Tutor System Included in Therapy for Surgical Pain

365 Days Project - Day 151 - Pain in the neck!

Image by Irina Souiki via Flickr

Mount Sinai’s Dr. Tanvir Choudri reporting in New York’s Daily News on November 1, 2011 says treatment can ease pain from disk herniation and spondylosis.
The specialist who is co-director of the Mount Sinai Neurosurgery Spine Program specializes in minimally invasive spine surgery with a special focus on the cervical spine. He performs 150-200 spine surgeries a year.
Some of the most important bones in the body form the cervical spine, or neck. Thus the cervical spine is made up of seven bones cushioned by disks. This bone disk stack goes from the bottom of the skull to the shoulder level. Running through these bones is the spinal cord, starting at the brain stem and passing down the spine.
Thus the cervical spine not only supports the head but the nerves running through it and branching from it control key areas of the upper and lower body, including the arms, legs, bowels and bladder.
The most common chronic problem that affects the cervical spine are disk herniation and spondylosis. Here the cushioning disks become damaged and displaced. They may then press on surrounding nerves or the spinal cord and cause pain, numbness and weakness.
Herniated disks may result from trauma e.g. a  motor vehicle accident, sports injury or fall. Wheras spondylosis is a degenerative disorder  common in patients > 50 and is due to excessive wear and tear on the disks. These present almost exclusively in people over age 70. A persons ocupation may give them a tendency to encounter spine disorders or sportsmen and woman.
Signs and symptoms:
Neck pain may be limited to muscular strain and will go away with  anti-inflammatories or fade away in a few day. However, a serious spine problem may be indicated if the symptoms  persist longer than a month and progressively get worse. In addition there may be neurological symptoms like numbness, weakness or problems with balance, bowel and bladder function.
The number one symptom of a cervical herniated disk is neck pain.
“Patients experience this pain in the neck region or radiating out toward the shoulders, arms or hands,” says Choudhri.
Cervical spondylosis is the leading cause of spinal cord dysfunction. It can lead to gradual development of symptoms all over the body, including numbness, tingling, weakness, changes in balance or gait, bowel or bladder dysfunction, and sometimes only pain.
According to Choudhri, “Cervical spondylosis can lead to significant neurological dysfunction before it is detected because there can be little to no pain in the neck and many of the symptoms are often attributed to other conditions common in people more than 50 years old.”
Traditional treatment:
The majority of patients with cervical spine disorders can manage their symptoms without surgery.
“Pain management can take the form of medications or injections, either into the muscles or directly to the spine,” says Choudhri. “Rehabilitation with physical therapy and good spine exercises can also make a big difference.”
Smoking takes a toll on the disks of the spine, so quitting smoking can reduce the stress you’re putting on your neck, as can weight loss and regular exercise.
Patients who have neurological symptoms in addition to pain require more aggressive treatment.
“The two main types of cervical spine surgery are decompression or fusion,” says Choudhri. “Decompression surgery removes either the disk, ligament or bone that’s pressing on the nerve or spinal cord, and fusion surgery stops the movement between two bones sometimes with the use of titanium screws to hold the bones in place.”
Surgeons perform neck surgery from the front or back, which they refer to as anterior and posterior approaches.
“Both types can be successful, but we’re still working to optimize which approach works best for which patients,” says Choudhri. “The anterior approach can cause trouble swallowing or voice changes (typically very temporarily) in some people but little pain, while the posterior approach can mean a bit more pain because there are more muscles in the back of the neck.”
Most patients can return to work a few weeks after surgery.
“While spine surgery cannot always resolve all the symptoms, the surgeries in the cervical spine are some of the most successful that we have,” says Choudhri. “The benefits are to manage the symptoms and to limit the chances of continued degeneration or a future major spinal cord injury.”
Research breakthroughs:
Spine surgery has become much less invasive and safer in the past decade.
“We’re continually working to prevent complications and make surgery safer,” says Choudrhi. “In the past 10 years, we’ve seen advances in spinal instrumentation, artificial disks and the materials that promote spine fusion, along with general surgical improvements in anesthesia and peri-operative care.”
Neck pain and stiffness as well as shoulder pain and stiffness can be alleviated and stabilized with the usage of the Tutor system during post surgery physical therapy.
The newly developed Tutor system which includes the  HandTutor, ArmTutor, LegTutor and 3DTutor have become a key componenet in neuromuscular rehabilitation and physical therapy. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation. See http://www.handtutor.com

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