TOCA Talks with Dr. Huston: Physical Medicine and Rehabilitation (PMR)

Physical Medicine and Rehabilitation (PMR) specialists diagnosis, treat and rehabilitate individuals suffering from a wide variety of neuromuscular and musculoskeletal conditions. As the complexities in medicine have grown, many PMR specialists subspecialize with additional fellowship training in the area of brain injury, spinal cord injury, pain management, sports medicine and interventional spine.

Interventional spine specialists receive advanced training in the diagnosis,interpretation of advance imaging studies such as MRI, treatment, rehabilitation and utilization of minimally invasive fluoroscopically guided spine procedures in the management of painful spine disorders. This is a relatively new subspecialty. The goal is to provide more accurate diagnosis of painful spine conditions to provide better and more specific treatment.

An individual with chest pain will often see an interventional cardiologist. The interventional cardiologist will make a diagnosis and determine the best way to manage the patient cardiac condition. An individual with back or neck pain will want to see an interventional spine specialist to obtain the correct diagnosis and treatment. Treatment may be as simple as activity modification and medication to working with a physical therapist to correct biomechanical deficits and develop muscle memory to dynamically stabilize the spine—to fluoroscopically guide spinal injections to promote healing to ablative procedures for degenerative conditions. Kyphoplasty is a procedure utilized to restore height of osteoporotic compression fractures and injection of cement to stabilize the fracture.

A study published in Spine 2013 found those individuals scheduled to undergo surgery who consulted with a PMR specialist were often able to avoid surgery and were satisfied with their care (Fox, et al. Spine 2013).

Minimally invasive procedures are constantly being developed to relieve pressure off of nerves for both disc herniations and stenosis. These procedures will need continued development before more generalized use in the population.

Gene therapy to rebuild discs using recombinant DNA has been performed in animals. The future in the treatment of degenerative disc disease will probably utilize interventional procedures to introduce gene therapy into a diseased disc to allow the disc to repair or regenerate.

– Dr. Christopher Huston

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