Mr. Curtis Leffler
Following a motor vehicle accident, he was suffering from severe lower back pain and left sciatica, and he was unable to participate in his exercises. Two week after percutanious discectomy, his pain relieve. He returned to his normal activities and sent this photos as token of appreciation.
H.G., is a 24-year-old, beautiful model, who was unable to work for two years following a motor vehicle accident, because of pain in her neck, arms, lower back and legs. She was diagnosed with herniated disc of the cervical spine and lumber spine. She underwent surgery to her neck and lower back. She returned to work in just six weeks. She sent this photo with appreciation.
When facing orthopedic surgery in California may just be one of the best places to find an orthopedic surgeon, boasting some of the top schools in the nation, and thus a competitive pool of experts that leads to incredibly high standards. This is what you want when putting your body into someone else’s hands.
Students of orthopedic surgery in California face a good deal of competition when breaking into the field, and this ensures that experts have gone through a long process and competed against the best to make a place for themselves.
This field of medicine deals with any condition that has to do with the musculoskeletal system. It may employ many different means of treatment of vary levels of invasive-procedures to confront a wide range of conditions that require orthopedic surgery. California orthopedic surgeons may see patients for reasons that are by no means limited to injury and may include degenerative diseases, tumors, disorders, and infections.
That said, a large number of surgeries do consist of trauma or injury. When it comes to orthopedic surgery, California surgeons deal with these five treatments most often: knee arthroscopy, shoulder arthroscopy, carpal tunnel release, knee arthroscopy, and support implant removals.
Maybe you are preparing yourself for orthopedic surgery. California has rigid standards for practicing surgeons, and our organization takes these standards to the next level. In short, you are in good hands when you come to us.
R.R. is a 40-year old female who was a top executive secretary in an international firm in Los Angeles, California. She injured her neck at work when a shelf fell on her head. She complained of pain in her neck. She was, of course, taken to a medical center. She was examined and had X-rays taken which revealed no fracture or dislocation, and she was referred for physical therapy. In spite of extensive therapy, her pain persisted, and subsequently she developed low back pain with numbness of her limbs.
This patient suffered from pain and missed work on and off for 3 years, while attending physical therapy with no relief. After 3 years, her company fired her. After seeing many prominent physicians and having a negative myelogram, she was finally given a psychiatric diagnosis and sent for psychiatric treatment. Two years later (5 years after the injury), her husband divorced her, unable to tolerate her and her pain. She stayed at home, was taking pain medications, and began eating more and drinking alcohol. Her weight increased to 195 pounds, and she became convinced her paid was psychological.
When she presented to our clinic, she came in walking with two canes supporting her. The key to the diagnosis of her pain was the intermittent quality. The pain was relieved when she lay down and was aggravated when she was upright or bending her neck forward. Because of her pain, a diagnosis of intermittent pain was given, and a myelogram showed 2 herniated discs. She underwent surgical treatment. Five days later, she was walking without assistance and without pain in the hospital corridor.
For the first time in 5 years, this woman was without pain, and she now could begin to rebuild her life. She suffered pain, loss of her work and marriage, and inappropriate psychiatric treatment due to lack of proper diagnosis. The patient’s lost past wages were paid by workers’ compensation. She was retrained and returned to work as a transcriber typist.
M.S. is a 52-year old female who was in the hospital for 14 days with pelvic traction because of low back pain. She was unable to walk due to pain that was always present with no relief. She had weakness of both legs, urinary incontinence, and was running a mild temperature (fluctuating around 99° to 100°). Lumbar spine X-rays were negative. First myelogram was negative.
This patient also fit well into our classification of low back pain. On reviewing her symptoms and using our criteria, we categorized her pain as constant, the etiology therefore being infection, tumor, or vascular problem. On review of her X-rays, a faint, unusual area was noted at L2-3 disc. Because of her fever, we decided to aspirate this area, and Streptococcus was seen on direct smear. She was placed on intravenous antibiotics and within a few days could walk without pain. She was subsequently discharged, resuming normal activity, and 3 years’ follow up revealed no further problem.
C.B. is a 37-year old female who was a cashier in a bank and was out of work for 8 months due to a typical pattern of left-sided sciatica pain that was constant. There was no history of trauma. She had no relief of her pain at any time, not even with rest. She was limping due to her pain. The localized skin over the posterior aspect of the thigh along the course of her sciatic nerve was extremely tender to touch. She was afebrile, and she had both myelogram and CAT scan of the lumbar spine, which were negative. Because of inability to find any cause for her pain and because of a recent broken engagement, her doctor gave her a psychiatric pain diagnosis. She was receiving psychiatric therapy without relief.
Using our classification, we diagnosed her as having constant low back pain and therefore began to look for a cause such as infection, tumor, or vascular problem. She was afebrile with no clinical signs or laboratory results indicating infection and presented without vascular signs. Because of the exquisite tenderness over the sciatic nerve and excruciating pain of sciatica, we decided to explore the localized tender area. This was before MRI was available. A neurosurgeon assisting in the case doubted that we would find anything wrong.
At surgery, as we approached the sciatic nerve, a lipoma was found over the nerve. When we reached the sciatic nerve, there was a bulging over the side of the sciatic nerve. As we incised the sheath of the nerve, we discovered a round tumor approximately 10 mm by 10 mm. Histological examination proved it to be a Schwannoma tumor. Her pain was completely relieved postoperatively. She was walking and able to resume her job activity in 7 days. Eight years later she is symptom free.
K.A. is a 14-year old girl, well-developed and well-nourished for her age. She is the daughter of a finance attorney and developed low back pain and later sciatica after some pre-swimming sports exercises. She was suffering for 18 months before she was referred to our clinic.
She had been frequently seen by her family physician, chiropractor, acupuncturist, neurologist, neurosurgeon, orthopaedic surgeon, and psychiatrist. She had been hospitalized twice and each time had been treated with skeletal traction. Her final diagnosis was psychiatric conversion reaction. She refused to go swimming and stopped going to school because of pain.
She fitted well into our classification. Her pain was intermittent and became worse with coughing and sneezing. Her pain was relieved with rest. Her only limitation was straight leg raising at 20° on the left with positive tension test, and a slight weakness of the posterior tibialis. MRI disclosed slight bulging at the level of L4-5. All other tests, including CBC, ESR, and bone scan were negative.
This patient was diagnosed as having herniated nucleus pulposus of L5-S1. The diagnosis was confirmed by dynamic discography. A percutaneous discography under local anesthesia reproduced her symptoms, and a percutaneous discectomy under local anesthesia relieved her symptoms completely. Three hours later, left straight leg raising was 90°. She stated, "For the last 18 months, I could not raise my leg." She resumed her schooling and swimming 1 week later. Just 2 months after surgery she competed with 250 girls in preparing for the next olympic swimming competition, and she won fifth place. Two years later she is active and cheerful.
The Modern Management of Back Pain
By S.M.Rezaian, M.D., Ph.D.,
From California Orthopaedic ,Medical Clinic,Beverly Hills,California
The Modern Management of Back Pain
By S.M.Rezaian, M.D., Ph.D.,
Elizabeth G., a 27 year-old well developed and nourished. She is married and was working as a cashier in a bank. One day the chair collapsed and she fell. Patient started to complain of low back pain and right sciatica, her treatment was as fallow
For 4 months later, she did not get better. Patient was referred to an orthopedic clinic and a brace was given, MRI of lumbar spine reported normal and more medication and P.T. for another 4 months was given. She did not get better and lost her job. 4 months later a neurosurgeon explored her back to decompress the nerve, but there was no herniated disc. With physical therapy 2 months later patient was referred to a pain management clinic, she did not get better. She then was referred to psych clinic and 6 months later she was worse and her husband divorced her. She was depressed and angry with her life.
At this stage she was referred to our clinic. Patient was using one auxiliary crutch, hardly could bear weight on her left leg. She was complaining of severe pain on her left leg and thigh and she could not sit on a chair. She was helped to lay on the examining couch. (Fig 1) Her pain was constant behind her left thigh. On deep palpation there was a very tender, painful just on mid-thigh. Pressure on that point produced pain across her sciatic nerve, up and down. X-ray of femur was normal (This was pre MRI era). There was a 3” incision on her lumbar spine well healed. SLR and all other tests were normal. I explained that the only way to understand and perhaps treat her was exploration of her sciatic nerve. She jumped up and said you mean to operate on my sciatic nerve?? I said YES and she said no, no and left our clinic.
Three weeks later she came back to our clinic with two axillaries crutches and stated my pain is worse. She said to me, “Everybody tells me that my pain comes from my head and I know that I am not crazy as all those Doctors thought and my husband divorced me. I believe you are right, I know that all my pain is on my thigh and if there is a God he also know that I am not crazy. I am here to tell you I am ready that you operate on my sciatic nerve.” This was one of my early surgeries in California. I schedule the surgery in one of Beverly Hills Medical Centers. Immediately Supervisor of surgery called me and said because you are new in this hospital, we need an experienced surgeon to proctor your surgery. I said I do not know anybody, you call any surgeon. She called back and said a good neurosurgeon will do proctoring.
Next day as I arrived I met that colleague, on the same time they were transferring the patient to operating room. As the proctor Doctor saw the patient he was angry and said, “This is my patient, I have operated on her lumbar spine and there is no disc to operate. There is no indication of surgery what so ever. I replied, “On my opinion she needs surgery. If you are sure she doesn’t need surgery go write on her chart and I will cancel the case.” He did not and we went to surgery. He was looking with uncertainty when I prepared the back of her thigh. He was assisting me but wouldn’t talk to me .When I found the sciatic nerve and split the neural sheet and a size of a big olive, tumor easily came out. He was surprised and said, “Good gracious how did you diagnose this?” I said just listening to the patient and examining her. The pathology examination showed Schwannoma, A BENIGN TUMOR. The literature confirms 5 cases previously have been reported. The patient went home the same day (FIG2).Ten days later she was pain free, two months later she got her job in the bank. Ten years later when she brought her mother to our clinic and she was perfect. (Fig4)
Low Back Pain (LBP) A New Concept of Etiology and The Modern Management
By: S.M Rezaian, M.D., Ph.D.
From: California Orthopaedic Medical Clinic, Inc.
Beverly Hills California
We have presented a new clinical classification for diagnosing the etiology of low back pain based on patient history. Using this practical classification has enabled us to diagnose successfully, and therefore treat, over 98% of 600 patients with low back pain.
Since we have adopted the above described classification method, we have seen 600 new patients with back pain. All have been correctly diagnosed. There has not been one patient with so called "psychiatric back pain." We, of course, believe that there are psychiatric patients with psychological pain. However, we firmly believe that when the back pain has a physical etiology, the psychological disturbances can be secondary manifestations and not necessarily the primary cause.
We have also described four case histories as examples, ease of whom were diagnosed with psychiatric back pain, but under our classification each of the four patients was successfully diagnosed and treated. Further details of the sample of 600 patients will be presented in another article.
We have reviewed the medical literature and have found no similar classification. We trust that this new classification can now be useful for other practicing physicians.