spk_0:   0:04
Welcome to the Med soup podcast, where we talk about trending health care topics. I'm your host, Laura Schumacher. Let's dig in. Today we're joined by Dr Robert Wilson, the founder and medical director of Piedmont Interventional Pain Care. Dr. Wilson has served patients in Salisbury in the Greater Rowan County region, for over 15 years. He is board certified in both anesthesiology and pain medicine by the American Board of Anesthesiology. He completed his residency in anesthesiology and a fellowship in pain medicine at Wake Forest University Baptist Medical Center in Winston Salem, North Carolina. Dr. Wilson is trained in the latest pain management techniques and therapies and is an avid speaker providing information to the public and medical professionals across the United States about the latest interventional pain treatments. He is an active advocate for the prevention of opioid abuse and serves on the opioid task forces for the Department of Health and Human Services, the Industrial Commission of North Carolina, the North Carolina Medical Board and the North Carolina Medical Society. Additionally, Dr Wilson is the president elect of the Pain Society of the Carolinas, also known as PS. Soc, a long standing member of the PS OSI and has served as chairman of the government advocacy committee right today Or with Dr Robert Wilson from Piedmont. Interventional pain Care in Salisbury. And we are going to discuss lumbar spinal stenosis and some very interesting treatment options available for patients who have this condition. Hi, Dr Wilson. How are you?

spk_1:   1:44
I'm doing well today. How are you?

spk_0:   1:46
Fine, thank you. So some people are familiar with lumbar spinal stenosis is also called lss. But describe to us what this condition is what really amounts

spk_1:   1:59
to is over a period of time as we age, we have a spinal canal that is fairly wide and Peyton in most of us, sometimes people were born with a congenital e narrowed spinal canal. But most of us have, ah, plenty of room for the spinal cord delay in the spinal canal. Um, and, uh, what happens as you develop arthritis as you developed bulging disk, etcetera. It will start to crowd the central canal where the nerve Ah, nerve roots air hub as well as the spinal cord. So what happens? You have to kind of imagine that it just tightens around these nerve endings. Um, the classic symptoms of it happened when you stand up when you stand erect or just stand, you have a little bit of extension near lumbar spine, and that is accentuated when you do stand. What happens is because you've got this stenosis in the lumbar spine in the canal. It causes pressure on the nerve endings that air hub there. And, of course, the main ones that air. They're the ones that, uh, are the nerves responsible for your motion of your legs and the sensation in your legs. So what happens is when you stand up very longer that you walk very long, you start putting more pressure on it because the extension of your spine it's made worse by the, uh, chronic conditions of arthritis and the generation that are occurring as well as you grow over. And so what happens is that this will. This will occur when you walk or stand. Then when you sit down within seconds, your your lower back, your legs will feel better. Near find patients will sit down and kind of lean forward. That sort of flexes your lumbar spine, which again opens up that canal, takes the pressure off the nerve ending so um, lumbar spinal stenosis is something that again you can't really keep from happening. And some patients, obviously it's worse than in others. But it's just really part of the aging process for most of us. Those who are born with congenitally narrow canal when you have a little bit of arthritis since no, since it gets worse, much quicker. But in all of us, as we age, these, these kind of conditions can start to develop.

spk_0:   4:09
So a person who's experiencing these symptoms is usually an older person. It is the youngest

spk_1:   4:17
person I've done has been 65 years of age, and ah, it ISS patients, usually around the age of 60 may start to develop. It becomes more of a problem. But, um, my patient population, the younger space has been 65 that I've been planted. Um, this device we're going to speak about in and the oldest patients 90 eso um ah generally is overpopulation because all these Oscar arthritic and the general processes take place over years and years and start to become more problem in your sixties.

spk_0:   4:51
And this condition is not to be confused with the type of condition where you'll see someone kind of hunched over like they have a little bit of a hump on their back from osteoporosis. Correct?

spk_1:   5:02
Correct. Yeah, that's war. What we call Kaif. Oh, sis on the threats explain that is a completely different and patience to develop that especially see it. And postmenopausal females tend to have more osteoporosis that occurs and and, ah, different conditions in the spine. Spinal compression fractures, vertebral compression fractures occurs, which accentuates that problem, too. But now this is completely different and really just affects the lumbar spine that were that were you treat.

spk_0:   5:32
So what are some of your initial treatment options? For a patient who's experiencing the pain from lumbar spinal stenosis, the first thing

spk_1:   5:40
we do is to, you know, examine them and see what they what. Their symptoms are what their history is. Ah, lot of times that will have again these arthritic conditions of the small joints in the post, your column of the spine just beside the spinal canal and a little bit lateral. A lot of times we can inject those joints and ah, do a procedure called radio frequency ablation, which could help their back pain. It won't do much for their leg pain. Ah, the times we could do epidurals. Uh, with the epidural steroid injections, I should say that will go into the central Canal and cause a reduction of inflammation in that area. The problem with that is, if we're dealing with lumbar spinal stenosis and you inject some medicine in that central canal because of the consistent in the constant tightening of that canal, the nerves may get relief for a while because that compression is there, their pain will come back quickly. So I don't spend a lot of time doing procedures on patients. They don't get some type of long term benefit. If we do, one or two procedures may be two different types procedures, and their pain comes back fairly quickly. It's probably time to move on to either this type of ah, procedure around, discuss or ah, get a surgical consult.

spk_0:   6:55
So discuss this, um, fairly new procedure that's it's available to patients with this condition that you're offering now in your office.

spk_1:   7:04
The ah, the procedure is a procedure. The device is called the superior honest, made by a company called Over Deflection has been out or, uh, say about two years now. I've been doing the procedure about 13 months and again our classic patient presentations gonna be when a patient has painter weakness in their legs, when they're Walker stand, they sit down that lean forward, the pain goes away. We have something called the shopping cart syndrome. If you catch a patient and the grocery store walking around leaning over on a grocery cart, most likely they're doing that not for balance. But they're doing that because it flexes the spine forward and it helps relieve their their pressure. Going down there hits back their hips in their legs. Um, this device that we implanted goes between the spine, its processes of the lumbar spine, and what it actually does on sort of a microscopic level, is that it causes selection to occur at the level of the spine where they're stenosis is the worst. We get an idea of the patients your candidates for simply by their history. We confirm on the lumbar m. R. I studies Ah, that the cyanosis is there. I view the different ones and they

spk_0:   8:21
could have

spk_1:   8:21
more than one area that is still not IQ. But when I do place these I've got a patient with two or three levels about always. They have one that is more severe than the other. And in those patients I've done this on, um I will pick the worst area, place the device in there to cause deflection to occur at that level. And generally all of them get better. It was just about a month ago that I placed the 2nd 1 in Another lady had place previously. About six months ago. I should continue to have pain in one leg and not the other, because the first placement got rid of her, uh, leg pain in that one leg. But the other one show compression at the level above. And it was pension. The nervous comes out of what we call the for Raman. When I placed the second device in it flexed her spine. It's process and all opened up. It flexed her forward in her canal and gave that for Raymond and opening It didn't have before, So her leg pain got better in the contra lateral aid.

spk_0:   9:23
This is a procedure that provides a permanent option retreating that compression, it is,

spk_1:   9:30
rather than doing injections that ah, again with steroids or do Kateri? I'm sorry, radio frequency procedures, which are type of a Kateri procedure. We actually really treat uh, the underlying condition rather than just treating the symptoms that they have retreats on the line conditioned by changing their anatomy in flexing their spine forward at that level, which helps get rid of the stenosis, and you have to understand that they may be very still not IQ, but they just need one or two through one or two or three millimeters of flexion forward to get the canal opened up. Enough with the nerves are compressed, so that's why we like to do just one level at a time. I don't ever want to do anything. It's unnecessary and do two or three levels. The reality is, a lot of times you do their worst level. That takes care of their problem, but it does street, uh, the underlying condition. Unlike a lot of times and pain management, we have to treat the symptoms. This actually treats underlying condition,

spk_0:   10:31
and then when you treat the underlying condition that takes a majority of the pain away, if not all of the pain away, correct it is. It

spk_1:   10:38
is amazing what it does. We Ah, actually, this has been looked at and studied for five years before we released by the FDA. It was studied a 29 centers. 470 patients altogether were implanted with the she Perriand devised. They were followed for five years. Um, at the end of five years, 80% of patients continue to have a reduction in leg pain, their back pain, 70% of patients that are continued reduction in back pain. And overall, the patient satisfaction was 90%. And another thing in this opioid conscious world that we're we live in now, in the opioid crisis that we're dealing with at 85% of the opioid users who've got a superior on device implanted ceased using opioids and five years as well.

spk_0:   11:26
And I think that's a good point that you you mentioned. The FDA has looked at this and this is FDA approved. It

spk_1:   11:32
is. It is exactly sometimes different devices. Procedures come out that don't have FDA approval. And this is one that was studied at length again at 29 different centers. Almost 500 patients before they gave their stamp of approval on it because the outcomes were so good, they did approve the device.

spk_0:   11:55
I noticed, um, on your website that one of your patients who gave a testimonial about this procedure even mentioned that she basically had stopped walking from one of her house to the other. And now that kind of pretty much changed your life. I mean, it was pretty significant. And if you think of an older population, the benefit of them having movement and being active and you take that away from them, not only are they gonna have problems with their lumbar spinal stenosis, but it's going to start affecting their other joints and even just there their mental attitude because they can't do what they used to do. Exactly. The

spk_1:   12:33
patients will come to me, and just like that said a lot of little old ladies I call him. I have a lot of sweet patients that I just can't go to church on Sunday because it just hurts too much or they can't stand in the choir and sing. And this one lady you referred Teoh that was one of her complaints, just hurt too much and shed actually already had back surgery and was headed towards a 2nd 1 Why offered this to her? And she is now back doing Berks Everything she wants to do. One of the things refined will replace this device in patients who have been, um, unable to do a lot of things. A lot of physical activity. We'll come back to us, always follow him up at six weeks and say, You know, my my pain that you put this in for is gone. My leg pain is gone, but I have these these leg cramps and these aches that occur that weren't there before an explanation is really quite simple. The reality is there so much more active that got muscles and joints that have been so de conditioned over time that they're now more active. When you point that out to him, you'll ask him how much more you're walking and you know where they could walk a block before. Now they're walking half a mile or so and things like that. So the patients, when you recognize when they recognize what ah, the reason for that pain is they're actually quite excited. So we've had a lot of good outcomes. It's been a life changer for a lot of people because you have to understand these patients you can't get up on, do their daily activities and now conduce Oh, it and get out and shop and travel more all that it does change your life.

spk_0:   14:00
So you mentioned that that particular patient to also had back surgery. So that's not something that would prohibit them from exactly during this option,

spk_1:   14:09
exactly exploring the option. I would say that because what we have to have for this device to be places we have to have what's called the spineless processes in place at the level where the stenosis is. And this one of the gentleman I mentioned who is 90 years old, my oldest patient, he had had a bigger back surgery where he'd had a decompressing Lamine ectomy performed at l one l two and L three in the lumbar spine. Eso I looked at him under, um, under X ray and the spineless processes which I need to have in place, uh, were taken out with that operations a fairly big operation. What he did have at the old 45 level, which were not previously operated on the spine, is processes were intact. I looked at Hiss, um, in more I and he had stenosis that occurred at that level. So at the age of 90 rather than sending back to the surgeon who probably couldn't operate on him because of his other health problems and justice general age. Now I was able to place this device, and he was one of the patients that got up out of recovery and walked out as we talk to him about this at his post op, Hey said, I walk out of recovery room feeling better, and that happens about 60 or 70% of time when the patients have this done. They actually feel better immediately with presenting pain that they had, and he continues to be much more active now, just about four weeks post off

spk_0:   15:28
now. Is this something that's done in a surgical center? It is.

spk_1:   15:32
We can't perform this operation since his ah incisions made a very small incision but need have absolutely strict a sterile environment. So it's done in the operating room, and the anesthesia that's required for this is not a general anesthetic Again. We get back to this point of patients who are not good candidates for lengthy operations, general anesthesia, etcetera. But we can do this procedure in 20 or 30 minutes with just heavy sedation. I don't have to have them completely unconscious or anything like that, and we can place this device and patients do quite well. They wake up from a quicker our so after surgery there up, ready to go home, etcetera. So it's something has to be done. And now patient surgeries sending surgery setting but doesn't require ah, big anesthetic or lengthy innocent acre operation.

spk_0:   16:23
So what's the recovery like after the procedure?

spk_1:   16:26
What we asked for the patients to do for the 1st 4 to 6 weeks is try not to bend and stoop a lot. We asked him, not a living thing. Heavier general rule has nothing over you know, the weight of a gallon of milk. I just kind of walk and do things Normally I don't want they're going outside and start toe, bend over doing yard work, etcetera like that. For a period of 4 to 6 weeks, this device will place it. It is tapped down to the Lambda, the spine to Bonnie, part of the spine in the post your area that, and it is going to stay in place. But if you twisted or bent or did too much activity, the possibility at least existed. It could move. So we ask patients for the 1st 4 to 6 weeks just to use, uh, good posture and bending, stooping, twisting too much. Just be careful about that. Other than that, they're free to walk and do things that way that they feel like they're able to do.

spk_0:   17:25
And then, in terms of any, you know, post op pain relief is, could they just take something over the counter? Typically for that use it is

spk_1:   17:33
if we have a patient, that air goes this operation with me. If they're on some pain medication, I never right for anything extra if they take a few ah pain pills a day for other conditions, etcetera. But if they're not taking any opioids, I don't prescribe it for this operation. They can take Tylenol or over the counter anti inflammatory medications, as they need to cause just not that much of a pill stop painful condition.

spk_0:   17:59
But this seems like a procedure that will be worth exploring rather than going direct to surgery. I mean, Why would anyone wanna have back surgery unless they really, absolutely had to have? Yeah, I completely

spk_1:   18:09
agree. If it was, you know, my my mother, my brother, that had a condition like this or myself. Ah, that I could, ah, have relief from the pain in a very extended fashion. This Lisa's faras with the five year studies show that certainly won't explore this first. Now, one thing to say, sometimes we'll see patients who have just multiple levels of spinal stenosis, and it's hard to pick out there all severe. Let's say it's hard to pick out one level that we could dio etcetera. You know, those patients may be better at least being sent to a surgeon for consideration of, ah, bigger operation if they're able to undergo that. If that surgeon looks at it and says that the operation will take five or six hours or not, a good anesthetic risk there may be two elderly and certainly come back and explore this option with them. But there are times where I see patients who have a lot of spinal pathology that I don't think that this condition I'm sorry that this procedure would work well for him than those kind of patients, and you get a surgical opinion about them. First on again, sometimes move on, have the surgery. Sometimes they come back here to explore this option that we can do for them.

spk_0:   19:23
I think it's also important to note that you have quite a few videos on your website that are, um, about this procedure and even patient testimonials discussing their experience. And I mean, they're real patients that have gone through that and talk about how much their life has changed from that. It is always

spk_1:   19:40
good to have these patients that come back, I think, from memory the three patients that ah talked on the video. We're probably three of my 1st 5 patients. I performed this on and ah yeah, again, patients who are looking or thinking about this. Ah, patient of back pain. We'll see what we have. Golfers that are etcetera. Our website has a lot of things on it, including this, But no, I I'm I'm always happy to see these patients and haven't come back. And yeah, I do a lot of procedures in here where I know that I'll do an injection or a, uh ablation procedure that other gonna come back to me in 3 to 6 months. These patients. What I found to be true in my 13 months of doing this is generally when I do this on them, I just don't see them again. They tend to do well and stay well. So no, not to say that that everybody is 100% when this is done. But the, uh, effects of this procedure as faras the benefit to the patients compared to a lot of things, I see both surgical onda procedural. Like what I do. It's been very rewarding to see this because of their their benefit that they get and again because we're treating the underlying condition that tends not to re occur again. And they just have a more healthier lifestyle.

spk_0:   20:55
And this is something that is covered by Medicare. It

spk_1:   20:59
is Medicare dust covered as well as all the Medicare replacement plans, like with any insurance company. Ah, when it comes to Medicare replacement plans, sometimes we have to convince them that it is covered well initially deny it. But then we we have ways of letting them understand that it is covered by traditional Medicare and they're bound, tapped to cover it. The insurance companies themselves. If you're under 65 you have commercial insurance. Um not say that it can't get covered, but it is more of a fight to get that done. We usually involved the company Verte Flex to help us out with those approvals. But yeah, without question. And I guess the good part about all this is that the patients who need this or generally Medicare age may catch him a little bit before Medicare age. I've got one gentleman now 64 he's gonna turn 65. He needs this procedure and basically he just waiting until he gets Medicare to get it done. So it is something that maybe over time, we'll see insurance companies stepping forward and covering something like this. If you could do this procedure for ah reduced cost and get the patients to do as well is what they do when they haven't an open ah decompress of lamb inactive me. They would have to look that and be happy that pay at less money to have ah benefit that each would provide

spk_0:   22:15
yes and for it being minimally invasive, the recovery period is so much quicker than an open back surgery.

spk_1:   22:23
Exactly. It ihsaa just a small incision. I tell patients, if you took a nickel and put it on, said you look down on it. That's about the lengthy decision. I guess that's about an answer. Last, Um and that's it. I mean, they come back here nine or 10 days just to look at the wound to make sure it's doing OK and healing. Okay, and that's it. It's, Ah, a very simple procedure. It's amazing what technology is came up with for us and who do interventional pain, um, to take care of these patients. And before there's nothing like it to be offered, you had to go a major medical institution to have a big operation. Recovery time was 3 to 6 months, etcetera, etcetera, and you can take now patient to an outpatient surgery center. Somebody 90 years old and they can leave their, uh, not having the pain that they walked in with is pretty amazing.

spk_0:   23:14
So if someone wanted to be evaluated potentially for this procedure for treatment for lumbar spinal stenosis, they need a referral or what would they dio

spk_1:   23:23
at our office? Ah, We get a lot of patients by referral, but no, you don't need to have a referral to get in the office. You could just contact us. Our phone number 7047970065 and make your own appointment. We may have some preliminary questions about you were from you that we need to find out what we're going to be treating, etcetera. But sometimes patients come here with all their X rays, all their memorize and ready to go. Other times faces come here. Just saying my back hurts. I don't know why. So you start in with our ah, differential diagnosis of what's going on and your own studies and order them etcetera. So, yeah, referrals are not necessary. You can make your own point of that referral.

spk_0:   24:04
So again, if you want to, um, learn more or schedule consultation, you can call Dr Wilson's office or visit his website at Piedmont pain care dot com. There's a lot of information on the website, and the phone number is there. So, um, probably you'll be able to help some more people with this procedure. Thank you, Laura. Appreciate your time. Thank you.