Stanley C. Jones MD

Orthopedic Surgeon in Houston Texas

Call us713-773-2273
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FAQs

Q: Is There A Back Pain Risk Scale Test that I can take to evaluate my pain?

A: Please answer these questions below and evaluate your score:

1) How old are you?
Under 30 – add 0
30 to 39 – add 1
40 to 65 – add 2
Over 65 – add 3
____
2) Do you smoke?
Yes – add 2
No – add 1
____
3) Are you overweight?
No – add 0
If yes and 0-5 lbs overweight – add 1
6-10 lbs overweight – add 2
11-15 lbs overweight – add 3
16-20 lbs overweight – add 4
More than 20 lbs – add 5
____
4) How often do you exercise?
0 times per week – add 3
1 time per week – add 2
2 times per week – add 1
3 times per week – add 0
4-7 times per week – deduct 1
____
5) How often do you lift heavy objects?
0 times per month – add 0
1-2 times per month – add 1
3-4 times per month – add 2
5-6 times per month – add 3
7-8 times per month – add 4
More than 8 times per month – add 5
____
6) Have you already experienced back pain?
Yes – add 3
No – add 0
____
TOTAL SCORE: ____
Scoring Scale:
0 Congratulations! You are doing what you can to prevent spine pain, but it is always important to see Dr. Jones at least once a year to make sure that you are on the right track.  Please call (713) 766-0061 to set up an appointment.
1-4 Low risk. You are doing many things right to prevent spine pain, but it is always important to see Dr. Jones at least once a year to make sure that you remain at low risk. Please call (713) 766-0061 to set up an appointment.
5-8 Potential risk. You should change some habits and make an appointment with Dr. Jones to avoid any further damage to your health.  Please call (713) 766-0061 to set up an appointment.
9-12 Moderate risk. You should make an appointment with Dr. Jones to learn more about how to prevent any further damage.  Please call (713) 766-0061 to set up an appointment.
13-16 Significant risk. You need to change habits now to prevent spine pain. It is imperative that you make an appointment with Dr. Jones as soon as possible.  Please call (713) 766-0061, now.
17-20 Serious risk! Spine pain is likely, and you need to visit with Dr. Jones immediately.  Please call (713) 766-0061, now.

Q: What are some common spine disorders and intervention?

A: Here are a few common spine disorders and intervention:


sketch1-300x165Arthritis/Degenerative Disc Disease
Part of the normal aging process involves the wear and tear of joints and the tissues which support the joints. The facet joints in the spine are extremely vulnerable to this degeneration process. In addition, the disc tends to dry out and narrow, allowing the vertebra to come closer together and become irritated. Bony outgrowths known as bone spurs may form, narrowing the exit for the nerves and therefore causing irritation.Non-steroidal anti-inflammatory drugs (NSAIDS) may help reduce the process of inflammation of the joints and reduce the pain, stiffness and other symptoms associated with arthritis. Movement and gentle exercise are critical in the maintenance of joint nutrition and function. Strengthening of the muscles surrounding the affected joints is also an effective means of improving the stability of the joint, thereby decreasing the pain and dysfunction. 

Bulging or Ruptured Disc
sketch2-300x126Commonly known as a “slipped disc”, a ruptured or herniated disc is usually the result of excessive wear of the disc and surrounding joints from exaggerated or repeated movement. As the disc wears out, the inner, the jellylike substance that cushions and absorbs the shock of movement for the spine, deteriorates and begins to bulge into the outer rings of the disc, the annulus. The pressure on the annulus can cause a tear and result in pain due to the many pain fibers present in this tissue.
sketch4As a disc bulges, its middle or nucleus, moves closer to the outer edge of the annulus. Sudden or repeated motion can cause the annulus to rupture, allowing the material of the nucleus to squeeze out and irritate a nerve. Occasionally, symptomatic bulging or ruptured discs heal spontaneously, requiring no other interventions once the pain has diminished. If pressure on a nerve continues, however, neurological signs such as decreased muscle strength, diminished reflexes, or sensation changes ensue. Permanent nerve damage can result if the pressure on the nerves is not relieved.

Decompression of the nerves is accomplished through a laminectomy, where a small piece of bone is removed from the spine to allow Dr. Jones to access to the damaged disc for removal. A discectomy,or removal of the damaged portion of the disc, can also be accomplished through the use of microsurgical techniques, when a small incision is made, and the disc removed with the aid of a microscope.

Spondylolisthesis
sketch3-300x166Spondylolisthesis is a condition in which one vertebral body slips forward on the next level vertebral body. In most people, no significant pain or other symptoms occur. In about 20% of people who acquire spondylolisthesis, the slippage causes additional disc degeneration and nerve root impingement can result. Most patients suffer low back pain and leg pain is present less commonly. As with other conditions in the back, some patients respond to conservative care such as physical therapy, inflammation management, and altered activity levels. For others, the management of spondylolisthesis can include surgery to remove damaged disc material. A spinal fusion may be indicated to stabilize the spine.

Spinal Stenosis

Spinal stenosis occurs when the tissues and joints of the spine are enlarged to due degeneration or inflammation and the resulting space for the spinal cord and the exiting nerves is inadequate. The pressure on the nerves, and sometimes on the blood supply to the nerves, increases in the standing position, causing increased pain and dysfunction. Conservative treatment of spinal stenosis includes physical therapy, activity modification and management of the inflammation. Some patients respond well to epidural injections, with results lasting from three months to a year in some cases.

Surgical intervention is almost always indicated to physically increase the space around the spinal column and nerves to give them adequate room. Surgery is successful in alleviating the pain and discomfort in approximately 80% of cases. Unfortunately, the effectiveness can deteriorate if the patient suffers from significant degenerative disease, due to the progressive nature of osteoarthritis.

 

Q: What is Osteoporosis?
A: Osteoporosis is a disease in which your bones have become thin and weak. It occurs mostly in women after menopause. That’s because the female hormone estrogen helps women maintain bone strength. As estrogen levels decline, bone is lost. As bones weaken, they can be more easily broken. However, there are things you can do throughout life to help keep your bones strong.
Bones that may be weakened from osteoporosis are more likely to break (fracture). The bones in your hip, wrist, and spine are at the greatest risk for breaking. Your upper back may curve if the bones in your spine fracture. You are at increased risk for osteoporosis if:

  • You are post menopausal
  • There is not enough calcium or vitamin D in your diet
  • You smoke
  • You use certain medicines
  • You don’t exercise much
  • You drink excessive amounts of alcohol

If you already have osteoporosis, falls or excessive strain on your back can put at risk for fracture.

You can protect yourself from the dangers of osteoporosis by taking these steps:

  • Assess your risk factors
  • Learn how bones change over time
  • Make sure your diet has enough Calcium and vitamin D
  • Get plenty of exercise
  • Ask Dr. Jones about medications to treat osteoporosis
  • Prevent accidents by living safely

Living with Osteoporosis

If you have osteoporosis, you may need treatment. But in addition to treatment, you can do a lot to reduce the effect of osteoporosis on your life. Knowing how to prevent fractures can help you live more comfortably and safely with this disease.

The most common fracture sites in people with osteoporosis are the wrist, spine, and hip. Accidents and falls often cause these fractures. Most fractures are painful and may limit what you can do. But hip fractures are very serious. They require surgery, and it can take months to recover. To reduce your risk of fractures:

  • Get regular exercise. Try walking, swimming or weight training.
  • Make your home safe to help avoid accidents.
  • Take your medicines for osteoporosis as directed by Dr. Jones.

Your spine is made up of many bones called vertebrae. Osteoporosis can cause the vertebrae in your spine to collapse. Spine fractures may result from placing excessive strain on your back. As a result, your upper back may arch forward, causing a curvature. Your lower spine then must adjust to keep your body balanced. This can cause back pain. You may also lose height. To prevent or lessen the impact of these spinal changes:

  • Maintain good posture
  • Use proper lifting techniques
  • Lying on your back may reduce the pain
  • Ask Dr. Jones about these and other ways to help you spine

You can protect against fractures by exercising and by doing other physical activities. Exercises that increase muscle strength and improve flexibility help prevent falls. It’s best to do a variety of exercises. Physical activity may slow further bone loss. It can also be fun.

  • Check with Dr. Jones before starting any new exercise program
  • Use weights only as instructed
  • Stop any exercise that causes pain

Resistance exercises build muscle strength and make you less prone to injury. Weight-bearing activities such as dancing, walking, and gardening, help your whole body and help you maintain bone mass. Non-weight-bearing exercises, such as swimming or water exercises, may help prevent back strain and pain. They do this by building the trunk and leg muscles.

Q: How Can I Prevent Back Pain?

A: An unhealthy back often originates from an unhealthy habit like poor posture. In addition, repeated or continuous standing, sitting, or bending causes wear and tear on the joints and muscles of the spine and can lead to painful conditions. To prevent back pain, you must keep the spine healthy by correcting posture and utilizing proper body mechanics in all the activities you perform. Movement is essential in maintaining a healthy back, but the movement must be the right amount and in the right way.

Proper posture and good body mechanics are the keys to safe movement. You must remember that your spine bears your weight throughout the day, in every motion you perform. Therefore, you must learn the positions that place excess stress on your spine, causing pain or fatigue. Avoid or limit the amount of time in those positions, and strive to maintain the three normal curves of the spine (see the anatomy series on this site) in the correct positions to limit the wear and tear on your spine and its supporting structures.

Q: Can You Explain Why Physical Therapy and Rehabilitation Are Important?

A: After a back or neck injury, many people become inactive. Sometimes it is because of the pain. Other times it is because of the fears of reinjury or making the pain worse. But inactivity leads to weak muscles, and weak muscles make it harder to get back to normal activity. A vicious cycle develops.

We treat many high-level amateur athletes and otherwise active individuals, and emphasize that they must continue to exercise to keep the injured muscles strong and to develop strength in other muscles to compensate for the injury. The process of using exercise, stretching, muscle substitution, and good muscle mechanics, to help injuries to heal is referred to as rehabilitation.

Many patients with back or neck injuries have not had adequate rehabilitation. They may have gone to physical therapy, but only received hot packs, ice, electrical stimulation, and massage. While these modalities feel good, the most effective long-term benefit is from exercise.

The job of our physical therapist is to design an exercise program that is safe, effective, and has a low risk of injury for each patient. Our experienced physical therapist will work with you on your exercise program, emphasizing trunk stabilization and strengthening.

Eventually you will be discharged from formal rehabilitation, and transferred to an independent program at home or at a gym. A personal trainer is available to work with you on an independent basis to accomplish your long term strength and training goals.

Q: How do you make an acurate spinal diagnosis?

A: The best mode of management for a spinal problem is based on an accurate diagnosis. Stanley C. Jones, MD and his staff combine the latest diagnostic technology available with their years of experience and their highly specialized expertise to make a complete and accurate diagnosis, and then offer patients the most effective and efficient treatment for their unique problem.

Although it is appealing to undergo the newest procedure, or the least invasive procedure, it is critical that the most appropriate intervention be chosen for the dysfunction that is presented by your signs, symptoms and results of diagnostic tests.

Some of the diagnostic procedures you may undergo include

  • X-Rays
  • Magnetic Resonance Imaging (MRI)
  • Computerized Axial Tomography (CAT) Scan
  • Electromyography (EMG)
  • Nerve Conduction Velocity (NCV)

You may be sent to our office with these records, or we will refer you to a facility to be tested. If referred to a facility, you will return to our office when the test results are received, and your spine specialist will review and discuss the results with you and determine the best mode of care. You can be confident that Stanley C. Jones, MD and his professional staff work in your best interest to help you achieve total spinal wellness.

Q: What do you mean by Spine Anatomy and what are some of the associated conditions?

A: Function of the Spine A healthy spine is arranged in three natural curves forming an “S” shape that maintains the structure of the trunk. These curves keep your body in balance as you move and help to distribute your weight evenly throughout the spine. The spine also serves as an attachment for strong, flexible muscles that help support your body, and acts as protection to the spinal cord and its exiting nerves.

Bones — 24 moving Vertebrae

7 Cervical Vertebrae
12 Thoracic Vertebrae
5 Lumbar Vertebrae
Sacrum — 5 Fused Vertebrae
Coccyx — Tailbone

Discs
The discs in the spine separate the vertebrae and are made up of
spinesketch2-300x163Annulus — Outer rings of cartilage-type material protecting the nucleus.
Nucleus – Jelly-type material that makes up inner part of disc Mostly made up of water with a cushioning material that acts as a shock absorber for the spine.
Disc Herniation occurs when a portion of the disc (the nucleus of the disc) ruptures, protrudes or tears through the annulus and causes pressure on the nerves that exit each level of the spine.

Joint/Facets
These are the small joints of the spine that allow two different vertebral bodies to perform flexion/extension, side bending and rotation of the spine. Facet joints are located on the back portion of the vertebral bodies and are designed to protect the vertebral bodies from too much movement in a particular direction.

Foramen
Foramen are the openings between the vertebral bodies which allow nerves to exit at each level of the spine. Narrowing of the foramen by extra bone growth or ligament thickening is know as spinal stenosis, which can entrap a nerve as it exits the spine. Movements affect the size of the foraminal opening, which may increase or decrease the symptoms of spinal stenosis. For instance, forward bending increases the opening for the exiting nerve, and conversely, backward bending, or extension, decreases the space.

Ligaments
Ligaments are supportive bands of tissue that run the entire length of the spine in the front and the rear of the spine that help with the stability of the spine. There are also ligaments at each joint of the spine that help limit rotational movements as well as flexion and extension of the spine. Ligaments can be stretched or torn by excessive or forceful movement, which can lead to spinal stability problems.

Muscles
Strong flexible muscles are critical in the maintenance of a healthy spine. Small muscles actually move each vertebral level. Other spinal muscles run the length of the spine in the back and support spinal extension. Larger muscle groups that also have an effect on the function of the spine include the abdominal, hip and leg muscles.

Q: If I must undergo surgery, what are some of my options?

A:  Laminectomy/Laminotomy

Spinal surgery usually involves either a laminectomy or laminotomy, or the removal or partial removal of a bony part of the spine called the lamina. During a laminectomey, the bone, or lamina, is removed to allow access to the damaged parts of the spine, such as an injured disc, where surgery is needed. The removal of the bone also often relieves the pressure on the nerve. Laminectomies are used when pressure is very extreme. A laminotomy, although used infrequently, removes just a small portion of the lamina. It is performed when Dr. Jones needs to have access to only a small part of a slightly damaged disc.

Discectomy
When a disc becomes damaged, it often bulges or herniates,(often called a slipped disc), and no longer remains inside the protective ring of the disc. When this occurs, pressure on the nerves can result. For people with a disc problem, the surgeon forms a window in the torn portion of the outer rings of the disc to allow access to the disc nucleus. The damaged nucleus is then removed, relieving pressure on the nerves. Some surgeons perform what is termed a micro-disectomy, which may require the removal of only a small portion of the bony lamina and the disc.

Spinal Fusion
As the tissues that protect and support the spinal column and nerves become stretched, flattened or otherwise damaged, the vertebra can slip back and forth, creating instability in the spine. For people with instability, a fusion may be necessary to provide protection for the spinal cord and exiting nerves. A fusion involves the joining, or fusing, of two adjacent vertebrae by using bone grafts. Bone-like grafting materials, and metal instruments such as screws, wires, clips, or plates are often used to enhance postoperative stability of the spine.

Cervical Fusion
Fusing vertebrae in the cervical curve may be necessary to stabilize the spine, reducing movements that may cause neck or arm pain. Fusion of the spine occurs when two or more vertebrae are fused, or joined together. Cervical fusion is usually done through an incision in the front of the neck. It may sometimes be done through the back of the neck, or through both the front and back. The surgery with Dr. Jones generally takes 1 to 4 hours.

The Fusion Procedure
These steps apply to fusion from the front of the neck (anterior cervical fusion):

  • The disk is removed from between the vertebrae.
  • Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it will grow into a solid unit.
  • To help keep your spine steady and promote fusion, extra support may be used.
  • The incision is closed with sutures and/or staples.

If Extra Support is Needed
Metal supports called instrumentation may be used to help steady your spine while it fuses. These supports are not removed. Dr. Jones may use one or more types of support, which may include plates, screws or hooks.

Anterior Lumbar Fusion
Fusing vertebrae in the lumbar spine may be necessary to stabilize the spine, reducing movements of the vertebrae which may impinge on nerves and cause back or leg pain. Anterior lumbar fusion is done through an incision in your stomach area. Depending on how many vertebrae are fused, the surgery with Dr. Jones may take 3 to 8 hours.

The Fusion Procedure

  • The disc is removed from between the vertebrae to be fused.
  • Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it will grow into a solid unit.
  • To help keep your spine steady and promote fusion, extra support may be used.
  • The incision is closed with sutures and staples.

If extra support is needed then metal supports called instrumentation may be used to help steady your spine while it fuses. These supports are not removed. Dr. Jones may use one or more types of support, including cages, screws, plates or hooks.

Posterior Lumbar Fusion
Posterior lumbar fusion is done through an incision in your back. Depending on how many vertebrae are fused, the surgery with Dr. Jones may take 3 to 8 hours.

Fusing the Transverse Processes

  • Bone graft is packed between the transverse processes (“wings”) on the sides of the vertebrae. Occasionally, other nearby parts of the vertebrae are fused as well.
  • To help keep your spine steady and promote fusion, extra support may be used.
  • The incision is closed with sutures and staples.

Fusing the Disk Space

  • The disc is removed from between the vertebrae to be fused.
  • Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it will grow into a solid unit.
  • To help keep your spine steady and promote fusion, extra support may be used.
  • The incision is closed with sutures and staples.

If Extra Support Is Needed

Metal supports called instrumentation may be used to help steady your spine while it fuses. Dr. Jones may use one or more types of support. Below are two common types of support used with posterior lumbar fusion:

  • A cage may be used when fusing the disc space.
  • Screws and rods may be used when fusing the transverse processes. In rare cases, these supports may be removed after fusion is complete.

Kyphoplasty
Kyphoplasty is a minimally invasive procedure for osteoporotic patients with one or more vertebral fractures. Kyphoplasty is designed to reduce pain and restore the height of the fractured vertebra, resulting in a reduction of the curvature/deformity of the spine due to osteoporosis. During kyphoplasty, Dr. Jones inflates a small balloon inside the fractured vertebral body, creating a cavity inside. The balloon is then removed and the cavity is filled with a material which hardens, stabilizing the fracture and allowing almost immediate mobility.

Kyphoplasty is designed to provide

  • Significant pain relief
  • Stabilization of the fracture
  • Deformity correction by re-establishing some or all the lost vertebral body height
  • Reduction in lumbar and thoracic spinal deformity (including kyphosis).

Q: If Dr. Jones and I decide that surgery is the best option for me then what should I expect?

A: Scheduling Surgery and Procedures will consist of a lead-time of 15 days before surgery is requested. This allows time to meet the requirements of your insurance, and to find time that is convenient to you your doctor. For some insurance companies this may need to be extended.

Please contact your insurance company to confirm whether a second opinion is required.

Consent forms must be signed prior to scheduling surgery.

 

Pre-Operative Testing

All patients must have testing done prior to surgery to insure that they are healthy enough for surgery. The testing can be done anytime 30 days before surgery up until the day before surgery, at the very latest. It is best to complete this testing as soon as you know you are going to have surgery. If ther is something wrong with your health, of which you are unaware, we will have time to have you evaluated. This may prevent us from having to postpone your surgery.

If you have medical problems such as high blood pressure, heart disease, diabetes or any other health problems you will need to have an evaluation by your family doctor or a specialist prior to surgery. As you will not be allowed to donate any blood for surgery until you have this doctors clearance and you will have to take a note from him or her to the blood center with you prior to donating blood.

Required testing includes: CBC, UA, SMA-18, PT, PTT (AS A VERY MINIMUM) EKG, CHEST X-RAYS (IF 50 OR OLDER, ANY HEALTH PROBLEMS THAT MAY INDICATE THE NEED TO THESE)

Pre-Operative Medicine

You will need to make a list of the name of all your medications and their dosages that you are taking. This list should be given to Dr. Jones prior to surgery. You will be told which medications you may take the morning of surgery.

ALL MEDICATIONS THAT HAVE ASPIRIN IN THEM SHOULD BE DISCONTINUED 7-10 DAYS PRIOR TO SURGERY. THIS INCLUDES MANY OF THE ANTI-INFLAMMATORIES THAT PATIENTS ARE TAKING. SUBSTITUTIONS WILL BE GIVEN BY DR. JONES FOR SOME MEDICATIONS.

All patients are asked to take vitamins prior to surgery and after surgery. This will help you with the healing process.

VITAMIN B COMPLEX          VITAMIN C 1000 mg    VITAMIN D3
VITAMIN E 400 IU           CALCIUM 1200 mg       MAGNESIUM 400-500 mg
MULTI-VITAMIN TABLET            CITRACAL WITH VITAMIN D

Any brand is ok but try and get as close to these amounts with whatever tablets you may take.

The Day of Surgery

You will be admitted to the hospital the morning of the planned surgery.

Do not eat or drink after midnight the night before the surgery. This includes chewing gum. The only exception should be the medications you will be instructed to taken by Dr. Jones.

Intra-Operative Neurophysiological Monitoring Of Nerves And Muscles

Monitoring of nerves and muscles during certain surgical procedures at the request of our physicians. (All Lumbar Fusion, Endoscopic Procedures and certain difficult Lumbar Laminectomies).

There are times and certain procedures that are performed by Dr. Jones that are considered to be much safer if the nerves and muscles are monitored by equipment that would let physicians know immediately if he or any equipment being used is to close to a nerve or muscle that could cause possible damage to either. This equipment is put on the patient prior to the procedures and the nerves and muscles are monitored the entire procedure by a certified technician and under the direction of a Medical Doctor who is certified in these procedures. It is another way to insure to the patient that every thing is being done to protect the patient from any possible injury to nerve or muscles. There is a charge by the company that monitors the patients for the use of this equipment and for the services of the technician that will be billed to your insurance company.

Q: Do you have a list of guidelines that I can follow for a healthy back?

A: Dr. Jones suggests that you follow these simple guidelines to keep your back in good shape:

  1. Standing
    Keeping one foot forward of the other, with knees slightly bent, takes the pressure off your lower back.
  2. Sitting
    Sitting with your knees slightly higher than your hips provides good low back support.
  3. Reaching
    Stand on a stool to reach things that are above your shoulder level.
  4. Moving Heavy Items
    Pushing is easier on your back than pulling. Use your arms and legs to start the push. If you must lift a heavy item, get someone to help you.
  5. Lifting
    Kneel down on one knee with the other foot flat on the floor, as near as possible to the object you are lifting. Lift with your legs, not your back, keeping the object close to your body at all times.
  6. Carrying
    Two small objects (one in either hand) may be easier to handle than one large one. If you must carry one large object, keep it close to your body.
  7. Sleeping
    Sleeping on your back puts 55 pounds of pressure on your back. Putting a couple of pillows under your knees cuts that pressure in half. Lying on your sides with a pillow between your knees also reduces the pressure.
  8. Weight Control
    Additional weight puts a strain on your back. Keep within 10 lbs of your ideal weight for a healthier back. For every one pound that you gain, 100 pounds of stress are put on your back.
  9. Quit Smoking
    Smokers are more prone to back pain than nonsmokers because nicotine restricts the flow of blood to the discs that cushion your vertebrae.
  10. Minor Back Pain
    Treat minor back pain with anti-inflammatories and gentle stretching followed by an ice pack.
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Stanley C. Jones MD
2311 W. Alabama St.
Houston
Texas 77098
Phone: 713-773-2273

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