Panorama Orthopedics & Spine Center has been a trusted provider of orthopedic care in metro Denver for more than 70 years. With more than 30 orthopedic surgeons, we are one of the largest and most specialized orthopedic groups in the United States and are known as a leader in orthopedic care. We offer highly trained surgeons and
specialists in sports medicine, spine, joint replacement, orthopedic trauma, foot and ankle, hand and wrist and non-operative pain management. We are committed to excellence in everything we do. That’s why patients of all ages — from children to seniors — trust Panorama Orthopedics to help them get them back to doing the things they love.
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At Panorama Orthopedics & Spine Center, our comprehensive approach to spine care means patients receive world-class, individualized treatment from a team of providers who are committed to delivering the highest-quality care. Whether it’s a pulled muscle, a herniated disk or a complex deformity, we understand spinal conditions can be extremely debilitating. Panorama is committed to reducing pain and improving function so patients can get back to doing what they love — whether that’s work or play.
Our spine care team includes orthopedic spine surgeons, a neurosurgeon, pain management doctors (known as physiatrists) who specialize in non-surgical care; and spine-specific physical therapists. Together we offer a range of treatments, and the vast majority of patients receive relief from such non-surgical options as activity modification, anti-inflammatory medications, physical therapy, or steroid injections.
We are also available for consults, second opinions, and MRI reviews.
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Back pain can get you down and it can bring life to a screeching halt. If you have injured your back – call us. Our team of physician assistants and surgeons will fit you in for an evaluation that day or the following day and help you get on the path to feeling better. Your initial evaluation will include an assessment of your back pain and a recommended treatment plan to help you feel better again.
Have you been told that you need spine surgery? If so, you may want to consider a second opinion from an experienced spine surgeon at Panorama Orthopedics & Spine Center. Anyone with questions or concerns, as to whether surgery is necessary should seek a second opinion. And our team of spine experts is here to help you.
It is important to not only understand your diagnosis, but also your recovery plan. Our doctors will take the time to walk through your individual diagnosis, discuss your lifestyle, expectations and help you understand your individual recovery plan.
Understanding the Common Causes and Treatments for Back Pain
If you suffer from back pain, you’re not alone. According to the National Institute of Health, back pain is one of the most common medical conditions in the United States. Fortunately, a number of non-surgical treatment options are available. Many conditions that cause back pain get better by themselves within weeks to months. and ultimately, fewer than ten percent of all spine patients seen at Panorama Orthopedics require back surgery.
Here are the most common reasons people suffer from back pain along with their treatment options:
1. Lumbar Strains and Sprains: common soft tissue injuries that may require a long time to heal, even with treatment. Strains occur when you stretch the muscles and/or tendons in your back abnormally. Sprains occur when you stretch a ligament abnormally. Ligaments are the tough bands of tissue that attach bones to bones and stabilize your back. Treatment for both strains and sprains are similar – short periods of rest followed by activity such as physical therapy, cardiovascular exercise, stretching and core strengthening to restore mobility. Ice, heat, massage, and traction can also help. Your doctor may also recommend anti-inflammatory medications to relieve your pain. Neither sprains nor strains require surgery.
2. Herniated (“Bulging”) Disc: a condition in which the intervertebraldiscs between the bones of your spine bulge beyond their hard outer shell. When lower back and leg pain (sciatica) occur together, a herniated disc is most often the cause. Treatment options include exercise, avoiding painful positions, physical therapy, muscle relaxants, over-the-counter pain medications, prescription drugs and corticosteroid injections. Less than two percent of patients require surgery to remove the herniated disc material. This is often done through a minimally invasive approach.
3. Spine Arthritis (Arthritic Disc & Facet Joint): a condition that involves the breakdown of cartilage, the cushioning material between your joints and bones. Because discs function like shock absorbers between your facet joints and bones, breakdown of this cushioning material can cause pain and stiffness, especially when you bend and twist.
Treatment of arthritis often focuses on reducing inflammation and relieving pain through over-the-counter medications, prescription drugs and cortisone or hyaluronic acid injections. Exercise therapy may also be recommended to decrease stiffness and strengthen muscles around the joint. Surgery is only recommended for certain types of facet joint and disc arthritis that affect the stability of the spine.
4. Spine Alignment Problems: the two most common forms of “misalignment” in the spine are conditions called spondylolisthesis and scoliosis. Spondylolisthesis is a condition in which one of the bones in your spine (vertebra) slips forward and out of place compared to the adjacent bone. The condition can cause back and leg pain ranging from mild to severe, although many people experience no symptoms.Treatment includes exercise, physical therapy, anti-inflammatory medications and steroid injections. Surgery may be recommended if less invasive treatments do not provide lasting relief.
Scoliosis is a sideways curvature of the spine that most often occurs in young patients. However, as people age, the degenerative spine can begin to curve and twist due to weakened discs and joints. As the curvature worsens, arthritic pains in the back and sciatic pains in the lower back and legs can develop from narrowing of nerve channels within the spinal column. Treatment includes all of the previously mentioned non-surgical options. In the proper setting, surgery can be done to correct alignment problems, which address instability of bones, joints and disks. Surgery also relieves nerve compression.
If you suffer from back pain, you can take comfort in knowing you have treatment options. When you come to Panorama for back pain, we will meticulously analyze your situation and make the proper recommendation for your condition. Panorama is know for their conservative spine doctors who want to provide the right treatments for each individual. Surgery is typically not the first option unless it is the best option.
Fewer than 10% of all spine patients seen at Panorama Orthopedics and Spine Center needed back surgery
Panorama has a team of spine experts. We take the simple cases of back pain from back strains to the most complex cases of paralysis or scoliosis. Doctors and patients alike, from around the Rocky Mountain region trust the team of experts at Panorama. We offer the newest options for pain relief to the most complex surgical interventions to get patients back to doing the things they love! Our spine team includes:
Spine specific physical therapists at locations across Denver
Non-operative pain management specialists who offer a variety of treatments
Highly specialized orthopedic spine and neurosurgeons
Many people live with back or neck pain for too long before seeking help. Often they do so because they worry they may need surgery. Take comfort in knowing that the team at Panorama has a conservative approach to surgery and fewer than 10% of all patients seen at Panorama Orthopedics & Spine Center needed back surgery.
No matter your back or neck problem – large or small – Our team is ready to help!
Minimally Invasive Spine Surgery
However, if conservative treatments fail, our highly experienced team is able to offer the most advanced surgical treatments, including microscope-assisted surgery and surgical navigation for improved precision. We are also able to offer minimally invasive spine surgery, which is a popular option for patients facing back surgery because it uses smaller incisions than traditional, “or open,” surgery. For the patient, this means less pain, shorter hospital stays and less scarring. There is also less disruption to surrounding muscle and tissue and a smaller risk of infection.
Dr. Lonnie Loutzenhiser talks about Minimally Invasive Spine Surgery
Despite its benefits, minimally invasive spine surgery is not performed by all spine surgeons. Doctors who perform this type of surgery must undergo additional training on the procedure. Dr. Lonnie Loutzenhiser at Panorama Orthopedics & Spine Center is specially trained in minimally invasive (microscopic) surgical techniques. He uses these techniques to treat patients with herniated disks, pinched nerves, spondylolisthesis, scoliosis and traumatic instability of the spine. Back surgery can now be done through incisions that are measured in millimeters.
Although minimally invasive spine surgery has many advantages for patients, there are some back and neck conditions that cannot yet be treated through this approach. Together we will find the best solution to treat your back pain.
Patients sometimes ask about laser spine surgery, with the impression that it offers the most up-to-date technology. Though there has been a large marketing push behind the procedure – you may have seen the TV ads – the clinical benefits are questionable. At Panorama, we remain committed to using the latest proven techniques and technologies.
Most of our surgeries are performed at OrthoColorado Hospital, the only orthopedic specialty hospital in the region. Like Panorama, OrthoColorado only treats orthopedic patients, and that focus means higher satisfaction and shorter hospital stays for patients. The average length of stay for spine fusions at OrthoColorado is 2.4 days, compared to a national average of 3.2 days. Working in conjunction with Flight for Life and St Anthony Hospital, Panorama serves Colorado and the Rocky Mountain region as the state’s premier spine, trauma and complex deformity referral center.
When Scoliosis Throws You a Curve, Panorama Can Help.
Many adults are surprised to discover they have a condition called scoliosis, an abnormal curvature of the spine. Unlike a normal spine that gently curves from back to front in a subtle S shape, spines with scoliosis curve from side to side in a C or S shape. If the curvature of the spine deviates off center by more than 10 degrees, it meets the criteria for scoliosis. The condition cannot be corrected simply by standing up straight to improve your posture.
Most cases of adult onset scoliosis are mild with few symptoms, which explains why many people are surprised to learn they have the condition. Adult onset scoliosis is very different from childhood scoliosis. In the majority of childhood cases, the cause is unknown; while adult onset scoliosis is primarily caused by age-related osteoarthritis, a “wear and tear” condition in which the soft cushioning material (cartilage) between the joints and discs in the spine break down. Over time, this causes the spine to weaken and curve.
Dr Amit Agarwala is an expert in surgery to correct scoliosis
Childhood scoliosis, on the other hand, is often discovered through school physicals, while adults typically discover they suffer from scoliosis later in life when they undergo screenings, such as an X-ray, for an unrelated condition. They may also discover the condition when it becomes more severe and causes pain. Scoliosis due to osteoarthritis is most common in adults over age 60 and is often felt as pain in the lower back. It may also be accompanied by a narrowing of the spinal canal (spinal stenosis), which can cause numbness and/or shooting pain radiating down the leg.
Scoliosis can be treated through physical therapy (exercise) or through fusion surgery in more severe cases. The goal of exercise is to strengthen the muscles around the spine to add support. Over-the-counter pain medication and anti-inflammatories may also be used to relieve pain. Doctors do not recommend long-term use of braces in adults because they can weaken core muscles needed to stabilize the spine.
Fusion surgery may be considered after more conservative approaches have failed, especially if the person is in a lot of pain. The goal of surgery is to relieve painful pressure on the nerves, stabilize the spine and improve mobility. Fusion surgery is an in-patient procedure that requires three to five days of hospitalization, although patients are up walking for physical therapy the day after surgery. The length of the surgery varies and can take anywhere from three to eight hours, depending upon its complexity.
Dr. Agarwala performs fusion therapy at OrthoColorado Hospital, Colorado’s only specialty orthopedic hospital designed specifically for the orthopedic patient. He describes the hospital as being like a 5-star hotel for orthopedic patients, offering the same kind of world-class orthopedic care you’d expect to find in New York or Boston.
Fusion surgery involves straightening and stabilizing the spine with titanium rods. Because Dr. Agarwala majored in biomechanical engineering at John Hopkins University as an undergraduate and then went on to complete medical school and a fellowship in orthopedics, he has an in-depth understanding of the nature of the spine related to the various materials used for fusion surgery. He also understands how to leverage specific biomechanical principles to achieve the best surgical outcomes.
Following surgery, patients often report their nerve pain is completely gone and their lower back pain is vastly improved. He informs his patients that they’ll be fully recovered six months after surgery so they can return to the activities they love, such as golf and skiing. It’s important to note the majority of adults with scoliosis will not require surgery. If you suspect Mother Nature has thrown you a curve, chances are you can benefit from a non-surgical treatment plan personalized for your exact condition.
Do you experience tingling or burning sensations in one or more of your arms or wrists? Is it sometimes challenging to button your clothes or hold coins in your hand? Do you feel numbness or shooting pains in a leg or even experience trouble walking? You may be surprised to learn that any one of these symptoms could be caused by a problem in your neck.
People with neck conditions can experience a wide variety of strange sensations in addition to pain. Some patients report feeling as if ants are crawling on their skin or as if someone is pouring hot or cold water over an arm or a leg. Others describe a profound sense of weakness in one isolated muscle.
Because your neck is connected to your spine, it can send signals down your spinal column to other parts of your body. Pain that originates in one part of your body but is felt in another is called “referred pain.” The top two neck conditions that trigger referred pain are cervical, also known as neck, herniated discs and cervical spinal stenosis:
1.Cervical Herniated Disc (also called a slipped or ruptured disc): a condition in which one of the discs in your spine bulges beyond its hard outer coating, irritating nearby nerves. Herniated discs are usually caused by injury, arthritis or aging. Patients with a herniated disc often experience pain, tightness or cramping in the neck and shoulder areas or tingling, burning or numbness in their arms, wrists or hands.
2.Cervical Stenosis (also called cervical spinal cord compression): a condition in which the spinal canal in your neck is narrowed due to injury, arthritis or aging.
This narrowing causes pressure on your spinal cord or on a nerve root, which can result in a combination of numbness, tingling, weakness or pain in one or both arms, hands or legs.
Treatment for herniated discs and cervical stenosis are diagnosed and treated in a similar way. At your first appointment, Panorama spine doctors will order an X-ray to rule out a fracture. They often will also recommend physical therapy (PT) and medications designed to reduce inflammation or to calm nerve hyperactivity. Approximately 60 to 70 percent of patients respond to this treatment within six to twelve weeks.
If you don’t respond to PT or medications, often we will recommend a corticosteroid epidural injection to relieve pain and reduce inflammation. We may also order an MRI (magnetic resonance imaging) to learn more about the condition.
If corticosteroid shots don’t work within five to six weeks, at that point we will consider surgery to relieve the pressure on the nerves. Surgery for both a herniated disc and for stenosis is minimally invasive and involves inserting a small wedge of bone through a tiny incision in the front of your neck. The bone is then fused into place to permanently decompress the area. (In the case of a herniated disc, the damaged disc is removed first.) Both procedures require an overnight stay in the hospital and recovery can take from two to twelve weeks.
Whether you suffer from a herniated disc, stenosis or another orthopedic condition, the doctor will take the time to listen and answer all of your questions carefully. It’s very important that our patients understand their condition and all of their treatment options.
Paralyzed in a Mountain Bike Accident - Matt Talks About His Miraculous Recovery and The Invisible Injury
Jack's Story of Minimally Invasive Spine Surgery
Linda's Story about Scoliosis Surgery with Dr Agarwala
Learning About Low Back and SI Pain with Dr. Desai
Up to 85% of Americans experience low back pain at some point in their lives. There are many causes of lower back pain that range from injury to deformity. There is, however, a commonly overlooked cause that is responsible for chronic low back pain in 15-30% of the cases – SI joint dysfunction, also known as sacroiliac joint pain, and sacral pain. The sacroiliac joint or SI joint, as it is more commonly known, is the link between the upper and lower body, it is the joint between the sacrum (bottom of spine) and the iliac (pelvis). The SI joint is actually has two joints, on either side of the spine that hold the weight of your body as it shifts when you walk.
Si joint pain can be caused by trauma or injury to the low back, childbearing, degeneration from arthritis or may develop in individuals who had undergone a previous lumber fusion. When your pain is caused by the SI joint, it can appear in many different places from the low back to the pelvis, hips, glutes and even radiate down to your calves. Sometimes the pain is a dull, aching pain and other times it can be a sharp, stabbing pain. It is estimated that up to 30% of this kind of pain is caused by SI Joint dysfunction.
Unfortunately, these symptoms mimic many other problems of the spine, legs, and hips therefore it is really important to find a proper diagnosis for your pain.
The first step in diagnosis is a physical exam, your doctor may also uses diagnostic imaging and diagnostic injections to help determine the source of your pain and determine if it may be caused by your SI joint.
There are many treatments available today to help stabilize the joint and eliminate the pain caused from SI joint dysfunction. Therapies can range from over-the-counter medication, injections, physical therapy to SI joint fusion, which is a minimally invasive procedure. If you suffer from low back pain, visit a specialist who can determine what is the root cause may be and help you get back to living an active, healthy, pain-free life.
The Panorama Difference - Our surgeons are committed to quality and constant improvement.
That’s why education, research and training are hallmarks of our spine specialists, who are known as experts in their field both nationally and internationally. Twice a month our surgeons meet to review major cases with the entire spine team to determine the best course of treatment for individual patients. This peer review enables us to maintain the highest standard of care for all our patients. Patients can rest assured they have a whole team of doctors working to find the best treatment plan for them.
Dr Drewek Reviews the Most Common Causes of Back Pain
Learning About Back Pain
Knowledge is power. Watch these videos to learn more about how to keep your back healthy and strong – watch a demo on how to lift properly to keep from straining your back, and find out why exercise is an important ingredient in keeping your back healthy.
Find out what you can do, at home, if you are unexpectedly hit by back pain – should you use heat or ice, what’s the best way to get up from lying down and learn simple stretches you can do to help calm the pain and stretch the back muscles.
Lindsey completed her Bachelors Degree in science at William Penn University in 2004 where she was a member of the volleyball team. She went on to get he Masters Degree in Science with an emphasis in Physician Assistant at Des Moines University in 2008. Once she was a Physcian Assistant she joined the spine team at Panorama. where she has been specifically trained in all aspects of spine ailments and fractures by Dr. Wong, Dr. Agarwala, Dr. Puschak and Dr. Loutzenhiser. Away from work, Lindsey enjoys sharing time with her husband and watching her two young daughters learn and grow. As a Colorado native she enjoys skiing, hiking, camping, playing piano and volleyball, and rooting for the Colorado Avalanche.
Katie Spight, PA
Katie grew up in Lakewood, Colorado. She attended college at CSU where she majored in Health and Exercise Science with a minor in Biomedical sciences. After college she worked in a Physical Therapy office as an aide and then at Panorama as a medical assistant before attending PA school at Red Rocks. While in PA school at Red Rocks, she also earned a Masters of Medical Science from St. Francis University in Pennsylvania. In her spare time she enjoys spending time with her husband and her two kids. She also likes running, going to the mountains and spending time with her German Shepard, Jax.
Nathan Youmell, PA
Nate received his bachelors in sports medicine from SUNY Brockport in NY. He then became an Athletic Trainer working for Health South before being independently employed by a local high school. He then joined Panorama as a medical assistant before he went to school to become a physician assistant. He attended PA school at Red Rocks and received a masters in medical science from St Francis University in Pennsylvania. After becoming certified in 2010, he began working with the spine team at Panorama.
Hannah Strauss, PA
Hannah completed her undergraduate degree from the University of Vermont in Nutrition and Food Sciences with a minor in Chemistry. She went on to get her Master’s Degree in Physician Assistant Studies from Northeastern University in Boston, MA. Hannah has a passion in clinical nutrition and prior to PA school, she worked as a Registered Dietician at the University of Colorado Hospital with the solid organ transplant team and the bariatric surgery team. Today, Hannah works with Dr. Agarwala, Dr. Drewek, Dr. Wong, Dr. Loutzenhiser, Dr. Puschak, and the rest of the surgical spine team. In her free time Hannah enjoys any activities and sports that take place in the mountains or on water.
Tracey Turgeon, PA
A native Kansan, Tracey graduated from Washburn University as a Physical Therapy Assistant. She then went on to graduate from Wichita State University in 1991 as a Physician Assistant. She has a Master’s degree in Physician Assistant Studies with emphasis in Orthopedics from the University of Nebraska-Omaha. She has been a PA for more than 30 years with experiences in pediatrics, family medicine, internal medicine and Orthopedics. She moved to Colorado with her family. Tracey works with Dr Karen Knight on the spine and non-surgical teams.
Shasta Vansickle, PA
Shasta was born and raised in Northwest Arkansas. She studied Pre-Med and received her BS in Biology with a Minor in Psychology from the University of Arkansas at Little Rock. At UALR, Shasta also competed in Division I Cross Country and Track & Field and played one year of basketball. She went to Stony Brook University in Stony Brook, NY for PA school. Her husband then recruited her to Colorado, which was not a hard sell! She was raised in a rural town in Arkansas and will always respect the hardworking and farming communities and still enjoys taking care of patients with this mindset and way of life. Little Rock and New York helped her to understand cultural diversity and to better understand people and patients from different backgrounds. Previously, Shasta worked in pediatric orthopedics and while unplanned was fortunate enough to fall into pediatric and adult spine surgery. She has worked with several spine surgeons in the area and has grown a real love and passion for this area of medicine. She works with Dr Horner on the physiatry Team at Panorama. In her spare time, she enjoys spending time with her kids and husband, running, hiking, skiing, going to sporting events, and traveling.Shasta has been a Pa for more than 10 years. She supports the non-operative philosophy of trying everything we can to avoid surgery, while also realizing that sometimes surgery is still necessary and the only thing that will correct the underlying orthopedic issues. Shasta is also well trained in understanding EMG results, reading her own x-rays and MRIs, ordering and explaining spinal injections, discussing cellular treatments, referring to specialized physical therapists, and performing ultrasound guided joint injections.