Spinal Cord Injury. Introducing Thomas N Bryce

Recovering from spinal cord injuries is a complex process as they can be the result of serious localized trauma or lifestyle habits. That is why it is helpful to have a professional by your side while you undergo recovery. Thomas N Bryce, our leader in Spinal Cord Medicine at the Department of Rehabilitative medicine, has been a part of our team here at Mount Sinai since 1997 and could be the answer to your problem.

Dr Thomas Bryce has an impressive academic record. Prior to joining us, he completed his undergraduate degree from Albany Medical College and received speciality training at Thomas Jefferson University Hospital. He is a leader in the field, being the principal investigator of several ongoing studies in these areas and “wrote the book” (quite literally) on spinal cord injuries having authored numerous chapters and peer-reviewed articles on the subject.

Dr Bryce’s research is focused on assessing residing pain after spine damage, use of robotic exoskeletons to facilitate walking, and stem cell implantations for neurological recovery. He has been involved in several international taskforces with the aim to reduce pain after spinal cord surgery.

He is currently Governor Cuomo to the New York State Spinal Cord Research Board. Dr Bryce’s method is intersectional. He works closely with physical therapists, occupational therapists, neuropsychologists, and other surgical specialists to provide bespoke comprehensive care.

Dr Bryce understands the intricacies that are involved in recovering from spinal cord injury.

A bespoke plan can be constructed to suit anyone’s individual needs when going through this difficult period. Spine damage can be the result of hard trauma or lifestyle or a mix of both. Dr. Bryce can accommodate plans that involve difficult lifestyle changes. This includes both long-term habitual corrections, such as posture to post-surgery rehab.

If you have suffered a sports-related injury, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. Contact our switchboard on: (212) 241-6321

Laminectomy, The Surgical Response to Sciatica

Laminectomy, the surgical response to sciatica

Sciatica is a symptom of spine damage that can usually be remedied at home. There are a myriad of steps you can take in tending to sciatica without needing surgery. However, in some cases patients need to undergo surgery to alleviate their symptoms. This procedure removes the lamina (a small vertebra in the spine), it may also remove bone spurs in your spine and takes anywhere between 1 and 3 hours. This process has the aim of reducing pressure in your spinal column; in turn lessening the symptoms of sciatica. 

The procedure is often done to treat spinal stenosis. It removes damaged bones or discs. As we explored in last week’s blog, sciatica is a symptom, and not a cause – and the best way to cure sciatica is to tackle the underlying problem. 

It is important to have an x-ray or MRI of your spine before making any decisions to undergo surgery. You must divulge any medication you are taking to your health provider.

Before you leave your home, ensure you leave it prepared for when you return. You must refrain from smoking in the days leading up to your surgery. It is imperative you do not smoke after the surgery is complete. You must speak with your doctor if you have been drinking lots of alcohol, especially if your consumption could be considered alcohol abuse. 

You will likely be asked to not drink or eat anything for 6 – 12 hours before the procedure. With everything prepared, you are ready undergo your Laminectomy. 

Laminectomy opens your spinal column with the aim of giving spinal nerves more space to move. You will be asleep and feel no pain. The procedure begins with you lying face down on the operating table. Once the anaesthetic kicks in, the surgeon makes an incision in your back.

The skin, muscles, and ligaments are moved to the side. Depending on the cause of sciatica, part or all of the lamina bones may be removed on both sides of your spine. Your surgeon may then remove small disc fragments, bone spurs, or other soft tissues. The muscles and other tissues are back in place. The skin is sewn together.

After waking, you will be encouraged to get up and walk around as soon as the anaesthesia wears off. You will be allowed to go home around 1 to 3 days after their surgery.

You will be able to drive within a week and resume light work after around 4 weeks. The surgery should relieve the patient of all symptoms of sciatica due to addressing the root cause of the problem.

As we have stressed in previous blogs, surgical procedure is not recommended as a treatment for sciatica – it should be a last resort and not a go-to when the symptoms of sciatica kick in. Before thinking about surgery, you should consult your physician and discuss options. Alternatively, you can read our blogs on living with sciatica found here.

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

How to Deal With Sciatica, The Do’s and Don’ts

How to deal with sciatica, the do’s and don’ts

This week, we are going to look at ways of managing sciatica. In our previous blog we looked at what sciatica is, and suggested some causes of the problem. To quickly recap, sciatica is the compression of the sciatic nerve – which in turn causes pain down the lower back, through the hamstring all the way to the foot. What is most important to remember when dealing with sciatica, is that is a symptom, and not the underlying problem itself.

The first step when dealing with sciatica is diagnosing the underlying issue. The root of the problem can be anything from a slipped disc in the spine, to a spinal stenosis, or in more serious cases, a tumor. It could even come from a small fracture in the hip. Although we can treat sciatica without dealing with the genesis of the problem, you are more likely to experience a reoccurrence of sciatic pain if we do not.

We recommend that if you suffer from sciatica, get a diagnosis on what caused it. That way we can deal with the pain alongside remedying the original problem, and reduces the chances of it reoccurring.

For now, let’s look at some of Mount Sinai’s recommendations for dealing with sciatica at home.

Conservative (non-surgical) treatment is best in most cases. When you are suffering from sciatica, or begin suffering due to some other cause, apply heat or ice to the painful area. Try the ice first (48-72hrs); then use heat on the pain. Over the counter pain relievers such as ibuprofen or acetaminophen can also help with inflammation and general pain relief.

Surprisingly to a lot of patients, bed rest is not recommended. Although short term bed rest may be needed for patients in extreme pain, staying inactive and reclined for long periods of time weakens the body and extend the life of agonizing symptoms.

Upon first suffering the symptoms of sciatica, it is recommended to tone down your physical activity for the first few days, and gradually work your way back to your daily routine.

You should reduce your activity in the first couple of days – and gradually adjust your body to your usual activities. This will ensure you do not overstress any of the damaged components, and give your body time to adapt.

Patients are recommended to start exercising again after around 2-3 weeks. You should include exercises to strengthen your abdominal muscles and improve flexibility in your spine.

If weightlifting or contact (collision) sports such as American Football are part of your usual exercise routine, you should not return to your sport/hobby for at least 6 weeks since the pain began. Do not lift heavy objects or twist your back. Your physician can help identify good exercises to remedy sciatica.

More serious complications depend on the causes of sciatica, such as slipped discs or spinal stenosis. Call a provider immediately if you have:

·        Unexplained fever with back pain

·        Back pain after a severe blow or fall

·        Redness or swelling on the back or spine

·        Pain traveling down your legs below the knee

·        Weakness or numbness in your buttocks, thigh, leg, or pelvis

·        Burning with urination or blood in your urine

·        Pain that is worse when you lie down, or awakens you at night

·        Severe pain and you cannot get comfortable

·        Loss of control of urine or stool (incontinence)

Also call if:

·        You have been losing weight unintentionally (not on purpose)

·        You use steroids or intravenous drugs

·        You have had back pain before, but this episode is different and feels worse

·        This episode of back pain has lasted longer than 4 weeks

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

A man who started as an athlete and became a Physical Medicine specialist. An interview with Dr. Herrera. 

We sat down with Dr. Joseph Herrera, a Rehabilitation and Physical Medicine specialist at Mount Sinai, to learn more about his specialism, career, passions and hobbies. Hope you enjoy!

Q: Why did you decide to become a doctor?

A: My overall purpose and why I get up in the morning is to help others get back to life. I love problem-solving and developing strategies for patients to overcome disabilities.  Whether it's knee pain and developing a plan to get back on the field to play soccer or if it is shoulder pain and developing a plan to put on a shirt, getting a patient back to their maximal function is my ultimate goal.

Q:  Could you tell us a little more about your specialties?

A: Physical medicine rehabilitation is such a broad field that covers all aspects of disability. Physiatrists can practice in several different subspecialties such as pediatrics, spinal cord injury, traumatic brain injury, sports medicine, pain management, and neuromuscular diseases to name a few.  The overall goal of the field is to maximize function and minimize disability. It is one of the most rewarding fields to be in. 

Q:  Where did your interest in fluroscopy/electrodiagnostic testing/sports injuries etc. begin?

A: I have always been active playing both recreational and competitive sports. I was a college athlete that suffered an injury and was treated. The process of return to play intrigued me. 

 My interest in electrodiagnostics and fluroscopic procedures occurred during residency.  I became especially intrigued in the ability to help people with pain through injections. 

Q: What is it that interests you in rehabilitation medicine specifically?

A: The ability to get people back to living their life is what interested me in rehabilitation medicine.

Q: How did you get into this field?

A: I was  introduced to the field in medical school. 

Q: Why Sports injuries?

A: Prior to medical school I was a crew coach and an athlete. Having the knowledge of biomechanics and knowing the mechanism of injury has helped me diagnose and treat various athletic injuries. 

Q: Favourite sport?

A: I love a number of sports rowing, baseball, football, basketball.

Q:   Favourite team?

A: Yankees, Giants, Knicks, Rangers and, of course, Rutgers University sports.

Q:  Favourite thing to do in New York City?

A: The Restaurants scene!

Q: Fun Fact about yourself.

A: I was a coach before going to Med school.