Mark A. Giovanini M.D.
NeuroMicroSpine Specialist
Andrews Institute
www.markgiovanini.com
www.NeuroMicroSpine.com
www.theandrewsinstitute.com
www.smiss.org
Overview
 Spine Anatomy
 Definition of Terms
 Spine evaluation
 Conditions
 Treatment options
Spine Components
Terms
 Axial Pain
 Radiculopathy
 Pain
 Parasthesia
 Motor Weakness
 Sensory
 Sciatica
 Mechanical Pain
Pinched Nerve
Nerves
Low Back Pain
Causes of Low Back Pain
What can you do?
 Home remedies
 Conservative Treatment
 Physician consult
 Emergent Evaluation
 Neurologic Dysfunction
 Bladder Incontinence
Home Remedies
Where Can You Go
 Andrews Comprehensive Spine Center
 Physical Medicine and Rehab
 Pain Management
 Physical Therapy
 Diagnostics MRI
 NeuroMicroSpine Specialists
 OrthoPaedic Spine Specialists
 Athletic Performance Center
See your Physician
Conservative Specialists
Conservative Management
 Physical Therapy
 Medications
 Anti-inflammatories
 Steroids
 Pain management
 Epidural Injections
 Facet Blocks
 Chiropractic Care
 Performance Enhancement
Spine Surgery
 Who get’s better?
 Patient motivation
 Nerve pain vs. back pain
 Does everything add up?
 Questions to ask yourself
 Can I live with this condition?
 Is it getting worse?
 Have I given it enough time?
 Spine surgery is usually a temporary fix in most cases
Surgery
Minimally Invasive
 Benefits
 Smaller incisions
 Back to the good life earlier
 Less pain post op and long term
 Less blood loss
 Less tissue damage to surrounding support structures
 Goals
 Same as traditional surgery through smaller less destructive
portals
 Artistry in Spine
 Surgery designed specific to a patients problem
Open vs. MISS
Conditions
 Disc Herniations
 Lumbar
 Cervical
 Arthroplasty
 Spinal Stenosis
 Degenerative Disc Disease
 Spondylolisthesis
 Scoliosis
 Compression Fractures
Lumbar Disc Herniation
 Symptoms
 Axial back pain
 Sciatica/Pinched Nerve
 Weakness

Foot Drop
 Numbness
 Conservative Care
 PT
 Analgesics
 Massage
 Chiropractic
 3 to 6 weeks
Lumbar Disc Herniation
Minimally Invasive Discectomy
Cervical Disc Herniation
 Symptoms
 Neck pain
 Arm pain or paresthesias
 Weakness/Numbness
 Aggravating factors
 Lateral bending
 Neck extension
 Sleeping with head back
 Compression activities
Treatment
 Physical Therapy
 Traction
 ROM
 Decompression Therapy
 Pain Management
 Epidurals
 Surgery
 Neurologic Deficit
 Intractable Pain
Cervical Disc
Surgery: Anterior Cervical
Discectomy and Fusion
Cervical Disc Replacement
 Indications
 Age 20 -45
 Single level
 Soft Disc herniation
 Benefits
 Preserves motion
 No Recovery time
Spinal Stenosis
 Definition
 Narrowing around the spinal cord and nerves
 Symptoms
 Back pain
 Burning pain in legs or arms made worse with walking
 May have “Neuropathy”
 Warning Signs
 Weakness, Numbness or Bladder dysfunction
Spinal Stenosis
Minimally Invasive Laminectomy
 Outpatient
 Minimal recovery time
 Minimal Tissue Damage
Degenerative Disc Disease
 Definition
 Aging disc
 Not a disease
 Cause
 Normal aging with aggravating activities
 Symptoms/Signs
 Axial Pain with motion
 May have associated mechanical limb pain
DDD
Treatment
 Conservative
 Pain management: Facet blocks, Epidurals
 PT
 Chiropractic
 Modification of Activities
 Surgical
 Fusion



Anterior
Posterior
Side
DDD and Spondylolisthesis
Surgery
Compression Fractures
 Kyphoplasty
 Video
Conclusion
Andrews Institute Spine Team
 Coordinator
 Bette Harrimen
 Patient Liason
 Maria Halpin
 Physical Therapy
 Pain Management
 Neuropsychologist
 Joel Fairbanks
 Physical Medicine and Rehab
 Robert Jensen and Dave Lemay
 NeuroMicroSpine Specialist
 Mark Giovanini
 Orthospine surgeon
 Dave Chandler