May 3, 2019 — Anaconda, Montana
Anaconda MT — If you’ve been told you have a herniated disc, you probably have also been told you need a spinal fusion, which up to 2019 has been the traditional treatment for herniated discs. However, that advice for a spinal fusion — especially in the neck — may no longer apply, according to Gus Varnavas, MD, a fellowshiptrained spine surgeon who sees patients from across Montana in his offices in Anaconda and Helena, Montana.
“Research recently released by the North American Spine Society has documented that artificial disc replacement reduces the likelihood you may need a second spine surgery down the road,” explains Dr. Gus
Varanavas. “For decades, spinal fusion has been the traditional recommended treatment for herniated discs. But with a fusion you are locking two vertebrae together. The problem is that fusion puts extra stress on the discs above and below. That can cause a second herniated disc and require another spine surgery. Artificial discs are designed replicate the natural rotation of the neck which lessens the stress placed on other discs. This is especially important in the neck as you only have seven levels to maintain needed rotation.”
Artificial disc surgery — also referred to as motion preservation surgery — has been rapidly evolving with new implants. The FDA has approved several artificial discs for use at two levels in the neck, including the Mobi-C and Prodisc-C implants.
“These are exciting times for the field of spine, as each year there are new discs that not only preserve the natural rotation of the spine, but also try to mimic the natural disc with some ability to compress up and down,” says Dr. Varnavas. “Mother Nature is quite an excellent engineer in that the healthy disc provides ample rotation but also some shock absorption. It’s a tall order to replicate the healthy disc with something that also doesn’t wear out too soon requiring it to be replaced — which can be a complex re-do surgery.”
Dr. Varnavas notes that in the low back, artificial disc technology is stilll evolving. “With lumbar artificial disc surgery we have to be very selective as to which discs qualify,” explains Dr. Varnavas. “The fear of having a disc wear out requiring revision surgery has caused many spine surgeons to move cautiously with lumbar disc replacement. While access to the front of the neck for artificial disc surgery is straightforward, that is not the case for the lumbar area. With lumbar artificial disc replacement the surgeon has to go through the abdomen and navigate around internal organs.”
“We try to make sure the patient understands all their treatment options, and we try to exhaust all nonsurgical options, including spine therapy and spinal injections, to relieve symptoms without surgery,” adds Dr. Varnavas. “But when herniated disc symptoms worsen and cause numbness or weakness in a leg or arm, we need to address that promptly to prevent those symptoms from becoming permanent.” More information on artificial disc replacement, home remedies for back and neck pain and a symptom chart on when it’s crucial to see a spine specialist is available through the online spine encyclopedia
December 10, 2018 — Anaconda, Montana
Anaconda, MT — It’s estimated that 4 out of 5 adults will have an attack of back pain at some point in their lives. One of every three on-the-job injuries is related to back or neck strain. That’s the bad news. The good news is that 80% of the time, simple back and neck pain can go away on its own. However, there will be hundreds of Montana residents that will self-diagnose themselves incorrectly in 2019, which can lead to permanent neurological symptoms that will stick with them for the rest of their life.
According to Gus Varnavas, MD, a fellowship-trained spine neurosurgeon based in Anaconda, the most serious problem related to back and neck pain is that people don’t understand the emergency symptoms of back and neck pain, which can lead to nerve symptoms that become permanent and lifelong. “We recognize that people will self diagnose themselves, but they usually do it with the wrong information,” Dr. Gus Varnavas explains. He cites the 5 most serious mistakes a person can make in 2019 related to back or neck pain.
“Unlike other health issues or joint problems, pain is simply NOT a good indicator of when you need to see a doctor,” explains Dr. Gus Varnavas. “A simple strain or spasm can cause excruciating pain that knocks you down to your knees. But a simple strain never requires surgery. It can resolve on it’s own with over-the-counter anti-inflammatories like Advil or Nuprin and a day of rest.”
Dr. Gus Varnavas instead cautions that the emergency symptom of a numb hand or numb foot from a herniated disc needs to be seen within a couple days or you risk permanent damage to the nerve off the spinal cord. “A heniated disc that presses hard on a nerve root over several weeks can create a permanent crimp that can’t be corrected with a surgery,” Dr. Varnavas explains. “That can cause that numb foot or numb hand to become permanent! So ironically, pain isn’t a good indicator of an emergency. Numbness in a hand or foot is the instead the emergency symptom.” Patients can download a symptom chart for back and neck pain at GusVarnavasMD.com.
The second mistake people make with back or neck pain is reaching for the pill bottle, Dr. Varnavas adds. “With back or neck pain, pills only mask symptoms, they don’t change the physiology of the back,” Dr. Varnavas explains. “Only exercise that makes the back stronger and more flexible — or surgery — changes the structure of the back. Worse, painkillers like opioids are quickly addictive, creating a bigger problem for you than your back injury.”
A sore back is not like a sore knee. “With back pain, research has shown conclusively that bed rest beyond a day or so is actually bad for the back,” says Dr. Varnavas. “Instead, some movement is good for a back strain, like specific stretches and a short 20 minute walk in the neighborhood. Movement is like WD-40 for the back. The other problem relates to over-use of ice and heat. Most insurance companies don’t pay for a spine therapist to use ice or heat in therapy — because they view it to be palliative. That means, it feels good but cures nothing. Instead, spine therapists use special stretches that can relieve symptoms of a back strain as well as a herniated disc.” Residents of Montana can request a free 36-page Home Remedy Book with these stretches at GusVarnavasMD.com.
“Americans love a quick fix, a magic pill or magic surgery,” says Dr. Varnavas. “It’s okay to use watchful waiting for a month or so for pain that radiates into an arm or leg. Spinal injections can provide relief for many herniated discs which may eliminate the need for spine surgery. But if symptoms progress and worsen to numbness or weakness, then spine surgery may be necessary. In this case the person should seek out a spine surgeon who does minimally invasive spine surgery. This shortens the incision, reduces time in the hospital and makes recovery faster and less painful.”
Dr. Gus Varnavas is a board-certified neurosurgeon who has specialized in spine surgery for more than 25 years, performing more than 5,000 spine surgeries over his career. He has an active practice in minimally invasive spine surgery and artificial disc replacement and is based at the Community Hospital of Anaconda. Dr. Varnavas had six years of service in the U.S. Air Force, serving as a neurosurgeon medical director; director of neurotrauma and critical care; and instructor of the military surgical trauma training course at Lackland Air Force Base at Wilford Hall Medical Center. Dr. Varnavas was a co-founder of a small business that helped Special Operating Forces (SOF) increase their effectiveness while operating in austere environments and in extreme combat conditions.
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