The importance of getting an MRI

The importance of What is an MRI (magnetic resonance imaging)?

Written by Fabio Pencle

An MRI or magnetic resonance imaging is a diagnostic test that uses magnetism, radio waves, and a computer to produce images of body structures. A patient is placed on a bed that moves through the circular magnet, creating a strong magnetic field using protons from hydrogen atoms exposed to a beam of radio waves. This spins the various protons of the body, and they produce a faint signal that is detected by the receiver portion of the MRI scanner. A computer processes the receiver information, which produces an image.

Technology of MRI machine have improved over time and can produce detailed imaging. For some procedures, contrast agents, such as gadolinium, are used to increase the accuracy of the images.

What are the uses for an MRI?

An MRI scan is an accurate method of disease detection throughout the body and is most often used after other testing modalities to provide sufficient information to confirm a patient's diagnosis. An MRI scan is used for defining brain anatomy and evaluating the integrity of the spinal cord after trauma. 

When considering problems associated with the vertebrae or intervertebral discs of the spine and MRI scan detects abnormalities such as herniated disc, spinal stenosis and other abnormalities. An MRI scan can evaluate the structure of the heart and aorta, where it can detect aneurysms or tears. MRI scans are not the first line of imaging test for these issues or in cases of trauma.

It provides valuable information on glands and organs within the abdomen, and accurate information about the structure of the joints, soft tissues, and bones of the body. Often, surgery can be deferred or more accurately directed after knowing the results of an MRI scan.

What are the risks and side effects of an MRI?

An MRI scan is a painless radiology technique that has the advantage of avoiding x-ray radiation exposure. There are no known side effects of an MRI scan. The benefits of an MRI scan relate to its precise accuracy in detecting structural abnormalities of the body. Patients who have any metallic materials within the body must notify their physician prior to the examination or inform the MRI staff. Metallic chips, materials, surgical clips, or foreign material (artificial joints, metallic bone plates, or prosthetic devices, etc.) can significantly distort the images obtained by the MRI scanner. Patients who have heart pacemakers, metal implants, or metal chips or clips in or around the eyeballs cannot be scanned with an MRI because of the risk that the magnet may move the metal in these areas. Similarly, patients with artificial heart valves, metallic ear implants, bullet fragments, and chemotherapy or insulin pumps should not have MRI scanning.

How is the procedure performed?

MRI exams may be performed in an outpatient or inpatient basis.  In the outpatient setting you will be positioned on the moveable exam table. Straps and bolsters may be used to help you stay still and maintain your position.

Some patients can experience a claustrophobic sensation during the procedure. Therefore, patients with any history of claustrophobia should relate this to the practitioner who is requesting the test, as well as the radiology staff. A mild sedative can be given prior to the MRI scan to help alleviate this feeling

MRI exams generally include multiple runs (sequences), some of which may last several minutes. You will be placed into the magnet of the MRI unit. The technologist will perform the exam while working at a computer outside of the room.

If a contrast material is used during the exam, it will be injected into the intravenous line (IV) after an initial series of scans. More images will be taken during or following the injection.

When the exam is complete, you may be asked to wait while the radiologist checks the images in case more are needed. Your IV line will be removed after the exam is over.

Depending on the type of exam and the equipment used, the entire exam is usually completed in 30 to 60 minutes.

Why is an MRI important?

This high-tech test is key to diagnosing and treating many health conditions that would otherwise remain hidden. While digital X-rays produce two-dimensional images, Magnetic Resonance Imaging renders three-dimensional images or even slices of internal organs.

This precision allows the doctors to gather and give information on health conditions such as:

·       Herniated Disc

·       Spinal Stenosis

·       Facet tropism

·       Multiple sclerosis

·       Tumors

·       Aneurysms (defects in artery walls)

·       Pinched nerves

·       Syrinx (fluid within the brain stem or spinal cord)

·       Congenital malformations

·       Stroke

·       Seizure disorders

·       Chiari malformation and associated balance problems

·       Head trauma

·       Bone infections

·       Problems with the inner ear and eye

Fortunately, an MRI is painless and non-invasive as it simply uses a strong magnetic field and radio waves to produce its remarkable “pictures.”

Building from the ground up, we strive to be a global outpatient Academic Orthopedic and Neurosurgery-Spine Specialty & Research Institute of Excellence. We aim to lead in Less Exposure Surgery techniques. For more information call 855-411-LESS.

What to Expect for Outpatient Surgery?

What to Expect for Outpatient Surgery?

Fabio Pencle, MBBS; Kingsley Chin, MD

The Consult Visit

When you are diagnosed by your primary care provider with a condition that requires surgery, they should send you to the surgical specialist for further investigation. Surgery is a treatment option for injuries or disorders of the body by incision or manipulation, especially with instruments.

During a consult visit, your surgeon will perform an examination and ask more questions. They will explain their findings and recommendations to you. They may recommend outpatient surgery, often a procedure that lets you go home at the end of the day.

Surgical Education

Our surgical team consist of a surgeon who makes the recommendation and advises the patient about the procedure. Most patients still have questions and we provide a dedicated education class to allow discussion and questions from the patient to be answered. Our trained surgical concierge educator and team provides additional support to the patients and help to coordinate preoperative and postoperative follow up.

Clearance & Preoperative Visits

Once your procedure has been scheduled, you will receive further instructions on clearance and a pre-operative visit will be needed. The Anesthesiologist is a medical specialist responsible for sedation, 'putting you to sleep', and pain control after surgery he will see you prior to surgery.

The Week Before Surgery

In the days before surgery your doctors will recommend that some medications be avoided as they might interfere with healing or anesthesia. Some examples are aspirin and anti-inflammatory drugs such as Motrin, Advil, Excedrin and ibuprofen. Also reduce or stop smoking in the week before surgery.

Night Before Surgery

Eat a light dinner in the late afternoon. Avoid alcohol 24 hours before surgery. Ask your provider if you should take your regular medications. The use of illicit drugs will prevent surgery from being performed.

After midnight, do NOT eat any food including gum, candy, breath mints, or cough drops. Also do NOT drink anything - water, coffee, juice, etc. Do NOT swallow any of the water that is used to brush your teeth.

If you accidentally consume food or water tell your provider as doing so could be dangerous and the surgery may have to be postponed. For your safety, surgery must be done on an empty stomach. Also, if you begin to feel sick or develop a fever call your provider.

These are very general instructions, so ask your MD, as instructions vary with treatment.

Day of surgery

For outpatient procedures, patients should be at the facility at least one hour before their surgery's scheduled time. A staff member will check you in and take you to the waiting area before your surgery. There you will change into a hospital gown.

If you wear glasses, contacts, and/or hearing aids they will need to be removed.

A staff member will come to check your blood pressure, pulse and temperature. Your anesthesiologist will come to talk to you about how you will be sedated, 'put to sleep', and cared for after surgery.

Shortly thereafter, you will be sedated and brought into the operating room for your procedure. If you have any questions feel free to ask them at any time. Our medical staff want to know about your concerns.

Remember to bring with you:

·       Someone to take you home

·       Your insurance card

·       A change of comfortable clothes

·       A case or holder for glasses, contacts, dentures or hearing aids (if you wear them)

·       Sometimes there might be some waiting involved so you might want to bring a book

 Do not Bring:

 ·       Do not bring valuables - jewelry, credit cards or more money than necessary to fill any prescriptions

·       Do not wear make-up and make sure nail polish is removed

·       Do not use lotions, creams, or aftershave, and do not wear perfume.

·       Do not use hairspray, mousse, or gels.

·       Do not shave or use deodorants near the site of surgery

·       Take off all body piercings

During Surgery for Friends and Family

We know that your surgery can be an anxious time for your friends and family who accompany you to your procedure. Our staff will keep them informed as to your progress while they wait in the waiting room.

After Outpatient Surgery

After your surgery you will be taken to the recovery room. You will be monitored and given time to recover. The length of time will depend upon the type of surgery you had. When it is time to leave, a staff member will go over instructions on how to take care of yourself at home. You may also be given prescriptions that you will need to have filled. If you need some extra help a staff member can help you to your car.

You should take it easy the next few days after surgery. Do not drive or operate machinery the day after surgery. If you have questions, please ask your provider.

You may be tired and feel discomfort after surgery. This is to be expected. Your provider will give you something to ease the pain or discomfort. If you are in pain, have a fever, or drainage and/or pus from where you had surgery, call your provider right away. If you have any acute concerns, call 911 or have someone drive you to the closest emergency room.

Be sure to keep all post-surgery appointments that you have with your surgeon. Call your provider's office for any questions that you might have.

The LESS Institute uses a new philosophy of Less Exposure Surgery (LES), utilizing the least invasive techniques and technologies to achieve the best and most efficient outcomes so patients can return immediately to an active lifestyle. As LESS Institute Founder, Dr. Kingsley Chin, board certified spine surgeon, pursues endeavors of medical entrepreneurship, tourism & mentorship throughout Florida, New Jersey, New York, Arizona & Jamaica, treating thousands of patients globally each year. For more information or to get in touch with our team visit www.thelessinstitute.com or call 855-411-LESS.

What should I know before a Surgical evaluation: Goals, Expectations and Concerns

Written by Fabio Pencle

Overview

Surgery is a branch of medicine that deals with the treatment, management, and assessment of a wide range of medical conditions. It is the treatment of injuries or disorders of the body by incision or manipulation, especially with instruments.

A surgery consultation is the first step towards understanding your diagnosis and asking relevant questions you may have. It is an essential part for both your surgeon and you. During the consultation a clinical assessment involves the surgeon asking about your complaint (History) and performing an examination (Physical) to determine your diagnosis. Based on this diagnosis a surgical recommendation is made by the surgeon and any further questions can be answered about the procedure, benefits and risks. At this time if the you agree to surgery, you may be consented to have a record of the type of procedure and a tentative date scheduled.

Our practice offers further follow up with a concierge service. Further education classes and logistics for surgery schedule is coordinated for you.

According to the data of Centers for Disease Control and Prevention (CDC), approximately 22.5 million surgeries are performed in ambulatory surgery centers every year.

Goals of Surgery

• Ensure the patient is not subjected to unnecessary pain, discomfort, and recovery process

• Suggest the most suitable surgical technique or procedure to treat the disease, reduce the symptoms, or manage the condition

• Make the patient fully understand the potential risks or complications of the procedure

• Outline an individualized surgical plan that can be followed through

• Keep track of the patient’s progress and recovery, especially during the first 24 to 48 hours after the surgical procedure

Expectations and Fears

Patients go through surgery consultation when they are referred by their primary care provider (PCP) or other specialists

Are meant for surgery? If the surgeons determine the patients are likely candidates for surgery, they conduct more consultations wherein they perform or interpret test results, plan the surgical procedure (including the date of the surgery), recovery program, etc.

What occurs when surgery is complete? Consultations are also carried out as soon as the surgery has been completed. At this point, the surgeon’s concern is to ensure that the patient responded well to the procedure and to verify whether there are complications.

What happens if there is a complication? Not all surgical complications occur quickly. In some cases, it takes days or even years for them to be discovered. Patients who develop such are encouraged to set an appointment with their surgeon, so the complications are addressed as soon as possible, preventing them from getting worse.

The expected results of the surgery depend on the goal of the consultation. The patients may:

• Learn whether they are fit for surgery or, if not, understand the reasons why and determine other possible treatment options

• Identify the risks and possible results of the surgery so they can decide for themselves whether to proceed with it or not. In the case of minors (pediatrics), the decision rests with the adult, who is either a parent or a guardian.

• Obtain a better picture and prognosis of the disease based on the additional tests

• Ensure patients are prepared physically, mentally, and even spiritually for the surgery

• Determine the best steps to take during the post-operative care

How Does the Procedure Work?

Most of the surgical consultations are planned. This means the patient has been referred by a doctor or a specialist following the results of initial tests. Patients then set appointments with the recommended or their chosen surgeon.

During the initial pre-operative consultation, the surgeon asks a series of questions to know the main concern of the patient, from the disease to the fears or discomfort about surgeries. The surgeon then reviews the results of the exams, which should have been forwarded before the consultation. If the tests are not enough to decide, the surgeon may request for more tests, which will then be evaluated and discussed during the next consultation.

Possible Risks and Complications

A surgery consultation doesn’t in any way guarantee the elimination of risks and complications. However, one of the primary objectives of the consultation is to reduce and/or mitigate these risks, which can include bleeding, infection, and organ failure. Patients and surgeons should work hand in hand to ensure the patient’s safety all throughout the surgical process.

Building from the ground up, we strive to be a global outpatient Academic Orthopedic and Neurosurgery-Spine Specialty & Research Institute of Excellence. We aim to lead in Less Exposure Surgery techniques. For questions and scheduling call 855-411-LESS.

Good news for the 31 million Americans with lower back pain: These lifestyle habits can bring relief and help you avoid future problems.

Sometimes all it takes is bending over to pick up a pen from the floor for pain to strike. Fortunately, most of the time back pain is short term and goes away on its own. But if you experience chronic back pain, you may benefit from making certain everyday adjustments.

In fact, lifestyle has the biggest influence on back pain, and healthy habits such as a good diet, exercising, stretching, and posture can give you back pain relief or help you prevent future problems.

Make these steps part of your back pain treatment plan:

Maintain a healthy weight. Staying fit is one of the most important recommendations for avoiding back pain, says Kingsley R. Chin MD, spine surgeon and founder of The LESS Institute. Extra pounds stress your back and can cause pain. Eating a healthy diet filled with fruits and vegetables and low on processed foods can keep your weight in a healthy range and your back healthy.

Keep your back muscles strong. The most common back problems happen because people who aren't in shape start doing heavy lifting or hard work and stress their back, Dr. Kingsley Chin says. Back pain usually happens when there's degeneration of the spine because the spine is working too hard. But when you build up enough muscle strength in your back with exercise, the muscles give your spine the support it needs to keep it healthy. That's why physical therapy is standard back pain treatment, but being in shape can help you avoid back pain to begin with.

Stretch your muscles. In addition to exercise, stretching is important for staying flexible and avoiding back problems. It's also a key part of recovering from a back injury. Stretch before doing heavy lifting or exercise and make a habit of doing it before bed. Stretches can be as simple as bending forward, bending back, and bending side to side. The ultimate stretching exercise is yoga.

Focus on good posture. Poor posture is another major contributor of back pain. Standing up straight with your ears over your shoulders, your shoulders over your hip joints, and your hip joints over your ankles will help keep your healthy pain-free. When you're sitting, getting a chair that's designed to keep your back straight will help.

Lift properly. When you do pick up a heavy object, bend at the knees and keep the item close to your body. Also, take care not to twist your body when you lift, and wear a brace if you have a job that requires heavy lifting.

Leave your purse at home. If you can, stash a few dollars and your identification in your pocket when you leave the house rather than carrying around a heavy purse. Carrying a bag changes your balance and can change the curve of your spine. Even a wallet packed full of cards and receipts in your back pocket can affect your back because it puts pressure on your sciatic nerve.

Practice stress relief for back pain relief. Stress tends to make back pain worse. That may be another good reason to practice yoga. Other ways to reduce stress include treating yourself well, avoiding over-scheduling your days, and taking time to enjoy life.

Sleep well. Soft mattresses push your back out of alignment, so it's best to choose a mattress that's in the range of medium to firm for back pain relief.

Living a healthy lifestyle that's full of exercise and taking some care to have a healthy back can help you live free of chronic back pain. If pain persists it’s time to make an appointment with your orthopedic doctor.

We at the LESS Institute are available to answer any questions or inquiries and we offer free MRI review. 

The LESS Institute is the world leader center of excellence in Less Exposure Surgery.  You deserve the best and at The LESS Institute, we focus on identifying the problem and performing effective treatments with minimal blood loss so that patients can recover quickly, avoid expensive hospital stays and return home to their family the same day.  The LESS Institute specializes in the best and most efficient least invasive techniques and technologies available.  As LESS Institute Founder, Dr. Kingsley Chin is a board-certified Orthopedic Spine surgeon who has been treating of patients throughout Florida, New Jersey, New York, Arizona & Jamaica each year. For more information or to get in touch with our team visit www.thelessinstitute.com or call 855-411-LESS.

You Won’t Believe the Most Common Question after Back Surgery

By Admin

As a healthcare professional in an orthopedic spine clinic, I field questions all day long from patients about their recovery.

The most common question after back injury or surgery is: “Doc, when can I have sex?”

Our LESS Institute Founder Dr. Kingsley R. Chin advises, “Remember -all our bodies are different, and your medical history, as well as the complexity of the injury or procedure ultimately determine how much time your body needs to heal.”

So although we can’t give an exact answer, there is a guideline that can help you answer that all-important question -just in time for Valentine’s Day.

Consult Your Surgeon

Before you attempt to engage in sexual activity, consult your surgeon to make sure your back is well enough.   You want to make sure that you don’t aggravate your pain or worsen your condition.

Learn

Learn more about your back condition.  Why is this happening? What can or can’t you do for now?  What precautions do you need to take?

Speak

Sit down and speak with your partner about what is happening. Tell them how you feel.  Communication is key as back pain can affect intimacy in the bedroom, as well as relationships in general.

Plan

Yes -that’s right: Plan your positions together.  Research how you can safely position your body to support your back and reduce your pain.  Also speak with your physical therapist for proper body mechanics or positions that will be safe during intercourse.

Explore

Be creative; be imaginative.  Surrender and approach new ideas together.  Try a little more sensuality versus sexuality by pleasuring your partner’s senses with some essential oils or music.

If you are experiencing back pain, don’t hesitate to contact us at the LESS Institute. We understand how challenging living with back pain can be and we’re here to help you.

About the LESS Institute

The LESS Institute uses a new philosophy of Less Exposure Surgery (LES), utilizing the least invasive techniques and technologies to achieve the best and most efficient outcomes so patients can return immediately to an active lifestyle. As LESS Institute Founder, Dr. Kingsley Chin, board certified spine surgeon, pursues endeavors of medical entrepreneurship, tourism & mentorship throughout Florida, New Jersey, New York, Arizona & Jamaica, treating thousands of patients globally each year. For more information or to get in touch with our team visit www.thelessinstitute.com or call 855-411-LESS.

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Setting Your New Years Resolution- & Keeping It

Content by Esther Rodriguez & Ana Williams

As we ring in the new year, we inevitably ring in resolutions to follow – from fitness aspirations to lifestyle improvements, we all share a common end goal: to improve our lives in the upcoming year, by altering bad habits and fostering positive ones. But goal setting is more than making a wish and hoping it will come true. It’s about making it happen and sticking to it. This year, don’t promise the same old new year’s resolution just to find yourself given up by February. The biggest mistake we see are goals that are too broad, too big or too complex. Read on for your guide to setting a manageable new year’s resolution – and keeping it for good.

TIP #1: RECOGNIZE WHAT YOU NEED TO CHANGE.

Take a serious step back and consider what you feel you need or want more out of life. It could be as major as a big move, or as “minor” as dedicating more time to home cooking. Whatever will increase YOUR quality of life – make it happen.

TIP #2: ESTABLISH SMART GOALS.

S.M.A.R.T. goals are those that are specific, measurable, attainable, relevant and time-based. Set these goals by writing them down, making them feel tangible. Then plan the steps you must take to realize that goal, and cross each off as you work through.

TIP #3: BEGIN A GOAL-DIRECTED ACTIVITY.

The first step to achieving your goals is starting. Don’t let the prospect of hard work keep you from beginning. It takes just one step – and voila! You’ve begun.

TIP #4: TRACK YOUR PROGRESS.

Tracking your progress doesn’t have to be intimidating, but it does need to hold you accountable. Whether it’s in baby steps or giant leaps, track your wins every time. This will serve as both proof of achievement and a motivator to keep you climbing for success.

TIP #5: REWARD YOURSELF.*

Perhaps the best step of all: reward. Don’t forget to celebrate your wins, even if it’s in a small way. You ran a mile every day last week? Highlight that by treating yourself to a new piece of gym swag. Or take a day off and pick back up twice as hard the following. Small wins are still wins.

*Just don’t go too easy on yourself! Goals are meant to challenge and better you – and hard work is tough for a reason. The easy path won’t get you to your desired destination, trust us. It’s all about a happy medium in rest & reward. You know your limits; establish those, stick to them & you’ll thrive.

Share below how YOU make & keep your new year’s resolution. How will you take 2020 by the horns?

Young Boy Fell From Trampoline. Neck Sprain?

It is very common for teenagers to encounter injuries due to sports or physical activities. Knowing what to do after an incident can be very crucial to finding out the main cause of pain.

A 16-year-old male was jumping on a trampoline when he fell and complained of neck sprain.

The patient was seen in the ER and sent home without any radiology.

Dr. Kingsley Chin, board certified orthopedic surgeon advices that all trauma patients have a cervical spine injury until proven otherwise.

It is important to clear the C-Spine which is defined as confirming the absence of cervical spine injury. Cervical spine clearance can be performed with physical examination and radiographic images. The fact that delayed clearance is associated with increased complication rates warrants this criteria.

Missed cervical spine injuries:

• May lead to permanent disability

• Careful clinical and radiographic evaluation is paramount

• A high rate of missed cervical spine injuries due to inadequate imaging of affected level loss of consciousness.

• Multisystem trauma

All cervical spine injuries necessitate careful examination of the entire spine.

The patient should be called back immediately for an urgent review and proper clearance with examination and radiology.

If anyone has experience these symptoms call 855-411-LESS to schedule an evaluation.

Sentinel Sign in Standalone Anterior Cervical Fusion: Outcomes and Fusion Rate

By Dr. Kingsley Chin

Scientific Paper

Kingsley R. Chin, Fabio J.R. Pencle, Luai M. Mustafa, Moawiah M. Mustafa, Amala Benny, Jason A. Seale

Interested medical professionals can read through the full paper, as published in the Journal of Orthopaedics, here.

Background

The authors aim to demonstrate the feasibility, outcomes and fusion rate of a standalone PEEK cage in the outpatient setting.

Methods

48 consecutive patients undergoing standalone ACDF (S-ACDF) (Group 1) were compared to control group of 49 patients who had ACDF with ACP (Group 2).

Results

Analysis of follow-up at the one year period postoperative outcomes between groups 1 and 2 demonstrated no intergroup statistical significant difference in VAS neck, arm and NDI scores p = 0.414, 0.06 and p = 0.328 respectively.

Conclusion

We conclude that S-ACDF can be safely done in an ambulatory surgery center with satisfactory clinical and patient-reported outcomes.

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, VisitingSpine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Studies at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

Scientific Paper Author & Citation Details

Authors

Kingsley R. Chinabcd, Fabio J.R. Penclee, Luai M. Mustafab, Moawiah M. Mustafab, Amala Bennyae, Jason A. Sealeae

Author information

a. Less Exposure Surgery Specialists Institute (LESS Institute), United States
a. Less Exposure Surgery Specialists Institute (LESS Institute) USA
b. Herbert Wertheim College of Medicine at Florida International University, USA
c. Charles E. Schmidt College of Medicine at Florida Atlantic University, USA
d. University of Technology, Jamaica
e. Less Exposure Surgery (LES) Society, USA

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The LESS Institute Fosters Adolescent Scoliosis Care With the Best in LES

Written by Fabio Pencle & Garianne Bowen

Compiled & edited by Esther Rodriguez

Adolescent idiopathic scoliosis (AIS) is the most common form of pediatric scoliosis in individuals between the ages of 10 and 18,1 found in as many as 4 in 100 adolescents.2 By definition, idiopathic scoliosis implies the cause is unknown or not related to a specific syndromic, congenital or neuromuscular condition. Treatment options include conservative management, bracing or operative intervention.

Marketing Intern Garianne Bowen is no stranger to a life with adolescent scoliosis, although she may not have known it at first.

“Looking back, though I had the signs of scoliosis growing up, my family wasn’t aware of the potential for this diagnosis. We all thought nothing could be done of it – and though I tried to accept it, I somehow could not,” she said. Bowen spent years settling for a life that held so much more potential, in the physical and emotional space. In a world where lives are hyper visual with social media exposure, “I always felt uncomfortable in my own body. It sometimes felt like I didn’t know how to walk correctly, and that eyes were always on me. My breasts were two different sizes, my stride wasn’t straight, clothes fit awkwardly and I experienced occasional annoying back pain. My shoulder was damaged by birth and my parents attributed that to me being ‘different,'” said Bowen.

Eventually Bowen’s parents discovered an article on scoliosis – and as they read, realized she fit the mold so entirely. Because of this, they scheduled an X-ray to be read by an orthopedic surgeon, witnessing first hand their daughter’s 40 degree spinal curvature.

A proper adolescent scoliosis evaluation includes X-ray imaging from various angles.  Generally speaking, those with curves of 10 to 25 degrees are monitored for surveillance with serial X-rays. This is usually at three, six or 12 month intervals. Those with curves greater than 25 degrees but less than 40 to 45 degrees are candidates for bracing. And those with curves of over 40 to 45 degrees who are skeletally immature are considered operative candidates.3

Bowen’s 40 degree spinal curvature seen through X-ray

During her preliminary orthopedic visit, her doctor at the time being highly encouraged Bowen to undergo a spinal fusion from the neck down, a more major procedure for an adolescent scoliosis case that would limit Bowen’s flexibility and motion. But Bowen was not so on board. She became determined not to undergo surgery, adapting to a life of covering her curvature and accepting pain as the norm.

Three years post scoliosis discovery, Bowen’s mother met Orthopedic Surgeon Dr. Kingsley R. Chin at a conference. Impressed by his profile as a successful Jamaican-born, Harvard-trained spinal surgeon, she brought her daughter to him straightaway to determine a second opinion regarding treatment options. Dr. Chin assured Bowen he would not be completing a full spinal fusion, introducing a Less Exposure Surgery procedure in its place – and clarifying her every concern regarding maintaining motion post-procedure.

Dr. Chin pioneered this LES procedure, a short segment scoliosis surgery with a focus on the apical curve, gearing treatment to the levels above and below – limiting fusion levels.

“As he reassured me, my perceptions of the procedure were altered for the positive,” she said, and after further personal research and consideration, she ultimately trusted Dr. Chin to perform the surgery. “I am so grateful to have gotten to that place,” attests Bowen.

We know it’s vital to prioritize our health, but we must also expose ourselves to our options that lie ahead. Explore your varying avenues of recovery and choose the most appropriate healing method for you.

“I can personally vouch for Dr. Chin as a top orthopedic surgeon, as I begin enjoying my young years to my utmost potential – confident and free of pain.”

— Garianne Bowen

And just like that, from curvature to confidence, Bowen leads a life of health, happiness and pain-free motion.

The Less Exposure Surgery Advantage

In advancing Less Exposure Surgery, The LESS Institute aims to reduce operative time, minimize blood loss and decrease instrumentation, while improving overall outcomes. For more on adolescent scoliosis cases with The LESS Institute, see the Jamaica Gleaner article and our post titled 15-Year-Old Jamaican Girl Appreciates Life Changing Scoliosis Surgery in Jamaica by Dr. Kingsley R. Chin.

About Dr. Kingsley R. Chin

Dr. Kingsley R. Chin is a board certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Studies at the University of Technology, Jamaica.

1. , 3. https://www.ncbi.nlm.nih.gov/pubmed/29763083

2. https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/adolescent-idiopathic-scoliosis 

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Option for Transverse Midline Incision and Other Factors That Determine Patient’s Decision to Have Cervical Spine Surgery

By Dr. Kingsley Chin

““I had my [cervical fusion and lumbar decompression] surgery ten days ago and I feel great, I’m wearing my heels and I’m ready to go!””

Introductory content by Fabio Pencle 

“[Dr. Chin] is a true professional… the whole team, the whole staff was great here at the LESS Institute.”

A newly published study has demonstrated that patients prefer a midline incision for cervical spine surgery.

The anterior approach to cervical spine surgery has become the standard for the treatment for degenerative disc, traumatic herniated disc and fracture dislocation. Cloward, Smith and Robinson have

devised operative techniques with modifications by several surgeons since 1958. There are varying types of skin incisions for cervical spine surgery; the incision is either on the right or left side of the trachea based on the surgical approach to the recurrent laryngeal nerve. Other factors determining the type of incision include a few pathological levels affected, if corpectomy is required and whetheraffected segments are contiguous.

Transverse midline incisions have been used by other surgical specialties such as ENT, vascular and general surgeons. This incision provides a more cosmetically acceptable result and allows for access to structures during surgery; however, few studies discuss the relevance of cosmesis. There are several named guidelines for determining surgical incision, most notably, Langer’s lines. A transverse midline incision would, however, follow the guideline by Kraissl, where the incision is made in a skin crease. The quality of surgery is judged immediately by the amount of relief of symptoms and the cosmetic.

Considering the patient-driven procedures offered to treat the same pathology, as well as recent trends in the increase in ambulatory surgery center (ASC) use, the authors felt it prudent to devise a questionnaire with the primary goal of determining the preferences of the patients. The secondary goal was to determine factors which lead to the decision to have anterior cervical spine surgery.

Scientific Paper

Fabio J.R. Pencle, Jason A. Seale, Amala Benny, Sephania Salomon, Ashley Simela, Kingsley R. Chin

To read the full paper & citations as published in the Journal of Orthopaedics, visit here.

Background

Authors aim to determine patients’ preference for surgical incision and factors affecting the decision for surgery to the anterior neck.

Methods

A questionnaire was presented prior to evaluation and if preceded to surgery followup given.

Results

243 patients completed questionnaire, with 60% female population and younger than 50 years. 151 patients preferred a transverse midline incision with a statistically significant increase in outcomes and cosmesis importance and a decrease in the importance of board certification.

Conclusion

Findings of questionnaire demonstrate that patients’ prefer a transverse midline anterior neck incision, with surgical outcomes being the overall factor affecting decision making.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, VisitingSpine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Studies at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

Scientific Paper Author & Citation Details

Authors

Fabio J.R. Penclead, Jason A. Sealead, Amala Bennyd, Sephania Salomond, Ashley Simelade, Kingsley R. Chinabcf

Author information

a. Less Exposure Surgery Specialists Institute (LESS Institute), United States
b. Herbert Wertheim College of Medicine, Florida International University, United States
c. Charles E. Schmidt College of Medicine, Florida Atlantic University, United States
d. Less Exposure Surgery (LES) Society, United States
e. Bronx Lebanon Hospital Center, United States
f. University of Technology, Jamaica

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