CredentialsPositions
Board Certifications
Education and Training
- Associate Professor, Department of Neurosurgery at NYU Grossman School of Medicine
Board Certifications
- American Board of Neurological Surgery - Neurological Surgery, 2015
Education and Training
- Fellowship, John Hopkins University, Spine Surgery, 2011
- Residency, New York Presbyterian - Weill Cornell, Neurological Surgery, 2010
- MD from SUNY - Stony Brook, 2004
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU Land
Going Health. It's CATS's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on seven ten WOOR
It's the Chairman of Urology at NYU Land Gone Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:36):
Well, good morning everyone and welcome again the CATS's Corner
here on WRI iHeartRadio. So glad you could join us
this morning. Have a wonderful show for you, one that
I think applies to all adults, maybe even children as well,
and that is the issue of back pain and what
to do about back pain, when to see a doctor,
when you should get imaging tests, and what type of
(00:58):
doctor you should see, how to even prevent it and
to help us with the discussion, I've asked doctor Ilia Laufer,
who is in the Department of Neurosurgery at the NYU
Grossman School of Medicine. He holds the title of the
Director of the Spine Tumor Program, and he's done a
lot of work and research in the area of improving
(01:20):
outcomes of spinal tumor care and incorporating some of the
latest and greatest minimally invasive techniques into spinal tumor surgery.
We'll get into that a bit, of course, but we
also want to talk about just managing back pain and
you know, some of the things that we can do.
(01:41):
He also is a member of the North American Spine
Society Spine Oncology Section and a member of the American
Academy of Neurological Surgery ILIA. Thank you, welcome to Katzis Corner.
Thanks for coming on the show this morning. Greatly appreciate that.
Speaker 4 (01:55):
Oh it's my pleasure to be part of it. Thank
you so much for inviting me. I'm looking forward to
having a fun discussion.
Speaker 3 (02:00):
Yeah and yeah, I mean, back pain is never fun.
I've had back pain. Most of us have had some
back pain. I've heard different theories as to why that is.
Maybe we evolved too quickly that we were on hind
legs on all fours and then we're on two legs,
and maybe the evolution process was too quick, but this
is something that you obviously see quite a bit of it.
(02:22):
Maybe you can start it by telling us, I guess
is there are there ways to prevent back pain?
Speaker 4 (02:30):
Well, you know, I spent a lot of time speaking
about that with my patients. Most of the time, by
the time they come to see me, they already have
back pain. So you know, the question is how to
try to reverse it prevent it from recurring. You know,
I think pasture and it's one of those things that
our parents told us from us being a little kids,
and we probably never really paid a whole lot of attention,
but I do think it matters tremendously. And you know,
(02:53):
whether there are theories about us standing too quickly on
two legs from four legs and so on, true, you know,
I think the really important thing is having good balance
in your body and in your lifestyle. When we lose
that balance, our muscles end up having to work over time,
and so does our skeletal system. And to prevent that,
(03:15):
the important thing that I tell all my patients is
you want to have your shoulders balanced over your hips,
and your head over your shoulders and hips, and if
we can get close to that alignment, then the weight
of the head, which is actually quite heavy, it becomes
really well distributed throughout the body and we don't overstress
(03:37):
specific parts of the spine. If we lean too much forward,
we stress the discs and the muscles become overextended and
the back and the neck hurts. So that's a pretty
common thing that we do. Of course, you know our
posture nowadays, we sit a lot, We spend a lot
of time in front of the computer. We spend a
lot of time looking down at our phones, and all
(03:59):
those things pitch our bodies forward. And it's really really
important and helpful to be mindful of the things that
we do when we're not paying attention to the posture
and trying to actually get yourself into some balance at least,
you know, bring the phone up in front of your
eyes more so than you know somewhere in your waist levels.
(04:21):
Try to find the chair and a desk in a
computer where your eyes are aligned with the screen and
you're actually sitting up straight with some curvature in your
lower back, you know, sit on the hard part of
your bottom rather than on the soft part where we
oftentimes sit when we lean back. So all those things
are really really important, and I think that's probably the
(04:42):
best way to try to prevent back vain from becoming chronic,
from occurring or from reoccurring.
Speaker 3 (04:49):
Yeah, I think that's really great. One of the other
things that I've done in my life if I'm taking
a long car ride, is I make sure that the
rear view mirror is tilted up a little bit makes
me sit up straighter. Do you think that's a reasonable
thing to do or not. I heard that some years ago,
just so that you can kind that's brilliant, really okay, Yeah,
(05:10):
I actually funny enough.
Speaker 4 (05:12):
You know, I've been doing that without realizing that I'm
doing it, but I see that in the car, and
I do it at other places as well. Yeah, so yeah,
I mean I think exactly as you said, when you
tilt the mirror to be a little bit higher than
where you expect it to be, right forces you'll sort
of pull your head up, and that stretches your whole
(05:32):
spine exactly along the same lines. You know, Walking is
really really important also, right. You know, when you walk,
you really kind of force yourself into upright posture, and
this activity of walking and engaging your core is really
really important as well. And the other thing that we
tell people is if you can try to find time
to walk on uneven surfaces, that's also really helpful to
(05:55):
engage in the core. So obviously, you know a lot
of us live in cities. We drive, we walk on pavement, uh,
and maybe we don't take too many hikes outside of nature.
But you know, when you're always walking on an even
flat surface, you aren't engaging your core as much as
when you are on something that's a little bit bumpy,
in a little bit uneven. So you can find time
to go outside in the park or nature and take
(06:17):
a walk, that's going to go a very long way
to strengthening your core and preventing back pain. Yeah.
Speaker 3 (06:22):
One of the things I do when I go to
the gym is I hold a weight in one hand,
a heavy weight, and walk around the gym just and
then try to maintain my posture straight up. So you know,
put you know, strengthening the core. As you say, you know,
you think that's a reasonable thing to do. I saw
somebody do that once. I said, it looks pretty good,
you know, So you know, just kind of holding a
(06:43):
weight in one hand. Uh huh.
Speaker 4 (06:45):
The other thing is I think okay, as long as
you are able to keep upright posture, and I think
it could be challenge. That's it right weight heavy. Now, Now,
what about long as you're mindful?
Speaker 3 (06:56):
Now, what about a technique if you if you see
something on the floor, a coin, let's say, is something,
and you're going to bend over to pick something up,
whatever it may be, anything that fell on the floor,
and you got any technique there they could so that
you're not putting strain on your back when you're bending
over to pick something up.
Speaker 4 (07:15):
Well, that'll probably depend on how old you are. I
think the safest way to do that right is when
you bend your knees and keeping it back straight. Right, Okay,
that us a way you could do that. Sometimes we
bend down, and you know, we hear plenty of stories
where somebody bent down because they got excited and it
was like a very sharp, acute and expected bend and
they came up with back pain. One of the ways
(07:36):
to get discrerenation is by leaning forward, because that actually
opens up the space between the vertebrate the bones and
the spine and weakens the wall of the disc a
little bit so big leans forward aren't always great, but
you know, you young people can certainly afford to do that,
(07:57):
and I do think there's some value in that, because
I do think that you know, being agile, being flexible
is not a bad thing. You don't necessarily have to
overdo it. But I think exercising within the normal range
of motion for young people as good. As we get older,
I think that gets a little bit restricted, and we
do run a higher risk of hurting ourselves when we
exercise like that. So I think for you know, probably
(08:20):
everybody fortying over, certainly maybe even a little bit younger,
trying to bend with your knees rather than leaning forward
is a good idea.
Speaker 3 (08:31):
And in any tips, you know, obviously rest, but any
tips when when you have an acute back injury and
you feel like, oh I just got this pain, you know,
obviously rest, But any other tips beside that, are any
position that you should put your body in or anything
that you should do.
Speaker 4 (08:47):
Maybe taking some especially you know, rest is okay. But yeah,
the right time I'm giving people is the opposite, you.
Speaker 3 (08:55):
Know, Okay, moving, keep good.
Speaker 4 (08:58):
We have more.
Speaker 5 (08:59):
Problems from spending too much time in bed and taking
the sort of position I am not well, which only
forces the muscles to basm more and become more inflamed
from disuse, rather than actually moving through things if possible. Obviously,
if there's acute pain, or you know, there's pain what'll
(09:22):
we call ridiculous pain that you know, shoots into parts
outside of the spine, into the legs. You know, that
could be different, and yeah, maybe that's the reason to rest.
Speaker 4 (09:30):
But most of the time when people have back pain,
the advice is actually to keep moving rather than to
lay in bed for a few days, because it's important
to use the muscles. It's important to engage them, and
if you do that, the back pain is more likely
to get better. Just the other day, funny enough, you know,
my daughter was on a playground and she went up
(09:51):
somewhere and I tilted my neck in a funny way
and I got this really bad pain on the right
side of my neck, and say, oh, I've heard this before.
But you know, I kept on doing a gentle range
of motion exercises for the neck, and the pain went away.
I'm pretty sure if I would have, you know, just
(10:11):
completely immobilized my neck. The pain and the muscle spasm
would have really set in and things.
Speaker 3 (10:16):
Could have been worse, and your mood would have went
real down, because when you have pain like that, your
mood gets bad. I mean, I don't mean you personally aren't,
but I'm just saying everyone's mood. It's just like you
can't focus on anything when you have pain like that,
and it's just you know, you just you want to
be left alone. And then, you know, I often wonder,
you know, how do you distinguish as you mentioned, you
(10:37):
were getting into a little bit about the disk issue.
Is it just like is it a muscle thing, or
is it really like a disc carnation or a disc
problem or a spine problem. How does somebody know that?
And I guess the obvious lead in question there is
how do you know when to see someone like yourself
a spine person?
Speaker 4 (10:57):
Of course, so batman is extremely common. Of course, Uh,
most of the people have had it, but will have
it during the course of their lifetime. For not too
many people, fortunately, does it become a recurrent chronic issue.
So an episode of back pen is by no means
an indication that people will have crinic back pain. So
(11:19):
you know, just back pen and what I really mean
by that is pain sort of just above the pelvis,
below the rib cage in the middle, or a little
bit off to the sides. That's quite common. Okay. Now,
if somebody has back pain again, you know the garden
variety back pain, pain without going into the legs, without
(11:42):
other neurological dyings or symptoms like numbness, tingling, weakness. Usually
is a back pain that is attributable either to muscle
spasm or some form of joint pain, some form of
bone or disc. Most of the time again, wear and
tear common problem that comes with either using our backs
(12:06):
or just getting older. Now, if pain is associated with fevers,
history of trauma, immunosuppression, you know, somebody whose immune system
is not working well, either because they're ill or because
they're taking medications, or with neurological problems such as pain
(12:27):
going into the arms or legs, or sensory changes meaning numbness, tingling,
or weakness, so trouble using a hand, or trouble you
know when you're walking your foot is catching the sidewalk,
those types of things. That's the reason to seek medical attention.
Most of the time. The actual midline back pain when
(12:50):
people come to see a doctor. The treatment there is
keep moving. You could take some anti inflammatory medications like
a leave or if you don't have contry unications or
talento and keep moving. Sometimes physical therapy, but even imaging
is most of the time not indicated for midline lower
(13:11):
back pain because imaging doesn't really provide actionable information most
of the time in these situations.
Speaker 3 (13:18):
And by imaging you mean just either an MRI or
a plane X ray or any you know, something like.
Speaker 4 (13:24):
That, any any one of those things. Somebody comes with
a single episode of back pain like this. Most of
the time, we don't really need to get imaging because
imaging is helpful to make a diagnosis in which we
would act, and by act I mean intervene. You know,
I'm taking medications like an anti inflammatory medication doesn't really
(13:45):
change whether you know, based on imaging, the red flag
things that I just mentioned, that's the type of symptoms
that can really warrant imaging, and they can indicate a
trauma or a fracture and infection, a discarnation, compression of
the nerves. You know, those are the things where we
may want to be more interventional, and sometimes we do injections.
(14:10):
Sometimes we talk about surgery In some instances where physical
therapy or rest or you know, activity aren't helping, those
are the times we may want to image in order
to adjust the treatment plan. But again for garden writing
lower backing, most of the time imaging doesn't give them
(14:31):
us much information, only makes people more concerned because most
people have some sort of degenerative process that we can
see on imaging. Now, you know, just because somebody has
degenerative this disease, a little bit of joint overgrowth doesn't
necessarily mean we need to do anything about it other
than maybe adjust the activity. But we know how to
(14:53):
adjust that activity without imaging.
Speaker 3 (14:56):
Okay, well that's really important if you just wake it
up in the morning. Here on Kansas Corner where talking
with doctor ili Alaufer, who's a spine surgeon at the
NYU Grossman School of Medicine, clearly an expert in back
issues and spine issues. And if you have a question
or you'd like to see him, or you know a
loved one that has an issue with chronic back pain,
I'll give you his number. I'll announce it again at
(15:18):
the end of the show. It's two one two, two
six three three six four zero. That number again, is
two one two, two six three thirty six forty. And
I was just wondering because I do have a dear
friend of mine who has this back issue, back pain
that she's been having, and it's been going on for
a long time, none of those neurological symptoms that you're mentioning.
(15:38):
But what about the duration? What about if someone you
know has this going on for like, you know, maybe
two three weeks, would that be an indication to to
get an image without any of those neurological types of
or warning signs, those things, those red flags as you
as you pointed out.
Speaker 4 (15:55):
I'd say anything for a few weeks, probably not. But
I think if it's going into months and year, then yes,
because you know, there certainly other reasons. You know, sometimes
people have deformity in their spine. Sometimes people really do
have significant degenerative processies the where we may want to
try some interventions like nerve blocks, and sometimes they relieve
(16:16):
the pain. Sometimes they help us pinpoint the source of
the pain that we may want to treat surgically for example,
or with some nerve reblations. So yes, if it's becoming
a recurrent or chronic problem, then that's the time to
get imaging and investigate further, and you know, treating a
treating back pan as a team approach. You know, I'm
a surgeon from just one of the team members. We
(16:39):
have other specialists who do that as well. We have
rehabilitation medicine specialists, we have pain medicine specialists, we have
neuro modulation specialists, we have neurosurgeons, we have orthopedic surgeons.
So you know, we all work as a team. When
somebody calls it back pain, the important thing is to
find the right first point of contact. And oftentimes it's
(16:59):
not a surge. Oftentimes it's maybe a rehabilitation medicine and specialist.
Speaker 3 (17:04):
Yeah, I think that's really an important message. Two messages
there that I could see. One is that it is
a team approach and you have an excellent team there
at NYU. And the other is is that just because
you have back pain, you don't need you don't need surgery,
and you need to think about these other options first
before surgery. But I guess there are situations, of course,
(17:25):
when people do need surgical approaches. Maybe you can tell
us in twenty twenty four, Now, what are the you know,
the general types of spinal surgery that you particularly do
in your team for patients with with I guess more
severe cases.
Speaker 4 (17:45):
Of course. So you know, the general buckets of things
that we do in spine surgery will be do you
compress the nerves or the spinal cord and stabilize the spine?
So do you compress the nerves. As we get older,
the spaces around the spinal cord, which is you know,
the big highway of nerves that carries signals from the
(18:08):
brain to the arms and legs and back can become
tighter and tighter and the spinal cord can get compressed.
That's when people start having trouble with you know, using
their fingers or walking steadily, so you know, those types
of decompressions really help. Sometimes people have back pain and
buttock pain and the back of the leg pain because
(18:30):
the nerves and the lower back are becoming compressed. Sometimes
pain is more what we call ridicular nature, meaning it
shoots down the arm of the leg almost like a
line or a is app Those are all indications that
the nerves are being compressed, and that's where if it
doesn't resolve over one, two, three months with some interventions
(18:51):
physical therapy, that's where surgery can be very beneficial and
decompressing the nerves. The other is where somebody has a
deformity or a trauma for tumor, where there's a fracture
that needs to be stabilized, the spine needs to be realigned.
That's when we start putting in spinal instrumentation in order
to provide additional support and healing the bones and in
(19:14):
order to get better alignment. So those are the types
of surgeries that we do, which is instrumented stabilization, decompression,
and when they're different combinations for different things. The most
common indication is degenerative, so as we get older again,
you know, things closing in around the nerves or just
people having back pain from leading forward too much and
(19:36):
having some sort of degenerative deformity that can be corrected,
and with excellent data to show that when we can
do that, when we can realign somebody's fine decompressed the nerves,
people feel dramatically better and have very good symptom relief. Ovations,
of course, are from when somebody falls and has a fracture.
(19:56):
Tumors are another one, and that's something that I spent
quite a bit of time treating. So removing the tumor,
stabilizing the fracture from a tumor, and again decompressing the
nerves being compressed by the tumor.
Speaker 3 (20:09):
And the majority of these these procedures that you're doing,
are they outpatient like or do the patients need to
stay in the hospital for that.
Speaker 4 (20:20):
So the majority of degenerative problems can be treated as outpatient.
So you know, if somebody has one two level disc
disease in the neck or in the lower back, also
the time we can do that as an outpatient where
people go home the same day or maybe just after
a brief overnight state. Some of the biggest surgeries, of course,
sometimes require a few days in the hospital associated with
(20:43):
healing and you know, just post operative recovery and rehabilitation.
In more rare instances, people actually go to inpatient rehabilitation
centers where they spend a few weeks intensively working with
the physical therapists in order to get back to normal.
Speaker 3 (20:59):
Yeah, so it really it obviously it varies, but the
overall success from what you're saying, is relatively quite high
these days, Is that right? I mean, it seems to
be you know, I don't know what if you quote
a number of patients. As you know, so patients ask
you all the time, what's the likelihood that I'm not
going to be in pain anymore? I'm not going to
feel this tingling down my leg, or I'm going to
(21:19):
be able to you know, not have this shooting pain.
What generally do you think that the overall success rate
is for these patients.
Speaker 4 (21:28):
Well, I think it's quite high. You know, when we
are we have everything that fits together in terms of imaging, symptoms,
the pathology, and we know that a nerve is being compressed,
and we decompressed the nerve, especially if it's not a
very very chronic, long standing problem. By that I mean
like years. Most of the time, the nerves recover and
(21:48):
the pain resolves. So, yes, weakness pain usually do respond
very well. Nerve pain respond really well to surgical decompression
and treatment. You know, back pain is a little more
challenging because oftentimes multiple reasons why people might have back pain.
Though it is quite challenging to pinpoint it and to
(22:08):
get people through the recovery. But we have gotten much
better at diagnosing the causes for that and finding good solutions.
Speaker 3 (22:18):
No, that's wonderful. And what do you see is the
future now, I mean, you're getting great outcomes, are there?
What are the things that you're working on at NYU,
And I know that you're a real specialist in tumors
you mentioned, maybe you can just give us a little
brief synopsis of what's going on there in the area
of oncology for patients with cancers that can invade the
(22:41):
spine and the other future directions that you may have
in your department.
Speaker 4 (22:46):
Well, of course, so the enviatients have cancer, you know,
we're really trying to integrate more minimumly invasive techniques into
their surgical treatment and treatment of their spinal tumors. And
the way we think about what treatment widelity is to choose.
So mini milli invasive means that we work through smaller
incisions and that facilitates recovery, decreases post operative pain and
(23:10):
risk of any complications. So we've gotten much better at
working through smaller incisions. We are starting to experiment with
using endoscopy, which is you know, small cameras that are
being placed through really really small incisions, you know, just
maybe under an inch. We are using robotic guidance, so
(23:33):
robots help us guide placemental instrumentation thumb surgeries are being
performed by robots that allow us to remove some of
the tumors. So all of this is really intended to
decrease the risk of the complication and to facilitate the recovery.
We are getting better at neuronavigation and using things like
(23:55):
augmented reality. Basically those are ways for us to get
as much imaging information as possible in order to do
the surgery as safely as possible. So there are a
lot of really exciting things that we're using that are
being developed on the horizon that make outcomes even better
(24:15):
for patients. And the other really important thing that we're
doing is actually not surgical. It's better use to the
understanding of very focused radiation and ablation technique. Yes, yes,
our radiation colleagues have made great strides in that realm
and they've really shifted our surgical indication. So for a
(24:36):
lot of patients who absolutely needed surgery five ten years ago,
we don't even have to do surgery. We refer them
for very focused out patient radiotherapy and that's all the
patients need. Yeah.
Speaker 3 (24:47):
Yeah, it's a great point and I've seen it personally
in my own practice as a urologist here in dealing
with you know, eurologic oncology and for prostate cancer patients.
You're right. I just want to give everyone out your
number again and if you've been listening, it's doctor Ilia Laufer.
The number is two one two two sixty three thirty
six forty. That number again is two one two two
(25:08):
sixty three thirty six forty. Are you continuing to see
a new patient early in your in your practice there?
Speaker 4 (25:15):
Absolutely, yeah, you know, we try to make sure that
patients actually need to see me before we move forward
with everything. But we try to help everybody. Uh. And
if I'm not the right person, we certainly make sure
that we cut people up with the right first point
of contact specialists. But yes, love seeing your patients. That's
why I'm here at NYU to help as many people
(25:35):
as we can.
Speaker 3 (25:36):
Yeah, and you certainly do well. You certainly helped educate
us quite a bit here learning about you know, we
went through how to prevent back pain and what to
do when you have back pain and went to see
a doctor, and when you should get imaging and the
different types of surgery you discussed really brilliantly and succinctly
For us and then told us about all of the
outcomes in the in the future directions in your department
(25:59):
there your division at NYU. So again, doctor Lee, I
want to thank you so much. The number if you've
been If you didn't get it, it's two one two,
two six, three thirty six forty and really a very
important show for so many of us. Thank you so much,
Eli for coming on the show. You were terrific. I
really appreciate it.
Speaker 4 (26:18):
Becca Katz, thank you so much for having me on
the show. And it's a real real pleasure to speak
with you, and I'm looking forward to connecting with some
of the.
Speaker 3 (26:27):
Listeners absolutely certainly will well. Thank you again, and I
hope you all enjoyed it as much as I did.
Tune in here at Kats's Corner every Sunday. We'll be
back next week with a great show at that time.
Have a great Sunday, everybody. This is doctor Aaron Katz.
Speaker 2 (26:42):
You've been listening to Katsu's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice so on how to live
your healthiest life.
Speaker 1 (26:53):
The proceeding was a paid podcast Iheartradios hosting of this
podcast constitutes neither in endorse of the products offered or
the ideas expressed.
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU Land
Going Health. It's CATS's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on seven ten WOOR
It's the Chairman of Urology at NYU Land Gone Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:36):
Well, good morning everyone and welcome again the CATS's Corner
here on WRI iHeartRadio. So glad you could join us
this morning. Have a wonderful show for you, one that
I think applies to all adults, maybe even children as well,
and that is the issue of back pain and what
to do about back pain, when to see a doctor,
when you should get imaging tests, and what type of
(00:58):
doctor you should see, how to even prevent it and
to help us with the discussion, I've asked doctor Ilia Laufer,
who is in the Department of Neurosurgery at the NYU
Grossman School of Medicine. He holds the title of the
Director of the Spine Tumor Program, and he's done a
lot of work and research in the area of improving
(01:20):
outcomes of spinal tumor care and incorporating some of the
latest and greatest minimally invasive techniques into spinal tumor surgery.
We'll get into that a bit, of course, but we
also want to talk about just managing back pain and
you know, some of the things that we can do.
(01:41):
He also is a member of the North American Spine
Society Spine Oncology Section and a member of the American
Academy of Neurological Surgery ILIA. Thank you, welcome to Katzis Corner.
Thanks for coming on the show this morning. Greatly appreciate that.
Speaker 4 (01:55):
Oh it's my pleasure to be part of it. Thank
you so much for inviting me. I'm looking forward to
having a fun discussion.
Speaker 3 (02:00):
Yeah and yeah, I mean, back pain is never fun.
I've had back pain. Most of us have had some
back pain. I've heard different theories as to why that is.
Maybe we evolved too quickly that we were on hind
legs on all fours and then we're on two legs,
and maybe the evolution process was too quick, but this
is something that you obviously see quite a bit of it.
(02:22):
Maybe you can start it by telling us, I guess
is there are there ways to prevent back pain?
Speaker 4 (02:30):
Well, you know, I spent a lot of time speaking
about that with my patients. Most of the time, by
the time they come to see me, they already have
back pain. So you know, the question is how to
try to reverse it prevent it from recurring. You know,
I think pasture and it's one of those things that
our parents told us from us being a little kids,
and we probably never really paid a whole lot of attention,
but I do think it matters tremendously. And you know,
(02:53):
whether there are theories about us standing too quickly on
two legs from four legs and so on, true, you know,
I think the really important thing is having good balance
in your body and in your lifestyle. When we lose
that balance, our muscles end up having to work over time,
and so does our skeletal system. And to prevent that,
(03:15):
the important thing that I tell all my patients is
you want to have your shoulders balanced over your hips,
and your head over your shoulders and hips, and if
we can get close to that alignment, then the weight
of the head, which is actually quite heavy, it becomes
really well distributed throughout the body and we don't overstress
(03:37):
specific parts of the spine. If we lean too much forward,
we stress the discs and the muscles become overextended and
the back and the neck hurts. So that's a pretty
common thing that we do. Of course, you know our
posture nowadays, we sit a lot, We spend a lot
of time in front of the computer. We spend a
lot of time looking down at our phones, and all
(03:59):
those things pitch our bodies forward. And it's really really
important and helpful to be mindful of the things that
we do when we're not paying attention to the posture
and trying to actually get yourself into some balance at least,
you know, bring the phone up in front of your
eyes more so than you know somewhere in your waist levels.
(04:21):
Try to find the chair and a desk in a
computer where your eyes are aligned with the screen and
you're actually sitting up straight with some curvature in your
lower back, you know, sit on the hard part of
your bottom rather than on the soft part where we
oftentimes sit when we lean back. So all those things
are really really important, and I think that's probably the
(04:42):
best way to try to prevent back vain from becoming chronic,
from occurring or from reoccurring.
Speaker 3 (04:49):
Yeah, I think that's really great. One of the other
things that I've done in my life if I'm taking
a long car ride, is I make sure that the
rear view mirror is tilted up a little bit makes
me sit up straighter. Do you think that's a reasonable
thing to do or not. I heard that some years ago,
just so that you can kind that's brilliant, really okay, Yeah,
(05:10):
I actually funny enough.
Speaker 4 (05:12):
You know, I've been doing that without realizing that I'm
doing it, but I see that in the car, and
I do it at other places as well. Yeah, so yeah,
I mean I think exactly as you said, when you
tilt the mirror to be a little bit higher than
where you expect it to be, right forces you'll sort
of pull your head up, and that stretches your whole
(05:32):
spine exactly along the same lines. You know, Walking is
really really important also, right. You know, when you walk,
you really kind of force yourself into upright posture, and
this activity of walking and engaging your core is really
really important as well. And the other thing that we
tell people is if you can try to find time
to walk on uneven surfaces, that's also really helpful to
(05:55):
engage in the core. So obviously, you know a lot
of us live in cities. We drive, we walk on pavement, uh,
and maybe we don't take too many hikes outside of nature.
But you know, when you're always walking on an even
flat surface, you aren't engaging your core as much as
when you are on something that's a little bit bumpy,
in a little bit uneven. So you can find time
to go outside in the park or nature and take
(06:17):
a walk, that's going to go a very long way
to strengthening your core and preventing back pain. Yeah.
Speaker 3 (06:22):
One of the things I do when I go to
the gym is I hold a weight in one hand,
a heavy weight, and walk around the gym just and
then try to maintain my posture straight up. So you know,
put you know, strengthening the core. As you say, you know,
you think that's a reasonable thing to do. I saw
somebody do that once. I said, it looks pretty good,
you know, So you know, just kind of holding a
(06:43):
weight in one hand. Uh huh.
Speaker 4 (06:45):
The other thing is I think okay, as long as
you are able to keep upright posture, and I think
it could be challenge. That's it right weight heavy. Now, Now,
what about long as you're mindful?
Speaker 3 (06:56):
Now, what about a technique if you if you see
something on the floor, a coin, let's say, is something,
and you're going to bend over to pick something up,
whatever it may be, anything that fell on the floor,
and you got any technique there they could so that
you're not putting strain on your back when you're bending
over to pick something up.
Speaker 4 (07:15):
Well, that'll probably depend on how old you are. I
think the safest way to do that right is when
you bend your knees and keeping it back straight. Right, Okay,
that us a way you could do that. Sometimes we
bend down, and you know, we hear plenty of stories
where somebody bent down because they got excited and it
was like a very sharp, acute and expected bend and
they came up with back pain. One of the ways
(07:36):
to get discrerenation is by leaning forward, because that actually
opens up the space between the vertebrate the bones and
the spine and weakens the wall of the disc a
little bit so big leans forward aren't always great, but
you know, you young people can certainly afford to do that,
(07:57):
and I do think there's some value in that, because
I do think that you know, being agile, being flexible
is not a bad thing. You don't necessarily have to
overdo it. But I think exercising within the normal range
of motion for young people as good. As we get older,
I think that gets a little bit restricted, and we
do run a higher risk of hurting ourselves when we
exercise like that. So I think for you know, probably
(08:20):
everybody fortying over, certainly maybe even a little bit younger,
trying to bend with your knees rather than leaning forward
is a good idea.
Speaker 3 (08:31):
And in any tips, you know, obviously rest, but any
tips when when you have an acute back injury and
you feel like, oh I just got this pain, you know,
obviously rest, But any other tips beside that, are any
position that you should put your body in or anything
that you should do.
Speaker 4 (08:47):
Maybe taking some especially you know, rest is okay. But yeah,
the right time I'm giving people is the opposite, you.
Speaker 3 (08:55):
Know, Okay, moving, keep good.
Speaker 4 (08:58):
We have more.
Speaker 5 (08:59):
Problems from spending too much time in bed and taking
the sort of position I am not well, which only
forces the muscles to basm more and become more inflamed
from disuse, rather than actually moving through things if possible. Obviously,
if there's acute pain, or you know, there's pain what'll
(09:22):
we call ridiculous pain that you know, shoots into parts
outside of the spine, into the legs. You know, that
could be different, and yeah, maybe that's the reason to rest.
Speaker 4 (09:30):
But most of the time when people have back pain,
the advice is actually to keep moving rather than to
lay in bed for a few days, because it's important
to use the muscles. It's important to engage them, and
if you do that, the back pain is more likely
to get better. Just the other day, funny enough, you know,
my daughter was on a playground and she went up
(09:51):
somewhere and I tilted my neck in a funny way
and I got this really bad pain on the right
side of my neck, and say, oh, I've heard this before.
But you know, I kept on doing a gentle range
of motion exercises for the neck, and the pain went away.
I'm pretty sure if I would have, you know, just
(10:11):
completely immobilized my neck. The pain and the muscle spasm
would have really set in and things.
Speaker 3 (10:16):
Could have been worse, and your mood would have went
real down, because when you have pain like that, your
mood gets bad. I mean, I don't mean you personally aren't,
but I'm just saying everyone's mood. It's just like you
can't focus on anything when you have pain like that,
and it's just you know, you just you want to
be left alone. And then, you know, I often wonder,
you know, how do you distinguish as you mentioned, you
(10:37):
were getting into a little bit about the disk issue.
Is it just like is it a muscle thing, or
is it really like a disc carnation or a disc
problem or a spine problem. How does somebody know that?
And I guess the obvious lead in question there is
how do you know when to see someone like yourself
a spine person?
Speaker 4 (10:57):
Of course, so batman is extremely common. Of course, Uh,
most of the people have had it, but will have
it during the course of their lifetime. For not too
many people, fortunately, does it become a recurrent chronic issue.
So an episode of back pen is by no means
an indication that people will have crinic back pain. So
(11:19):
you know, just back pen and what I really mean
by that is pain sort of just above the pelvis,
below the rib cage in the middle, or a little
bit off to the sides. That's quite common. Okay. Now,
if somebody has back pain again, you know the garden
variety back pain, pain without going into the legs, without
(11:42):
other neurological dyings or symptoms like numbness, tingling, weakness. Usually
is a back pain that is attributable either to muscle
spasm or some form of joint pain, some form of
bone or disc. Most of the time again, wear and
tear common problem that comes with either using our backs
(12:06):
or just getting older. Now, if pain is associated with fevers,
history of trauma, immunosuppression, you know, somebody whose immune system
is not working well, either because they're ill or because
they're taking medications, or with neurological problems such as pain
(12:27):
going into the arms or legs, or sensory changes meaning numbness, tingling,
or weakness, so trouble using a hand, or trouble you
know when you're walking your foot is catching the sidewalk,
those types of things. That's the reason to seek medical attention.
Most of the time. The actual midline back pain when
(12:50):
people come to see a doctor. The treatment there is
keep moving. You could take some anti inflammatory medications like
a leave or if you don't have contry unications or
talento and keep moving. Sometimes physical therapy, but even imaging
is most of the time not indicated for midline lower
(13:11):
back pain because imaging doesn't really provide actionable information most
of the time in these situations.
Speaker 3 (13:18):
And by imaging you mean just either an MRI or
a plane X ray or any you know, something like.
Speaker 4 (13:24):
That, any any one of those things. Somebody comes with
a single episode of back pain like this. Most of
the time, we don't really need to get imaging because
imaging is helpful to make a diagnosis in which we
would act, and by act I mean intervene. You know,
I'm taking medications like an anti inflammatory medication doesn't really
(13:45):
change whether you know, based on imaging, the red flag
things that I just mentioned, that's the type of symptoms
that can really warrant imaging, and they can indicate a
trauma or a fracture and infection, a discarnation, compression of
the nerves. You know, those are the things where we
may want to be more interventional, and sometimes we do injections.
(14:10):
Sometimes we talk about surgery In some instances where physical
therapy or rest or you know, activity aren't helping, those
are the times we may want to image in order
to adjust the treatment plan. But again for garden writing
lower backing, most of the time imaging doesn't give them
(14:31):
us much information, only makes people more concerned because most
people have some sort of degenerative process that we can
see on imaging. Now, you know, just because somebody has
degenerative this disease, a little bit of joint overgrowth doesn't
necessarily mean we need to do anything about it other
than maybe adjust the activity. But we know how to
(14:53):
adjust that activity without imaging.
Speaker 3 (14:56):
Okay, well that's really important if you just wake it
up in the morning. Here on Kansas Corner where talking
with doctor ili Alaufer, who's a spine surgeon at the
NYU Grossman School of Medicine, clearly an expert in back
issues and spine issues. And if you have a question
or you'd like to see him, or you know a
loved one that has an issue with chronic back pain,
I'll give you his number. I'll announce it again at
(15:18):
the end of the show. It's two one two, two
six three three six four zero. That number again, is
two one two, two six three thirty six forty. And
I was just wondering because I do have a dear
friend of mine who has this back issue, back pain
that she's been having, and it's been going on for
a long time, none of those neurological symptoms that you're mentioning.
(15:38):
But what about the duration? What about if someone you
know has this going on for like, you know, maybe
two three weeks, would that be an indication to to
get an image without any of those neurological types of
or warning signs, those things, those red flags as you
as you pointed out.
Speaker 4 (15:55):
I'd say anything for a few weeks, probably not. But
I think if it's going into months and year, then yes,
because you know, there certainly other reasons. You know, sometimes
people have deformity in their spine. Sometimes people really do
have significant degenerative processies the where we may want to
try some interventions like nerve blocks, and sometimes they relieve
(16:16):
the pain. Sometimes they help us pinpoint the source of
the pain that we may want to treat surgically for example,
or with some nerve reblations. So yes, if it's becoming
a recurrent or chronic problem, then that's the time to
get imaging and investigate further, and you know, treating a
treating back pan as a team approach. You know, I'm
a surgeon from just one of the team members. We
(16:39):
have other specialists who do that as well. We have
rehabilitation medicine specialists, we have pain medicine specialists, we have
neuro modulation specialists, we have neurosurgeons, we have orthopedic surgeons.
So you know, we all work as a team. When
somebody calls it back pain, the important thing is to
find the right first point of contact. And oftentimes it's
(16:59):
not a surge. Oftentimes it's maybe a rehabilitation medicine and specialist.
Speaker 3 (17:04):
Yeah, I think that's really an important message. Two messages
there that I could see. One is that it is
a team approach and you have an excellent team there
at NYU. And the other is is that just because
you have back pain, you don't need you don't need surgery,
and you need to think about these other options first
before surgery. But I guess there are situations, of course,
(17:25):
when people do need surgical approaches. Maybe you can tell
us in twenty twenty four, Now, what are the you know,
the general types of spinal surgery that you particularly do
in your team for patients with with I guess more
severe cases.
Speaker 4 (17:45):
Of course. So you know, the general buckets of things
that we do in spine surgery will be do you
compress the nerves or the spinal cord and stabilize the spine?
So do you compress the nerves. As we get older,
the spaces around the spinal cord, which is you know,
the big highway of nerves that carries signals from the
(18:08):
brain to the arms and legs and back can become
tighter and tighter and the spinal cord can get compressed.
That's when people start having trouble with you know, using
their fingers or walking steadily, so you know, those types
of decompressions really help. Sometimes people have back pain and
buttock pain and the back of the leg pain because
(18:30):
the nerves and the lower back are becoming compressed. Sometimes
pain is more what we call ridicular nature, meaning it
shoots down the arm of the leg almost like a
line or a is app Those are all indications that
the nerves are being compressed, and that's where if it
doesn't resolve over one, two, three months with some interventions
(18:51):
physical therapy, that's where surgery can be very beneficial and
decompressing the nerves. The other is where somebody has a
deformity or a trauma for tumor, where there's a fracture
that needs to be stabilized, the spine needs to be realigned.
That's when we start putting in spinal instrumentation in order
to provide additional support and healing the bones and in
(19:14):
order to get better alignment. So those are the types
of surgeries that we do, which is instrumented stabilization, decompression,
and when they're different combinations for different things. The most
common indication is degenerative, so as we get older again,
you know, things closing in around the nerves or just
people having back pain from leading forward too much and
(19:36):
having some sort of degenerative deformity that can be corrected,
and with excellent data to show that when we can
do that, when we can realign somebody's fine decompressed the nerves,
people feel dramatically better and have very good symptom relief. Ovations,
of course, are from when somebody falls and has a fracture.
(19:56):
Tumors are another one, and that's something that I spent
quite a bit of time treating. So removing the tumor,
stabilizing the fracture from a tumor, and again decompressing the
nerves being compressed by the tumor.
Speaker 3 (20:09):
And the majority of these these procedures that you're doing,
are they outpatient like or do the patients need to
stay in the hospital for that.
Speaker 4 (20:20):
So the majority of degenerative problems can be treated as outpatient.
So you know, if somebody has one two level disc
disease in the neck or in the lower back, also
the time we can do that as an outpatient where
people go home the same day or maybe just after
a brief overnight state. Some of the biggest surgeries, of course,
sometimes require a few days in the hospital associated with
(20:43):
healing and you know, just post operative recovery and rehabilitation.
In more rare instances, people actually go to inpatient rehabilitation
centers where they spend a few weeks intensively working with
the physical therapists in order to get back to normal.
Speaker 3 (20:59):
Yeah, so it really it obviously it varies, but the
overall success from what you're saying, is relatively quite high
these days, Is that right? I mean, it seems to
be you know, I don't know what if you quote
a number of patients. As you know, so patients ask
you all the time, what's the likelihood that I'm not
going to be in pain anymore? I'm not going to
feel this tingling down my leg, or I'm going to
(21:19):
be able to you know, not have this shooting pain.
What generally do you think that the overall success rate
is for these patients.
Speaker 4 (21:28):
Well, I think it's quite high. You know, when we
are we have everything that fits together in terms of imaging, symptoms,
the pathology, and we know that a nerve is being compressed,
and we decompressed the nerve, especially if it's not a
very very chronic, long standing problem. By that I mean
like years. Most of the time, the nerves recover and
(21:48):
the pain resolves. So, yes, weakness pain usually do respond
very well. Nerve pain respond really well to surgical decompression
and treatment. You know, back pain is a little more
challenging because oftentimes multiple reasons why people might have back pain.
Though it is quite challenging to pinpoint it and to
(22:08):
get people through the recovery. But we have gotten much
better at diagnosing the causes for that and finding good solutions.
Speaker 3 (22:18):
No, that's wonderful. And what do you see is the
future now, I mean, you're getting great outcomes, are there?
What are the things that you're working on at NYU,
And I know that you're a real specialist in tumors
you mentioned, maybe you can just give us a little
brief synopsis of what's going on there in the area
of oncology for patients with cancers that can invade the
(22:41):
spine and the other future directions that you may have
in your department.
Speaker 4 (22:46):
Well, of course, so the enviatients have cancer, you know,
we're really trying to integrate more minimumly invasive techniques into
their surgical treatment and treatment of their spinal tumors. And
the way we think about what treatment widelity is to choose.
So mini milli invasive means that we work through smaller
incisions and that facilitates recovery, decreases post operative pain and
(23:10):
risk of any complications. So we've gotten much better at
working through smaller incisions. We are starting to experiment with
using endoscopy, which is you know, small cameras that are
being placed through really really small incisions, you know, just
maybe under an inch. We are using robotic guidance, so
(23:33):
robots help us guide placemental instrumentation thumb surgeries are being
performed by robots that allow us to remove some of
the tumors. So all of this is really intended to
decrease the risk of the complication and to facilitate the recovery.
We are getting better at neuronavigation and using things like
(23:55):
augmented reality. Basically those are ways for us to get
as much imaging information as possible in order to do
the surgery as safely as possible. So there are a
lot of really exciting things that we're using that are
being developed on the horizon that make outcomes even better
(24:15):
for patients. And the other really important thing that we're
doing is actually not surgical. It's better use to the
understanding of very focused radiation and ablation technique. Yes, yes,
our radiation colleagues have made great strides in that realm
and they've really shifted our surgical indication. So for a
(24:36):
lot of patients who absolutely needed surgery five ten years ago,
we don't even have to do surgery. We refer them
for very focused out patient radiotherapy and that's all the
patients need. Yeah.
Speaker 3 (24:47):
Yeah, it's a great point and I've seen it personally
in my own practice as a urologist here in dealing
with you know, eurologic oncology and for prostate cancer patients.
You're right. I just want to give everyone out your
number again and if you've been listening, it's doctor Ilia Laufer.
The number is two one two two sixty three thirty
six forty. That number again is two one two two
(25:08):
sixty three thirty six forty. Are you continuing to see
a new patient early in your in your practice there?
Speaker 4 (25:15):
Absolutely, yeah, you know, we try to make sure that
patients actually need to see me before we move forward
with everything. But we try to help everybody. Uh. And
if I'm not the right person, we certainly make sure
that we cut people up with the right first point
of contact specialists. But yes, love seeing your patients. That's
why I'm here at NYU to help as many people
(25:35):
as we can.
Speaker 3 (25:36):
Yeah, and you certainly do well. You certainly helped educate
us quite a bit here learning about you know, we
went through how to prevent back pain and what to
do when you have back pain and went to see
a doctor, and when you should get imaging and the
different types of surgery you discussed really brilliantly and succinctly
For us and then told us about all of the
outcomes in the in the future directions in your department
(25:59):
there your division at NYU. So again, doctor Lee, I
want to thank you so much. The number if you've
been If you didn't get it, it's two one two,
two six, three thirty six forty and really a very
important show for so many of us. Thank you so much,
Eli for coming on the show. You were terrific. I
really appreciate it.
Speaker 4 (26:18):
Becca Katz, thank you so much for having me on
the show. And it's a real real pleasure to speak
with you, and I'm looking forward to connecting with some
of the.
Speaker 3 (26:27):
Listeners absolutely certainly will well. Thank you again, and I
hope you all enjoyed it as much as I did.
Tune in here at Kats's Corner every Sunday. We'll be
back next week with a great show at that time.
Have a great Sunday, everybody. This is doctor Aaron Katz.
Speaker 2 (26:42):
You've been listening to Katsu's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice so on how to live
your healthiest life.
Speaker 1 (26:53):
The proceeding was a paid podcast Iheartradios hosting of this
podcast constitutes neither in endorse of the products offered or
the ideas expressed.
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