Dr. Louis Magdon, is the newest orthopaedic surgeon at Blue Ridge Orthopaedic & Spine Center.[/caption] This August, Dr. Louis Magdon, a fellowship trained spine surgeon, will be the latest orthopaedic surgeon to join Blue Ridge Orthopaedic & Spine Center. "I am excited to join the practice and eager to start serving the community," Magdon shared. He will complement seasoned spine surgeon Dr. Charles Seal, pain management specialists Dr. Daniel Heller and Dr. David Kim, and six additional orthopaedic surgeons and five physician assistants at Blue Ridge. Together, the large team of orthopaedic surgeons, pain management specialists and healthcare providers work together to further its mission of providing comprehensive orthopaedic and spine care to the community. Prior to his arrival, Dr. Magdon collaborated with us to provide the community with a glimpse into spine care by offering some answers to common patient questions. Blue Ridge: Let us begin by talking about low back pain. It is very common in the adult general population. What is the best approach to acute low back pain? Dr. Magdon: Acute low back pain is, indeed, very common but fortunately, for the vast majority of people, it will resolve within 6 weeks regardless of treatment. It is advised that patients stay active and continue ordinary activity within the limits permitted by the pain, avoid bed rest, return to work early, and use acetaminophen or non-steroidal anti-inflammatory drugs if medication is necessary. Blue Ridge: Well, that’s reassuring! When, though, is back pain a serious health concern? Dr. Magdon: There are findings called “red flags” that are ascertained by providers to screen for serious underlying spinal pathologies in adults. These may include a history of cancer, night pain, urinary retention, bowel or bladder incontinence, unexplained fever, osteoporosis, steroid use, trauma, saddle numbness, or weakness in the limbs. Urgent consultation with your doctor and/or a visit to the ER is advised if your back pain is accompanied by one or more of the aforementioned red flags. Additionally, back pain could also be a symptom of a non-spinal pathology. Now would be a good time to stress the importance of visiting your primary care doctor on a routine basis! Blue Ridge: Great point! Be sure to see your primary care provider regularly. Let’s now dive further into the discussion and talk about when patients experience pain radiating down their legs, often referred to as “sciatica”, or perhaps pain radiating down their arms. What causes these symptoms and what can patients do about it? DM: You are referring to lumbar and cervical radiculopathy, respectively. I’ll begin by saying that although the most common etiologies are either a herniated disc or spinal stenosis, a myriad of pathologies can mimic the symptoms of radiculopathy. Some examples of mimickers include hip pathology: e.g. hip osteoarthritis, compressive neuropathies, carpal tunnel syndrome, and peripheral neuropathy, most commonly caused by diabetes mellitus, to name a few. Collaboration between your doctors, possibly including your primary care doctor, spine surgeon, orthopaedic surgeon, pain management specialist, neurologist, and rheumatologist, is important to arriving at an accurate diagnosis and thus, an effective treatment plan for you. Having said that, though, if your symptoms are indeed lumbar or cervical radiculopathy, initially, conservative, nonsurgical management, i.e. anti-inflammatories and physical therapy, is recommended. For most patients, their symptoms will improve within six to eight weeks. BR: Got it! Conservative management to start as most patients with radiculopathy will get better within six to eight weeks. What happens if symptoms persist, though? DM: For these patients, it is prudent to obtain advanced imaging, usually an MRI, and seek consultation with a spine surgeon. Depending on your unique, individual case, treatment options may include staying the course with physical therapy, seeking consultation with a pain management specialist for an injection procedure, or surgery. BR: So patients with radiculopathy have both time and options? DM: In the absence of any red flags previously discussed, patients can be reassured that watchful waiting is safe and options include both nonsurgical and surgical treatment. BR: Are there any other symptoms that should alert patients to seek consultation with a spine surgeon? DM: Yes, there are two other sets of symptoms worthy of our discussion that should prompt a visit to a spine surgeon. First, often occurring in patients with lumbar spinal stenosis is another kind of leg pain called neurogenic claudication. Patients often describe cramping in their legs. Their symptoms inhibit them from being able to walk long distances, and they experience relief of the pain by sitting or leaning over a shopping cart. These patients can also, initially, expect conservative, nonsurgical management. The other set of symptoms are that of myelopathy and are a more urgent matter. They usually result from spinal cord compression in the neck, though it can occur in the upper back as well but less frequent. Symptoms of cervical myelopathy include imbalance with walking, clumsiness of the hands, and weakness of the arms and hands. Urgent consultation with a spine surgeon is recommended. Unlike cervical radiculopathy, the clinical course of patients with cervical myelopathy is not benign and, with the exception of mild cases, surgical treatment is advised. BR: While on the topic of surgery, let’s segue into back surgery. Among non-medical people there appears to be certain pre-conceived notions regarding back surgery that are pervasive. Some patients are concerned that back surgery doesn’t work. What would you tell them? DM: Let me preface my remark by saying that, in general, with surgical treatment, there are risks along with benefits that your surgeon will discuss with you as well as the alternatives to surgery. Every case is unique and there is no guarantee of a certain outcome. With that being said, there is ample empirical evidence in the literature that dismantles that notion. In general, in appropriate patients, lumbar spine surgery can be very effective at relieving leg pain symptoms while back pain relief is less predictable. Without boring you with data, I will highlight one of the most high quality and well known trials in support of that claim, the SPORT, or Spine Patient Outcomes Research Trial. For three common lumbar spine conditions - disk herniation, degenerative spondylolisthesis, and spinal stenosis - surgical treatment resulted in more significant degrees of improvement, though greater for the latter two, with no significant risk of neurologic deficit. BR: I’m sure many patients will be relieved to hear that. As we round out of our discussion, let’s end on a personal note. Can you tell us what motivated you to pursue sub-specialized training in spine surgery and what is your approach to spine care? DM: My interest in spine care began in college. I sustained a low back injury while snowboarding and that experience had a profound impact on me. The injury took away many of the joys of life for me for a period of time. But in my suffering, I found my purpose in helping others through similar trials in their lives. I once read that your greatest ministry will most likely come out of your greatest hurt. If that wasn’t enough, I was further humbled by developing radiculopathy during my training. As I cared for patients with terrible leg pain, that same pain shot down my leg. Though challenging, it was an enriching experience. From my perspective, it is a privilege to be entrusted with a patient’s care. Every patient has a unique story that deserves to be heard and shared decision-making is paramount to implementing the right treatment plan. I look forward to serving the community! Disclaimer: This article is intended for educational purposes only. It should not be used to diagnose or treat any medical condition. Contact your doctor if you have a health concern. Dr. Magdon has no conflicts of interest pertaining to this article. 
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