I'm Dr.
Jay Khanna, physician executive director for the MedStar Orthopaedic Institute
and chair of Orthopaedic Surgery for MedStar Georgetown University Hospital.
Like most spine surgeons, I see patients with different types
of conditions of the spine, often it's spinal stenosis, and they have
symptoms of neck or arm pain, arm weakness or dysfunction
or back pain, leg pain, weakness or dysfunction.
And I'll evaluate the patients, like most physicians do,
by getting the history
to figure out where the symptoms are coming
from, we'll examine the patients to see what their strength is like.
And then I'll take a look at the imaging studies of them.
And I find that very important.
And my stethoscope for evaluation of the spine is really the MRI.
So, I want to make sure almost all of my patients, or most of my patients,
have an MRI study so I can see exactly what's going on in their spine
and which nerves are compressed and which levels are involved.
And then I'll go over the various options with my patients,
and I often break the options down into three broad categories.
One, to leave it alone and do physical therapy and medications.
Two, to consider what I call interventional modalities,
which are modalities short of spine surgery, such as epidural injections,
facet injections, and different types of things to get a patient better.
And the last option is always spine surgery.
And I like to exhaust options one and two before we think about the option
of spine surgery.
There's a lot of new things on the horizon
in spine surgery, and it's an area of very rapid development.
Over the last several years, we've seen the use of more image-guided technology
and navigation for placement of pedicle
screws and other instrumentation into the spine.
We also have newer technologies such as robotics
now that are being developed and things that we're using here
at MedStar Georgetown
University Hospital and throughout the MedStar
Orthopedic Institute and our other programs.
So, we can use robots, intraoperative CT scanners, intraoperative MRI scanners
to help guide our instrumentation and our surgery
to make sure we do the best possible surgery for our patients
while minimizing any potential complications.
It's very important to take a look at everything.
So, I look at them from a spine standpoint, but we have to look at them
from a neurosurgical standpoint, orthopedic standpoint,
rheumatology, neurology, physical medicine, rehabilitation.
And then we also have to consider their other factors.
What are their social circumstances?
Their physical circumstances? And really we're taking care of the whole person.
Cura personalis.
I think patients should come to MedStar Georgetown
and the MedStar Orthopedic Institute because we have great physicians,
we've got great surgeons, and I'm really proud
and honored to be working with some of the leaders in the field
right here in Washington, D.C., at MedStar Georgetown.
I really love the field of spine surgery, the ability to help a patient
who is suffering and can't walk or can't move an arm or a leg
and be able to relieve those symptoms and get the pressure off of their spinal cord
or their nerve roots and stabilize their spine is very satisfying
and I feel very lucky to be able to help patients with these types of conditions.
So, back pain is very common and there's many things that can cause back pain.
Spinal stenosis is one of them:
compression of the nerves in the back. Degeneration of the discs is yet
another one. In other conditions around the spine, such as tumors,
infections, obviously trauma such as fractures.
Most of our patients that end up needing surgery have spinal stenosis
or compression of the nerves in and around the spine.
Spinal stenosis is very common.
Spinal stenosis is really the compression of the nerves
in the lower back that can cause leg pain, weakness, and dysfunction,
or in the neck and cause arm pain, weakness, or dysfunction.
And many times,
the spinal stenosis can be treated non-operatively with physical therapy,
anti-inflammatory medications, and various different types of injections.
Epidural injections are one type,
but when patients fail those non-operative management modalities,
they may be candidates for spine surgery to get the pressure off
of the nerves.
Patients may require surgery for spinal stenosis
if the non-operative measures fail.
So, we try to treat almost all of our patients first with physical therapy,
anti-inflammatory medications and various interventional pain management
modalities, meaning epidural injections and different types of injections.
If those interventions don't work, then we think about surgery,
especially if the patient's symptoms are very severe, and/or
if their MRI findings with spinal stenosis, matches
their symptoms.
Spinal stenosis can be very debilitating.
When patients have severe lumbar spinal stenosis, they can have severe back
pain, leg pain, weakness, difficulty walking.
A lot of patients will say they can't walk unless they lean forward on
a grocery cart, for example.
Some patients will have bowel and bladder dysfunction.
Other patients with cervical spinal stenosis may have similar findings
in their arms with weakness in their arms, pain, numbness, dysfunction.
So, spinal stenosis can be very debilitating.
But spinal stenosis sometimes is not so bad.
And in those patients we can treat them non-operatively with physical therapy,
anti-inflammatory medications and injections.
There is a broad range of surgeries that we perform for spinal stenosis,
and there's two broad categories.
One is for the cervical spine when we have spinal stenosis here,
and the other is for lumbar stenosis;
spinal stenosis in the lumbar spine.
With regard to surgical options in the lumbar spine,
we can break those down into two separate categories.
We have decompression,
which means getting pressure off of the nerves in the lumbar spine.
And then we have stabilization or fusion, which means stabilizing the bones
if they're unstable
or if we make them unstable by getting the pressure off of the nerves.
So, we can perform the procedure in different ways with minimally invasive
techniques to make small incisions using special tools to get down to the spine,
to get pressure off of nerves such as with the disc herniation.
And then we can also do fusion procedures by putting screws, rods,
and different types of materials into the spine to stabilize the spine
or realign the spine.
If a patient has a scoliosis or a curvature of the spine,
or if they have a spondylolisthesis, meaning a slippage of the spine,
or, you know, God forbid, if we have to take care of a spine tumor,
sometimes we have a tumor in the spine and we have to get
the tumor off of the spinal cord or infection off of the spine,
and then re-stabilize the spine. So, there's many different surgeries
that can be done for spine patients.
So, there's a lot of new technologies that we use for spine in orthopedic surgery.
And we're very fortunate
that the MedStar Health System has provided us with all of these tools
to provide our patients with best in class care for their spine condition.
So, we have all the latest image guidance tools in the operating room, intraoperative
CT scanners, robotics and a lot of other very
advanced tools that help us provide the best possible care for our patients.
And it's very important to have those tools because they let us
perform the surgeries in ways that allow our patients to recover faster
with fewer complications, less blood loss, smaller incisions,
shorter hospital stays, quicker recovery, and back to their activities
of daily living, which of course, is the goal with many of these surgeries.
The recovery time
after spine surgery is something a patient and family will always think about.
How long will it take me to get back to my activities?
And when I was a resident and I finished training about 18 years
ago, patients could be in the hospital for a week after some of these surgeries.
But now with the newer technologies and minimally invasive spine surgeries
and better rehabilitation protocols, physical therapy and social work
in the hospital, our patients can sometimes go home the same day,
depending on the size of the surgery.
Sometimes they'll be here for a day or two.
But it's gotten amazingly better over the years because of the new ways
we do things and the new technologies we have to help our patients recover
from their spine surgery.
We take care
of a lot of patients with spinal stenosis, but there's other conditions as well
that affect the spine.
We can have scoliosis, which means a curvature of the spine,
kyphosis, when a patient has bent forward, spondylolisthesis, where there's
a slippage of the spine, disc herniations,
tumors, trauma, infections.
And one of the benefits of our group is that we have ten spine surgeons
in the MedStar Orthopedic Institute, all in the Washington, D.C.
area at our five hospitals, and our neurosurgery colleagues
that we also collaborate with very closely on conditions of the spine
that are also sharing our patients with us.
And sometimes I'll see a patient and I'll realize there's
another surgeon in my group
or in one of my parallel groups that's better for this particular patient.
And so we like to use a technique which I call demand matching.
So, some patients should only be taken care of at one or two of our hospitals.
Other patients can be taken care of in one of our ambulatory surgery centers.
Another patient might be better
taken care of by one of our partners who has a special interest,
because I have ten partners
and we all know what we're all good at and what we have greatest expertise in.
And so instead of taking on a case that I may have done once or twice,
I may refer that patient to my partner who's done a couple hundred of these.
And I think that's really the best thing we can do for our patients,
is to get them to the best surgeon for the given diagnosis
at the right place, in the right type of hospital
or ambulatory surgery center to give them the best care possible.