As seen in local publications
Hitting the links again following back surgery
As published in Petoskey News-Review June 15, 2019
When can I golf after back surgery?
This is a very common question physical therapists are asked after a patient has started their post-operative rehab for back surgery.
As with most things in medicine, the answer is it depends.
Factors such as the type of surgery, the number of spinal levels involved and the pre-surgery/injury fitness level of the patient all play significantly into the speed of recovery.
Other factors like cardiovascular health, metabolic disease and bone density also play a role. Even smoking can be a factor, as tobacco use slows tissue healing time.
The most common types of back surgeries are lumbar laminectomy, discectomy and fusion.
A laminectomy is a procedure which creates space by removing the back part of the vertebra which covers the spinal canal. Also known as decompression surgery, a laminectomy enlarges the spinal canal to relieve pressure on the spinal cord or nerves.
A discectomy is a procedure which removes herniated disc material that is pressing on a nerve root or part of the spinal cord. It is fairly common to have both a laminectomy and discectomy at the same time.
A fusion is essentially a welding process that joins two or more vertebrae so that they heal into a single, solid bone, providing improved stability.
To learn more about how soon a patient can return to golf after surgery, I spoke to Dr. Anthony Bozzio. Dr. Bozzio sees patients in Petoskey, Charlevoix, Roger’s City, St. Ignace, Cheboygan and Gaylord.
MYM: After a lumbar laminectomy, how soon might a fairly-fit patient under 50 hope to return to playing golf? How about a less-fit patient over 70?
Bozzio: “There are a number of different opinions on when to return to sport after this, and no clear consensus, so the timeframes will differ based on surgeon, patient factors, and specific type of surgery performed. Regarding age, I don’t make any specific changes based on the number alone. For golf, chipping and putting is fine around the 3-week post-op mark, after the skin incision has healed. If there is no discectomy performed, return to sport is fine around the 6-week post-op mark. I see patients again around 6 weeks after surgery and at that point golfing is fine. If there was a discectomy performed, I have patients wait 10-12 weeks before golfing to reduce the risk of disc re-herniation.”
MYM: After a single-level lumbar fusion, how soon might an average patient before able to return to golf?
Bozzio: “For a single level fusion, regardless of approach which could include either anterior, lateral, or all posterior surgery, chipping and putting is fine around the 6-week post-op mark and most patients are golfing again at 10- 12 weeks after surgery.”
MYM: What advice do you give to patients who want to get back to golfing as soon as possible after a back surgery?
Bozzio: “I try to encourage most people to do a gradual return to golf and take things one step at a time. Immediately after surgery, the goal is walking more each day and resuming day to day activities while the skin is healing- this is usually for the first 3 weeks. Then, patients start gentle physical therapy that gradually progresses to more golf-specific movements. Patients can start to do some chipping and putting soon after that. Finally, they can return to golf, progressing from some easy time on the driving range, then 9 holes, then full rounds.”
Protecting your lower back while shoveling snow key this time of year
As published in Petoskey News-Review February 21, 2019
Mother Nature has been extremely generous this winter in terms of snowfall.
All that snowfall often is followed by hours of shoveling heavy snow or slipping on ice and contorting your back to avoid a fall, which places undue stress on your lower back.
Even fun wintertime activities such as sledding, skiing, ice skating and even snowmobiling may lead to back pain.
Jeff Samyn, a physical therapist and board certified orthopedic clinical specialist at Northern Michigan Sports Medicine Center in Petoskey, said back pain is among the most common reasons for patients to seek medical care with some estimates that as many as 80 percent of the population will experience lumbar pain at some point in life.
This time of year in particular, Samyn sees more patients with lower back symptoms.
“Unfortunately, wintry conditions bring with them the risk of injury sustained while shoveling or blowing snow,” Samyn said. “One of the easiest ways to injure your back is combining the movements of lifting and twisting. I have personally seen patients who hurt themselves moving very light objects such as empty boxes or laundry baskets.”
Samyn noted shoveling snow is especially risky because of the distance the head of the shovel is from your spine.
“The further the object being lifted is positioned from your torso, the greater the force placed on your spine is,” Samyn added.
According to Dr. Eugene Wang, a physiatrist who specializes in spinal intervention and pain management at Harborside Spine and Sports Center in Petoskey, lifting and twisting motions like shoveling snow can sometimes result in injuring your lower back muscles, discs, and/or joints.
“A visit to a physician is warranted in instances where someone starts to experience a pinprick sensations shooting down their leg repeatedly, worsening weakness in their legs, and/or significant back pain and muscle spasms not relenting several days after the injury,” Wang said.
Samyn said fortunately, most episodes of pain are self-limiting and may resolve within two to four weeks.
“Surgery is always the last resort when it comes to addressing low back pain, and depending on the anatomic issue being addressed, recovery times can vary widely,” Samym said.
Dr. Tom Bozzio of Bay Street Orthopaedics, who sees patients in Petoskey, Charlevoix, Rogers City and Gaylord, said for more generalized lower back pain, it may be time to see a surgeon when quality of life becomes an issue.
“If someone is unable to cope with lower back pain, they should see a spine surgeon for an opinion,” Bozzio said. “A detailed history, exam, specialized X-rays, and MRI can give valuable information and help guide treatment.”
Bozzio said he also tends to be very conservative for low back pain and uses physical therapy extensively with good results.
“With certain types of back pain, injections can sometimes be helpful,” Bozzio said.
Samyn noted there are several tips one should enforce before they set out to clear out their driveway or walking areas, including warming up ligaments, tendons and muscles before you start.
“Before you start the blower or take that first scoop, go for a three- to five-minute walk,” Samyn said. “Doing so will increase blood flow and elevate the temperature of your movement system.”
Breaking up the area you’re about to clear is also key, and focus on clearing essential areas first and then do something else for 20-30 minutes, Samyn said.
“This is especially important if your drive takes more than 30 minutes to clear,” Samyn said.
Using good ergonomics such as pushing snow instead of lifting it, keeping the head of the shovel as close to your torso as possible, using your legs to do most of the lifting and not throwing snow any further than you have to is key to avoid possible injury.
“If you don’t have to do it, don’t do it,” Samyn said. “You might be able to find a high-schooler in the neighborhood who’ll do it for some cash, which is cheaper than a trip to the doctor or a possible MRI.”
Maximize your mobility:
Surgery typically the last resort when it comes to addressing lower back pain
As published in Petoskey News-Review November 5, 2018
Back pain is among the most common reasons for patients to seek medical care, with some estimates that as many as 80 percent of the population will experience lumbar pain at some point in their life.
Fortunately, most episodes of pain are self-limiting and resolve within 2-4 weeks.
Surgery is always the last resort when it comes to addressing low back pain, and depending on the anatomic issue being addressed, recovery times can vary widely.
Surgical outcomes can be drastically different depending on the condition of the patient before they undergo surgery.
Things like decreased muscle mass, obesity, having a sedentary lifestyle, smoking status and the presence of diabetes can all reduce the chances of a good surgical outcome to varying degrees.
To learn more about back surgery and recovery, I spoke with Dr. Tony Bozzio from Bay Street Orthopedics. Bozzio sees patients in Petoskey, Charlevoix, Rogers City and Gaylord.
MYM: How does a patient know when it is time to consult a surgeon about their back pain?
Bozzio: “In terms of back pain alone, there are several types and treatment can differ based on age. Any of the following should be evaluated sooner rather than later:
— Back pain which begins after injury, such as a severe fall or car accident
— Persistent pain in younger patients longer than a month or two in duration
— Pain which develops in elderly patients with osteoporosis due to the risk of compression fracture.
I try to see these patients within a few days to expedite their care and limit time in wheelchairs or being bed bound.
For the more generalized lower back pain that I think you are referring to, I think its time to see a surgeon when quality of life is an issue. If someone is unable to cope with lower back pain, they should see a spine surgeon for an opinion. A detailed history, exam, specialized x-rays, and MRI can give valuable information and help guide treatment.”
MYM: Are there any interventions that are considered before surgery is decided upon as the best option for relief?
Bozzio: “I tend to be very conservative for low back pain and use physical therapy extensively with good results. With certain types of back pain, injections can sometimes be helpful.”
MYM: What are some of the considerations that a surgeon reviews with the patient when deciding whether to proceed with surgery?
Bozzio: “There are two main considerations. The first is deciding if a surgery will solve the problem. The second is evaluating if symptoms are severe enough that quality of life is being impacted or if someone is unable to do the things they want to do or need to do. Then the risks of surgery have to be weighed against the benefits.”
MYM: What is the typical recovery time after surgery, and when can people get back to activities like skiing or cycling?
Bozzio: “Recovery all depends on the type of surgery and everyone is different. For smaller lumbar spine surgeries, the recovery can be weeks. For larger surgeries it can really take up to three to six months before people are back skiing and biking.”
Getting 'back' into the swing
As published in Petoskey News-Review May 1, 2018
Golf season is in full swing and that means many golfers will be dusting the cobwebs off their equipment and bodies to try to improve their handicap over the coming months.
Unfortunately, many seasons are either derailed or completely interrupted by bouts of back pain that restrict movement and quality of play.
To learn more about the effects of back pain on golfing, I spoke with Dr. Anthony Bozzio from Bay Street Orthopedics. Dr. Bozzio is an orthopedic surgeon who specializes in interventions for the spine.
He treats patients in Petoskey, Charlevoix and Cheboygan.
MYM: Around what age do golfers typically start to experience issues with their low back?
Dr. Bozzio: "Golf is a sport that is very hard on the lower back. I typically see patients in their 50s and 60s with low back pain with or without leg pain related to disc herniations and degenerative changes in the lumbar spine. Repetitive bending and twisting can lead to pain in the facet joints, disc degeneration and disc herniations. Back pain can occur at almost any age in golfers, and is most commonly related to mechanical sprain or strain. This commonly resolves over time and often with physical therapy. Most people can expect to improve within three months."
MYM: What are a couple of the more common pathologies that might impact someone's golf game?
Dr. Bozzio: "The most common by far is mechanical back pain that is non-surgical. However, I do see a fair number of patients with disc herniations or spinal stenosis causing compression of nerves. This leads to leg pain, numbness, and weakness. Degenerative changes in the disc can also lead to both back pain and compression of the nerves as they exit the spinal canal."
MYM: Can compensating for back pain cause issues in other areas of the body?
Dr. Bozzio: "This can definitely cause aches and pains in other areas of the body such as the shoulders or knees."
MYM: If a golfer has been experiencing pain that affects their swing, at what point should they see their doctor or specialist for assessment?
Dr. Bozzio: "I would recommend anyone with more than a couple months of lower back pain, or anyone with leg pain or weakness see their doctor. They may decide to start a course of physical therapy, or advanced imaging such as MRI and referral to a spinal surgeon for evaluation."
MYM: What are a few treatments options that you offer to golfers with low back pain?
Dr. Bozzio: "Proper technique or perhaps changing their swing, core strengthening, and stretching are the key to preventing injuries and managing lower back pain. If the pain is worsening, it can be investigated further. There are options that include physical therapy, anti-inflammatory medications, epidural injections, surgical decompression and in some cases disc replacement or fusion."
There have been several professional golfers who have undergone surgery and returned to play, but recently Tiger Woods is a great example of a golfer with lower back pain and leg pain who failed numerous conservative measures, failed non-fusion surgical attempts and ultimately underwent anterior lumbar fusion to both decompress the nerves to relieve leg pain, as well as fuse a single level to relieve back pain.
He’s back on the course now and time will tell how his performance is impacted or improved by the surgery.
Bay Street Orthopaedics:
Keeping Northern Michigan Moving
As published in Petoskey News-Review's Our Community 2017 – 2018
Northern Michigan, especially the Petoskey area, has a long history of offering a wide variety of top quality health care options. Among those options is a practice that has been helping people stay or return to moving for more than 40 years.
Bay Street Orthopaedics was founded in 1975 by Dr. H. Ross Hume and Dr. Loyal Jodar on Bay Street in downtown Petoskey. Since then the practice has grown to offer an array of services all areas of orthopaedic care at six locations including Petoskey, Charlevoix, Cheboygan, Gaylord, Rogers City, and St. Ignace.
“As the science of orthopaedics has expanded, so have our services, our skill sets, and our staff,” said Dr. Brian Wittenberg, orthopaedic surgeon and senior partner at Bay Street Orthopaedics. “Forty years ago, we excelled at general orthopaedic surgeries and therapies using the best practices of the time, but we were also focused on the most promising advancements in the field to better serve our patients and referring physicians.”
In addition to general orthopaedics and joint replacement surgery, Bay Street Orthopaedics offers minimally invasive scope procedures, ultrasound guided injections, trauma and fracture care, and complex hand and foot treatments. The newest specialties, added in 2017, include orthopaedic spine and comprehensive sports medicine care.
To support these offerings, medical staff has expanded accordingly.
“We have been fortunate to attract top tier specialists,” Dr. Wittenberg saoid, “And our new surgeons are examples.”
Recent medical staff additions include:
ERIC MANCINI, MD
University of Michigan and Wayne State University School of Medicine graduate Dr. Eric Mancini, specializes in all areas of sports medicine. The board-eligible orthopaedic surgeon honed his skills working for both college and professional teams, including the USC Trojans and the Los Angeles Dodgers and Rams.
“I like helping people get back to doing what they enjoy,” Dr. Mancini said. Since starting with the practice this past August, Dr. Mancini has been reaching out to coaches and trainers throughout the community to assist athletes in maintaining current levels of sport and activity.
“I welcome those interested to contact our office regarding clinics and educational opportunities as well.”
ANTHONY BOZZIO, MD
Dr. Anthony Bozzio, a graduate of the University of Utah and Michigan State University College of Human Medicine, is a board-eligible surgeon specializing in the surgical treatment of the cervical, thoracic, and lumbar spine. Dr. Bozzio also treats scoliosis and spine deformity, two treatments previously unavailable in the region. Prior to moving to Petoskey in August, “I spent two clinical years in Traverse City with many rotations in Petoskey and the surrounding area,” Dr. Bozzio. said. “I was impressed with the level of care for patients in the area, and I am pleased to bring my skills in comprehensive orthopaedic spine care to the community.”
For staff support, Bay Street Orthopaedics welcomes two specialty physician assistants, Kelsey McConnell, PA-C, who began in August and Heath Mier, PA-C, who will join the practice this December
“A physician assistant has a very broad range of clinical skills and works in tandem with the physician, in the operating room, the hospital, and the office,” said orthopaedic surgeon Dr. Alfred Wrobleski.
For more information about Bay Street Orthopaedics services, talk to your primary care provider or call 800.968.5155. Details about providers, services, and locations can be found at baystreetortho.com.
Spinal Disc Degeneration:
Disc Replacement Improves
As published in Traverse Magazine's Medical Insider 2018 (page MI 11)
Please click on the image or link above to read the full article.
How to Choose an Orthopaedic Surgeon
As published in Petoskey News-Review 2018
If you experience joint pain — whether knee, shoulder, hand, or spine — an orthopaedic surgeon is the go-to specialist to help you find a solution that could vastly improve your quality of life.
Orthopaedic specialists treat patients with surgical and non-surgical treatments from non-urgent to emergency care. Patients may seek the care of an orthpaedic specialist for treatment from sports-related injuries, accidents, and age-related degenerative issues.
If your primary care physician has recommended that you seek consultation with an orthopaedic specialist about your musculoskeletal system, it is important to find the best medical professional for you.
Here are some things to consider in finding the best surgeon for your needs.
Ask your primary care provider for the names of recommended orthopaedic surgeons. Your primary care provider is the best resource for finding a medical professional who can handle your case effectively. Other medical professionals in his/her practice might also be able to direct you appropriately.
Many orthopaedic specialists become experts at performing varying types of procedures to address individual patient conditions. It may be recommended that the orthopaedic surgeon you choose specializes in the care you need, though many are highly qualified to offer treatment for several conditions.
“The orthopaedic surgeons at Bay Street Orthopaedics treat patients with a wide range of conditions,” explains Orthopaedic Surgeon Scott Nemec, DO. “With six surgeons in our medical team, we work together to ensure that our patients are matched with the most appropriate specialist.”
What’s The Best Treatment for Me?
Patients should also understand that determining the best treatment path comes from consultation, medical team collaboration, evidence-based research, imaging and many other factors. Do not be misled by internet articles, for example, that explain “the best” solution for your situation. Just like a dentist knows more about teeth than we do, you can rely on an orthopaedic surgeon to be highly qualified in their area of specialty, too.
“Since 1975, the surgeons of Bay Street Orthopaedics have built their reputations on strong patient and referring provider relations and the use of advanced treatments and surgical techniques,” shares Orthopaedic Specialist Eric Mancini, MD. “Our goal is to make patients feel comfortable and confident in their healthcare decisions.”
It is recommended that you bring a list of questions to your first appointment, so you can discuss your goals and concerns with your specialist.
The best orthopaedic specialists help patients with the full continuum of care. When surgery is part of the treatment plan, for example, your specialist should guide you through preparation, recovery and rehabilitation. They do more than just perform an actual procedure. They will take the time to answer all of your questions patiently and offer practical suggestions based upon your individual lifestyle. “We don’t simply fix broken bones,” adds Dr. Mancini. “We work with patients to help them get back to their favorite activities and to lessen the susceptibility for future injuries.”
Close to Home
Northern Michigan patients are fortunate to have orthopaedic specialists close to home. Whether your condition requires surgery or a non-invasive procedure, ask your primary care provider for a referral that doesn’t require you to travel. You can always seek another opinion, but you may find that the best specialist for your care is just down the street.