Listen to the whole interview here, or read the transcript below:
Peter McArthur: It’s 9:10 here in Delaware. It’s Wednesday, April 12th. I’m Peter MacArthur. Hey, thanks for joining us this morning. If you are dealing with back issues, the ones that don’t go away, they get worse. They affect your quality of life. You are in the right place at the right time because this morning we are talking with Dr. James Zaslavsky. He is with First State Spine. Talking about the things that lead up to those types of back issues and also a remedy potentially that you likely have never heard of. So first of all, Dr. Z, thanks for being here.
Dr. Z: Thank you Peter. Appreciate it. So excited to be on the air with you.
[00:00:54] Peter: I guess we start with the back itself. If you look at a skeletal picture of our bodies and what has always occurred to me as a layperson, mind you, is you look at the spine and that’s a big ask. We ask a lot of our spine, you know, considering all the things that our body does mobility wise, and there’s just a lot of pressure there to start.
[00:01:15] Dr. Z: Absolutely. The first pressure we put on our back is asking you to stand upright. We were never meant to stand upright, putting that kind of stress on our discs and our ligaments and the structure of our spine, but that’s an essential part of the way we live these days, so taking care of that structure and treating it and managing it is what is essential.
[00:01:35] Peter: Who are the people that come into your practice? Is it people generally that are dealing with lower back pain or back pain wherever it is on a chronic basis? Or what is kind of your demo in that respect?
Dr. Z: So we see a variety of patients. Some of our patients have been injured acutely in motor vehicle accidents, work injuries, falls, lifting injuries. We see about 60% cervical spine or neck issues. We see about 40% low back issues. We treat the entire spine. Some of those patients have degenerative issues where it’s been ongoing and chronic for extended periods of time. A lot of our patients also come in thinking I’m gonna have surgery because I’ve gone through all the conservative treatment. And part of our job is to really review what have you done, conservatively, to treat your back because we find big gaps in conservative treatment that could help patients manage their symptoms rather than rush into major spinal surgeries.
Peter: Spinal surgery, we’re talking about a pretty complex procedure here too, that has varying results of success.
[00:02:41] Dr. Z: Spinal surgery for a very long period of time has been very variable in terms of its ability to treat and cure spinal issues. The hallmark of surgery is the neck or back fusion, and that’s one of the few joints that we still fuse. We don’t fuse knees anymore. We don’t fuse ankles, we don’t fuse hips, we don’t fuse shoulders. Pretty much the only part of the body where surgery is focused on fusion is in the cervical and lumbar spine, and that is readily changing in the new environment of spinal surgery and the new techniques that are coming out in spinal surgery. But, before even thinking about a major spinal procedure, patients really need to think, have I covered my conservative options?
I used to be a physical therapist and I practiced as a physical therapist for about four years. So I have a pretty good grip on what a patient needs physical therapy wise and that’s usually a customized program. Physicians should be responsible for prescribing that customized program. Every patient is different. They come in with different problems. They come in with different deficits. And they need to go to a therapist with a very specific outline of what needs to be done. If they just come in with a prescription for generalized therapy, they get a cookie cutter approach to their problem, and they think they’ve not gotten any benefit from the therapy, but really it’s been therapy that hasn’t been helpful for them.
The next important part of physical therapy is also to be invested in it. So, if you get a personalized therapy program that’s really targeted at your deficits, the things that are really bothering you and your functional and capabilities that are a result of your back pain, you’re gonna do your exercises long term. You’re gonna do the stretches long term. You’re gonna incorporate them as part of your life. You gotta own it. Absolutely. You gotta make it part of your life. I’ve had a great therapist. He’s taught me the right things. He’s brought me from point A to point B where I can really function and manage my problem and I’m gonna keep doing it on my own.
[00:04:46] Another thing we focus on is people don’t think about nutraceuticals. So turmeric, fish oil, magnesium. Really essential vitamins and the right doses that could really help limit inflammation and nerve pain. And instead of the caustic anti-inflammatories and narcotics, they can really make a big difference in a person’s life without that tax on their body, without that damage to their liver, their kidneys, their gastrointestinal tract.
[00:05:13] Peter: Do you find, doctor, that people have something of a rigidity when it comes to not exploring some of those options you just talked to that, that we as an American culture, that’s not our first avenue that we take is, is uh, some of the things you just, uh, mentioned?
Dr. Z: Absolutely. Yeah. We have a stressful lifestyle. Everything needs to happen immediately. We’re looking for the quick fix and a lot of people don’t invest in their own health to look at options like the proper therapy program and long-term postural correction and exercise, the proper nutrition, adjusting their footwear, getting the right postural support system for their bed. Those kind of things make a huge difference over. And could definitely be essential and avoiding surgery altogether. And that’s our primary goal. Do you even need any surgery? The next thing is obviously somebody has recommended a lumbar fusion or cervical fusion and a fusion of your neck or your back. How do we avoid that?
Fusion surgery is very helpful in the short run. People have a fusion surgery. They invest a good chunk of time to recover from that surgery, meaning there’s months of physical therapy. There’s months of bracing. There’s months of immobility and months of avoiding activities that you enjoy doing like hunting, fishing, exercising, even going to work. And after that, you definitely have a considerable improvement. But, the biggest deficit is that once you have a fusion and you’ve locked up one of your vertebral segments where you’re supposed to move, the disc above and below tend to take on a lot more stress there.
A couple years go by and we’re back in Dr. Z’s office or somebody else’s office looking for another fusion procedure, and our goal is to provide patients with other options and those options come in terms of minimally invasive procedures and what we call motion sparing procedures. We’re gonna save your motion. We’re gonna keep you moving. We’re gonna minimize the recovery time. We’re gonna minimize the bracing, and get you back to those functional activities quicker and easier.
Peter: You know, just the term fusion to my ears sounds like a procedure that doesn’t necessarily enhance or stress mobility. It sounds rigid to me in, in some way, shape, or form.
Dr. Z: It absolutely is. And even for the knee and the hip, it worked. It eliminates pain. However, we found, oh my gosh, this causes a tremendous amount of problems in the ankle, causes a tremendous amount of problems in other joints because you’re transferring the stress. Same is true in the spine. And as we learn more and more about the spine and we evolve with our technology, the evolving technology is focused on maintaining motion. So we focus more on replacing the disc or doing a procedure to alleviate the the need for a fusion.
[00:08:00] Peter: Yeah. Which leads us really nicely into, into where we’re at today, because there are new procedures and new technology at work that really could be, as I mentioned at the top, game changers for some people that haven’t found that in some of the other avenues that have been offered traditionally.
Again, we’re talking with Dr. Z here from First State Spine. Obviously, people can listen to you and understand that you’re looking at a full circle of potential ways to address their problems. But what about this new procedure I’m hearing about. It’s called Intracept. What does that entail and what might it offer to people that are really in a bad way?
[00:08:36] Dr. Z: An Intracept procedure is a very exciting procedure that has been recently very impressive in terms of treating back pain. People with degenerative discs had one option in the past, and that was a fusion procedure. Now we have a procedure called Intracept, where instead of fusing the bones together, what we do is just destroy the nerve endings to the bone with a simple procedure that takes about 20 minutes at First State Spine. Basically by destroying those nerve endings, we eliminate the pain sensation to the brain and people don’t have that sensation of deep burning, backache type pain that comes from a degenerative disc that’s causing inflammation in the bones themselves. After that short procedure, people can resume activities fairly quickly, meaning like in a couple days you could be back to swimming, biking, running, and even back to work. You spend about a half hour to an hour in our surgery center after a half hour procedure, and you’re on your way home. The rest of your day, you can spend doing normal activities such as walking around the house and and functioning normally.
Very little downtime, very little side effects that could occur with the procedure, and very little long-term effects. This is an exciting new procedure that has given so many of our patients such a tremendous relief from their back pain and improve their functional capabilities quickly without a fusion, without bracing, without a long period of downtime. Being able to get back to activities you love quickly. Being able to get back to activities that you need to do quickly, like go to work and make a living and provide for a family which is essential to a lot of people that we take care of.
Peter: Here’s something else I learned. I think it’s important not to downplay this. This is not, this is, yes, pioneering, but this is not, you know, test tube things. In other words, this is FDA approved, is what I’m saying. It’s been put through the paces.
Dr. Z: It’s FDA approved. More impressively, there have been large studies that have been done on Intracept. Both studies had to be stopped early because the results of Intracept were so good that they couldn’t withhold the procedure from the group of patients that were the control patients. So, the control patients who were not getting the procedure, that were just not getting the proper benefit from what possibly could happen. They stopped both studies early and said it’s unethical to continue to study it because both groups of patients need to have Intracept. That’s a great thing for the actual procedure and a great testimony to the effectiveness of it.
Peter: Yeah, Doctor, I know you and your colleagues are cutting edge at First State Spine and I realized that. When you first heard about this did you kind of put your heads together and say, geez, that could work. How did you get affiliated with the procedure?
Dr. Z: I think that when we first hear about a procedure like this, you kind of take it with a grain of salt. You get a little skeptical at first. And so we did a lot of research on it, as we do with most new things that we do. And, after a lot of research and a lot of talking to people who’ve been doing the procedure, we took a couple courses and our master’s course in the procedure itself, spoke to many clinicians across the country who have been doing this procedure for extended periods of time. We decided it’s definitely a procedure with very little risk and a tremendous upside, and we started to perform the procedure at First State Spine. And it has been a godsend for a lot of our patients who have improved considerably in very short periods of time who have had years and years of failed back pain treatment.
[00:12:10] Peter: I know patients are listening right now because we’ve gotten a note from a couple as we are talking who wanted to say thank you because it did, it did right by them. And so that’s a testament in and of itself. For others that are listening and getting word of this for the first time. You went through this a little bit at the top, they have back pain to them the degree that is pretty heightened. Who should maybe be coming in to check out what it is you have to offer that, you know, who may be a good candidate for Intracept.
Dr. Z: They should come to First State Spine. I really feel strongly that if you’ve had a recommendation to have a lumbar fusion or a cervical fusion, you should come to First State Spine or anywhere else for at least a second opinion, and ask what are my other options. First of all, have you covered all your conservative care? Have you done the right therapy with the right therapist? Have you tried nutraceuticals? Have you changed your footwear? Have you changed your pillow? Have you changed your mattress? Have you done all those simple things that could really make a giant improvement? Second of all, have you considered options that are not fusion, like Intracept or cervical disc replacement where a half hour, 45 minute procedure your’e not wearing a brace and a couple days later you’re back to almost all the activities that you used to enjoy with very little downtime. The downtime is a commitment that we go through after a big fusion procedure, but it’s also a time period where you develop immobility and chronic pain.
All of a sudden you get an outcome that is really suboptimal and in a relatively short period of time, there’s a good chance you’re back for another surgery. Our focus is to avoid that and we need to pioneer a new path in spine surgery where we’re heading towards a position where you’re getting a procedure that allows you to continue to move, that allows your body to continue to move more naturally and prevent the need for further fusion surgeries, prevent the need for long periods of downtime and immobilization.
Peter: Just as you’re explaining, you know, making sure people go through the proper paces ahead of diving into something. Back pain can be so debilitating. I think it takes people out physically, but I think mentally and emotionally, it starts to take a toll too, where they’re just looking for the easy path and even sometimes the easy path when you’re in some deeper stages of back issues, you might be better served to take a more conservative approach that you just haven’t been directed to yet.
[00:14:36] Dr. Z: Absolutely. Yeah, absolutely. I’d recommend that if you have been directed in a certain direction, always get a second opinion. Come to us with your neck and back pain. Get a second opinion. Ask about other options and really understand what the possibilities are before you embark on a procedure that is a fusion that has significant consequences to it.
Peter: Let’s get some logistics in here for people. First State Spine is located where, and how can people get in touch with you guys? Dr. Z
Dr. Z: We’re located on Ogletown Stanton Road. Obviously, call the main office, ask for an appointment with one of our clinicians. I’m happy to see all types of patients. People think they need to have surgery if they see a spine surgeon. I’m happier to suggest non-surgical options than surgical options. My patients are more appreciative when they realize that they might not even need spine surgery at all. So make an appointment with us, get your second opinion, and get all the answers before making a decision to have a spinal procedure.
Peter: What I think is great is that your background in physical therapy lays that foundation of you having, you know, a sound basis to evaluate these things. This is something you were doing day to day for four years plus.
[00:15:46] Dr. Z: Correct. And, being a physical therapist, a lot of times I’ll ask patients when they say, yeah, I’ve already done therapy. It didn’t help me. I say, well, what did you do? What did it consist of? And when you start to get the list, you realize, first of all, they haven’t been prescribed the right therapy. They haven’t been prescribed a personalized program and a customized program for their problem and their needs. And maybe they haven’t even seen the right therapist. And, when you go down that direction and you ask them to try it one more time, they usually come back and say that’s much different than the first time, and I do feel better, and I do have a better path to where I need to go. So, I agree that my background as a therapist has really helped me understand that you need to ask the questions before you say yes, you failed therapy. What kind of therapy did you do and where was this done? And when you asked those questions, you realize there might be other options before even thinking about any spinal procedure at all.
[00:16:40] Peter: Right. I can tell though, talking to you about it, that there’s an enthusiasm there and it has to feel good to make people feel good, this has become a much easier road than it has traditionally been because, you know, the whole fusion thing has been, I don’t wanna say not all that promising, it changes some lives, but it’s not a free ride by any stretch.
Dr. Z: I agree. Fusion surgery has helped a ton of patients. Yeah. But when you help people avoid a fusion surgery, it’s a good day. You see the new dad holding his baby two weeks after surgery. Or you get a picture of a grandfather fishing with his son and his grandkid three weeks after a surgery. Or, you get somebody who’s flying helicopters a couple weeks after having neck surgery. When we see those pictures, it makes the struggle worthwhile, the struggle to do something new, to pioneer a new option for patients. Yeah, it makes it real. So it is very exciting. I am very enthusiastic about it. Again, we love taking care of people, giving ’em the best options and we do appreciate any second opinions. We want to help you get the right option.
Peter: First State Spine, Dr. Z, Dr. James Zaslavsky joining us here on W D E L, glad we got a chance to talk today because again, you know, there’s people listening. One of your patients, one of your already standing patients chimed in saying it’s really been a game changer for him. So, for people that are listening. Listen, all you can do is find out. Knowledge is power. Figure out a way to better address the issue that you have been blowing off. Maybe you’re waving the white flag at your back pain. You don’t have to do that. And so First State Spine might be a good avenue for you to explore. It’s great to see you and we’ll talk again down the road.
Dr. Z: Thank you, Peter. Thank you for letting me talk about other options.