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A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E

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WINTER 2019

Valley athlete doesnâ€™t let knee injury steal his passion to play

Biomechanics lab leads cutting-edge research on joint replacements Leading edge treatment smooths away pain so you can get back in action sooner The CORE Institute opens new clinic in Scottsdale

On the Rebound

SCORE!

Helping a teen soccer star win it all

A hip ďŹ x with less risk. Minimally invasive techniques enable surgeons to replace your hip and get you back to life.

anterior approach

Sources: Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:5-8, American College of Sports Medicine, Exercise and the Older Adult, US Department of Health and Human Services, Osteoporosis Research, Education and Health Promotion, Annals of internal medicine (Impact Factor: 16.1). 04/1996; 124(6):568-72, J Am Geriatr Soc. 1995 Jul;43(7):756-60, J Am Geriatr Soc. 2004 May;52(5):657-65, Health Day March 11, 2014, Journal of Strength & Conditioning Research: October 2012, Volume 26, Issue 10, p 2806-2811, Archives of Internal Medicine August 6, 2012, Nutrition & Metabolism May 17, 2012

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WELCOME VOLUME 9, ISSUE 4 – WINTER 2018

FROM THE CHAIRMAN

Fast Forward With the turning of a calendar page, a New Year is upon us. It’s a time to celebrate great successes, build upon challenges, overcome and look ahead to all the promise and potential that 2019 has to offer. For The CORE Institute, we move forward with great pride, having, once again, been voted Arizona’s Number 1 rated orthopedic practice, named as one of Arizona’s Most Admired Companies, and honored in the Arizona Corporate Excellence Awards. All of that is made possible by the extraordinary employees here at The CORE Institute, and our treasured patients, to whom we are absolutely devoted. That devotion is on display in this issue of CORE Ink. Our cover story features a recreational league basketball player who overcame a torn ACL with care from The CORE Institute, and not only returned to the court, but began running long distance races. You’ll also read the inspiring story of the Novi, Michigan high school soccer star who counted on The CORE Institute to conquer a series of serious injuries,

and then went on to score the winning goal in the state championship game. Plus, news about a minimally-invasive surgery technique called kyphoplasty that’s helping osteoporosis patients overcome debilitating back pain. And, in our “Ask the Expert” column, you will find important information for those suffering sciatic nerve pain from spinal stenosis. We’ll take you inside The MORE Foundation’s Orthopedic Biomechanics Research Lab, where scientists are using robots to build better prosthetic joints, go behind-the-scenes at our brand new, stateof-the-art Scottsdale Clinic, and introduce you to nine outstanding new providers who have joined us here at The CORE Institute. It’s all part of our commitment to excellence, to meet a growing demand for world-class care, and to deliver that care to every patient, every time. It’s a commitment you can always count on this year, and in years to come.

Keep Life in Motion!®

David J. Jacofsky, MD Chairman & CEO

A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E

CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE Editor: Jim Williams, JLWilliams@republicmedia.com Design: Rachel Tullio

Contents

12 COVER STORY

On the Rebound Valley athlete doesnâ€™t let knee injury set him back. See page 8.

PATIENT CARE

8 16

SCORE! Teen soccer star gets help from The CORE Institute en route to a championship goal. See page 12.

D E PART M E N T S Whatâ€™s New?

Nutrition

6 The CORE Institute is pleased to introduce its new providers

18 Getting back on track in the new year

Research

20 Leading edge treatment smooths away pain so you can get back in action sooner

7 Biomechanics lab leads cutting-edge research on joint replacements

Specialty Spotlight

connect with us 1.866.974.2673

16 The CORE Institute opens new clinic in Scottsdale

Trends

Ask the Expert 22 Severe sciatica and nerve pain? CORE orthopedic spine surgeon Tajdip Sandhu has answers

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WHATâ€™S NEW

NEW PROVIDERS The CORE Institute is pleased to announce additions to our Arizona provider team AMMAR R. KARIM, DO

PARAMJIT SINGH, MD

PETER BOYLE, DO

JESSE ANDERSON, MD, FRCSC

Ammar R. Karim, DO is a fellowship-trained orthopedic surgeon specializing in trauma, adult and pediatric fracture care, infections, osteomyelitis, amputations, nonunions, malunions, pelvic fractures, acetabular fractures, periarticular fractures, leg length discrepancy, spine problems, and foot and ankle trauma.

Dr. Boyle is a fellowship-trained orthopedic surgeon specializing in primary and revision total hip and knee replacements. He incorporates many of the newest techniques and technologies available for total joint replacement surgery, including the muscle sparing, Direct Anterior, approach to hip replacement.

Dr. Anderson is a boardcertified and dual fellowshiptrained orthopedic surgeon with a keen interest in primary and revision joint replacement surgery of the hip and knee. Dr. Anderson also has an interest in arthroscopic surgery of the knee, shoulder, and ankle, including non-operative treatment options and rehabilitative principles for sports injuries.

MICHAEL ROSE, MD

Michael B. Rose, MD is a fellowshiptrained orthopedic sports medicine surgeon. He specializes in advanced shoulder and elbow surgery, knee ligament reconstruction, hip arthroscopy, knee cartilage restoration and meniscus transplantation, malalignment correction including osteotomies of the femur and tibia, and patellofemoral disorders. He is experienced in reparative medicine, featuring ÂŽ Lipogems and Platelet-Rich Plasma (PRP) Injections.

MICHAEL TALERICO, MD

FARHAD DARBANDI, MD

BRANDON HIRSCH, MD

NICHOLAS WISCHMEIER, MD

Dr. Darbandi is a fellowshiptrained specialist in hand and upper extremity surgery and is certified in basic microsurgery. He specializes in the treatment of complex disorders of the hand, wrist and elbow.

Dr. Singh is a fellowship-trained orthopedic spine surgeon with a keen interest in treating spinal deformity, degenerative conditions of the spine, extradural spinal tumors, and trauma. He also has an interest in motion preservation surgery using cervical disc replacements and cervical laminoplasty procedures for stenosis.

Dr. Hirsch is a fellowshiptrained orthopedic spine surgeon with clinical interests in minimally invasive treatment of complex degenerative disorders of the cervical, thoracic, and lumbar spine.

Dr. Talerico is a fellowship-trained orthopedic traumatologist. He specializes in orthopedic trauma, adult and pediatric fracture care, infections, post-traumatic deformities, osteomyelitis, amputations, nonunions, malunions, pelvic fractures, acetabular fractures, periarticular fractures, leg length discrepancy, periprosthetic fractures, and foot and ankle trauma.

Dr. Wischmeier is a fellowshiptrained orthopedic surgeon specializing in foot and ankle reconstruction with a special interest in ankle replacement surgery, foot deformity correction, sports injuries, and foot and ankle trauma and arthritis.

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RESEARCH

Building a Better Joint Biomechanics lab leads cutting-edge research on joint replacements By Elise Riley When Marc Jacofsky, PhD goes to the grocery store, he sees how people reach for items from shelves. At the gym, he watches people move and bend. He sees how people use their joints — where they’re applying force, how tendons and ligaments work to make the motion happen. When he’s at work in his lab, Dr. Jacofsky’s robots manipulate those same joints to help him unlock the secrets — and limits — of human physiology and joint replacement. It’s not the lab from “Westworld,” but it’s close. The MORE Foundation’s Orthopedic Biomechanics Research Lab (OBRL) conducts state-of-the-art experiments using robots to discover how orthopedic repair procedures work with muscles and bone to restore function. TAKING A DIFFERENT VIEW Dr. Marc Jacofsky directs the research at the lab, which has revolutionized the approach taken in validating the design and surgical techniques for artificial joints. Previously biomechanics research would put a joint into a machine and apply force to test the strength, and limits of, the joint. Computer simulations provide similar analysis. But the OBRL takes a much-different approach. Dr. Jacofsky’s team connects cadaver joints to motors that act like muscles to study how the joint moves and where there are limitations. Their work helps us learn how the human body works, how it works with a prosthetic joint, and how those prosthetics could be improved. “In the way a puppeteer moves a marionette, we’re able to move the joint, we’re re-creating the anatomical system,” said Dr. Jacofsky, who also serves as the Chief Scientific Officer for The CORE Institute. “We’re pulling on the muscle in the same way your body would. We’re studying how the joint moves under this more realistic, simulated environment.” “Our goal each time we put a shoulder in the robot is to recreate the anatomy of the donor,” Dr. Jacofsky said.

“We don’t attach the cables in the same spot for every specimen. We attach the motor to the muscle. When we pull on those muscles, the shoulder will actually move a little bit differently. That’s the beauty of our system. We can take into account these differences from patient to patient.” THE RESULT? Prosthetics manufacturers learn how to improve the joints they produce for shoulders, hips, knees and the like. Orthopedic physicians learn about the subtle changes they can make when performing a joint replacement. “It may be the cadaver can still lift its arm, but it takes 50 percent more force,” Dr. Jacofsky said. “We’re looking at how we could change the geometry of an implant to overcome deficiencies. We want a shoulder that takes 50 percent less force to move, not 50 percent more.” The lab’s work has realworld implications. Based on FOR MORE INFORMATION their experiments, the team For more information, visit www.more-foundation.org. can see which movements are weakest after joint replacement. That data informs the rehabilitation process. Research also can help doctors determine which type of implant is right for a particular patient. They’re even learning subtle differences in implantation techniques and positioning that can dramatically affect the success of a new joint. “It really advances our ability to understand how these joints function once you put them in the human body,” Dr. Jacofsky said. Once you put it in (a patient), you can’t see how it’s performing. But in the lab, we can see it in real-time and monitor it.”

COVER STORY

On the Rebound

One Valley athlete didnâ€™t let a knee injury set him back By Meghann Finn Sepulveda | Photos by Jay Worsley

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everal years ago, Jonathon Simpson injured his knee while playing on a recreational basketball league. His doctor instructed him to rest, and his knee eventually healed on its own. But last year, Jonathon began experiencing pain again in the same knee. During a basketball game, Jonathon’s knee could no longer bear weight when he came down on it. His knee buckled, and he fell to the ground. An MRI revealed Jonathon had torn his anterior cruciate ligament (ACL). That’s when he turned to The CORE Institute for comprehensive treatment. ALL TOO FAMILIAR An ACL tear is considered one of the most common knee injuries among adults, according to the American Academy of Orthopaedic Surgeons.

Athletes like Jonathon who participate in sports like football, soccer or basketball are more susceptible to injure their ACL. “When an individual has an acute trauma to the knee, he or she may hear a pop and then experience immediate swelling,” said Tony Nguyen, MD, an orthopedic surgeon and knee specialist, at The CORE Tony Nguyen, MD Institute. “It’s a good idea to see a physician for treatment.” EXPLORING OPTIONS Jonathon was able to quickly schedule an appointment with Dr. Nguyen at The CORE Institute to discuss treatment options. “When I met with Dr. Nguyen, I liked

that he explained the different types of treatment that were available,” said Jonathon. “Based on my age and activity level, he recommended surgery because he thought it would provide the best outcome.” While there are alternative treatment options for a torn ACL, surgery is often recommended for individuals who are young and active. During the procedure, orthopedic surgeons carefully reconstruct the ACL so that knee stability is reestablished, and the previous level of activity can be resumed. “Jonathon was an excellent candidate for surgery,” said Dr. Nguyen. “Our goal was to restore his knee and get him back to doing the activities he enjoyed.”

who put together a comprehensive, individualized rehabilitation plan. “ACL surgery can be tough and usually takes between six months and a year Elise Harris, PT, DPT, before a OCS, CSCS patient can get back to their pre-operative level of function,” said Elise. “Jonathon was very active and fit prior to surgery which helped set him up for success.” Elise worked closely with Jonathon to first reach small goals like walking. After a few weeks, he was back in the gym. Elise gave him targeted exercises he could do on his own — in addition to ongoing physical therapy — to strengthen his knee. “Jonathon was very ambitious to reach every milestone,” Elise said. “He breezed through the exercises so quickly that we actually had to slow him down a bit to avoid re-injury to the knee and safely get him back to playing basketball.”

FOR MORE INFORMATION Learn more about treatment for an ACL tear at thecoreinstitute.com.

A few weeks later, Jonathon underwent surgery to reconstruct his ACL at The CORE Institute. Dr. Nguyen also discovered that Jonathon had damage to his meniscus, which was also successfully repaired during the procedure. FOCUSED ON HEALING Following surgery, Jonathon spent two

weeks at home to rest and recover. “The swelling went down quickly, and the pain was not nearly as bad as I expected,” he said. After a follow-up appointment, Jonathon was cleared to begin physical therapy to regain strength and range of motion in his knee. He met Elise Harris, a physical therapist at The CORE Institute,

MAKING A COMEBACK After seven months of physical therapy, Jonathon was back on the basketball court. “My knee felt good and strong,” he said. “I was confident it would not give out again.” Jonathon also began training for a Ragnar Relay, a team race comprised of 18 miles of trail running and completed his first one just six months following surgery. Today, Jonathon exercises regularly, incorporating agility drills into his workouts to keep his knee strong. “I’m happy my knee was able to heal completely, and I could remain active,” he said.

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PATIENT CARE

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Teen Soccer star gets help from The CORE Institute en route to a championship

SCORE! By Debra Gelbart

n orthopedic surgeon isn’t top of mind when thinking about who inspires a high school athlete. But Sean Bak, MD, with The CORE Institute in Michigan, gave a teen soccer player the confidence this past June to lead her fellow team members to a crucial victory. Novi High School soccer player, Avery Fenchel, has been under Dr. Bak’s care since May 2017, when an injury during a soccer game left her unable to play forward on the girls’ soccer team. Avery fractured her collarbone during a game when another player Sean Bak, MD tripped and fell, knocking Avery onto the ground as the other player landed on top of her. “Until that moment, she had been playing well all season,” said her mom, Lisa Fenchel. She said her daughter “heard a snap” when the collision happened. Lisa drove her to the nearest hospital emergency department, where doctors stabilized her condition.

>>>

PATIENT CARE

CONNECTING CARE Lisa is a grade school principal and knew that one of the teachers at her school has a daughter who plays sports and had experienced an injury. The teacher recommended that she see Dr. Bak, who’s also a sports medicine specialist. Lisa was able to get an appointment with the doctor the next day. Because Avery was only 14 at the time of her injury, Dr. Bak determined that her broken collarbone would likely heal, without surgery, pins or screws. He prescribed only a special arm sling to hold the collarbone in place, allowing it to heal more quickly. “Dr. Bak was really good at educating me, my husband Ken and Avery on what the issue was,” said Lisa. “He showed us the X-rays and explained the injury to Avery, who was understandably scared.” Dr. Bak reassured them that although the bone was separated into two pieces, it would grow back together. He emphasized that Avery’s injury required a lot of immobility and seeing Dr. Bak on a regular basis so he could monitor her progress.

Novi High School soccer player Avery Fenchel is back to her competitive self after recovering from a collarbone fracture. Left: X-rays, before and after healing.

“We needed to follow her pretty closely through X-rays for the first couple of weeks to make sure the bone didn’t shift into a less advantageous position,” said Dr. Bak, who for 13 years has served as the team physician for Novi High School. Gradually, over the next three months, Avery’s collarbone grew back together. “You could see on the X-rays that the bone was growing,” Lisa said, “and there was a new layer of bone above and below where the break had been. It kind of looks on the X-ray like a tree trunk now with a knot in it.” “Once she healed, her bone really thickened up, and now her clavicle is very strong,” Dr. Bak confirmed. By August of 2017, Avery resumed physical activity and began physical therapy. By September, she was playing soccer again with her year-round club team. CHAMPIONSHIP STATE In March 2018, she began playing with her high school team again. “The team had a great season, and Avery again was

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scoring lots of goals,” Lisa said. The team advanced to the state championship game in mid-June. “The other team was exceptional, too, and everyone assumed that team would win,” she said. “After an injury like Avery had, it’s natural to be a little bit cautious,” Lisa said. “But Dr. Bak had been really good at saying to Avery, ‘Don’t be overly cautious. Trust that your body is strong and don’t play like you’re afraid, because that could result in possibly being injured again.’ He gave her that confidence and took away that worry. His mental support for her was really helpful. Those pep talks he gave her were very beneficial.” It was a scoreless game until about three minutes to go in the second half. “Avery got past a couple of defenders, moved around the goalie and poked the ball into the net,” Lisa said. The remaining moments of the game were nerve-wracking as the girls prevented the other team from scoring. Avery ended

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up scoring the winning and only goal of the game. Novi High School became the Division I Michigan State Champion in girls’ soccer. WINNING ATTITUDE “Avery is a tough kid,” Dr. Bak said. “While she was healing, it was more of an issue of our holding her back than her holding herself back. She has a lot of drive and once she’s out there, you really can’t stop her.” Today, Avery is a junior in high school and looking at colleges. Soccer “is her life,” Lisa said, and Avery is hopeful that she will get a scholarship to play the sport in college. “We’re so grateful that Dr. Bak helped her through what was probably the most difficult thing she’s ever had to deal with.” “Although I also work with college teams and pro athletes,” Dr. Bak said, “helping high school athletes is especially rewarding. It’s fun to see these kids playing for the love of the game instead of for monetary gain.”

SPECIALTY SPOTLIGHT

World-class care, contemporary design comes to East Valley The CORE Institute opens new Scottsdale clinic

By Joan Westlake o meet the growing patient demand for highly skilled orthopedic services in the Northeast Valley, The CORE Institute has opened its 10th Arizona clinic at 90th Street and Shea Boulevard. Scottsdale patients can now more conveniently access all orthopedic specialties, including sports medicine, foot

and ankle care, musculoskeletal oncology, spine surgery, pain management, interventional spine, hand and upper extremity and adult joint reconstruction. The new clinic features four orthopedic exam pods, X-ray units, THE CORE INSTITUTE â€“ SCOTTSDALE 8952 E Desert Cove Ave, Suite 113 Scottsdale, Arizona 85260 thecoreinstitute.com/scottsdale. For an appointment, call 877-206-0661

a medical equipment/supplies area and an Interventional Spine procedure center with medical imaging and pre/post-op rooms. Nicole Ford of Evolution Design reimagined the existing 6,500 squarefoot building with a contemporary Scottsdale vibe, while bringing it up to The CORE Institute patient care standards. Exam room comfort was maximized, finishes and lighting were upgraded, wheelchair accessibility was enhanced and the most efficient patient flow patterns throughout the clinic were created.

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EXCLUSIVE PRIVACY In addition, patient privacy was elevated in the procedure area by placing the rooms on the edge of the clinic. A separate space and exit for these patients, often recently waking up from sedation, provides a calm and personal environment as they leave the clinic. “Every new clinic brings the challenge of reaching even higher levels of meeting patient expectations,” said Jennifer Bravo, The CORE Institute associate vice president, Integration & Facilities. “It is very, very rewarding to create exciting new facilities and deliver a new clinic to our patients and staff. We look forward to caring for our patients in the new facility and contributing to the Scottsdale economic community

by meeting health care needs and providing professional employment opportunities.” SCOTTSDALE CLINIC PHYSICIANS Physicians caring for patients in their new Scottsdale location include Ali

Araghi, DO; Robert Cercek, MD; Tyler Collins, MD; Amalia DeComas, MD; Eric Feldman, MD; Melissa Galli, DPM; David Jackson, MD; A. Kurt Lundberg, MD; Steve Myerthall, MD; Tony Nguyen, MD; Nina Patel-Hinkle, MD; Frank Raia, MD; and Ryan Scott, DPM. “The CORE Institute is pleased to be continually redefining leading-edge orthopedic services and care across the Valley with our renowned standardized care approach, proprietary quality IT platform and proven outcomes,” said Dr. Jason Scalise, The CORE Institute’s Vice Chairman and an internationally recognized expert in the field of shoulder reconstructive surgery.

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NUTRITION

Tips for ‘guiltless’ eating

ere we are, well into 2019. How are you doing on those New Year’s resolutions? Are you feeling pretty good about yourself or have you slipped back into bad habits? Let’s face it, making, and keeping resolutions is not easy. We give ourselves any excuse to indulge on sweets, snacks and everything in between. Another glass of wine? Don’t mind if we do. A heaping plate of Buffalo wings? Yes, please! Oh, and can we have cheese fries with that? If this is you, don’t despair; you have plenty of company. However, that doesn’t mean you have to stay in an unhealthy rut. There’s still plenty of time in this new year to make healthy and make nutritious choices. From planning ahead to fitting in a little exercise, you’re sure to get back on track — with a little less guilt and a whole lot of balance. KEEP IT CLEAN If you’re the official cook in your house, there are simple things you can do to make your dishes cleaner and healthier. For instance, rather than using refined grains, opt for whole grains. Trim the unwanted fat from dairy projects by choosing lowfat versions. And instead of using granulated sugars, replace them with

ZUCCHINI CHICKEN ALFREDO 3 small zucchini, cut lengthwise with a vegetable peeler or spiraled 1 tsp. sea salt, divided 1 tbsp. avocado oil 16 oz. boneless skinless chicken breasts or thighs 1 tsp. Italian seasoning 1/4 tsp. cayenne pepper 1/4 cup unsalted grass-fed butter 3/4 cup quinoa cream or organic heavy cream 1 tsp. minced garlic 6 oz. Parmesan cheese 1/4 cup fresh parsley, chopped Place sliced zucchini in a colander and place the colander over a bowl. Sprinkle with 1/2 tsp. sea salt and allow to sit for at least 30 minutes. Meanwhile, heat avocado oil to

minimally processed ones like honey or dehydrated sugar cane juice. Another good tip is to reduce ingredient amounts and substitute ingredients. “When making desserts, use half the sugar the recipe calls for. Or replace it with Stevia,” says Nicole Hahn, Clinical Nutrition Senior Manager at Banner Boswell Medical Center in Sun City. “You can also use mashed bananas or applesauce as sweeteners. Chia, which is packed with omega 3 fatty acids,

medium-high heat in a large skillet. Place chicken on a plate and sprinkle on both sides with Italian seasoning, remaining sea salt and cayenne pepper. Add chicken to skillet and cook over medium-high heat until cooked through, about 8 to 10 minutes per side. Remove from skillet. Allow to cool, then chop. Reduce heat to medium and add butter to the skillet. When it’s melted, scrape up the browned bits. Add heavy cream and bring to a boil, whisking constantly. Reduce heat to medium-low. Add garlic and Parmesan cheese, and cook until the cheese is melted. Stir in chopped chicken, zucchini noodles and parsley, and cook for 2 minutes, until warmed through. Source: WendyPolisi.com

is also a good substitute for eggs.” For beverages, make your wine go a long way by spritzing it with mineral water or seltzer. And instead of serving sugary sodas and juices, offer unsweetened teas with honey or sugar cane juice. FORWARD THINKING As is the case with all things nutritional, the key to a healthy eating is in the planning. A little thinking ahead can make all the difference in ensuring

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a good balanced diet, Hans says. “For instance, if you’re going to a dinner party in the evening, cut back on sugar and carbohydrates during the day,” she says. “Also balance your intake of proteins and vegetables, and, most importantly, don’t starve yourself and go to the party hungry. That’s when portion control and overeating go out the window.” Hahn also suggests filling up on fruits, vegetables and crudités instead of chips, dips and processed snacks. For entrees or main dishes, go heavy on the vegetables, such as leafy greens and roasted varieties. WALK IT OFF Eating healthy goes hand in hand with staying active. While the hustle and bustle of negotiating the new year can wreak havoc on your fitness

CHOCOLATE KETO PROTEIN SHAKE

3/4 cup almond milk 1/2 cup ice 2 tbsp. unsweetened cocoa powder 2 to 3 tbsp. keto-friendly sugar substitute to taste (such as Swerve) 1 tbsp. chia seeds, plus more for serving 2 tbsp. hemp seeds, plus more for serving 1/2 tbsp. pure vanilla extract Kosher salt, pinch Combine all ingredients in a blender and blend until smooth. Pour into a glass and garnish with more chia and hemp seeds. Source: Delish.com

schedule, Hahn says sticking with your normal routine as best you can is key to keeping fit and healthy. “Keep up with your daily routine, whether it’s walking, weights, yoga or cardio. Consistency is still key,” says

Hahn, who also suggests making exercise a social affair. “Gather your friends or family together and go for a walk around the neighborhood or at a nearby park? It’s a great way to socialize while being active.”

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Leading edge treatment smooths away pain so you can get back to active sooner By Leigh Farr

Spine Solution 20

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TRENDS

hen back pain from osteoporosis gets in the way of your daily life, the team at The CORE Institute can help you get back to your normal activities with the least amount of recovery time. The CORE Institute’s comprehensive spine team offers an effective solution for patients suffering from pain after a fracture from osteoporosis. “For our patients who experience severe pain following a compression fracture of the spine caused by osteoporosis, we offer a minimally invasive outpatient procedure called kyphoplasty,” says orthopedic spine Ali Araghi, DO surgeon Ali Araghi, DO. “For more than 16 years, I have been performing this procedure and I can say that this has been one of the most successful procedures that I do for pain relief and I am very happy to be able to offer this revolutionary treatment to the patients of my community.” RELIEF IN SIGHT Each year, more than 2.1 million bone fractures occur in the U.S. as a result of osteoporosis. Fortunately, there are solutions for relieving pain and regaining mobility. Kyphoplasty is a highly effective surgical solution for individuals with a fracture from osteoporosis who have tried conservative pain management through physical therapy and medication and were unable to find relief. “The goals for this procedure are to improve pain, reestablish the height that was lost in the vertebra and improve the forward angulation, or kyphosis, of the vertebra resulting from the fracture,” says Dr. Araghi. “Like any other procedure, kyphoplasty has its own inherent risks but they are extremely rare.” He recommends checking with your orthopedic provider to determine whether the procedure is right for you.

STRONGER THAN BEFORE During the procedure, which takes 20 to 30 minutes, the physician makes one to two tiny incisions and inserts a special balloon within the spine, inflating it to create space. The balloon is then deflated and removed and cement is injected into the cavity created, stabilizing the fracture and alleviating pain caused by the fracture. “Within 15 minutes of the procedure, the treated vertebra is stronger than it was before the fracture,” says Dr. Araghi. Patients are usually discharged within an hour of the procedure and are able to resume an active lifestyle within a week, he says. “They get excellent range of motion back and they are allowed to go back to playing pickleball, cycling, hiking and just about any activity they did before the procedure.” COMPREHENSIVE CARE Dr. Araghi and many of the other spine providers are excited to be able to provide an effective treatment for back pain as part of the comprehensive spine and bone health programs at The CORE Institute. “Given the experience of our surgical/interventional team and our medical and surgical providers being under the same roof, patients are able to get the most efficient and best care possible for spine fractures related to osteoporosis,” he says. “It is important to realize that most fractures are caused by underlying osteoporosis and the osteoporosis should be treated and evaluated by the patient’s medical provider. At The CORE Institute, we have a team of specialized personnel who can treat osteoporosis and help prevent future compression fractures.”

TO LEARN MORE about the bone health program, or to schedule an appointment with a member of the spine team, please visit www.thecoreinstitute.com.

ASK THE EXPERT

Q&A

with Tajdip Sandhu, MD

Core Relief By Julie Maurer

Q: I have been diagnosed with spinal stenosis and have severe sciatica nerve pain from time to time. What do you suggest preventing this pain and, when it occurs, to relieve the pain? A: Sciatica nerve pain is an electric shock-like pain that goes down your sciatic nerve â€” which starts in your lower back and spreads to your hips, buttocks and down your legs. Spinal stenosis is when the space around the spinal cord narrows. It can tighten on the nerve roots, causing sciatica nerve pain. There are a few things you can do to prevent sciatica pain with spinal stenosis. One of these is to keep your core strong. We often send patients to physical therapy to build up those muscles, so they are not putting as much pressure on their lumbar area. Core building activities can include: > Front and side planks: Keeping your

back straight and holding yourself off the ground with your forearms and your feet. > Curl-Ups: Put less pressure on your back than sit ups but build strength in your abdominal muscles. Lay flat on your back with your knees up and inhale, holding your stomach muscles tight for five seconds before exhaling and relaxing your abdominal muscles. Repeat this several times. Tajdip Sandhu, MD Obesity can also be a factor in contributing to sciatic nerve pain as well. If you are putting a lot of weight on your spine, you are going to put more force on those discs, and there is a greater chance of herniating and bulging. Losing some weight can ease some of the burden on your spine. In addition, to prevent sciatica pain, you should avoid prolonged activity

that can trigger the nerve compression, like sitting or standing too long. Try alternating activities so you are not in the same position too long. Sometimes itâ€™s helpful to set an alarm to remind yourself to change positions. Gauging when onset pain begins will help you understand at what intervals you should change positions before the pain begins again. For patients who are past the prevention stage and are already experiencing pain, rest assured there are methods for relief. We approach conservative treatment options first, such as physical therapy and over-the-counter anti-inflammatory medications. If you feel like you have exhausted all treatment options and pain is not improving, we have alternative options. Some options may include muscle relaxants, steroid injections, or epidural injections.

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