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

Age-Related Musculoskeletal Changes

As we get older our bodies become more fragile, as bone and muscle densities reduce, increasing the likelihood of broken bones and body instability. Movement may become slower, and walking gait may become shorter, more unsteady, and with less swinging of the arms. Older individuals may become tired more easily and perform tasks less energetically, but what are the internal processes that drive these changes in musculoskeletal function?

From around the age of thirty bone mass begins to decrease in both men and women, increasing in rate in women after the onset of menopause. As a result, the risk of bone fractures increases. One common feature of ageing is a gradual shrinking in size. This is due to fluid loss in the spinal disks. Between the vertebral bones in the back are the gel-like cushions which serve to absorb shocks between the vertebrae. With age these discs begin to lose fluid, meaning the spinal bones grow closer together and the spine shrinks. Furthermore, the actual bones begin to lose mineral content, becoming thinner. Being less rigid the spinal column becomes curved, adding to the appearance of height loss.

As with the spinal disks, lubricating fluid between joints may also be lost during the ageing process, reducing protection against cartilage rubbing together and wearing away. As a result, the joints may become stiffer and less flexible, increasing the risk of developing arthritis. As bone wears away the minerals may be deposited around joints and calcify, causing extra joint stiffness.

In tandem with skeletal wear, the muscular system is also affected by age. As bone density decreases around one's 30s so does muscle mass. The result of this muscle loss, known as sarcopenia, is that the muscles are less able to support the bones, and stress on certain joints, such as the knees or back, increases. Deterioration is not universal throughout all types of muscle, and the muscle fibres that contract faster are more susceptible to damage than the slower contracting fibres. This translates into overall slower contraction of the muscles in old age and affects physical mobility, muscular strength, and grip. Around 7% of people over 70 are affected by functional sarcopenia - age-related muscle loss – and this figure increases to around 20% of the elderly over 80. As muscles lose function people become less able to move autonomously and this may translate into the development of muscle contractures, where the muscles shorten and harden.

While it is a natural process of ageing to lose both muscular and skeletal mass, the process can be slowed and prevented to a certain degree by maintaining a healthy lifestyle, with regular exercise to promote strength, balance, and flexibility. Keeping fit can also help the bones to stay strong, to reduce the risk of shrinking or breaking. To further support the maintenance of sturdy bones diet control is crucial, being well-balanced and high in calcium. Particularly women need to be aware of getting enough calcium and vitamin D in their diet as they age to lessen the risk of developing arthritis or osteoporosis. 

Introducing Dr. Spinner

Last month we met Dr. Joseph Herrera. This month we introduce you to Director of Pain Medicine and Minimally Invasive Spine Surgery for the Department of Rehabilitation Medicine, Dr. David Spinner.

Dr. Spinner has always had a keen interest in sports, specifically baseball, basketball and the winter Olympics. Besides being a fan of various teams, he has also participated in many sports over the years, including volleyball, skiing, tennis, and most preferred of all, baseball. This interest in sports directly links to his current particular interest in sports injuries and the related field of musculoskeletal medicine. Musculoskeletal medicine is left largely unexplored in most medical sectors and it was his interest in this niche topic which led him to eventually specialize in Rehabilitation Medicine.

The medical education leading towards Dr. Spinner's eventual specialization began at Emory University, before being continued at the New York College of Osteopathic Medicine. Following this he completed an internship at Maimonides Medical Center, Brooklyn and subsequently embarked on a residency at the Icahn School of Medicine. In 2015 he won an award for pain medicine fellowship excellence for his work during a fellowship in Interventional Pain at the Beth Israel Deaconess Medical Center and the Harvard Spine Center. He has made contributions to furthering the field of Rehabilitation Medicine through investigating new ways to advance procedures and improve patient care. Dr. Spinner is one of the first physicians in the country to be certified in diagnostic musculoskeletal ultrasonography, and performs many musculoskeletal pathologies. His focus lies in ultrasound guided interventions, advanced spine interventions, and minimally invasive spine surgery, and he has written several publications concerning these techniques. The list of other interventions that Dr. Spinner performs also includes spinal cord and peripheral nerve stimulation, kyphoplasties, endoscopic rhizotomies, and disectomies.

As a specialist within his field, Dr. Spinner lectures on musculoskeletal ultrasonography across the country and was the lead editor for the Atlas of Ultrasound Guided Musculoskeletal Injections, the first textbook on this subject. He has developed his own unique strategies towards the treatment of both acute and chronic pain.

The interest that Dr. Spinner has in this field continues beyond his professional practice. He is a supporter of various pain and musculoskeletal charities, including the Facial Pain Association, a resource for information and guidance for those suffering from neuropathic facial pain. Dr. Spinner is also an active and involved supporter the Wounded Warriors Project, whose mission it is to honour and empower war veterans who suffer from physical and mental ailments in relation to their military service.

Top Tips for a Healthy Spine

Back pain and spinal conditions can be some of the most debilitating that there are. According to NINDS (the National Institute of Neurological Disorders and Stroke) lower-back pain is the leading cause of job-related disability, and – worst of all – back pain can be particularly difficult to diagnose and treatment can take time. All this considered, it is worth doing everything you can to ensure that you keep your spine healthy – either to manage existing back pain or to prevent its occurrence altogether. To help, this week our Mount Sinai spine care experts have compiled a list of useful tips for keeping your spine healthy.

1. Stretch and Strengthen

The spine is supported by a complex system of muscles. 20-30 minutes a day spent toning and strengthening the abdominals and the muscles in your lower back can help keep them strong and flexible, taking pressure off the spine. Stretching frequently is invaluable too. A short routine of targeted stretches first thing in the morning can help keep you supple, maintaining joint function and range of motion and reducing your risk of back injury.

2. Sleep smart

Sleep is essential for helping the body heal and repair itself after a long day, so it is important that you are maximising its effectiveness when it comes to spinal health. Research pillows and mattresses before you buy them to ensure you are getting the correct level of comfort and support for your back. If you find yourself feeling stiff or in pain in the mornings, it could also be a sign that your sleeping position is putting unnecessary pressure on your spine, so perhaps try sleeping on your side.

3. Practice healthy working habits

That spending hour upon hour sitting at a desk is bad for your body is a well-researched fact. Not only can sitting for long stretches of time exacerbate a back condition – it can even create one, as the discs in the lower spine are loaded three times more while sitting than while standing. From unsupportive chairs to desks at the wrong level, office life and a healthy spine can often seem incompatible, but there are some key things you can do to minimise this. Be sure to get up and stretch every half hour, walk around whenever you can, and do what you can to find an office chair which offers support and a desk set to the right height for you.

4. Exercise

Getting and staying active is a healthy choice for more than just your spine – but it can be particularly helpful. Increasing your heart rate will encourage blood flow, bringing nutrients to the spine to fuel it and help it heal. An exercise routine which involves aerobic activity, stretching and strengthening, as we mentioned above, is particularly good. Being unfit increases your risk of lower back pain considerably, as does being overweight, or gaining a considerable amount of weight in a short period of time. Excess weight puts extra stress on ligaments, tendons and muscles in the lower back – another excellent reason to hit the gym.

5. Listen to your body

And, finally, we would urge you to remember that pain is never normal, nor is it something you should accept. Pain, or even discomfort, in your back could be an indicator of more serious issues, so do not ignore it. Get regular check-ups and make an appointment with your doctor if you notice any pain – be that after lifting something too heavy, persistent stiffness from sitting still, or an unexplained twinge for no obvious reason. 

If you are experiencing back pain of any kind, please reach out to us by telephone on 212-241-6335 to make an appointment.