- All right, Brad.
This is a video by Dr. Erik Ekstrom.
He's a specialist in back, neck and spine care.
- And he's doing some very advanced treatments on these
and it's something you're gonna wanna know.
- Yeah. Check it out.
Yeah, I was gonna say something else.
Just check it out. - Check it out.
♪ Bob and Brad ♪
♪ The two most famous physical therapist on the internet ♪
(air whooshes)
- Well, welcome back to the program Dr. Ekstrom.
- Hey, morning. Good to see you.
- So today we're gonna talk
about Carson Daly's back procedure.
So what procedure did he actually have done?
- Carson had a procedure called Intracept.
He had it at the bottom segment of his back.
It's called L5-S1.
If you watch the video,
you'll hear the story specifically,
but he had about a 25 year history of chronic low back pain.
He got injured apparently in a snowmobile accident
when he was working with MTV.
And so, since that time, he's been dealing
with this back issue.
He describes it as like he's wearing his pain every day.
He tried all sorts of different treatments
from rehab options to interventions and so forth
and didn't get better.
And so, his spine provider, Dr. Patel,
he talked him into finally getting an MRI
to try to get more information
on what's going on.
And he had some changes in his spine
that made him a candidate for this Intracept procedure.
So
specifically, he had these changes in his spine
that suggests that the pain is not coming from the disc.
And that's what we've historically
treated all these decades.
If you have a chronic low back pain problem,
it's probably a bad disc,
but what we discovered
and actually, it was always there.
There's like 30 years of basic sciences that says,
"Well, the pain could probably not be coming from the disc
but from the bone on either side of the disc."
And that's what we now call virgenic pain, not disc pain.
And so, using that perspective
and knowing the information that Dr. Patel had
on Carson Daly, she chased this Intracept procedure on him.
So maybe a couple things
about why the pain would be coming from the bone.
What happens is,
we know that the disc breaks down, right?
But there's this, let's say, border wall
between the vertebral body and the disc,
as we call that the endplate.
And when disc breaks down,
that endplate starts to break down along with it.
And that causes a reaction
into the bone or into the vertebral body.
That's an inflammatory reaction in the beginning.
And pain nerves get activated,
pain nerves get produced.
And then there's this main line nerve called
the base of the vertebral nerve.
And that's what the Intracept procedure does.
It treats that nerve.
It basically burns it off,
disconnecting the phone line is kind of how I put it.
And that's how you can hopefully then lose that back pain
that you're having.
So, yeah, he underwent that Intracept procedure
and he did pretty good.
- So you actually performed
the Intracept procedure, correct?
- Yeah.
I was one of the early providers or adapters of Intracept.
I started getting involved with the company.
It's called Relievant,
who helped evolve the literature behind it
and of course, the procedure itself, Intracept.
In 2019 is when I started my journey.
And in fact, when I get done this morning,
I get to go do three cases.
And, yeah, it's been quite a journey
and an exciting journey.
I'm glad I got part of it.
I'm glad to see the outcomes
in these patients with this vertebrogenic pain.
- So with this type of surgery,
it's more minimalistic, right?
So noninvasive?
- Right.
I mean, we still do it either at a surgical center
or a hospital.
You're set pretty up like a surgery.
You can't eat and you have to have a physical
and all those sorts of things.
The procedure itself is done
under some kind of high level anesthesia.
I do mine under general anesthesia.
To do a single level, it's probably gonna take
about a couple hours of your day to go through that process.
Once we're done with the procedure,
our average length of stay after the procedure
is about 45 minutes and you go home,
and we've had very little pain post procedure.
People are staged up to go back
to physical therapy usually afterwards.
The procedure itself,
you're on your belly,
we make for at one level you have to treat the bones
on either side of that bad disc.
So two small incisions, like the size
of a baby aspirin or a P are made.
You use a special needle.
We call it an introducer
to go into the bone and eventually into the vertebral body.
And you create a very small little cavity
that allows you to put a probe
into the core of the vertebral body.
That's where you're gonna find most of that nerve.
And then you burn it.
And the cauterizing, we call that radio frequency,
takes about seven to 15 minutes per level.
And then, of course,
we've removed all your probe and so forth
and there's no hardware left.
We don't alter the anatomy at all
except for cauterizing that nerve.
And for those that are listening,
and you've had some experience with chronic low back pain
and you've had some
of these radial frequency procedures previously
for other things in the spine
and you've heard those nerves can grow back.
And that is true.
But in this case, this particular nerve,
the basivertebral nerve or the BVN
is structured where it doesn't have
what we call myelination.
The bottom line is that nerve can't grow back.
So the procedure is permanent.
You don't have to come back and have it repeated.
It's kind of a one and done thing.
- So who would be appropriate
to receive this type of procedure?
- So, it's a very specific criteria.
And there's three things you have to have.
The first is, chronic low back pain greater than six months.
Carson Daly, he get it for 25 years.
Second thing is,
you've had to have failed conservative treatments
and that would be the rehab options, chiropractic care,
physical therapy, massage, all those things.
Maybe you failed interventions
and different injections and so forth.
And then the last thing is you have to have an MRI
in most cases and it has to show
what are called Modic changes.
And again, if you go back to that video on Carson,
Dr. Patel actually does throw out his MRI
and points those out,
or you can Google it.
And what Modic changes represent are his signal changes
within the bone that represent those changes
within the bone that I described earlier
where the end plate breaks down, that inflammatory action,
those angry pain receptors get activated and produced.
And the Modic changes again represent
that process occurring.
In addition, if you go back and again,
look at the basic sciences again,
Modic changes highly correlate
or connect up to people who have chronic low back pain
and have failed treatments.
So, I mean, that data's already there too.
So again, three things.
You have to have failed conservative treatment six months,
chronic low back pain greater than six months.
And on your MRI, you have to have these Modic changes.
And the specific levels that are treated are from L2.
So up to the top of the lumbar spine
down to S1 or to the top of the sacrum.
So those are the segments that Intracept
has indicated to treat.
- So if people are interested in Intracept,
they're finding more information about you,
where can they go?
- Couple things.
You can get on Intracept.com,
and there's a physician finder on that site.
And so, just type in, I believe your zip code.
And then you can find providers that do this procedure.
I'm with Summit Orthopedics here
in the Minneapolis St. Paul area.
If you get on Summit site, summitortho.com,
you can find me.
And my team is listed there and you can connect up
with the phone numbers that are there
and otherwise Google and you can find me too.
- Perfect. Is there anything else you wanna add about this?
- So again, I've done a lot of cases
and I've had great outcomes in the majority of patients.
So what I like about Carson's video is,
I mean, he's happy.
I mean, the thing is, he's 60 to 70% better.
And I like the fact
that the successful Intracept patient is the one
that the back pain is affecting the little things in life.
You can't load the dishwasher,
you can't sit and play with your kids.
One of my first patients was a nurse from Mayo
and she couldn't manage that car ride
from Rochester up to Minneapolis.
So he does a nice job getting that out there,
that Intracept.
I mean, it's not gonna improve your marathon time
but it's gonna help the little things in life
that are getting in the way just to have good quality
of life.
And his expectation, he's happy with 60 to 70 percent.
And we get more than that sometimes,
and sometimes we get less
but I think he describes that very nicely in the video.
And the other thing I like
about the video is I learned what manralysis was.
Did you pick up on that?
- No, I didn't watch this whole video.
I've seen little news articles about it.
- Oh, yeah.
Apparently they talked about that on "The Today Show"
when they were interviewing Carson.
And manralysis is when men are tasked
to do the little things in life
like unloading the dishwasher
or putting the toilet seat down.
And, anyway, I'd never heard manralysis before.
And, God, my family's running with it now. So-
- I just call them chores, but, okay.
- Yeah. - It's good to know.
- I guess there's a medical term.
- Yeah.
- Anyway, so yeah, that's what I got for you.
- Perfect.
Well, thank you for joining us today,
and hopefully, we'll have you back in the future.
- Yeah. I always enjoy talking with you, guys.
You have a great rest of your day.
Okay.
(upbeat music)