An Interdisciplinary Spine Center Provides Expert, Integrated Care in a Convenient Setting

By Judith Lee-Sigler, M.D.

Memphis Spine Center

As Americans today we are generally living longer, more involved in health care decisions, and more invested in the quality of our lives.  Yet, as a population, we are more sedentary, more overweight, and spend more physically inactive hours in front of computers and televisions than ever before. Weekend warriors are common; often with little advanced physical conditioning or warm up, individuals place great demands on their backs engaged in occasional work or sporting activities. It is no wonder that approximately eight out of every ten Americans will at some point have an episode of significant back pain.  It is true that in most cases, these episodes do not involve any tingling, numbness, or weakness.  The pain generally improves with two or three days of bed rest, reduction in activity, over the counter pain medications and perhaps a few stretches.  Although the pain will often resolve completely in a few weeks, this is not always the case.  Perhaps more importantly, when these individuals are followed for a year or more they show recurrent back injury rates of approximately 80%.

Once quality of life becomes impaired by incomplete recovery or continued recurrent episodes of back pain it is important to have a comprehensive, balanced evaluation and treatment plan.  This plan should correlate the patient’s history and physical exam findings, with the anatomy seen on radiographic studies such as X-rays and MRIs. It should also emphasize a stable functional recovery, promote the patient’s independence, and fit with the patient’s personal goals.

The field of Physical Medicine and Rehabilitation, also known as Physiatry, has, since its inception, trained physicians to combine a strong knowledge of the nervous, musculoskeletal, and internal organ systems, with knowledge of function and an ability to thrive in an interdisciplinary, team environment. Our approach also seeks to meet the individual needs of the patient, the most important member of any interdisciplinary team, by developing proactive goal oriented diet and exercise programs to prevent recurrence and disability.

This practical approach creates a particular advantage when applied to the development of a dedicated spine center.  The philosophy of a dedicated interdisciplinary spine center is to provide those individuals with ailments of the neck or back, expert, comprehensive care in a convenient setting.  This kind of all inclusive approach relieves patients and referring physicians of the burden of deciding when to pursue surgical versus non-surgical care.  The multiple referrals that often lead to three and four week waiting periods between each specialist appointment are significantly reduced or eliminated.  Each patient receives ongoing and consistent education from all providers.  Patients also perceive the distinct advantage of an interdisciplinary team that communicates and coordinates not only with them, but with each other. There is just one telephone number to call when there is a question or concern. Protocols are employed to insure that the patient gets the right care at the right time. These act as a roadmap for everyone on the team, setting expectations of what lies ahead.

The Memphis Spine Center was founded to offer this type of interdisciplinary spine care.  By combining the backgrounds and skill sets of an interventional physiatrist, a fellowship trained spine surgeon, a spine fellowship trained advanced practice nurse practitioner and key manual physical therapists we have created a team which is uniquely qualified to deal with most aspects of spine care. Dr. Lee-Sigler an interventional physiatrist was Director of the Carle Spine Center before moving to Memphis earlier this year. Dr. Pratt, founder of Memphis Spine Center, is a fellowship trained spine surgeon who helped develop the area’s first spine center, SPINE Memphis in 1998 and has since dedicated his practice to minimally invasive surgical care of spinal disorders in a spine center setting.  Kevin Taylor, a spine trained advanced practice nurse practitioner joined Dr. Pratt in 2002, completing a two year spine fellowship in 2004. By adding state of the art all electronic medical records and dedicated spine personnel we strive to provide this expertise in a comfortable and convenient setting.

Our goal is to educate the patient as he or she is evaluated so that the decision making process becomes easier. Gains we may achieve are often fleeting unless coupled with long term lifestyle changes. We therefore encourage and promote those changes to minimize recurrence.  Communicating and coordinating with referring and primary care physicians on the day of each visit gives patients their best chance for a seamless plan for better spinal health.  To involve the patient most efficiently, communication must be in clear, understandable language, appropriate goals must be set and articulated, and progress towards those goals tracked and shared.

A Protocol is a plan for treatment which provides for what treatments are offered, when and how often they are offered, and what the expected results should be. Although diagnosis specific protocols are used in order to insure consistency and better track outcomes, these must be customized to meet our patients’ unique and specific needs.  As an example, two fifty year old men may come to the spine center for evaluation, each having severe pain, tingling, and numbness down his right leg and an aching pain in the lower back.  Neither has leg weakness; both have normal bowel and bladder function.  One is a thin well muscled railroad worker who is traveling four to five days per week and is unable to take any medications that might make him drowsy or slow his reflexes.  The second man is overweight, with poor muscle tone and trunk control, has a computer based, sedentary job, does not travel, and could work from home.  After complete evaluation each man is found to have a herniated or ruptured disc in the lower back as the cause of the pain, tingling, and numbness.  Because we consider the whole person and involve them in the process, we are able to develop specific plans for each man which incorporate not only the acute problem, but their overall fitness, job demands and treatment expectations. For this reason, the two men mentioned above would require specific differences in their treatment plans if each were to be given their best chance for recovery.

A pain generator is a tissue or structure which is the primary source of a patient’s back or neck discomfort. In some instances there may be more than one pain generator in the same patient.  There are other instances when a new injury or severe condition is superimposed upon a pre existing, more chronic problem. As such, we work with the patient to prioritize their problems, determining the best course and order of evaluation and treatment.  For example, a person may have predominantly leg pain from a disc herniation at one particular level.  In addition, the person may also have ongoing or recurrent back pain from other aging or degenerated discs, tight, weak, muscles or arthritic joints.  In order to gain the most positive outcome, all, or as many contributors to the complaint as possible must be addressed.  In other words, it is seldom good enough to perform selective nerve blocks or surgery for a herniated disc causing acute leg pain, without addressing as appropriate the patient’s underlying mechanical dysfunctions, weakness, stiffness or arthritis that may have contributed to the overall picture. Exercise, manual physical therapy, and medications are commonly a necessary part of the road to maximum recovery.  Specific lifestyle advice and education must occur all along the way so that the patient gains independence and self-management skills.  This type of comprehensive care is more conducive to positive outcomes and is an important part of our practice philosophy.

Patients with spinal disorders can present with very challenging constellations of problems. People who develop back or neck pain may also have a separate hip, knee, or shoulder problem. In these situations, treatment programs are designed to avoid aggravating these additional areas and where possible actually help them while addressing the primary back or neck condition.  Patients often harbor considerable fear regarding the concept of surgery, much of which is simply fear of the unknown. Surgery is rarely the first option, and should only be considered when all less drastic options have been found ineffective. It can be a powerful tool in improving pain and function for otherwise uncurable conditions. Occasionally, either because disease is too widespread, or simply not surgically treatable, surgery is not an appropriate option. In addition, patients will suffer from such severe cardiac or pulmonary problems that surgery is simply too risky to consider even if surgery would otherwise have been advisable. Here, the interdisciplinary team can shine. An alternative treatment plan can be created which can help transition into a longer term pain management program administered by some of the areas foremost pain management experts.  In short, we will do all that we can to insure the best possible outcome.

In a dedicated spine center, specialists work side by side, as a team, for the benefit of the patient.  This differentiates an interdisciplinary center from a multi- specialty practice where specialists work in the same building but not necessarily in a collaborative manner.  We can also track outcomes and patient satisfaction for comparison and program development purposes.  We also remain ultra focused on one small area of the medical profession, spending all of our practice time, and educational efforts on spine care issues. Thus, the patient can be assured of our commitment to the provision of state of the art care.

Expertise, balanced treatment plans, outcome tracking, and patient focused teamwork are the hallmarks of a dedicated interdisciplinary spine center like Memphis Spine Center. This approach offers a significant advantage for the patient with neck and/or back pain.

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                                                    Last modified: 04/04/06