Category: Spine

The Myth of Laser Spine Surgery

Posted on April 24, 2018

Many people are under the impression that a laser is the main surgical tool used in the procedure advertised as laser spine surgery. That couldn’t be farther from the truth, according to back painneurosurgeon Dr. Scott Simon of Orthopaedic and Neurosurgery Specialists (ONS).

What’s more, Dr. Simon believes that use of a laser in spine surgery is more of a marketing gimmick than surgical innovation. “The laser is only used to remove the soft tissue over the spine after an incision has been made and the surgeon performs whatever minimally invasive procedure is called for,” Dr. Simon explained. “Using a laser actually creates an unnecessary step to the surgery.” If soft tissue needs to be removed from the spine, electrocautery, in which a heated needle is used, is a more effective technique, he added

Lasers are certainly not new technology. Lasers have been available for use in medicine since 1973. However, they have not been widely adopted as a tool to be used in spinal surgery. “Most neurosurgeons do not use or recommend the use of lasers for spine surgery because there are no clear benefits and there are other well-established and documented studies proving the effectiveness of more modern and established spine surgery techniques,” Dr. Simon said, adding that ONS neurosurgeons do not use or recommend laser spine surgery.

The laser is in fact just a light that burns soft tissues and is unable to remove ligaments, discs, bone or bone spurs. It is actually much less precise than the more modern surgical tools. Bone spurs that press on nerves or the spinal cord, for instance, are easily taken care of through minimally invasive spine surgery. “The outcomes are excellent and patients often go home the same day as their procedure,” Dr. Simon said.

The majority of spine conditions can be effectively treated without surgery, noted Dr. Simon. When surgery is recommended, he advises patients to carefully research the qualifications of the neurosurgeon and surgical facility. “Minimally invasive spine surgery, fusionless spine surgery and outpatient spine surgery are often advertised as the latest advances in spine care, when in fact the specialists at ONS and elsewhere have been performing and improving these procedures for nearly 20 years,” he said.

Schedule a consultation with an ONS spine specialist at our offices in Greenwich or Stamford, CT or in Harrison, NY by calling 203-869-1145 or submit this online form.

 

ONS Featured in Greenwich Sentinel

Posted on January 25, 2016

sentinel_logo_transparentYou can learn about the early days of ONS and the philosophy that made us the most comprehensive and advanced practice the region. The writer, Sara Poirier Correa, did an excellent job explaining that with 22 top sub-specialty trained physicians, ONS is able to provide personalized services to patients. The article also highlights the Women’s Sports Medicine Center and the ONS Foundation for Clinical Research and Education, which has published internationally and competes among researchers at larger universities such as Harvard, Yale, and Johns Hopkins. http://bit.ly/1PNTkfh

 

Tips to Prevent Back Injury from Shoveling Snow

Posted on January 22, 2016

If the local forecasts are to be believed, many of us will be doing a fair amount of snow shoveling this weekend. Before you bundle up and head out, though, Dr. Jeffery Heftler, an interventional pain Blog-shoveling show 300 pxspecialist at Orthopedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, has a few words of advice to protect your back from strain and injury.

“The most important thing is to stay ahead of the accumulation of snow. It’s much easier on your back to shovel after every few inches has fallen than to wait and lift heavier loads of snow for a longer period of time,” he advises. Waiting can make the task even harder if the snow melts and then freezes over. Dr. Heftler also recommends investing in so called “push shovels” that are specially designed for pushing the snow aside while shovels with bent handles can help ease the tension on back and shoulders.

Without a doubt, Dr. Heftler sees more patients with back pain following a large snow storm. One reason, he suggests, is that people tend to think of shoveling snow as a nuisance and chore, when in fact it is an intense and strenuous exercise. “All too often, people who are generally inactive underestimate the physical challenge involved in clearing snow. Even someone in good shape can strain their back from the rotation of lifting the snow and throwing it over their shoulder,”   he says.

To protect your back, it’s best to take a few moments to warm up your muscles before going out in the cold. When shoveling, maintain the correct posture and technique to minimize the pressure on your weaker back muscles. Avoid rounding your lower back, for instance. Instead, go through the motions with a straight back leaning forward and your knees slightly bent. Use your core, hips and hamstrings to provide strength and stability instead of relying on your back and shoulder muscles to do the heavy lifting.

People with pre-existing back conditions are most vulnerable to shoveling related injuries and should avoid the activity altogether. “Even if you have to hire someone to clear the snow for you, it will pay for itself in terms of avoiding pain and days lost from work and winter sports,” Heftler says.

If you do experience pain while shoveling, Dr. Heftler says to stop, go inside and rest in a comfortable position until the discomfort passes. He recommends anti-inflammatory medications such as Advil or Aleve, and using ice or heat directly on the area where the pain is most acute. If the pain is severe and persists through the next day, consult with a physician.

Greenwich Hospital Announces New Chief of Staff, ONS Neurosurgeon Paul Apostolides, MD

Posted on March 28, 2015
Paul Apostolides, MD Neurosurgeon
Paul Apostolides, MD
Neurosurgeon

Dr. Paul Apostolides, Section Head of the division of Neurosurgery at Greenwich Hospital, has been appointed hospital Chief of Staff as of January 1. Dr. Apostolides joined Greenwich Hospital’s medical staff in 1998 and has served on many committees including the credentialing committee, executive committee and peer review committee. For three years prior to his current appointment, he was Assistant Chief of Staff. He has served on the Greenwich Hospital Board since 2012.

A graduate of Stanford University and University of Massachusetts Medical School, Dr. Apostolides completed his residency and fellowship training at the Barrow Neurological Institute. He is board certified by the American Board of Neurological Surgery, and is in practice with Orthopaedic & Neurosurgery Specialists (ONS) in Greenwich. He specializes in minimally invasive as well as complex reconstructive spinal surgeries.

ONS is an advanced multi-specialty orthopedic and neurosurgery practice serving patients throughout Fairfield and Westchester Counties and the New York Metropolitan area. ONS physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. For more information, visit www.onsmd.com, or call (203) 869-1145.

Looks like more snow is in the forecast, we have some skiing tips for you!

Posted on January 31, 2014

skierThe knee is the most vulnerable body part for any athlete, including skiers. Downhill skiing produces large amounts of torque on the knee, challenging the integrity of ligaments and tendons. Whether from a fall or overuse, the most common injuries in skiers are tears to the MCL (Medial Collateral Ligament) or ACL (Anterior Cruciate Ligament), two important structures that give our knee stability.  When a skier is thrown off balance, his skis will sometimes shoot out in front of him, creating extra torque on the knees and damaging our stabilizing structures.

Both novice and experienced skiers are at risk of hurting their knees. We frequently see novice skiers hurt themselves when they do not know how to turn, stop or fall properly. Taking lessons and working with an instructor goes a long way in preventing knee injuries for beginner skiers. Experienced skiers frequently take risks and assume that they can manage faster speeds on any slope.  Many injuries, whether you are a beginner or an experienced skier, are related to weather conditions. It is important to realize that as visibility and surface conditions deteriorate, the slope or trail level goes up. In poor visibility or icy conditions, a beginner trail becomes an intermediate trail, and an intermediate slope becomes advanced slope. Keep injury prevention in mind, if the conditions are difficult, ski down a level.

A second reason injuries occur is fatigue. Most skiers’ bodies are not accustomed to exercising 6-8 straight hours. In addition, many skiers push their bodies to take advantage of the whole day, even when they start to feel tired and stiff.  For this reason, injuries tend to happen at the end of the day.

Having the knowledge of what places skiers at a higher risk for knee injuries, we are passing on recommendations about how to stay safe on the slopes.  Both beginners and experienced skiers can benefit from these tips!

  1. Start a conditioning program a few months before your first ski trip. Leg strengthening, flexibility and balance are important aspects of an adequate ski conditioning program.
  2. Ski with good technique. Maintain your balance and control, keep your hips above your knees, keep your arms forward, and maintain a safe speed.
  3. Learn how to fall correctly: keep your legs together, keep your chin to your chest and your arms up and forward.
  4. Pay attention to weather conditions and remember to ski down a level if conditions deteriorate.
  5. Listen to your body. If you start to feel pain or stiffness upon exiting the lift chair, then you should probably make that run your last. Head to the lodge and enjoy a warm drink by the fire.

Good luck and stay warm!

If you become injured, while skiing, remember, ONS sports medicine physicians are trained at the top universities and hospitals in the country and have expertise in the latest treatments for sports-related injuries in high-performance and recreational athletes.

Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit https://onsmd.com/ or call 203.869.1145.

 

ONS Physical Therapist, Alicia Hirscht Discusses How to Help Avoid Neck and Back Pain in the Workplace

Posted on January 29, 2014
ONS Senior Clinical Specialist Alicia Hirsch
ONS Senior Clinical Specialist Alicia Hirsch

Let’s face it, if you don’t have a smartphone or a tablet, LTE or Wi-Fi, if you are not tweeting and networking 24/7….well, with the way we all depend on technology today, you might as well be living in a cave and drawing hieroglyphics!

We’ve come a long way from the years of the caveman, the question is, at what expense have we make this progress? From manufacturing and robotics, trading and purchasing, to filing and storage of records and data, almost everyone in the workplace uses computer technology. While computers and the internet enable workers to be more efficient and productive, our global workforce is quickly becoming more sedentary, and more painful.

Data collected from office workers reveals that 20% suffer from chronic neck pain, and 60-70% report having suffered from neck pain at some point in their career. Neck pain is highly correlated to workers who sit with a forward head for more than 5 hours per day, and is twice as likely to affect women and workers older than 40. Luckily, though, research also shows that workers who exercised regularly, reported good sleep habits and engaged in productive stress management reported a lower incidence of neck pain.

While 8 hours of sleep, regular meditation and a gym membership (that you actually use) might not fit into your busy, computer driven life, do not worry, hope is not lost. There are small steps you can take to keep yourself as pain free in the office as possible… and less irritable.

Step 1: Get up and move! We are not built to sit, we are built to MOVE. Set a timer on your computer that reminds you to change position every 20 minutes. Even if you stand for 1 minute 2 times an hour, your risk of developing neck pain reduces dramatically. While standing, engage is some basic exercises that can be done easily at your desk (see below).

Extensions: Place your hands on your waist and lean your shoulders back. Move slowly, repeat 15 times.
Extensions: Place your hands on your waist and lean your shoulders back. Move slowly, repeat 15 times.
Chin tuck: Pull your chin back towards your spine, keeping your eyes focused straight ahead. Hold for 3 seconds, relax, repeat 15 times.
Chin tuck: Pull your chin back towards your spine, keeping your eyes focused straight ahead. Hold for 3 seconds, relax, repeat 15 times.
Stand with your shoulders back and your chin tucked. Take a large step back with your right foot, allowing your left leg to bend. Sit your hips down into the stretch, hold for 20 seconds, repeat on each leg.
Stand with your shoulders back and your chin tucked. Take a large step back with your right foot, allowing your left leg to bend. Sit your hips down into the stretch, hold for 20 seconds, repeat on each leg.
Chest stretch: Reach up and back with one arm while reaching down and back with the other, open up your chest and squeeze your shoulder blades together. Keep your chin tucked, hold for 15 seconds.
Chest stretch: Reach up and back with one arm while reaching down and back with the other, open up your chest and squeeze your shoulder blades together. Keep your chin tucked, hold for 15 seconds.

Step 2: Make sure your work area is set up properly. Your desktop monitor should be even with your line of sight. Not in a corner away from you, right in front of you. If you work with a lap top or tablet, prop them up on risers so that you do not have to look down. Consider wireless/external keyboards to keep your hands in front of you and your elbows bent at 90 degree angles. Use a lumbar support to keep your spine in a neutral position, and adjust your seat height so that your hips, knees and ankles can rest at 90 degree angles. (See the picture below) Download or view our Workstation Ergonomics flyer to use as a guideline for improving your work space to help improve sitting posture and help to minimize neck and back pain.

NeckPain_Office
Desktop even with your eye sight, lumbar support to keep spine in a neutral position, knees and ankles resting at 90 degree angles.

If you are experiencing neck and back pain it may be time to talk to the experts at the ONS Spine Center. ONS Spine Center physicians specialize in non-operative and operative treatments for neck and back pain. Visit the Back and Neck Pain page on our website to learn more and see our physicians. To learn about our physical therapy services visit ONS Physical Therapy.

Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit www.onsmd.com or call 203.869.1145.


Golf Advice For US Open Championship Fans

Posted on June 14, 2013

Golf may be perceived as a low risk sport, but it is physically demanding and golf related injuries are increasing.

Another great stretch to do before and during play.
A great stretch to do before and during play.

If watching the US Open Championship has inspired you to head for the links, here are a few exercises for golfers to ensure an injury free day on the course and to get the most out of your summer golf! The pros do it, you should too!

Golf advice for US Open Championship fans!

1. Train by repetitive motor learning specific to golf. Example: long distance runners are not trained by sprinting.

2. Never separate the torso from the hips while swinging.

3. For a more beneficial aerobic workout, walk outside, NOT on a treadmill.

4. Improving flexibility will result in fewer injuries, swing consistency, improved distance through less compensation and greater power.

5. Remember to stretch AFTER you warm-up your muscles.

6. To achieve a more powerful swing, strengthen your core through resistance training, yoga and Pilates.

7. Avoid surgery by taking care of your body on and off the course through exercise, healthy diet habits and minimizing stress.

8. Wrist weakness and radiating forearm pain could be “golfers elbow.” Be sure to maintain proper form and resist the temptation to play too much. REST is the best treatment for this injury.

9. Swimming, biking and using the elliptical machine are three of the most effective cross-training exercises.

10. When picking up your ball, always remember to bend with your knees.

Most IMPORTANTLY: Listen to your body and don’t play if you’re experiencing pain or are tired. If something is beginning to hurt, get it checked out.

– See more at: https://onsmd.com/2012/07/02/golf-hazards-and-injury-prevention/#sthash.pKnTk8as.dpuf

Eliminating the Confusion about Spinal Fusion

Posted on December 19, 2012

Spinal Fusion is used to treat spinal instability and alleviate chronic mechanical back pain but many people are unsure of what spinal fusion actually does. The following video explains how the procedure secures vertebrae together so they permanently “fuse,” thereby restoring stability to the spine. When abnormal movement between vertebrae is eliminated, pain is relieved.  Spinal fusion performed by ONS neurosurgeons at Greenwich Hospital is frequently with minimally invasive techniques through small incisions.

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Seminar on Non-operative Treatments for Neck and Back Pain on Tuesday

Posted on November 29, 2012


On Tuesday, December 4 at 6:30 p.m. Tamar Kessel, MD will present a seminar in the Noble Conference Center at Greenwich Hospital on conservative treatments for neck and back pain.

Tamar Kessel, MD
Physiatrist Tamar Kessel, MD

When physical therapy and oral anti-inflammatory medications fail to resolve a spine-related problem, some patients achieve significant relief from a spinal injection. Injection therapy is a way of delivering anti-inflammatory medication directly to the injured area of the spine. ONS physiatrist Dr. Tamar Kessel uses steroidal and non-steroidal injections to help patients return to their normal lifestyle. Learn how these treatments are given, who is benefited most and what to expect from interventional therapy.

Tamar Kessel, MD graduated from Cornell University and earned her medical degree from Albert Einstein College of Medicine. After completing a residency in physical medicine and rehabilitation at New York Presbyterian Hospital of Columbia and Cornell, she received fellowship training in spine and sports medicine at Hospital for Special Surgery in New York.

Registration required. Please call (203) 863-4277 or (888) 305-9253, or register on-line at www.greenhosp.org.

Patient Information Update: ONS Spinal Injections Not from tainted supply

Posted on October 5, 2012

According to the Center for Disease Control (CDC), the medications that have caused fungal meningitis from spinal injections that are currently being talked about in the media, were made in a New England Compounding Center, located in Framingham, MA .

ONS does not use compounded steroids for any injections and there is no chance that any of our patients have been administered the tainted steroids in question. ONS obtains our medications directly from the drug manufacturer which is regulated by the FDA.

Wide variety of spinal disorders treated at the ONS Spine Center

Posted on June 12, 2012

The large majority of people in the United States will have some type of spinal disorder but most will recover completely with nonsurgical treatments. The first line of treatment after a full evaluation should be conservative measures like physical therapy, medications, injections or even acupuncture. If a patient does not improve using conservative treatments, spinal surgery may be an option.

The ONS Spine Center is made up of a team of highly-skilled and experienced neurosurgeons who specialize in the full spectrum of non-operative spine treatments and operative spine treatments. From diagnostic imaging to physical therapy to therapeutic spinal injections to the most advanced surgical techniques including Minimally Invasive Spine Surgery, our Spine Center offers premier and comprehensive spine care.

Seminar on Spinal Fusion: Treatment for Spinal Instability -May 8th

Posted on May 3, 2012


Considering a Spinal Fusion? Attend this informative seminar on Tuesday, May 8, 2012, 9:00 a.m. at Greenwich Hospital, 5 Perryridge Road, Greenwich.

Spinal fusion is used to treat spinal instability and alleviate chronic mechanical back pain. The procedure restores stability to the spine by securing vertebrae together so they permanently “fuse.” By eliminating abnormal movement between vertebrae, pain is alleviated. Once only performed as open surgery, spinal fusion at Greenwich Hospital is now often done minimally invasively through small incisions. Neurosurgeon Paul Apostolides, MD will explain how and why spinal fusion is performed and will take questions about the procedure and its recovery.  Registration is required. To register, call 203-863-4277 or 888-305-9253.

The Spine Institute at Greenwich Hospital is certified for cervical (neck) and lumbar (lower back) spinal fusion for adhering to national standards for excellence, quality and safety.

Understanding Injection Therapy for Neck and Back Pain Relief

Posted on March 29, 2012

Tuesday, April 3, 6- 7:30 p.m.
Noble Conference Center, Greenwich Hospital

Speaker: JEFFREY HEFTLER, M.D. , PHYSIATRIST
at Orthopaedic and Neurosurgery Specialists PC and Greenwich Hospital

When physical therapy and oral anti-inflammatory medications fail to resolve a spine-related problem, some patients achieve significant relief from a spinal injection.

INJECTION THERAPY is a way of delivering anti-inflammatory medication directly to the injured area of the spine.

ONS PHYSIATRIST JEFFREY HEFTLER, MD uses steroidal and non-steroidal injections to help patients return to their normal lifestyle.

Learn how these treatments are given, who is benefited most, and what to expect from interventional therapy.

Registration required. Please call (203) 863-4277 or (888) 305-9253, or register on-line at www.greenhosp.org.

 

“Does Laser Spine Surgery Work?”

Posted on February 7, 2012

 

…a question often asked by our patients.

Here’s the answer:

Spine surgery is typically done to relieve pain and other symptoms by decreasing pressure on a compressed nerve or by stabilizing the spine.  In the case of a herniated or ruptured disc, a discectomy may be done to remove the damaged portion of a disc in the spine; or a laminectomy may be done to remove bone spurs or other spinal growths. In cases where the spine is unstable, a spinal fusion can be performed to secure together two or more of the vertebral bones so that they “fuse” together.  These surgeries are now often performed using minimally invasive techniques that minimize damage to the surrounding tissue and allow for a faster recovery with much less blood loss. Laser spine surgery is often promoted as being minimally or even noninvasive and risk-free.  However, these laser spine procedures do require incisions and the laser itself can result in serious complications.

Laser spine surgery has never been studied in a controlled clinical trial to determine its effectiveness. Marketing pitches for spine surgery performed with a laser often make bold promises of pain relief for chronic neck and back pain and a quick return to normal life; sometimes in a matter of days. What is often not clear from marketing hype, is that laser spine surgery does actually involve surgery.  An incision is required to allow access to the spine.  A focused beam of light (laser) is then used only to remove the soft tissues over the spine.   Bone and ligament are then removed in order to free the nerve from compression using small instruments.  The laser in laser spine surgery actually plays a very minor role.

Lasers are certainly not new technology.  Lasers have been available for use in medicine since 1973.  However, they have not been widely adopted as a tool to be used in spinal surgery.  The fact is that most neurosurgeons do not use or recommend the use of lasers for spine surgery because there are no clear benefits and there are other well-established and documented studies proving the effectiveness of more modern and established spine surgery techniques.

The Importance of a Proper Diagnosis

It is important to have a proper diagnosis of your problem before deciding to undergo spine surgery.  Most cases of back and neck pain are muscular in origin and do not require or benefit from surgery. Unless severe pain or muscle weakness is making walking or performing daily activities extremely difficult, surgery is rarely the first line of treatment. Anti-inflammatory medication, physical therapy and exercise, lifestyle changes and other noninvasive treatment modalities such as therapeutic massage are often successful at resolving back and neck pain.

If conservative treatments fail to reduce back pain, then surgery may be necessary, depending on your diagnosis. For example, if you have a herniated disk with leg or arm pain as a major symptom that hasn’t been relieved with other treatments, discectomy may be appropriate. If surgery is recommended, get a clear explanation of your diagnosis and how the surgery will help relieve your symptoms.

Traditional spine surgery has been tested in numerous clinical trials.  The vast majority of patient who undergo discectomy for treatment of a herniated disc experienced relief from pain and other symptoms.  In elderly patients diagnosed with spinal stenosis, laminectomy is also a highly effectively procedure. Very few neurosurgeons regard laser spine surgery as a viable alternative to conventional spine surgery techniques. ONS neurosurgeons do not use or recommend laser spine surgery.

Mayo Clinic Opinion on Laser Spine Surgery