Dr. Robert Watkins IV on Side Effects

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ContributorDr. Robert G. Watkins IV, M.D.Read Full Bio

Biography

Robert Watkins IV, M.D., is co-director of Marina Spine Center and Chairman of the Surgery Department at Marina Del Rey Hospital. Dr. Watkins is a board-certified orthopedic spine surgeon, specializing in minimally invasive spine surgery, computer-assisted surgery, spinal-deformity treatment, and disc replacement. Dr. Watkins earned his medical degree at the University of Southern California’s Keck School of Medicine and completed his residency in orthopedic surgery at the L.A. County/USC General Hospital. He then worked as a traveling fellow in Europe, specializing in artificial-disc replacement and scoliosis surgery. Over the past decade, he has lectured on spine issues to doctors, patient groups, athletic trainers, and physical therapists; led research teams that have published studies; and taught surgeons on specialized techniques. He is the spine consultant to many Los Angeles sports teams, and has treated professional, college, and high school athletes from all over the country.

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ContributorDr. Robert G. Watkins IV, M.D.Read Full Bio

Biography

Robert Watkins IV, M.D., is co-director of Marina Spine Center and Chairman of the Surgery Department at Marina Del Rey Hospital. Dr. Watkins is a board-certified orthopedic spine surgeon, specializing in minimally invasive spine surgery, computer-assisted surgery, spinal-deformity treatment, and disc replacement. Dr. Watkins earned his medical degree at the University of Southern California’s Keck School of Medicine and completed his residency in orthopedic surgery at the L.A. County/USC General Hospital. He then worked as a traveling fellow in Europe, specializing in artificial-disc replacement and scoliosis surgery. Over the past decade, he has lectured on spine issues to doctors, patient groups, athletic trainers, and physical therapists; led research teams that have published studies; and taught surgeons on specialized techniques. He is the spine consultant to many Los Angeles sports teams, and has treated professional, college, and high school athletes from all over the country.

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Recovery after fusion is a big deal. The benefits of us putting graphs into the disc and screws in the back is that it's so stable it's pretty hard to mess up the surgery. And we can mobilize people very quickly. We usually get 'em up the same day of the surgery and walk right away. People typically stay in the hospital for two or three nights. They can go home, in general, when three things occur. When they're passing gas so we know that their intestines are awake, when they're ambulating independently, they can get in and out of bed and walk so when they go home they can go to the bathroom on their own and get up and move. And the third part is, their pain has to be controlled with oral medications.

I tell patients all the time, it's gonna hurt when they get in and out of bed. When you change position to get in and out of bed, it hurts. And people don't need to be too paranoid that they think they may be messing up the surgery, cause it hurts when they get in and out of bed. They're not messing up the surgery, the screws and the graphs are so stable, you're not gonna mess up the surgery getting in and out of bed. It's gonna hurt when you do that, and that's normal, that's part of the surgical pain. Once you get up and move and you walk around, and your body loosens up, you'll feel better overall. I see people back two weeks after the surgery typically. And I would say at least 50 percent of people are doing better than they thought. They're actually mobilizing pretty well, the hard part about our job is, we can never predict who are gonna be the 20 percent of people who aren't doing well.

And who are gonna take twice as long to heal. Recovery from a fusion obviously varies person to person, but in general, most people's surgical pain lasts for six to eight weeks. WE start physical therapy around eight to 10 weeks after a fusion. So the first eight to 10 weeks, we just want 'em to walk. Just get out and move and walk around and don't stress your back too hard. We generally start physical therapy when we think the muscle pain has settled down, and their muscles are starting to fire to where they can protect that segment and work properly. Typically, for the fusion to occur takes three to six months, so we don't wanna start the activity too early before we think we have some bone growth in there to provide some stability.

So we start physical therapy around eight to ten weeks, we generally want the patient to go two to three times a week for basically 12 weeks. And that's about the average, so it's about three months altogether. We have a trunk stabilization program, you start at level one as the most basic, level five is the max; professional athlete can't go back to their sports until they're level five. Most people, I want them to get to level three. If they get to level three, we know they have a good enough core strength and it's firing properly to protect the other segments that if they reach level three and they're six months after a fusion, we generally will let them go back to almost any activity.

I would say full recovery from a fusion, the bone growth takes three to six months typically, but most recovery’s really a year. And part of that is, most people have had pain for two to three years before the surgery so none of the muscles are working properly. They have neural muscular dysfunction, they're guarding they're protecting. Mentally they have this block that doesn’t allow them to move in certain situations so they don't provoke the pain. It takes three to six months for the bone to grow, the fusion to get solid, it takes another six months to retrain all those muscles and the neural-muscular connection to not guard and not protect, but to work properly. So really a fusion takes a year to sometimes even two years to recovery from, because a lot of it is the preexisting pathology before the surgery.

One of the great things about a fusion is it can immobilize a segment and stop the pain from that segment. But, the downside is, it can put more stress on the next segment. Cause if this doesn't move, well then the stress and the motion has to occur from the next level. And it can accelerate the normal wear and tear that's already occurring at that next level. So people can develop pathology and degeneration at the level above a fusion, and that can happen anywhere from six months to 20 years after a fusion, at any time. There is no way to stop it from happening, per say. Some of the things we do surgically is we really try and recreate the normal curvature in the lordosis when we do the fusion to put less stress on these other levels.

Keep cardiovascular exercise as part of their routine three to five times a week, get out and exercise, mobilize their muscles, circulate their blood has been shown to decrease back pain in general. And then the third thing is doing trunk stabilization exercises. Having a normal program, 15 minutes every day for the rest of their life, do core strengthening and exercises to wake those muscles up and to keep them firing to take stress off the other joints and discs and to keep it on the muscles.

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