Basic Low Back Pain


This is most of what we do.  About 70% of our patients come to us with some degree of lower back pain with some degree of leg pain.

Pain can come directly from inflamed or damaged disks, small joints called "facet" joints, muscle, ligament, tendon or any combination.

Below we will "walk through" some, but not all, of the major reasons for back pain.  Dr. Mike may have directed you to this page for two major reasons:
 
One, by understanding the details, you can better understand the rationale behind your your specific therapy program and find reason to maintain better compliance and be less likely to re injure yourself.
Two, to better understand what is being scheduled for you and answer any other questions you may have.  You have a right to know as much, or as little, detail as you want.

If you are a patient being scheduled for a procedure, you should have a specific handout.  This web page can function as a supplement to that handout.  Some of the handouts are entitled:
 "Your Injection"
 "Your Perc Disk"
 "Your Shoulder RF"
 "Your RF"
 "Your Diskogram"
It is possible you do not have a handout, or there is no handout for what is being scheduled for you.  This is often the case if you decided to be treated the same day as the initial visit.  This is not a problem.  Please call the main number and one will be sent or available for pick-up.  

On rare occasion, patients are not given a handout where it may only add to anxiety and fear.  Some patients also request  "I don't want to know" or "Please just knock me out and do it"  We are able to comply with this request, but you need to know enough to give standard informed consent. 


Below is a "Diskogram"  Notice the black liquid or "contrast" leaking out into the sides on the right image.  A normal diskogram should look like a cotton ball.  This disk was later treated with an electrical burn on the inside to "tighten the disk" and "seal the leak"


Another patient had leg pain as shown in the diagram.

Below you can see the needle on the right and the black contrast again on the right tracing the right L5 nerve root.  There is also a thin flexible tube in the middle in a hook shape.  The catheter can be used to inject or to directly break up scarring in the lower back, neck or thorax.  Some on the catheters are so soft they cannot be pushed through a flower petal.  Others are much more rigid.



No, this really does not hurt.  We use what is called a 30 G needle to numb the skin.  This is the smallest needle available and smaller than most of the needles even used by dentists.  The numbing medicine, or lidocaine, we used is mixed with Bicarbonate so it does not burn.  
We are usually done before you know we have started.

This is really a very painless experience.  If absolutely necessary, we can start and IV and a very light sedation can be provided through the  IV.
(Above)

   Click here to see more about catheters themselves



Compression Fractures:

A vertebral comression fracture, also called a vertebral "crush fracture", is a collapse or breakdown of one or more of the bones in your spine (the vertebrae).  Imagine a piece of stale bread wrapped in plastic wrap that gets squeezed and goes "crunch"

Causes

This type of fracture typically results when osteoporosis, the ""brittle bone'' disease, weakens the bones in the spine. Women and smokers are at increased risk. Sustained use of some medicines, such as prednisone, can also lead to weaker bones. A fall or jump may cause the fracture; but the bones sometimes collapse from the body's own weight. Other risks include are caucasian, small stature, excessive alcohol use, previous compression fracture, renal failure, poor nutrition, inactivity and secondary bone loss as well as several other metabolic diseases of or effecting bone.

Signs/Symptoms

The injury may occur suddenly, you may have severe pain or weakness in your back, arms, or legs. In a young person a fall or accident can cause a fracture.  If the collapse happens more slowly, the pain may be much milder. You might also experience problems with urination and bowel movements.  It is possible that an open surgery may be required in those cases to decompression the spinal canal.  In older patients other problems such as degeneration and narrowing of the canal may be complicating factors.

Compression fractures can be a devastating injury for 2 reasons. First, fractures can cause direct bony pain from the fracture itself, and this pain sometimes does not resolve.  Patients do not get up and move. Problems such as bedsores, depression and constipation follow. Second, the fracture can alter the mechanics of the posture. Most often, the result is an increase in thoracic kyphosis (bending over or stooped posture), sometimes to the point that the patient cannot stand upright. In trying to maintain their ability to walk, patients who are kyphotic report secondary pain in their hips, sacroiliac joints, and spinal joints. Patients with kyphotic posture are also at risk of falls and accidents, increasing the risk of secondary fractures in the spine and elsewhere.

If you have more questions about the definition of a compression fracture, Dr. Mike suggests this website
          
The patient above has one of these compression fractures.  The two "introducers" are in place.  The "Balloons" are not inflated yet.  The black dots show where the edges of the balloon will be and where the "cavity" and inflation of the vertebra will occur. 





Above is a close-up view of one of the balloons



Above, Both balloons are inflated with a liquid that we can see on X-ray.  This is the same contrast material we use in all of our other interventions.  In the Kyphoplasty case, the contrast stays inside the balloon and is allowed to come back out into the syringe.  This contrast material does not get injected into the patient.  

Below, the final picture with the cement (black smudge) in place.  Notice how it is irregular and almost "frothy".  The cement is about toothpaste consistency when injected and fills thethe cracks or "nooks and cranies" in the shattered/crushed bone.



This patient sat up, ate lunch and walked out carrying her walker over her shoulder with no pain less than 60 minutes after the procedure.  She reports she put her tomato plants in that afternoon.


                                                                                                                                                                 

Headache and Pain After Neck Surgery

              This is for anyone with a history of Headache and/or Migraine



Despite being in their later 80's.  This patient had to undergo a rather large complicated surgery in the upper neck to release the entire back part of the spinal canal.  This was critical if there was any chance of her still moving her arms and legs.  Despite a perfect surgery, she continued to have neck and shoulder pain and complained of terrible right-sided headaches.







 Several large  nerves come out from under the base of the skull and provide sensation to the back of the head.
They can become inflamed and the muscles around them can go into spasm.  There is an artery that pounds with your pulse coming out here as well.  The artery pounding within the tight muscles and inflamed nerve can give a picture that seems like a migraine, but is actually a tension-type headache or a form of cervicogenic headache.  This is especially true after there has been a surgery on the neck or skull.  Any one of these nerves, or nerve, can be treated 
                                                        as a group or individually.







                              Side view                                                     Front (Open Mouth) view
                               (above)                                                                        (above)


  During an outpatient procedure taking
  about 15  minutes.  Small nerves in
  back of her neck were  treated with a
  combination of some  injections, then
  using radiofrequency we  permanently
  took these nerves out of the
  picture and treated both the neck pain
  and the head pain.  There was no
  incision or surgery. The needle is the
  same size as is used in a atypical flu
  shot.  This picture is of a similar case.


                                                                                                                      


 The small nerves, or Medial Branches are seen here  to the left exiting from the base of the skull and along the small joints on the side of the neck were they can generate neck pain or be involved in sprains.



















  Dr Mike is holding the RF 
  (radiofrequency) wand used in
  this case.  The white cable to
  his right goes off the screen to
  a computer device that
  generates the signal that can
  pulse and put a nerve to sleep
  or burn and destroy a nerve
  completely







       Click Here   for more information on radiofrequency in
                               treatment equipment in general


Regarding safety and Informed Consent:
The bottom line is that anything bad can happen to anyone anytime a doctor does something for a patient.  Dr. Mike's safety record is 100% so far.  There have been ZERO major complications in his practice. 

That does not mean patients have not been transfered to the main hospital as a precaution.  Every once in a while someone gets light-headed or dizzy and we hold them for a little while longer.  We have seen 3 seizures since 2001, two were diabetics that took their insulin and did not eat.  All of these patients have done fine and probably did not have an issue because of what we did, but because of underlying medical issues.  Yes, we are very able to manage any complication that may occur in our office.    Dr. Mike holds not only a valid ACLS status but ATLS as well.   He ran an intensive care unit and worked as a "house doctor" doing basic internal medicine until the very last week of residency.  This is where he acquired most of his gray hair.  We have a completely stocked "code cart" and many extra pieces of equipment that we have never, and hope to never use.

                                                                                                                              

                   DANGER: 
       Live Cobra!




    Two fang marks are evident on the
    on patient's  left hand








This is not a sign from some foreign country, but right here in Mansfield Ohio.  This professional snake-handler and educator with 20-years experience was bit on the hand by a white albino monocle cobra during routine care.  This is an extremely dangerous animal that can kill a human in 8 minutes. 






   Monacled Cobra, Naja Kaouthia 
  (Left)  
 
    Naja Naja Kaouthia


  Respected in all it's native regions. 
 This animal is revered and in some  
 cultures it is even believed to be able
 to forgive certain sins.

The above animal injects it's venom directly though fixed non-retractable fangs in the front of it's mouth.  This cobra does not "spit" or spray it's venom like some other species.  It uses a nerve toxin like a sea snake and very little muscle poison (myotoxin, proteolytic enzyme) or blood poison (hemotoxin) which are found more in US native poison snakes.  Only about 4% of all species of snakes have any poison. 

There are ~420 known venomous species of snakes that fall into two major categories: retractable-fang (colibridae, hydrophiidae, viperidae and fixed-fang or Elapidae (kraits, cobras, mambas and coral snakes)  Most venoms are a heterogeneous blend of toxins having different functions based on region, species and temperature.  The retractable-fang category is generally being thought of as a more durable organism having more proteolytic enzymes and hemotoxins whereas the fixed-fang being the more fragile and using faster-acting post-synaptic neurotoxins with a curare-like property potentially causing respiratory compromise within minutes from envenomation.

This relatively very calm animal carries a great air of dignity and is usually not aggressive towards humans.  Regardless of initial impressions to the photo above, the animal moves with an incredible grace, elegance and sense of practical intelligence.  Many cobras are are on display at several zoos in the midwest.  Please consider viewing one at in such a controlled environment.

No snake anywhere out in the wild should ever be approached by anyone other than a well-trained well-equiped professional!  Even under the best circumstances, bites do occur. Click herefor more.


His life was saved by the excellent and expedient Emergency Room team at MedCentral Mansfield Hospital, the MedCentral ICU staff and 5 vials of anti-venin (anti-venom) shipped from the Columbus Zoo.  However, he developed a generalized decline in function and a neuropathic pain syndrome with electric-like shock sensations and burning everywhere.  This is theoretically possible with the type of venom - pure neurotoxin - in this particular species of cobra (or Elapid).  

At the time he presented to us with pain, he was essentially indigent, completely uninsured and he considered himself "circling the drain"    As far as we know, we have performed the first reported treatment of this pain syndrome with a spinal cord stimulator or using neuromodulation in general. The leads were placed in an atypical top and bottom configuration as seen here (below).



 
 Front to Back view of the upper
 neck taken with X-ray machine
 during the procedure.
 (left)

  One set of eight magnets above
  the other set of eight.  This is 
  what we had to do to
  cover BOTH arms and Both
  legs
 

 




  



.









Dr Mike making final attachment
of Stimulator Leads to Generator
(above)  Dr Ligman is smiling
through his mask in the background.

Dr Mike has so much faith in Dr. Ligman and Dr Ligman's staff that Dr Ligman has sedated Dr Mike's own father, uncle and Godmother.

The patinet is much better but not perfect by any means, but is now rebuilding his life, his business and his home.  This case has been submitted for publication in the peer-reviewed literature.

All work on this patient was done completely GRATIS, which means everyone doanted their time and services.
  

                           Our Gratitude and Thanks to

Mr. Matthew Smith & Ms. Denise Fetter 
the Advanced Bionics^® Corporation
Paul Ligman, MD (Chief of Anesthesia, Surgicenter Mansfield)
Staff, Management & Executive Board of the SurgiCenter Mansfield 

Without your generous donation of time, equipment and resources we could not have done this case.


Remember:  No snake anywhere out in the wild should ever be approached!   No animal, for that matter, should ever be teased, taunted or handled recklessly.  Any freightened or confused animal, wild or domestic, will attempt to protect itself to the best of it's ability.  


For every one snake you have seen, hundreds have seen you.  Very few of the snakes we have here in Ohio are poisonous.  They blend in very well with their surroundings, particularly the foliage and they will have seen you long before you saw them. If they wanted to hurt you, which they do not, they would have done so long before you knew they were there.  Our domestic snakes here in Ohio mostly eat rodents are part of our ecosystem, and should be considered a natural resource and conserved just like any other wildlife.

This Web site is meant for information purposes only and is not a substitute for professional medical advice. Patients should consult with a physician to discuss treatment options.  It is always reasonable to obtain a second opinion.