Transcription:

Prakash Chandran: If you're suffering from lower back pain, especially back pain caused by the SI joint, there are a range of treatment options from physical therapy to surgery. Today, we'll be learning more with Dr. Christopher Payne, a neurosurgeon at San Juan Regional Medical Center and one of the only surgeons in the area providing minimally invasive surgery for the SI joint-related back pain.

Welcome to Celebrate Health, a podcast from San Juan Regional Medical Center. I'm your host, Prakash Chandran. So Dr. Payne, thank you so much for joining us today. I really appreciate it. Now, you are a neurosurgeon and I thought I'd start with just a basic question. What exactly does a neurosurgeon do?

Christopher Payne, M.D.: Okay. First of all, thank you for having me. I appreciate being on here. So as neurosurgeons, we are focused on the structural side of the central nervous systems. So that involves, you know, structural brain problems, whether that be a tumor or, you know, structural injury in terms of a trauma. And we also focus a lot on spine problems, which is, you know, what the vast majority of people will experience. And whether that be from your neck all the way down to the base of your spine, those are all kind of areas that we focus on from, again, a structural side, a surgical side, things that we can kind of fix surgically.

Prakash Chandran: Okay. And I know you've talked broadly about structural injuries around spine problems, but what are the most common things that people come to you with that you typically treat?

Christopher Payne, M.D.: I think, you know, the most common things that we see are combinations of neck pain or low back pain. Those tend to be the most common. Typically, the thoracic spine, you don't see as many problems because there's not as much motion there. But you know, people with neck pain and pain that radiates down the arms or radiates down the legs, like, you know, that kind of sciatic-type pain that most people will talk about, that's one of the most common things. And as you can imagine, your spine and your neck and your back are always in motion. They're always doing things, they're taking the load of your body, so those tend to be areas that wear out quickly.

Prakash Chandran: Yeah. Absolutely. So one of the things that I mentioned in the introduction was the SI joint. Can you tell us a little bit about what that is?

Christopher Payne, M.D.: Yeah. So the SI joint or the sacroiliac joint, that is the very base of the spine that interacts with the pelvis. So if you can imagine, you know, your spine starts at your neck and goes all the way down to your low back. It interacts with the pelvis there at the sacroiliac joint. And that is where the sacrum and the pelvis have small range of motion joint, but one that can cause a fair amount of issues for, you know, degenerative reasons or whatnot.

Prakash Chandran: Yeah. I was just going to ask you to expand on that. So typically, there is pain caused by the SI joint. It sounds like it happens over time and with age. Is there anything else that causes that pain to exist?

Christopher Payne, M.D.: Yeah. So just like, you know, the other parts of the spine that experience degenerative disease, so arthritis like some people will have in their hands or hips or whatnot, that same thing can happen in the sacroiliac joint. It tends to be a little more specific to certain things.

So, people who have had spinal fusions in the past, you know, say they've had a spinal fusion and they've done really well. But now, they're starting to get some pain way low in the base of their spine, you know, usually it tends to be on one set of the other, that can be an an issue with the sacroiliac joint kind of getting added stress from a fusion people. People who've had repetitive trauma, say, if you're a longtime runner, people who have had multiple pregnancies. Just because of the way the pelvis interacts to pregnancy because of hormonal changes. You can get some sacroiliac pain associated with that. And sometimes trauma too, so, you know, just simple falls and whatnot can stir up sacroiliac joint pain.

Prakash Chandran: Okay, understood. And one of the other things that I mentioned in the introduction was that there is a wide range of treatment options. So I guess the question is when does surgery come into play? You know, I imagine you always start with non-invasive treatment modalities, like physical therapy. But at what point does someone come to a neurosurgeon like yourself and get treated with surgery?

Christopher Payne, M.D.: Yeah, that's a great point. That's exactly right. You know, what we want to do first is to try to exhaust everything before we get to surgery. So, you know, the surgery itself as you had touched on briefly is a minimally invasive surgery. It's doesn't require a night in the hospital. It's fairly quick to recover from, but it's still a surgery. So, you know, we want to do things like injections and physical therapy first. You know, those are also things we kind of offer through our spine clinic here at San Juan Regional Medical Center. So we incorporate, you know, pain specialists in our spine center that can do injections here as well. We can do, you know, this procedure called a radiofrequency ablation to try to burn the nerves to the sacroiliac joint to try to relieve pain from that standpoint. You know, if it comes to the point where we've tried multiple injections and say, you know, the first injection for example works for six months and now we've got another injection, it's not working as long, it's only lasting a couple months, and you're kind of going through that same cycle of being back to square one for lack of a better word and not getting as much relief as you did before, that's kind of the time when we start to think about, you know, maybe surgery is a good option for long-term kind of relief, you know, because we've tried all these other things before, but now we want something definitive because the other modalities aren't working as effectively as they were before.

Prakash Chandran: Yeah. So, you mentioned minimally invasive. Let's talk a little bit about exactly what that looks like and what that means.

Christopher Payne, M.D.: Yeah. So, so when we say, you know, minimally invasive, we refer to procedures that involve a much smaller incision for one. Usually, a lot of the work is done with x-ray machines to kind of show us where we're going instead of, you know, opening up the whole area to view. So, you know, again, one of the great things about minimally invasive surgery is that people tend to not have as much pain because you don't have to move as much, you know, soft tissue and muscle around off of the joints to see what you're doing. You're using those x-rays to guide you. And again, you know, smaller incisions, you know, not having to be in the hospital, not having to use as many post-op narcotic medications for pain control. All those are kind of great advantages for a procedure like this, which, you know, before the ability to do this minimally invasively was a fairly extensive surgery.

Prakash Chandran: Yeah. And one of the things that you mentioned before was the recovery time. So if someone has minimally invasive surgery, how quickly can they expect to go home and return to a sense of normalcy?

Christopher Payne, M.D.: Right. And I'll say kind of clarifying point, you know, there are various different types of minimally invasive surgery that we do for spine problems. So I'll just talk specifically about the sacroiliac procedure. But I didn't want to mislead anyone to thinking that it's always the same for every procedure. But specifically, for the sacroiliac joint procedure, most people will not have to stay a night in the hospital. So they'll have the procedure, you know, preferably early in the day. As long as they're doing well and their pain is reasonably controlled, you know, they're doing all the normal things that they should post-op like eating, drinking, they're not nauseated, you know, they can go home right away. You usually will have them limited weight-bearing. So they'll use a crutch for about two weeks and then probably put about 50% of the weight or so on that leg. And then after that, you know, you can kind of start getting back to normal things over the next three to four weeks with increased stability to lift heavier things. And then at about a month, you know, most people are starting to get back to normal in terms of they're back to work, they're back to doing normal day activities in terms of lifting, bending, twisting, that kind of thing. And you know, a small portion of people can use some physical therapy to kind of get them back to where they want to be. But for this procedure, most people tend to bounce back really well and do awesome after it.

Prakash Chandran: That's awesome. So another thing I wanted to ask you is I know that you see patients in Farmington. But outside of that, does San Juan have any other resources or locations for neurosurgery patients?

Christopher Payne, M.D.: Yeah, that's a good question. So we have recently started seeing patients in Durango. And that is something that we've started recently and we're proud of expanding into that region. So that's definitely somewhere where you can be evaluated as well.

Prakash Chandran: Yeah, that's good to know. So in this area, are there a lot of options for treatment of lower back pain and minimally invasive spine surgery?

Christopher Payne, M.D.: So in terms of minimally invasive spine surgery, you know, myself and one of my partners are two of the only people in the area that specifically do minimally invasive spine surgery. With regard to sacroiliac joint procedures, I myself am the only one doing that in the region here. But again, it is something I'm very excited to bring to the area and offer the community here as another alternative to the treatment of a potential cause of low back pain.

Prakash Chandran: Yeah. And just for clarity, we're talking about these minimally invasive procedures, but I'm curious as to the traditional methods. If you don't get minimally invasive, what have people traditionally done to treat SI joint back pain?

Christopher Payne, M.D.: So traditionally, SI joint pain, and this is quite a few years ago now would have been treated with an open procedure where you would have to expose the area around the sacroiliac joints, so we're moving gluteal muscle, large muscular areas that have to be kind of moved from around the sacroiliac joint. But again, over the last number of years, this sacroiliac joint procedure that is done minimally invasive has taken off and is something that is much more favored. And you look at the research and people are doing much better in terms of recovery time. Again, like we had mentioned, you don't have to be in the hospital, which is always a plus,. So, compared to the procedures in the past, we've come a long ways in treating the SI joint.

Prakash Chandran: So Dr. Payne, this has been a fascinating conversation. Is there anything else that you'd like to share just before we close here today?

Christopher Payne, M.D.: No. I think that we at the spine clinic here are kind of comprehensive. We'd like to offer a comprehensive views to patients in terms of how to treat them. You know, again, we have our pain specialists here that can offer a number of different procedures, whether it be the treatment of back pain or leg pain or whatnot all the way up to surgery if that is needed. And again, joining the practice here and being able to offer a procedure that no one else is doing for miles around the area, I'm happy to join this practice and be able to offer that to the community.

Prakash Chandran: Love it. Well, Dr. Payne, Thank you so much for your time. Really appreciate it.

Christopher Payne, M.D.: Thank you so much. I appreciate being here.

Prakash Chandran: That was Dr. Christopher Payne, a neurosurgeon at San Juan Regional Medical Center. Thanks for listening to Celebrate Health, the podcast from San Juan Regional Medical Center. For more information, you can call (505) 609-6595 or visit us online at sanjuanregional.com/spine. I am Prakash Chandran. Thank you so much, and we look forward to you joining us again.