New Cure for Back Pain??

Many of my clients suffer from back pain.  Whether it is caused by a work related injury or a car or truck accident or a fall in the grocery store, I see back injuries all the time with my clients.  So, when I read stuff (and I read a lot of stuff...) I'm always interested in medical research related to the injuries and conditions that affect my clients.  That's why I was very interested in this new report regarding new research in curing back pain.....from RawStory.com:

"Up to 40% of patients with chronic back pain could be cured with a course of antibiotics rather than surgery, in a medical breakthrough that one spinal surgeon says is worthy of a Nobel prize. Surgeons in the UK and elsewhere are reviewing how they treat patients with chronic back pain after scientists discovered that many of the worst cases were due to bacterial infections.

Specialists who deal with back pain have long known that infections are sometimes to blame, but these cases were thought to be exceptional. That thinking has been overturned by scientists at the University of Southern Denmark who found that 20% to 40% of chronic lower back pain was caused by bacterial infections.

“This will not help people with normal back pain, those with acute, or sub-acute pain – only those with chronic lower back pain,” Dr Hanne Albert, of the Danish research team, told the Guardian. “These are people who live a life on the edge because they are so handicapped with pain. We are returning them to a form of normality they would never have expected.”

In the first report, they explain how bacterial infections inside slipped discs can cause painful inflammation and tiny fractures in the surrounding vertebrae. Working with doctors in Birmingham, the Danish team examined tissue removed from patients for signs of infection. Nearly half tested positive, and of these, more than 80% carried bugs called Propionibacterium acnes.

The microbes are better known for causing acne. They lurk around hair roots and in the crevices in our teeth, but can get into the bloodstream during tooth brushing. Normally they cause no harm, but the situation may change when a person suffers a slipped disc. To heal the damage, the body grows small blood vessels into the disc. Rather than helping, though, they ferry bacteria inside, where they grow and cause serious inflammation and damage to neighbouring vertebrae that shows up on an MRI scan.

In the second paper, the scientists proved they could cure chronic back pain with a 100-day course of antibiotics. In a randomised trial, the drugs reduced pain in 80% of patients who had suffered for more than six months and had signs of damaged vertebra under MRI scans.  Albert stressed that antibiotics would not work for all back pain. Over-use of the drugs could lead to more antibiotic-resistant bacteria, which are already a major problem in hospitals. But she also warned that many patients will be having ineffective surgery instead of antibiotics that could alleviate their pain."

So, in summary, this potentially could be a huge help in curing chronic, long-lasting back pain.  It really is a fascinating read.  Take a look at the link above.

Trench Collapse Leads to $1.12 Million Verdict

There are so many way to injure or kill yourself in the construction injury.  This is the reason why we have a lot of regulations that control what contractors need to do regarding safety of their employees.  For example, there are regulations and safety standards when digging trenches.  Depending on the size of the trench, if there is a collaspe, a worker could be bured alive and either killed or seriously injured.  See the following case for an example:

A 100-pound mound of dirt collapsed onto Plaintiff while he was installing a 12-inch water pipe into a trench. The impact crushed Plaintiff’s left ankle, causing fractures and torn tendons and ligaments. Plaintiff also suffered a lumbar-disc herniation and radiculopathy. Consequently, Plaintiff underwent multiple debridement procedures, physical therapy, epidural injections, a lumbar fusion, a laminectomy and surgical repair of the tendons. According to Plaintiff’s experts, Plaintiff is considered permanently disabled and can no longer perform physical labor. Plaintiff also claims he needs counseling for psychiatric issues associated with the trench collapse, including major depressive disorder.

At the time of the incident, contractor Miniscalco Construction, LLC (Miniscalco) had been hired by Aqua Pennsylvania Inc. (Aqua) to supervise Plaintiff’s work. According to a U.S. Occupational Safety and Health Administration (OSHA) expert, Aqua discovered that the trench was not in compliance with OSHA regulations, which required shoring to brace the walls of trenches over five feet deep. Aqua ordered Miniscalco to shore the trench wall, which Miniscalco did. Nevertheless, the OSHA expert testified that Miniscalco did not continue to enforce the OSHA regulations to ensure the walls were properly shored and braced thereafter.

More evidence against the use of spine fusion surgery

A few months ago I blogged about the rise in the use of spinal fusion surgeries. You can see this post here. The basic gist of the post was that the evidence clearly demonstrates that spinal fusion surgeries don't work, but doctors are continuing to use the technique anyway.

I've come across more evidence that spinal fusion surgeries are not ultimately helpful to injured workers, as opposed to other more conservative treatment. This study was performed specifically with injured workers. You can see the full article, with related links, here. Also, here's an interesting review of the evidence and it's implications from the excellent blog Workers' Comp Insider.

At a time of continued debate over the role of spinal fusion surgery (lumbar arthrodesis), the results suggest that this operation "may not be an effective operation for workers' compensation patients" with certain causes of low back pain. The lead author was Dr. Trang H. Nguyen of University of Cincinnati College of Medicine.

Using Ohio workers' compensation data, Dr. Nguyen and co-authors identified 725 workers with chronic low back pain who underwent spinal fusion surgery. Spinal fusion is an operation done to fuse together adjacent vertebrae in certain types of chronic back problems. Most of the patients in the study had degenerative disc disease, herniated discs, or nerve root disease (radiculopathy).

The researchers assessed the final treatment outcomes—including return to work, disability, and use of strong pain medications (opioids)—at two years' follow-up. They compared the results of spinal fusion with those in a random sample of 725 patients who underwent nonsurgical, conservative treatments (such as physical therapy, exercise, etc).

Almost all categories of outcomes were worse for patients undergoing spinal fusion. Just over one-fourth of spinal fusion patients had returned to work, compared to two-thirds of those treated without surgery. Twenty-seven percent of patients in the spinal fusion group had repeat surgery, while 36 percent experienced some type of complication.

The use of spinal fusion surgery for chronic low back pain has increased dramatically in recent years—despite a lack of consistent evidence that it improves patient outcomes. Few previous studies have looked at the use of spinal fusion surgery, compared to nonsurgical treatment, in workers' compensation patients.

Although it's not a controlled scientific trial, the study raises questions about the long-term effectiveness of spinal fusion surgery for workers' compensation patients with chronic low back pain. Dr. Nguyen and co-authors write, "This procedure is offered to improve pain and function, yet objective outcomes showed increased permanent disability, poor return to work status, and higher doses of opioids."

Doctors Getting Rich With Fusion Surgery Debunked by Studies

Many of my workers' compensation clients suffer from work-related back injuries. They range from simple pulled muscles and pinched nerves to full blown herniated discs to severed spinal cords causing a paralyzing condition. The treatment for these injuries can be as simple as rest to physical therapy all the way to serious spine surgery.

One of the types of spine surgeries that many of my clients have undergone is spinal fusion surgery. This surgery entails screwing together, with a metal cage, several vertebrae in the spine in order to limit painful movement in the vertebrae. Here is a picture of what a typical fusion surgery looks like:

I recently came across a Bloomburg article about fusion surgeries that was very disturbing. From the article, I learned that the number of fusions at U.S. hospitals doubled to 413,000 between 2002 and 2008, generating $34 billion in bills, data from the federal Healthcare Cost and Utilization Project show. The number of the surgeries will rise to 453,300 this year, according to Millennium Research Group of Toronto.

In and of itself, the rise in the number of fusion surgeries should not be a concern, assuming the procedure helps patients live productive, relatively pain free lives. But the studies say different.

It’s amazing how much evidence there is that fusions don’t work, yet surgeons do them anyway,” said Sohail Mirza, a spine surgeon who chairs the Department of Orthopaedics at Dartmouth Medical School in Hanover, New Hampshire. “The only one who isn’t benefitting from the equation is the patient.

The Evidence

British and Norwegian researchers found fusion no better than physical therapy for disc-related pain in three studies, totaling 473 patients, published in the journals Spine, Pain and the British Medical Journal between 2003 and 2006. A 2001 Swedish study of 294 patients in Spine found fusion better than physical therapy that was less structured than the kinds used in the other studies.

Rates of complications from surgery in three of the European studies -- including bleeding, blood clots, and infections -- were as high as 18 percent. None reported complications from physical therapy. The four studies are cited in journals as the only head-to-head, randomized comparisons between the two treatments.

In a U.S. study in Spine in 2007, surgeons reported fusion was successful in only 41 percent of 75 patients suffering from lower-back disc degeneration. Success measures included pain reduction. Two years earlier in the same journal, surgeons found a 47 percent success rate among 99 patients, 80 percent of which were taking narcotics for pain two years later. Both studies compared fusion to artificial disc replacement in trials submitted to the FDA.

The Blommburg article, from which this information was taken, is quite extensive and has many personal examples of how this surgery has not helped people, but ruined their lives. In my practice, I have seen both sides of this issue. I have clients who have undergone the surgery and have had a good result and I have had clients have a bad result and have to return to the surgical table and ultimately, be diagnosed with failed back syndrome.

If you are contemplating undergoing this type of surgery, please consider all of the factors. Also, always obtain a second opinion. If this is a Pennsylvania workers' compensation injury, you would have a right to a second opinion that the insurance company would have to pay for.

Pa. company admits crime in secret human bone-cement experiments

Because many of our clients undergo spine surgery to repair herniated discs caused by work injuries or automobile accidents, this story caught my eye. Basically, this company was giving untested bone cement to doctors to use during spinal surgeries, when the patients knew nothing of their guinea pig status. The company was experimenting on humans without their knowledge, and apparently, people died because of it.

What is unclear from the story is the role of the doctors. I could not confirm if any of the doctors who performed the surgeries were complicit in the crime.

New procedure as alternative to lumbar fusion surgery

Many of our clients suffer from back injuries and symptoms emanating from their spine. Also, many of our clients treated at the Southern New York Neurosurgical Group, specifically by Dr. Bajwa or Dr. Sethi.

I just noticed an ad in a free health magazine from Dr. Bajwa and Dr. Sethi requesting patients to be enrolled in a new study. The doctors are conducting an investigational research trial with a surgically implanted motion restoring device that replaces the facet joints of the spine as an alternative to fusion surgery.

They are asking for anyone to contact them that has experienced chronic leg pain with or without back pain, have been diagnosed with spinal stenosis and are considering surgery as a treatment option. The participants must be between 50 and 85 years of age and can not have a history of fusion surgery of the lumbar spine.

People who are interested are urged to call the Southern New York Neurosurgical Group at (607) 754-6247