Western Occupational & Environmental Medical Association-2011

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Bonnie Pearson
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Medical Center and Head of Spine Service Orthopedic

1 Western Occupational & Environmental Medical Association El Camino Real, Carlsbad, California Neville Alleyne MD Chief of Orthopedics Tri-City Medical Center and Head of Spine Service Orthopedic Specialist of North County Disclosures: Consultant: Alphatec spine Royalties: Alphatec Spine Founder: SpineOvations 1

Hot Topics in Low Back Pain Conservative

Accupuncture Chiropractic MRI/CT Hot Topics in

Signature or Radiculopathy Re-Examine Pain

2 Hot Topics in Low Back Pain Conservative Treatment Medications-TLC Physical Therapy Accupuncture Chiropractic MRI/CT Hot Topics in Low Back Pain Surgical vs Non-Surgical Failed Conservative Treatment Epidural Steroid Injection Hot Topics in Low Back Pain No Root Signature or Radiculopathy Re-Examine Pain Management - Facet Injection - Spinal Cord Stimulator - Morphine Pump 2

Hot Topics in Low Back Pain Patient Selection for Surgery

Chronic Narcotic Use Psychiatric Disorders Cultural

Multidisciplinary Evaluation of NSLBP Physician Rule Out

Clear/Accurate Information about Patient s Condition.

3 Hot Topics in Low Back Pain Patient Selection for Surgery BMI Bone Density Smoker Co morbidities Hot Topics in Low Back Pain Patient Selection for Surgery Prior Surgery Chronic Narcotic Use Psychiatric Disorders Cultural variations (Cont) Role of Team Members in the Multidisciplinary Evaluation of NSLBP Physician Rule Out any Red Flags Identify Demographic Risk Factors Provide Clear/Accurate Information about Patient s Condition. Patient s Expectations for Recovery 3

Role of Team Members in the Multidisciplinary Evaluation of NSLBP Physical Therapist Assess the Patient s Physical Capacity Set Realistic Physical Goals for

Function Identify psychosocial Yellow Flags Introduce patient to the biopsychosocial perspective of low back pain Role of Team Members in the

4 Role of Team Members in the Multidisciplinary Evaluation of NSLBP Physical Therapist Assess the Patient s Physical Capacity Set Realistic Physical Goals for Treatment Identify Physical Risk Factors Role of Team Members in the Multidisciplinary Evaluation of NSLBP Psychologist Evaluate Psychological and Social Function Identify psychosocial Yellow Flags Introduce patient to the biopsychosocial perspective of low back pain Role of Team Members in the Multidisciplinary Evaluation of NSLBP Ergonomist Evaluate Work Demands Identify Workplace Risk Factors Explore ways to address obstacles with worker and/or workplace representative 4

Psychological Progression from Acute to Chronic Sick role Loss of Identity Withdrawal Depression Helplessness Anger Blame Anxiety Uncertainty Work Comp Statistics Results of Elective Lumbar

Spengler SUMMARY: Noncompensation Group Compensation Group 81% 29% Work Comp Statistics Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the

5 Psychological Progression from Acute to Chronic Sick role Loss of Identity Withdrawal Depression Helplessness Anger Blame Anxiety Uncertainty Work Comp Statistics Results of Elective Lumbar Discectomy for Patients Involved in the Workers Compensation System John Klekamp, Eric McCarty, and Dan M. Spengler SUMMARY: Noncompensation Group Compensation Group 81% 29% Work Comp Statistics Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm? Harold L. Asch, Ph.D., Jeffery Lewis, M.D., Douglas B. Moreland, M.D., James G. Egnatchik, M.D., Young J. Yu, M.D., David E. Clabeaux, R.T., and Andrew H. hyland. Ph.D. Object: assess the efficacy and outcomes of lumbar microdiscectomy performed on outpatient basis with the results reported in literature in which the success rates vary between 70-80% and in excess of 90%. 5

6 Work Comp Statistics Results: This study supports the evidence that lumbar microdiscectomy performed on an outpatient basis is a very safe and effective treatment for sciatic pain due to disc herniation with outcome success rates closer to 75-80% rather than the 90% that some have reported. Work Comp Statistics Outcomes and presurgery correlates of lumbar discectomy in Utah Workers Compensation patients M.Scott DeBerard, PhD., Rick A. LaCaille, PhD, Glen Spielmans PhD, Alan Colledge, MD, Mary Ann Parlin, PhD Purpose: to examine long-term multidimensional outcomes of lumbar discectomy of worker s Compensation patients from Utah and identify presurgical biopsychosocial factors related to poor outcomes Work Comp Statistics Conclusions: this study suggest that compensated back surgery patients are at greater risk for poor outcomes than those noncompensated patients. Work disability rate: 12.7% Approximately 25% of patients experienced poor outcome 6

Work Comp Statistics Predicting factors of successful recovery from lumbar spine surgery among

Covington, BS; Heidi Harrom, BS Results: type of surgery performed significantly affected patient

conditions and compared surgical and nonsurgical treatments.

7 Work Comp Statistics Predicting factors of successful recovery from lumbar spine surgery among workers compensation patients Scott d Hodges, DO; S. Craig Humpherys, MD; Jason C. Eck MS; Laurie A. Covington, BS; Heidi Harrom, BS Results: type of surgery performed significantly affected patient outcomes with 72% of microdiscectomy patients returning to work versus 43% for fusion patients. SPORTS Study What is SPORT? The Spine Patient Outcomes Research Trial is a year study that looked at 3 of the most common back conditions and compared surgical and nonsurgical treatments. Approximately 2500 patients took part in the study, which was conducted at 13 sites across the country. SPORTS Study What Conditions were Studied? Spinal Stenosis Intervertebral Disc Herniation Degenerative Spondylolisthesis 7

8 SPORTS Study Why is SPORT important? Surgical vs Nonsurgical treatment options? SPORTS Study Results of the SPORT Study? Intervertebral Disc Herniation Degenerative Spondylolisthesis Spinal Stenosis Perception is Reality Outpatient vs Inpatient Procedures MIS PIC 360 Pic 8

Criteria Types of Procedures -Anterior -Posterior -X-LIF

9 Surgical Procedures Disc Excision Micro dissection Laminectomy Insert image here Surgical Procedures Fusion Criteria Types of Procedures -Anterior -Posterior -X-LIF -GLIF(look for video) INSERT IMAGE HERE Surgical Procedures 9

10 Surgical Procedures Dynamic vs Solid Fusion Insert image here (Dynasys) Surgical Procedures Surgical Procedures Stand Alone Interbody Devices prodisc 10

11 Surgical Procedures M.I.S. Future Technologies Disc Replacement Future Technologies Lumbar Nucleus Replacement 11

12 Future Technologies Total Facet Replacement Future Technologies Annular Sealants Future Technologies Gene Therapy Technologies 12

13 Return to Work Communication with Adjustors Realistic Expectations of Timetable Realistic Work Restrictions Outcome Data Physical Rehab Training Physical Rehab Training 13

Clinical Pearls Femoral Acetabular Impingment Trochanteric Bursitis AVN of the Hip RSD/Chronic Regional Pain Syndrome Sacral Insufficiency Fracture Waddell s Signs Red

14 Clinical Pearls Femoral Acetabular Impingment Trochanteric Bursitis AVN of the Hip RSD/Chronic Regional Pain Syndrome Sacral Insufficiency Fracture Waddell s Signs Red Flags Conclusion Communicate Conservative Treatment Surgical vs Non Surgical Outcomes Patient Selection Role of Team Members Clear/Open Channels between MD and Adjustor 14

15 Thank You! 15

2016 OPAM Mid-Year Educational Conference, sponsored by AOCOPM Thursday, March 10, 2016 C-1

2016 OPAM Mid-Year Educational Conference, sponsored by AOCOPM Thursday, March 10, 2016 C-1 Long-term Outcomes of Lumbar Fusion Among Workers Compensation Subjects : An Historical Cohort Study Trang Nguyen M.D., Ph.D. David C. Randolph M.D, M.P.H. James Talmage MD Paul Succop PhD Russell Travis