Usman Zahir, MD

05/02/2021

3-D Printing in spine surgery is often associated with creating custom implants (cages). In addition, small 3-D printed molds can help with intra-operative targeting as well. The goal is to reduce radiation and promote efficiencies in the OR, especially in the outpatient setting.

The use of 3D-printed spine devices and implants has grown in recent months, allowing for more customized surgical planning. Many spine surgeons see potential in 3D-printed technology but also foresee challenges that will need to be addressed to ensure its success.

11/29/2020

Spinal fusion surgeries in the elderly are often unnecessary. Rods and screws are sometimes unnecessary to treat a patient with leg pain. Consider non-fusion options.

Usman Zahir, MD. (I apologize if some medical terms are confusing for the general public, I added links to help.

11/16/2020

How does a disc herniation in the lower back pinch a nerve that causes leg pain?

The video below shows how to remove pressure on a nerve through a endoscopic spine procedure, less than 1 cm in length. This is a same day surgery, no external stitches, and no major restrictions afterwards.

This is the least invasive way to perform spinal surgery.

Fortunately most people with a pinched nerve do not need surgery, but for those who need it - try selecting the least invasive option possible.

11/15/2020

What does a pinch nerve look like in the lower back?

https://www.instagram.com/p/CHn76IuLrFA/?utm_source=ig_web_button_share_sheet

11/10/2020

Most patients with back and leg pain, do not need surgery. Physical therapy, medications, injections, lifestyle changes, all can help. However, if all of these treatments have failed, consider the least invasive surgical option before more traditional open spinal procedures. Consider endoscopics before considering any large fusion procedure.

Endoscopic spine surgery is the least invasive way to remove a disc herniation in the lower back. Endoscopics can help treat sciatica through a less than 1 cm incision. This is also less invasive than a traditional microdiscectomy.

The video below is from an endoscopic lumbar discectomy. The slender piece of tissue on the right is a nerve (when this is compressed it causes sciatica/leg pain). The white fluffy fragments that I am removing are herniated disc material that were pressing on the nerve.

This is all through a less than 1 cm incision. Home the same day. No stitches. Just skin glue. No major restrictions. No significant time off from work needed.

Not everyone is a candidate for this procedure. Always review all possible options with a spine surgeon. These decisions are always made after a careful review of a patient's history, physical exam, xrays, and MRI. Majority of patients can avoid surgery altogether.

I admit this video is a bit technical, and might be confusing. However, it might be interesting for anyone who is curious about how a endoscopic procedure is performed inside the spine. Before, surgeons would just do surgery, and patients had no idea what was actually done. It was just a mystery for many. Today, patients are much more informed.

10/20/2020

80% of people will have an episode of back pain at some point in their lives. The vast majority of episodes will get better within a short time.
Having neck or back pain even if it’s present for a few weeks does not require an MRI.
Most cases of neck and back pain will resolve with a basic treatment plan consisting of exercises, lifestyle changes, medications, and in some cases therapy. Even if a person has a pinched nerve in the neck or back, the vast majority of people will get better. MRIs are not needed.
When is an MRI necessary?
1.) neck/back pain associated with arm or leg pain that has not resolved with either physical therapy, medications or conservative treatments. Time frame varies - but 4-6 weeks is a decent time frame.
2.) if the neck or back pain is associated with concerning signs:
- weakness in the arms or legs
- problems with bowel or bladder function
- fevers, chills , unexplained weight loss, or night sweats - where there is a concern for infection or cancer
- a person who sustains a fall who might have osteoporosis, if xrays are unclear - an MRI can sometimes detect missed fractures.
- a patient with the above and balance issues or coordination problems.
3.) if a person is interested in trying injections as a treatment plan for neck/back issues - an MRI is often helpful for identifying which parts of the spine would be best to inject.
4.) lastly, MRIs are necessary for anyone considering surgery.
For any other situation, MRIs are likely not necessary. Feel free to have a discussion with your physician to review the pros and cons with getting testing. I find that some patients get disappointed when I suggest that an MRI is not necessary. Hopefully the examples help clarify this a bit further.

10/13/2020

Car seats are designed to protect the neck from whiplash (hyperextension). Unfortunately the desire for safety can exacerbate neck problems in many people.
The head rest in most cars will typically tilt forward, this causes the neck to flex. The seats are also shaped in a way that cause the shoulders to protrude forward. These two factors can cause beck and back pain.
Back support is also typically lacking in most cars even with the options to “inflate-in” lumbar support.
One way to address this problem is to shift the center of the seat forward. This can be achieved by a low profile thoracic or lumbar pillow. In many cases placing a pillow for the lower back will automatically shift you forward and improve your neck alignment as well. This is what I did when I drive. I use a low profile lumbar pillow that I place along my lower/mid back ( slightly higher than the pillow shown in these pictures).
If this is not enough, you can also consider cervical support higher up as well. The goal with all these supports is to shift you forward, so you aren’t slouching in your seats. This will improve your back and neck alignment by also preventing your shoulders from rolling forward.
Regardless of what option you choose, one still needs to make sure the head is protected. If someone has a condition called thoracic kyphosis - which is a rigid curvature of the mid back, then these pillows and cushions will not work. Instead, the head and neck might become unsupported putting the person at risk in a car accident. For any person with a more rigid spine, can always discuss options with your physician or therapist.

10/06/2020

Many of my patients have asked me for my opinion on posture correctors.
With poor posture the shoulders tend to roll forward, the chest muscles can tighten, and the head is typically in a forward position. This can result in upper back, neck pain, etc.
As a surgeon I deal with neck pain myself primarily from looking down when I operate (over many years). So as a trial, I decided to try a posture corrector.
I have found it to be very effective. It’s not a cure, and one should only use it as a way to remind ourselves on proper alignment. This includes optimizing ergonomic settings at work as I have mentioned previously. I am also actively working on strengthening my upper back throughout the day while using it. It’s a constant reminder and a proactive way for me to engage muscles that might have weakened overtime. An active exercise program is important if you use a brace like this.
The mistake with these types of braces and supports is that people become dependent on them. They think that the brace itself will correct the problem. This is not true. If used improperly, a person can even weaken supportive muscles even further.
However as a reminder, I have found it to be very effective. Overall, I am walking straighter and I feel better.

09/24/2020

As someone who deals with neck pain myself, raising the laptop definitely helps.

There are a variety of platforms/stands you can buy that will raise your laptop. This helps keep your screen at eye level. Work at a table or workstation. Don’t slouch on a couch.

09/15/2020

This may seem intuitive but a 2011 research study of 401 people in the Annals of Internal Medicine, found that massage therapy is effective for the treatment of low back pain with benefits lasting atleast 6 months after receiving weekly massages for 10 weeks. This study looked primarily at low back pain, but other studies show benefits for the neck/upper back as well.
There was no difference between the type of massage: relaxation massages or more structural massages. Both types of massages were generally effective. So you don’t need a painful or deep tissue massage to see a benefit.
One can always review these options with a specialist if unsure. There are certain conditions which may not benefit or may not be appropriate for massage therapy, but it’s still generally a safe, reasonable, and conservative option for most people.

Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, et al. A comparison of the effects of two types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011;155(1):1–9.

09/08/2020

What’s the best pillow for sleeping?
The answer depends on which position you tend sleep in, are you a side sleeper or a back sleeper?
If you sleep on your back, you want the thinnest pillow possible and ideally something that supports the back of the neck (not the head). Avoid sleeping with multiple pillows or a very thick pillow - this will just flex your neck and can exacerbate neck pain. I am a back sleeper and I don’t sleep with a pillow at all. I sleep with a roll behind my neck and that’s it (the back of my head touches the mattress). Sometimes I’ll just sleep with a horseshoe/traveling pillow. Takes a little getting used to...but It keeps my neck in a neutral position while sleeping. I deal with neck pain myself, sleeping in this way has been very helpful for me.
If you sleep on your side, you want a pillow that best keeps your neck in a neutral position. A very thin or thick pillow should be avoided. This may require a little trial and error before you find the perfect height.
Generally it’s much better to sleep on your back vs the side.
For those who have sleep apnea or bad reflux and need some elevation - consider a “wedge pillow.” This way you can elevate the head and upper back without flexing the neck.
The least ideal position is sleeping on your stomach. If you tend to sleep this way, you should avoid a pillow altogether. If you do choose a pillow - choose the thinnest one possible.
For more info on general sleeping advice, consider typing the following link:
https://health.clevelandclinic.org/sleep-position-causing-back-pain/amp/

08/30/2020

Most people are familiar with “ text neck”. Why does this happen? The average human head weighs around 10 lbs and is carefully balanced on 7 vertebrae (bones in the neck).
Texting, poor computer posture (working on a laptop while sitting on a couch for example) with shoulders rolled forward causes the neck to tilt forward. Even mild changes in flexion results in a dramatic increase in forces across the neck. Tilting 45-60 degrees will increase that stress to 60 lbs. The signs of this stress will be neck pain, shoulder pain, etc.
Overtime this can worsen disc problems, bulging discs, herniated discs, etc. If you go to my website, there are a set of neck and back exercises under the FAQs tab.
Try a daily stretching and exercise routine while doing sedentary work. Every 45 min take a quick stretch break. image from https://www.spine-health.com/