Lumbar radiculopathy or sciatica represents one distinct presentation of low back-related leg pain, which is generally characterized by pain radiating to below the knee and into the foot and toes. Low back pain is very common presentation in general practice and sciatica represents 10% of these patients. Sciatica has a lifetime incidence of between 13-40% however up to 86% of episodes will resolve with aggressive non-operative therapies. Small lumbar disc herniations are commonly seen on imaging in patients who are asymptomatic and do not require treatment. Most common causes of radiculopathy include disc herniation and lumbar canal stenosis. History, examination and MRI are important for accurate diagnosis. Most patients will improve with conservative management within 6 to 12 weeks. Conservative options include analgesia, physiotherapy and transforminal injections. Surgery is recommended for patients who fail conservative treatment and for weakness. The most common surgical procedure for sciatica is a micro discectomy and this generally has good outcomes.
Learning Objectives:
At the end of the workshop, the general practitioner should be able to:
- Discuss the diagnosis and natural history of sciatica
- Explain the role and outcomes of physiotherapy in the management of sciatica
- Explain the different pharmacological approaches to treating sciatica and the importance of avoiding opioids
- Identify specific criteria for surgical intervention
Speakers:
Dr Omprakash Damodaran MS FRACS (Neurosurgery)
Dr Omprakash Damodaran (MS FRACS) is an Australian trained neurosurgeon with extensive surgical experience in the management of brain tumours, degenerative spine and peripheral nerve conditions. Dr Damodaran is a VMO at Concord Repatriation General Hospital. He consults at the Sydney Spine Institute in Burwood and Campbelltown.
David Anderson MPhty, PT, APAM, BExSc, MSc (Spine Physiotherapy)
David is a consultant physiotherapist with extensive experience in both acute and chronic spinal conditions. He is also trained in Clinical Exercise Physiology. David is currently completing his PhD at the University of Sydney on a world-leading trial of spinal surgery. He consults at the Sydney Spine Institute.
Dr Alan Nazha B Med FANZCA FIPP (Pain Specialist)
Dr Alan Nazha is a Specialist Anaesthetist consulting in pain management. He completed his anaesthetic fellowship at Royal North Shore Hospital in 2011 and has also completed core training for his pain medicine fellowship at Royal North Shore Hospital and Concord Repatriation General Hospital. He consults at the Sydney Spine Institute.
[Feature image copyright: www.spine-health.com]
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Presentation:
“Psychological Management of Pain” by Dr Margaret Tadros & Dr Bradley Wood
This is the second part of a three-part series on Pain Management. The presentation will outline the rationale underlying a psychological approach to pain management and how to determine if a patient is likely to benefit from a psychological approach. It will cover guidelines for how to decide what type of psychological management would be appropriate for the patient and how to talk to the patient about referral to a psychologist, including tips for how to address the most common issues that patients raise during this discussion. It will outline the various aspects and components of a typical psychological approach to pain and provide tips on what to expect from a pain psychologist as the treating doctor.
Dr Margaret Tadros and Dr Bradley Wood are Clinical Psychologists with PhDs in the area of chronic pain. Together they have 40 years of experience in the provision of psychological management of chronic pain in public and private health settings. Currently, they are both providing psychological services in Leichhardt for Dr Margaret Tadros Clinical Psychology, a private practice that specialises in the psychological management of chronic pain, trauma and psychological injuries.
Date: Wednesday 23 May 2018
RSVP by Tuesday 22 May 2018.
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Presentations:
1. “Bio-Psycho-Social Model of Pain: Practical implications for Occupational Medicine” by Dr Christella Mylordi, Occupational Medicine
This talk will address a major public health issue, non-cancer pain, by providing practical short cuts for assessment of pain and monitoring of outcomes. It will also provide an introduction to the 23rd May presentations on the Psychological Management of Pain to be delivered by pain psychologists, Dr Margaret Tadros and Dr Bradley Wood.
2. “Case-presentations and discussion” by A/Prof. James van Gelder, Consultant Neurosurgeon
Date: Wednesday 18 April 2018
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Lumbar radiculopathy or sciatica represents one distinct presentation of low back-related leg pain, which is generally characterized by pain radiating to below the knee and into the foot and toes. Low back pain is very common presentation in general practice and sciatica represents 10% of these patients. Sciatica has a lifetime incidence of between 13-40% however up to 86% of episodes will resolve with aggressive non-operative therapies. Small lumbar disc herniations are commonly seen on imaging in patients who are asymptomatic and do not require treatment. Most common causes of radiculopathy include disc herniation and lumbar canal stenosis. History, examination and MRI are important for accurate diagnosis. Most patients will improve with conservative management within 6 to 12 weeks. Conservative options include analgesia, physiotherapy and transforminal injections. Surgery is recommended for patients who fail conservative treatment and for weakness. The most common surgical procedure for sciatica is a micro discectomy and this generally has good outcomes.
Learning Objectives:
At the end of the workshop, the general practitioner should be able to:
- Discuss the diagnosis and natural history of sciatica
- Explain the role and outcomes of physiotherapy in the management of sciatica
- Explain the different pharmacological approaches to treating sciatica and the importance of avoiding opioids
- Identify specific criteria for surgical intervention
Speakers:
Dr Omprakash Damodaran MS FRACS (Neurosurgery)
Dr Omprakash Damodaran (MS FRACS) is an Australian trained neurosurgeon with extensive surgical experience in the management of brain tumours, degenerative spine and peripheral nerve conditions. Dr Damodaran is a VMO at Concord Repatriation General Hospital. He consults at the Sydney Spine Institute in Burwood and Campbelltown.
David Anderson MPhty, PT, APAM, BExSc, MSc (Spine Physiotherapy)
David is a consultant physiotherapist with extensive experience in both acute and chronic spinal conditions. He is also trained in Clinical Exercise Physiology. David is currently completing his PhD at the University of Sydney on a world-leading trial of spinal surgery. He consults at the Sydney Spine Institute.
Dr Alan Nazha B Med FANZCA FIPP (Pain Specialist)
Dr Alan Nazha is a Specialist Anaesthetist consulting in pain management. He completed his anaesthetic fellowship at Royal North Shore Hospital in 2011 and has also completed core training for his pain medicine fellowship at Royal North Shore Hospital and Concord Repatriation General Hospital. He consults at the Sydney Spine Institute.
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This year’s MEDTECH INNOVATION COMPETITION, organised by the Biomedical Engineering Program @ USYD in conjunction with the Westmead Precinct Development Group is taking place this Friday 3rd November. The competition will include 20 clinician-guided student teams presenting innovative medtech solutions. Prototypes & demonstrations will be exhibited on the night. The projects are guided by Concord Neurosurgeon, A/Prof. James van Gelder, and other clinical and industry experts.
DATE: Friday 3rd November: 6pm – 8:30pm
VENUE: Westmead Hospital
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Does our cultural background affect our perception of pain? Apparently, it does. Read the full story about Australian research on cultural perceptions of pain and its implications on pain management approaches:
http://www.sbs.com.au/news/article/2017/09/22/australian-researchers-combine-cultural-practices-pain-management
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The next Clinical & Research Meeting will feature the following presentation:
‘SUcceSS trial: Randomised Placebo-controlled surgical trial on lumbar spinal stenosis’ by David Anderson, PhD candidate, Principal Physiotherapist at Sydney Spine Institute
This NHMRC-funded trial will be the world’s first to elucidate the treatment effect of decompression spinal surgery for central spinal canal stenosis. 160 people with symptomatic central lumbar spinal canal stenosis, who have failed to respond to a course of conservative care, will be randomly allocated to receive either decompressive surgery or placebo surgery. The trial will be conducted in Sydney and Melbourne with leading spine surgeons. Two SSI associates (
David Anderson and
A/Prof James van Gelder) are involved in the study with David Anderson being the PhD student and A/Prof van Gelder an advisor and participating surgeon.
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Faculty of Engineering and IT first-year PhD student Suri Susilo recently took part in the MIT Global Entrepreneurship Bootcamp, an intensive week-long new ventures leadership program attracting young entrepreneurs across the globe.
Suri was able to thrive in the program and her business idea – a “smart” pillow system to optimise spine neutrality – was chosen as one of the top 25 ideas, securing her a coveted spot as ‘CEO’ in the program. Suri has been developing her product with clinical assistance from the Sydney Spine Institute.
With real-world experience and a new start-up company under her belt, she is now progressing her smart pillow concept through a PhD, also in biomedical engineering.
Read the full story here!
Biomed students with SSI clinicians at Biomed Innovations 2015
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http://theconversation.com/despite-escalating-prescriptions-nerve-pain-drug-offers-no-relief-for-sciatica-74699
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The first multidisciplinary meeting of the year took place on Wednesday 1 March 2017.
Title: “Something for Everyone” (Journal Club)
Presenter: A/Prof. James van Gelder
Scientific articles presented and discussed:
- Surgical versus nonsurgical treatment of chronic low back pain: A meta-analysis based on current evidence
- Central sensitization in chronic low back pain: A narrative review
- Percutaneous Vertebroplasty versus Conservative Treatment in Aged Patients with Acute Osteoporotic Vertebral Compression Fractures: A Prospective Randomized Controlled Clinical Study
- Return to Play in Elite Athletes after Lumbar Microdiscectomy: a Meta-analysis
- Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy: a meta-analysis
- Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations
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