energy availability, the female athlete triad, and the prevalence of overuse injuries in young athletes has heightened the team physician’s awareness even further.

The result of all those years of improved knowledge means that as an orthopedic team physician I’m much more aware of the possibility of a stress fracture. In the low back I’ve become much more attuned to some signs that would indicate the need for proper imaging studies. A sudden start of pain, possibly associated with a “pop” is a red flag. Pain that doesn’t improve in spite of several days of rest is another red flag. Localized tenderness on one side of the spine can be a sign of an underlying stress fracture. And a young athlete who feels she/he simply can’t play is a big red flag.

ssd.bannerStill in spite of improved awareness I have the feeling we’re not doing enough in the earliest phases of the problem. A stress fracture is one of those classically preventable problems, where rest and treatment early on might result in a short time off from play, but playing through and then treating at the stress fracture phase can result in months off from play, and sometimes withdrawal from the sport. For me it means that our trainers, physicians, and strength coaches are going to have a very close look at all athletes with low back pain and be very cautious about return to play. We may end up sitting more kids out early but I’d rather do that than lose them for months.

If you’re a parent of a young athlete with low back pain I’d urge a cautious approach for you too. If you hear complaints of low back pain from your son or daughter, if it lasts more than a few days, or if it’s affecting their play I’d strongly recommend early evaluation from a qualified physician. Don’t let this injury become a game-ender.

Review Options for Relieving Back Pain

back-painAn array of non-surgical treatments, along with disc replacement, can help restore spinal function and offer relief from discomfort.

In this West Suburban Living magazine feature, ‘Relieving Back Pain,’ two Midwest Orthopaedics at Rush physicians talked about the spectrum of treatment options available to patients. Dr. Edward Goldberg, spine surgeon, says, “After about age 40, many of us are walking around with minor spine arthritis and herniated discs without even knowing it. By age 70, we don’t see new hernias because the discs are too worn out to herniate. Older people are seeking treatment more often now than they did in the past because they are still physically active and they want to stay that way.”

Dr. Madhu Singh, interventional physiatrist, explains, “I’m here to help patients exhaust every conservative measure we can before resorting to surgery. Most back injuries can be successfully treated without surgery, so it makes sense to avoid the complications and risks of going through surgery if possible.”