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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 successful surgery.

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.