Neck & Back Pain – Graham Mouw, MD Radio Interview
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Female Announcer: One of the largest acute care facilities in the San Fernando Valley, Valley
Presbyterian Hospital has been serving the community since 1958. We’re
proud to present this special audio chat series – VPH Med –
with Valley Presbyterian Hospital. Here’s Melanie Cole.
Host Melanie Cole: Your health and safety is the top priority at Valley Presbyterian Hospital
and those factors are especially important in the operating room. Many
procedures performed at VPH involve minimally invasive techniques with
smaller incisions, which can minimize pain and speed your recovery time,
and we’re talking today with Board Certified Neurosurgeon with VPH,
Dr. Graham Mouw. Welcome to the show Dr. Mouw. So tell us a little bit
about spinal surgery. What conditions would require somebody to seek out
a neurosurgeon and say, ‘I think I, you know, have some issues with
my back and it’s pretty severe.’
Graham Mouw, M.D.: Hi, nice to speak with you. The conditions that I normally treat involve
people who have either a pain in their arms or hands, or numbness in their
arms or hands, or sometimes weakness in their arms or hands, similar symptoms
with legs, they have pain shooting down a leg or any numbness or possible
weakness. I even treat people who have difficulty walking, which is stemming
from the nerves from the spinal cord.
Cole: So if people are experiencing these symptoms and they come to see you,
is there something you do with them first? Do you try medications or at
this point has medications already been tried and now it’s time
to discuss procedures?
Mouw: Well I think the most important part of the analysis is that a patient
has to start off with a MRI imaging most likely depending if it’s
of the neck or the lower back. So I think that’s usually a good
start. Usually by the time people come to see me, they’ve had some
sort of imaging study and if they haven’t that’s certainly
something that I can order for them.
Cole: OK, so once they’ve gotten that and you’ve looked at it and
you’ve said ‘OK this is the situation whether you’ve
got stenosis or, you know, severe arthritis or some cervical issue.’
Then what? What kind of procedures are we talking about that can not work
on reducing mobility and that are not fusion involved.
Mouw: So, you know, one should always take a conservative approach to the spine
and you alluded that sometimes we use medications or sometimes I’ll
send them to a pain specialist but very often surgery is actually needed
and we’re moving into the realm of very high success rates with
spinal surgery and I think a lot of that success is coming from what I
call ‘motion sparing surgery’ - surgery where you maintain
the normal motion of the spine, as well as what I also call ‘less
invasive surgery,’ which is surgery that doesn’t require a
long hospital stay and people can return very quickly to their normal
function of life. And the success rates are very high today with these
newer techniques that are available.
Cole: So people always want to know…I myself am an exercise physiologist
and people ask me this question all the time, Dr. Mouw, do you go to an
orthopedist when you’ve got a back issue or do you go see a neurosurgeon?
Mouw: Well, that’s an excellent question and I’m a Board Certified
Neurosurgeon with fairly extensive experience with the spinal surgery.
I come from the Cleveland Clinic and have come to Valley Presbyterian
because of the excellent services that are offered. The advantages of
seeing a neurosurgeon is that often times you can get a smaller surgery
and my particular expertise is in motion sparing, so I’ve helped
develop certain techniques, particularly in the neck, that allow patients
to have a surgery and not have what we call ‘spinal fusion’
where the bones are fused together. That’s a very common procedure
in America but in other parts of the world procedures have been developed
that allow full motion of the spine. And I’ve developed those techniques
in my practice and that’s something that’s now available at
Valley Presbyterian Hospital.
Cole: In motion sparing surgery, whether, I mean, people get very afraid of anything
having to do with their neck, Dr. Mouw, and even for their spine. What
is recovery like? Are they able to start physical therapy pretty quickly?
How soon can they resume some activity?
Mouw: Well that’s the really nice thing about motion sparing surgery is
that people can resume activity very quickly and have a very normal, natural
feeling to their neck because if they’re motion sparing. Just to
give you an idea there are two types of motion sparing surgeries. One
is disk replacement surgery in the neck. And in that particular case,
people usually go home the next morning and can usually within a week
have a fairly normal activity level. And the other procedure that I’m
an expert at, probably more than just about anybody in the United States,
is what we call Cervical Laminoplasty, where I will actually reconstruct
the back of the spine, what we call the lamina. I expand it. I make it
wider. And those people similarly can return a fairly normal activity
level. Usually within two to three weeks, and by about four to six weeks
there are really no restrictions at all. I’ve performed that procedure
on NFL players. I’ve also performed that procedure on a wide range
of people ranging from forty to eighty years old, and it’s an incredibly
Cole: Are there certain people that are not candidates for the Cervical Laminoplasty?
Mouw: So the most important thing when you have the symptoms that we talked about
at the beginning of the interview – symptoms down the arms or hands,
weakness or numbness, or symptoms in the legs – is to meet with
a spine surgeon who can perform most aspects, if not all aspects, of spinal
surgeries. So there are absolutely certain indications who I would choose,
for instance, to do a disk replacement or a patient I would choose to
do a laminoplasty. That’s for the neck. In the lower back there
are also less invasive procedures similarly where I could decide to do
a micro-nerve root decompression versus a (inaudible) open laminectomy
where you remove the whole lamina of the back part of the spine, I can
do very selective surgical nerve root decompressions, and these are almost
out patient procedures where people would certainly be home by the next
morning. There are also procedures in the lower spine where I can preserve
motion where there’s some weakness in the back, some (inaudible)
that are available. Really, in order to be able to tell what is the best
option for you, you need to meet with a surgeon, such as myself, who is
trained in all of these procedures and even pioneered some of these procedures
so that you get the exact procedure or get the best fit for you and your
spine. Very often a surgeon may only know how, for instance, to do a fusion,
and you’re going to meet with them and that’s what you’re
going to be offered. But the surgeon you need, such as myself, should
be able to do just about everything so you get the best fit for you.
Cole: That’s great information and in the last few minutes if you will,
Dr. Mouw, please give us your best advice for people suffering from cervical
or spinal pain, and what you really want them to know about this type
of pain and what procedures and help there is out there for them.
Mouw: Well I think that as we are all experiencing these sort of symptoms at
some point in our life, I think people need to know that spinal surgery
has improved significantly and that relief is certainly quite possible
now. I quote people very, very high success rates, well over 90% for the
relief of these symptoms, however, it’s very important to seek out
a surgeon who has specialized training such as a neurosurgeon with spinal
fellowship training such as myself and somebody who can try and do the
least invasive surgery and always trying to preserving the motion of the
spine. But what I can tell people is that they don’t need to suffer
and there certainly, if you’re a good candidate for surgery, the
surgical success rates today in the right hands are extremely high. I
quote people, like I said, well over 90% success rate, if I sign them
up for surgery.
Cole: Thank you so much. That’s absolutely fascinating and gives hope to
a lot of people who are suffering from cervical and spinal pain.
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You’re listening to VPH Med with Valley Presbyterian Hospital. For
more information you can go to ValleyPres.org. That’s ValleyPres.org.
This is Melanie Cole. Thanks so much for listening.