Dr. Pradhan, MD, MSE
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www.laspinesurgeon.com
Surgery of the Cervical, Thoracic,
and Lumbar Spine
and Microsurgery of the Spine
- OTHER SPINAL LINKS
Spine Surgery
SPINAL FUSION
Spinal fusion is a surgical procedure used to correct problems with the small bones of the spine (vertebrae). It is essentially a "welding" process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
Spine surgery is usually recommended only when your doctor can pinpoint the source of your pain. To do this, your doctor may use imaging tests, such as x-rays, computed tomography (CT), and magnetic resonance imaging (MRI) scans.
- Degenerative Disk Disease
- Spondylolisthesis
- Lumbar Spinal Stenosis
- Scoliosis
- Fracture
- Infection
- Tumor
Understanding how your spine works will help you better understand spinal fusion.
Learn more about your spine:
INCISION SITE
Surgeons can reach the spine by making an incision (cut) in different places on your body. Incision sites are often described as:
Anterior.This term refers to the front of your body. In spinal fusion surgery, an anterior fusion is done by making an incision in the abdomen (belly).
Posterior. This refers to the back part of your body. If you are having a posterior fusion in your lower back, you will lie on your belly during the operation and your surgeon will make the incision in your lower back.
Lateral. This refers to the side part of your body. Surgeons can reach certain parts of the lumbar spine by making an incision in your side.
Hip & Knee Surgery
WHO IS VUNERABLE TO HIP FRACTURES?
Hip fractures are caused by a variety of factors that weaken bone and, often, are caused by the impact from a fall. The common characteristics of persons who are vulnerable to hip fractures are:
Age:The rate increases for people 65 and older.
Gender:Women have two to three times as many hip fractures as men.
Heredity:A family history of fractures in later life, particularly in Caucasians and Asians.A small-boned, slender body.
Nutrition:A low calcium dietary intake or reduced ability to absorb calcium.
Personal habits:Smoking or excessive alcohol use.
Physical impairments:Physical frailty, arthritis, unsteady balance, and poor eyesight.
Mental impairments:Senility, dementia, e.g., Alzheimer's disease. Weakness or dizziness from side effects of medication.
DIRECT ANTERIOR APPROACH
Dr. Laster is among a small but growing number of surgeons nationwide who are now offering patients a new surgical
approach that may speed recovery and decrease postoperative pain for hip replacement procedures.
Called the Direct Anterior or "front" approach, this new technique involves making an incision on the front
of the hip rather than the side or back as traditionally done. As a result, Dr. Laster can follow the natural
spaces between the hip joint's muscles and tendons, resulting in less damage to these soft tissues.
Rehabilitation is often accelerated because the hip is replaced without detachment of muscle from the
pelvis or femur. Additionally, because the gluteal muscles and other natural stabilizers are left
undisturbed, it is possible for patients to regain mobility more quickly and ultimately go home from
the hospital sooner. In fact, the normal post-operative restriction of limiting hip movement to 60 or
90 degrees does not apply to those patients who have undergone the Direct Anterior Approach.
Following the Anterior Approach, patients may be allowed to bend their hip freely, allowing them to
resume their normal daily activities such as sitting or getting into or out of a car without restriction.
Other key advantages of the Direct Anterior Approach include:
> Hospital stay may be reduced from 3 to 10 days to 2 to 4 days
> Smaller surgical scar
> Reduced risk of post-surgical dislocation of the hip implant
QUESTIONS PATIENTS SHOULD ASK THEIR SURGEON
1) What are the major and/or most frequent complications of surgery?
2) Is the skill and experience of the orthopaedic surgeon more important than the device or procedure?
3) Can you give me any information on outcomes and complication rates?
4) If I do not have surgery, what is the risk?
5) Which device would you choose for yourself, if you needed a total joint replacement now, and why?
6) How much pain can I expect, and how will it be managed in the hospital and after I go home?
7) How long will the device last, and what can I do to make it last as long as possible?
8) What are the pros and cons of minimally invasive (mini-incision) surgery? Does it really make a
meaningful difference in the result, or does it pose unnecessary risks?
9) Should I believe what I see on TV or read in the ads in magazines?
10) What will I be able to do/not do after my total joint replacement?
Joint Replacement
WHAT IS TOTAL JOINT REPLACEMENT?
An arthritic or damaged joint is removed and replaced with an artificial joint, called a prosthesis. WHAT IS A JOINT?
A joint is formed by the ends of two or more bones that are connected by thick tissues. For example, the knee joint is formed by the lower leg bone (tibia and fibula) and the thighbone (femur). The hip is a ball and socket joint, formed by the upper end of the femur (the ball), and a part of the pelvis, called the acetabulum (the socket).
The bone ends of a joint are covered with a smooth layer called cartilage. Normal cartilage allows nearly frictionless and pain-free movement. When the cartilage is damaged or diseased by arthritis, joints become stiff and painful. Every joint is enclosed by a fibrous tissue envelope or a capsule with a smooth tissue lining, called the synovium. The synovium produces fluid that reduces friction and wear in a joint.
Sports Medicine
COMMON SPORTS INJURIES & CONDITIONS
Burners and Stingers COMMON KNEE INJURIES ADOLESCENT ANTERIOR KNEE PAIN
Female Athletes: Health Problems Caused by Extreme Exercise and Dieting
Heat Injury
Muscle Contusion (Bruise)
Muscle Cramp
Sports Concussion
Sports Hernia (Athletic Pubalgia)
Sprains and Strains: What's the Difference?
Sprains, Strains and Other Soft Tissue Injuries
Stress Fractures
Many athletes experience injuries to their knee ligaments. Of the four major ligaments found in the knee, the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are often injured in sports. The posterior cruciate ligament (PCL) may also be injured.
ACL Injury
Changing direction rapidly, slowing down when running, and landing from a jump may cause tears in the ACL. Athletes who participate in skiing and basketball, and athletes who wear cleats, such as football players, are susceptible to ACL injuries.
MCL Injury
Injuries to the MCL are usually caused by a direct blow to the outside of the knee. These types of injuries often occur in contact sports, such as football or soccer.
PCL Injury
The PCL is often injured when an athlete receives a blow to the front of the knee or makes a simple misstep on the playing field.
Torn Cartilage
When people talk about torn knee cartilage, they are usually referring to a torn meniscus. The mensicus is a tough, rubbery cartilage that is attached to the knee's ligaments. The meniscus acts like a shock absorber. In athletic activities, tears in the meniscus can occur when twisting, cutting, pivoting, decelerating, or being tackled. Direct contact is often involved.
Chronic pain in the front and center of the knee (anterior knee pain) is common among active, healthy young people, especially girls.
It is usually not caused by any particular abnormality in the knee and does not mean that the knee will be damaged by continuing to do activities.
Pain located in the upper shinbone area below the kneecap is a different problem, and information about this can be found at
Osgood-Schlatter Disease (Knee Pain)Osgood-Schlatter Disease (Knee Pain)
In many cases, the true cause of anterior knee pain may not be clear. The complex anatomy of the knee joint that allows it to bend while supporting heavy loads is extremely sensitive to small problems in alignment, activity, training, and overuse. Pressure may pull the kneecap sideways in its groove, causing pain behind the kneecap.
In teenagers, a number of factors may be involved.
> Imbalance of thigh muscles (quadriceps and hamstrings) that support the knee joint
> Poor flexibility
> Problems with alignment of the legs between the hips and the ankles
> Using improper sports training techniques or equipment
> Overdoing sports activities
Read more on SYMPTONS DOCTORS EXAMS TESTS TREATMENTS & PREVENTION
Hand & Upper Extremity
WHAT IS HAND SURGERY?
Our hands serve many purposes. Hands help us eat, dress, write, earn a living, create art, and do many other activities. To do these activities, our hands require sensation and movement, such as joint motion, tendon gliding, and muscle contraction. When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.
WHAT DO HAND SURGEONS DO? Why Visit a Hand Surgeon?
When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.
Not every visit to a hand surgeon results in hand surgery. Hand surgeons often recommend non-surgical treatment options to assist you. Sometimes, they may refer you to a hand therapist for more treatment.
Hand surgeons are specialists in hand care. If you have pain in your fingers, hand, wrist or arm, or have other upper-extremity related concerns, you may want to consult a hand surgeon.
Examples of conditions treated by a hand surgeon are:
Carpal tunnel syndrome
Wrist pain
Cuts on the fingers and hand
Sports injuries to the hand and wrist
Creating fingers from toes and other joints
HAND FRACTURES & SYMPTOMS
Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.
Signs and symptoms of a broken bone in the hand include:
A depressed knuckle is often seen in a "boxer's fracture." This is a fracture of the fifth metacarpal, the long bone below the little finger.
- SPECIALTIES:
Fracture Management of Thoracic
and Lumbar Spine
Dr. Norquist, MD
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- OTHER FRACTURE LINKS
Joint Pain & Fracture Management
TYPES OF TREATMENT
Cast Immobilization
A plaster or fiberglass cast is the most common type of fracture treatment, because most broken bones
can heal successfully once they have been repositioned and a cast has been applied to keep the broken ends in proper position while they heal.
Traction
Traction is usually used to align a bone or bones by a gentle, steady pulling action. The pulling force may be transmitted to the bone through skin tapes or a metal pin through a bone. Traction may be used as a preliminary treatment, before other forms of treatment.
Open Reduction and Internal Fixation
In this type of treatment, an orthopaedist must perform surgery on the bone. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment, and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone.
These methods of treatment can reposition the fracture fragments very exactly. Because of the risks of surgery, however, and possible complications, such as infection, they are used only when the orthopaedic surgeon considers such treatment to be the most likely to restore the broken bone to normal function.
External Fixation
In this type of treatment, pins or screws are placed into the broken bone above and below the fracture site.
Then the orthopaedic surgeon repositions the bone fragments. The pins or screws are connected to a metal bar or bars outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal. After an appropriate period of time, the external fixation device is removed.
Each of these treatment methods can lead to a completely healed, well-aligned bone that functions well.
Remember that the method of treatment depends on the type and location of the fracture, the seriousness
of the injury, the condition and needs of the patient, and the judgment of the orthopaedist and the patient.
Successful treatment of a fracture also depends greatly on the patient's cooperation. A cast or fixation
device may be inconvenient and cumbersome, but without one a broken bone can't heal properly. The result may be a painful or poorly functioning bone or joint. Exercises during the healing process and after the bone heals are essential to help restore normal muscle strength, joint motion and flexibility. Help your broken bone heal properly-follow your orthopaedist's advice.
- SPECIALTIES:
Physical Medicine & Rehabilatiation - SUB-SPECIALTIES:
Sports Medicine
Dr. Sheng, MD
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- OTHER FRACTURE LINKS
Physical Medicine & Rehabilitation
What is a Physiatrist?
A Physiatrist is a physician that specializes in the field of Physical Medicine and Rehabilitation. Physiatrists are experts on how nerves, muscles, bones, joints, and the brain work together. They are doctors of function and are trained to help patients return to healthy and active lifestyles as quickly as possible, whether it be return to work, sports, or just returning to normal daily activity.
Physiatry is a person-centered specialty. Physiatrists look at the whole person in the context of their daily lives, not just one symptom or condition.
Physiatrists specialize in non-surgical care, and will work with you, your family, and the rest of your healthcare team to make an accurate
diagnosis and come up with a customized treatment plan for rehabilitation.
What sorts of conditions does a Physiatrist treat?
Physiatrists are specialists in the non-operative treatment of a wide array of disorders affecting the musculoskeletal system.
They are highly skilled in sports medicine, spine medicine, and general orthopaedic conditions. These can include:
What sort of training does a doctor have to complete to become a Physiatrist?
Typically, a Physiatrist has completed four years of medical school, a one year internship in either internal medicine or surgery, and a three year residency in Rehabilitation Medicine. At that point, they may choose to subspecialize by completing additional training in the form of a fellowship such as sports or pain medicine.
What can I expect at my clinic visit?
At your initial clinic visit, your Physiatrist will take an oral history and perform a comprehensive physical examination. If necessary, he may order additional diagnostic tests such as X-rays, CTs, MRIs, or Bone Scans. Your physiatrist is also an expert in electrodiagnosis, and if necessary, may perform a specialized nerve test called electromyography, or EMG, in order to help pin-point the source of your pain.
Because every patient is unique. treatment plans are always individually tailored. Your plan may include referral to physical or occupational therapy, bracing, orthotics, or medications. Sometimes, the above treatments are not enough, and your physiatrist may recommend state-of-the-art spine or peripheral joint injections. These are usually performed under fluoroscopy, which enables your physiatrist to obtain "live" X-ray images during a procedure. If a surgical referral becomes necessary, your physiatrist
Physiatrists believe that patients do their best when they are properly educated regarding their diagnosis so they can have an active role in the decision-making and treatment process. Your Physiatrist will do this through careful explanation of your medical problem and treatment plan. will work closely with orthopedic surgeons to provide integrated care that maximizes your return to function.
