Episode 31 - Uncovering Pediatric Spinal Deformities with Dr. Michael Bohl
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Episode Summary
On Episode 13 of Back Talk Doc we spoke with Dr. Matt McGirt about Adult Spinal Deformity (Ep. 13 - Adult Spinal Deformity with Dr. Matt McGirt.) It proved to be a popular and valuable episode for our community, so today we’re following up that episode with a discussion of scoliosis and spinal deformity in pediatric patients.
Joining us is Carolina Neurosurgery and Spine Associates’ new partner, Dr. Michael Bohl. Dr. Bohl attended medical school at the University of Michigan and completed his residency at Barrow Neurological Institute. A U.S. Marine Corps Veteran, Dr. Bohl was involved in humanitarian aid missions in East Africa. While he was not considering medical school at the time, the impact of that experience led him to return to East Africa after leaving the Marine Corp to work as a nurses aid.
Dr. Bohl and Dr. Lakhia first differentiate between the terms ‘scoliosis’ and ‘spinal deformity’, which are frequently used interchangeably. (10:17) The latter is the umbrella term which describes a condition wherein the shape of the spine is leading to a problem. Scoliosis, on the other hand, is a type of deformity where the spine shows an S- or C-shaped curve.
They examine the causes of pediatric spinal deformities and urge parents to be mindful of their child’s posture as they grow. (13:20) Indicators of pediatric scoliosis include a visible curve in the spine, a curve that worsens over time, and whether or not the spinal deformity is causing symptoms like pain or neurological symptoms. The goal of treatment is to keep the curve from getting worse, usually through minimally invasive methods like bracing and physical therapy. (16:32) And, as with many medical conditions, early intervention is the key to more successful outcomes. (21:21)
Scoliotic curves get worse during periods of active growth, so a brace can help stabilize and control the growth of the curve. (21:55) Early intervention is important here because once the curve reaches a certain severity the problem is likely to continue getting worse into adulthood. If bracing is ineffective and the curvature is becoming more sever, spinal surgery may be an option. However, in a pediatric patient, smaller, less invasive surgeries are performed to manage the curve and not impede the child’s growth. (25:10)
Candidates for surgery include curves greater than fifty degrees and curves that are rapidly progressing and not adequately responding to a brace. Dr. Bohl stresses that while surgical outcomes are overwhelmingly positive, non-surgical treatment options remain a priority for treating pediatric spinal deformities.
For more information on Dr. Sanjiv Lakhia and Back Talk Doc visit BackTalkDoc.com.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
On Episode 13 of Back Talk Doc we spoke with Dr. Matt McGirt about Adult Spinal Deformity (Ep. 13 - Adult Spinal Deformity with Dr. Matt McGirt.) It proved to be a popular and valuable episode for our community, so today we’re following up that episode with a discussion of scoliosis and spinal deformity in pediatric patients.
Joining us is Carolina Neurosurgery and Spine Associates’ new partner, Dr. Michael Bohl. Dr. Bohl attended medical school at the University of Michigan and completed his residency at Barrow Neurological Institute. A U.S. Marine Corps Veteran, Dr. Bohl was involved in humanitarian aid missions in East Africa. While he was not considering medical school at the time, the impact of that experience led him to return to East Africa after leaving the Marine Corp to work as a nurses aid.
Dr. Bohl and Dr. Lakhia first differentiate between the terms ‘scoliosis’ and ‘spinal deformity’, which are frequently used interchangeably. (10:17) The latter is the umbrella term which describes a condition wherein the shape of the spine is leading to a problem. Scoliosis, on the other hand, is a type of deformity where the spine shows an S- or C-shaped curve.
They examine the causes of pediatric spinal deformities and urge parents to be mindful of their child’s posture as they grow. (13:20) Indicators of pediatric scoliosis include a visible curve in the spine, a curve that worsens over time, and whether or not the spinal deformity is causing symptoms like pain or neurological symptoms. The goal of treatment is to keep the curve from getting worse, usually through minimally invasive methods like bracing and physical therapy. (16:32) And, as with many medical conditions, early intervention is the key to more successful outcomes. (21:21)
Scoliotic curves get worse during periods of active growth, so a brace can help stabilize and control the growth of the curve. (21:55) Early intervention is important here because once the curve reaches a certain severity the problem is likely to continue getting worse into adulthood. If bracing is ineffective and the curvature is becoming more sever, spinal surgery may be an option. However, in a pediatric patient, smaller, less invasive surgeries are performed to manage the curve and not impede the child’s growth. (25:10)
Candidates for surgery include curves greater than fifty degrees and curves that are rapidly progressing and not adequately responding to a brace. Dr. Bohl stresses that while surgical outcomes are overwhelmingly positive, non-surgical treatment options remain a priority for treating pediatric spinal deformities.
For more information on Dr. Sanjiv Lakhia and Back Talk Doc visit BackTalkDoc.com.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Intro: 00:00
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Intro: 00:30
Welcome, you're listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 01:04
Several episodes ago, I had the pleasure of interviewing my partner, Dr. Matt McGirt on the topic of adult spinal deformity. And it was a really good episode. I learned a lot personally and I received great feedback from the community about the episode. So today I'm really excited to follow up that episode with an interview with one of our new partners at Carolina Neurosurgery and Spine Associates, Dr. Michael Bohl. And Michael's going to take us through somewhat of a similar topic, and that is scoliosis and spinal deformity, but we're going to look at it through the lens, more of a pediatric perspective. And I know there's a lot of parents who listen to our show and are going to be interested to hear what Dr. Bohl has to say.
Sanjiv Lakhia: 01:49
Michael, welcome to the show today.
Michael Bohl: 01:51
Thank you very much. Thank you for having me. This is a wonderful program you're putting on and I'm real excited to have the opportunity to join you today.
Sanjiv Lakhia: 01:59
Michael comes to us through a residency program at Barrow Neurological Institute and he's fellowship-trained in orthopedic spinal deformity through Virginia Mason Medical Center. And you did medical school at University of Michigan, is that correct?
Michael Bohl: 02:16
Yeah, that's correct. I spent four years at the University of Michigan from 2009 to '13.
Sanjiv Lakhia: 02:22
Yeah. I'm not sure how you slipped through the recruiting process for our group, given that we do have several docs who are from Ohio. But I think it's to our benefit. And I want you to go ahead and introduce yourself a little bit to the people who are listing and the local Charlotte community as well. A little background. I think you've got a pretty unique background with your military service, but I want to let you articulate kind of how you came into the field of medicine and neurosurgery and what your military background kind of meant to you in your development.
Michael Bohl: 02:58
Yeah. Yeah, absolutely. I graduated from high school in the year 2000 and I never had any ideas at that time that I was going to end up in medicine. I ended up enlisting in the Marine Corps and left for my first day of bootcamp early in the morning, around 4:00 AM on September 11th of 2001. And just as I was swearing in and getting ready to go get on an airplane to go to Paris Island, the news reports of the terrorist attacks that day started showing up on the news. I knew from day one that my four year enlistment was going to be, I was going to have more life experiences than I had originally anticipated.
Michael Bohl: 03:39
I spent my four years in bootcamp and then later the school of infantry. I passed a screening to get into the Marine Reconnaissance Program and spent my four years from 2001 to 2005 as a Reconnaissance Marine. And on one of my deployments to Iraq, we stopped in East Africa where we did a few humanitarian aid missions and those missions felt tremendously meaningful to me. They impacted me a great deal and I think initiated a thought process and some insight that eventually led me to decide that when my enlistment ended, I was going to go back to East Africa and volunteer as a nurse's aid in a health clinic to figure out whether or not a career or some kind of job, I didn't know what, but something in healthcare, whether or not that was right for me, whether it was something I wanted to do or not because I suspected that I would enjoy it based on those humanitarian aid missions.
Michael Bohl: 04:43
So in 2005, my enlistment ended, I got honorably discharged and then immediately traveled back over to East Africa and spent several months working as a nurses aid and really loved it. I knew Swahili. I had learned Swahili while I was in the military. And that opened a lot of doors for me while I was there, including an opportunity to shadow a surgeon from New Zealand for a little while. And so it was while I was volunteering in East Africa that I was first introduced to the field of surgery. The first surgery I saw was in Tanzania. It was a C-section child delivery. I was really captivated by it. Not only was I loving just working as a healthcare provider, but spending time with this surgeon really kind of brought into focus more clearly, maybe what I wanted to do.
Michael Bohl: 05:37
So when I came home from East Africa, I went to college to get my undergraduate degree, not thinking medical school necessarily, but ended up doing really well in school. Got into medical school at the University of Michigan, met my wife while I was in college and went with her to nursing school in Rochester, New York. And then when she was finished with that, she came to the University of Michigan with me for medical school, where we started our family. And then it was in medical school that I found the field of neurosurgery. And again was just really blown away by the tremendous positive impact that the neurosurgeons I was working with were able to have on their patients' lives. I really loved that and was captivated by that.
Michael Bohl: 06:24
After medical school, I matched into the Neurosurgery Residency program at the Barrow Neurological Institute where I found the field of spinal deformity surgery and had the good fortune of working with several complex spine deformity surgeons who did training in both fields of neurosurgery and orthopedic surgery. And they encouraged me to do the same. During my residency, I sought out fellowship experiences with orthopedic surgeons and they were absolutely right. I think that as a spine surgeon who focuses primarily on spine deformities and complex spine conditions, it's really important to be comfortable with both skill sets.
Michael Bohl: 07:08
And so now I'm here, I feel tremendously lucky and honored to have this job here, where I'm focusing on adult and pediatric spine deformities and complex spine conditions. And it's been just absolutely fantastic so far.I'm convinced that I've got the world's greatest partners. Not only are they phenomenal surgeons, but they're phenomenal people. And me and my family just feel so fortunate to be here and be part of this group.
Sanjiv Lakhia: 07:36
What was it about the humanitarian work that struck a cord with you?
Michael Bohl: 07:42
I think to put it plainly, my job in the military was I was a Reconnaissance Marine, which is a specialized infantry job. And I did two combat deployments, both to Iraq. Those are fighting jobs and those experiences are very, very starkly contrast against what we were doing just several weeks after leaving, which was spending time at an orphanage, helping take care of children, delivering medical supplies to hospitals. And I think for me, the stark contrast between those experiences as a young man, I was 19, 20 years old at the time, they really brought into focus for me, the kind of impact I wanted to have on the people around me and what kind of job I wanted to have for the rest of my life moving forward.
Michael Bohl: 08:34
I started to look at healthcare as a potential career where I could positively impact people around me and try and give something back. It's not that I don't think we were doing good in Iraq. I think we certainly were. It was just through very different means. The humanitarian aid just struck a very different cord with me and made me feel like what I was doing was tremendously meaningful and impactful. And I wanted to find a job that enabled me to feel that way regularly.
Sanjiv Lakhia: 09:08
Yeah. That's actually the word that comes to my mind is what an impactful life event for you and how it's shaped you. And we're all blessed to have you in our community. And it does sound like you've upgraded from the cold weather of Michigan in Rochester, and you guys must love the Carolinas right now.
Michael Bohl: 09:26
We do. Yeah, it's funny, when I came home from my second deployment to Iraq, I told myself that I never needed to live in the desert again. And so inevitably, I imagine to a seven-year program in Phoenix, Arizona-
Sanjiv Lakhia: 09:40
Right.
Michael Bohl: 09:41
... that program was fantastic. It was really wonderful. But after seven more years in the desert, we're more than happy to be in the Charlotte climate. No question. My kids are getting to see seasons for the first time. And it's fantastic.
Sanjiv Lakhia: 09:55
Yeah. That's got to be great. All right. Let's jump into the topic today for those that are really interested in getting this information. One of the things I wanted to clear up as we get started is this idea of the terminology. Can you kind of clarify if there's a difference between the words scoliosis versus spinal deformity and kind of what those words mean?
Michael Bohl: 10:17
Yeah, absolutely. So yeah, a lot of these words get used interchangeably. The way I think about it and I think the way it gets used most often is that spinal deformity is very much an umbrella term that encompasses any condition where the shape of the spine is leading to some problem, some functional problem, pain problem, some neurological problem. And there are a lot of different types of shape problems that a spine can have. And one type is scoliosis. When we talk about scoliosis, most of us are talking about an abnormal curve in the spine when viewed from the front. So if you're looking at a normally-shaped spine from the front, it typically looks straight up and down, but sometimes the spine will look curved. Either there will be a C-shaped curve or an S-shaped curve, or even several S-shaped curves in the spine. And that is typically what we refer to as scoliosis.
Michael Bohl: 11:22
There are also problems with the shape of the spine when viewed from the side. And we have different terms for those. Kyphosis is too much forward angulation of the spine. Lordosis is backwards angulation of the spine. And the normal spine has lordosis and kyphosis in certain parts of it, but sometimes those curvatures when seen from the side are either excessive and lead to functional problems, or they're too little and that leads to functional problems.
Michael Bohl: 11:55
And then when we're talking about pediatric spine deformity, there are also congenital problems, bones in the spine that aren't supposed to be there, bones in the spine that don't fully form. And those can lead to misshapen spines as well, which are broadly defined as spine deformities. And they themselves can then lead to scoliosis or exaggerated kyphosis or hypokyphosis, any number of different problems with the shape of the spine.
Michael Bohl: 12:28
So generally speaking, I think spine deformity is really the umbrella term that refers to any problem with the spine's shape. And then scoliosis is the term we use to talk about the shape of the spine when viewed directly from the front or from the back.
Sanjiv Lakhia: 12:46
In the pediatric population, why are we concerned about scoliosis in general? So what are some of the things or problems that can develop if we're not observant of the kids' posture as they develop? Because I know the school districts will check it. And I see a lot of patients where they say, "Yes, my daughter was told she has scoliosis when she was really young." Just in general, why is this relevant? What are some of the things you're looking out for as a physician, as it relates to pediatric scoliosis?
Michael Bohl: 13:20
Yeah. So there are really three major factors that we consider. And these are also revealing of why it's important to monitor this. The first is, is there a curve present? And if so, how severe is it? It's not unusual for people to have small curves. And how big the curve is. And we measure that in angles. So if a normal spine is zero degrees, that means it's perfectly straight. Many people will have 10 degree, 15 degree curves and curves that are that small typically do not cause a problem. Obviously, a very severe curve is very different. A 90 degree curve is visibly deforming. Anybody walking on the street would notice that kind of spine deformity, spine curve. And so the severity of the curve is something that matters not only for visual aesthetics, but also because in children, we know that once you reach a certain severity of curvature, that curve is much more likely to progress and get worse into adulthood.
Michael Bohl: 14:25
And that's actually, the second important point is whether or not a scoliotic curve is getting worse over time, or whether or not it's stable. Curves that are stable, meaning they don't change, they stay the same degrees over time are a lot less worrisome than curves that get worse and worse and worse with time. Curves that are progressive and we typically keep a closer eye on and the most common type of pediatric scoliosis, which would be idiopathic scoliosis, a type that school districts screen for, and that teenagers typically find out they have. When teenagers have a scoliotic curve that is getting worse with time and they have a lot of growing left to do, we'll typically put them in braces to try and control the growth of that curve because once it reaches a certain severity, we know that the curve is much more likely to continue getting worse into adulthood, which then typically requires surgical treatment so that it doesn't become a debilitating and/or visibly deforming spine problem.
Michael Bohl: 15:34
And then the third issue is whether or not the spine deformity is causing any symptoms. Most often idiopathic scoliosis in teenagers is not symptomatic, but sometimes it is. And especially progressive curves that continue getting worse into adulthood, those can certainly become symptomatic. And there are a large number of other spine deformities that children can get that are certainly symptomatic.
Michael Bohl: 16:02
And so how severe a curve is, if the curve is getting worse over time, and if the curve is causing symptoms, whether those symptoms are pain, visible deformity, or neurological symptoms, difficulty with walking, difficulty with bowel or bladder function, nerve pain, those types of things, those are all symptoms that we consider when trying to decide how best to treat any given scoliosis. And the goal of treatment is always to keep a curve from getting worse, keep it as small as possible, keep it from getting worse, and keep it from becoming symptomatic through the most minimally invasive means possible. And so things like bracing and physical therapy and nonsurgical methods to try and control curves are always the first, second and third choice for treating these conditions with surgery, being there and being a good choice, but always being the last choice for only the most problematic curves.
Sanjiv Lakhia: 17:07
Okay, let me unpack that a little bit. You just went through quite a bit of stuff there. So let's talk about it from like a case. Okay? So let's say a mom brings in her, let's say 13 or 14 year old daughter. They've noticed a curve and she's having a little bit of back pain and you get some initial x-rays. Here's the questions that I get that I just want to present to you and get your thoughts on. Number one, parents want to know, do braces work. Number two, how often do I need to check her curve? Number three, when is this going to stop getting worse? Does it correlate with adolescence, puberty, hormonal changes? So these are the things that I think are on people's minds that I'd love to get your opinion on.
Michael Bohl: 17:51
One of the most important factors in all of this is how much growing a patient has left to do. We can make an estimation of that based on some simple history. Are they growing actively? How tall are the parents? Simple questions like that. We can also look at growth plates on x-rays. If a patient has all their growth plates are closed, then we know they've reached what we call skeletal maturity, which means their skeleton, their bones have stopped growing. And there are a number of ways to measure how open or closed growth plates are to determine how much growing somebody has left to do. So that's one major factor is, are somebody's growth plates still open because if they are, scoliotic curves tend to get the worst during periods of active growth. And so it's important to know that.
Michael Bohl: 18:43
The next thing that I would typically talk about with the parents is how severe is the curve? We know from a lot of studies going back decades, that scoliotic curves that are anywhere from 10 to 20, 25 degrees at the time of skeletal maturity finishes growing, and they have a curve that's 10 to 25 degrees. Those curves almost never become a problem later into adulthood. Curves that are at 50 degrees or more at the time of skeletal maturity, those have a very much higher risk of becoming a problem later into adulthood. And then curves that are between roughly 20, 25 degrees and 50 degrees, that's the gray zone.
Michael Bohl: 19:31
And so if a 13-year-old patient who still has a lot of growing left to do comes in with a 30 degree curve, we have an opportunity at that point to try and control that curve during that patient's growth and keep her from reaching this 45 to 55 degree range, where we know that she's much more likely to have problems further into adulthood with a progressively worsening and progressively more and more symptomatic curve. And so typically what we do for those patients is bracing. And some of the best data that we have in the entire field of spine surgery is in support of bracing for adolescent scoliosis. Very high quality data, level one data has shown that bracing works. Not only does bracing work, but the more you wear a brace, the more it works.
Michael Bohl: 20:27
And so the goal with bracing is to stabilize the curve, keep it from getting worse through a child's period of active growth of skeletal growth. With as much certainty as we know anything in medicine, we know that braces work. Curves that are in that 20 to 50 degree range in kids who are still growing, that's where braces are really their most useful. Then again, the goal is to get them through their growth curve, to get them to skeletal maturity with a curve that's less than roughly 50 degrees.
Sanjiv Lakhia: 21:05
Perfect. So, that really clears up a big question that I get about the braces. One question also, that really pops into my mind here is, does earlier intervention help? Like the earlier you can identify the issue and get bracing started, does that lead to better outcomes?
Michael Bohl: 21:21
It certainly does. Most curves, by the time we see them are usually beyond that 20 degree range. But if you can find a curve early or when it's smaller and start treating it earlier, you have a much, much better chance of getting that child through their growth with a smaller curve. So time definitely does matter.
Sanjiv Lakhia: 21:44
And what are we talking about here in terms of the brace? Someone comes into you with, let's say a 20 degree curve, how often, and how long do they have to wear that brace for?
Michael Bohl: 21:55
Braces are not fun. I certainly understand not wanting to wear a brace. The data's pretty clear though, that braces work. They work better the more they're worn. In most of the studies, including the most powered studies, there was a direct correlation with the number of hours a day that the brace was worn and the probability of that patient avoiding the need for surgery, for treatment of their scoliosis.
Michael Bohl: 22:25
So as close as you can get to 24 hours a day, you want to wear the brace. I know that that's difficult to do. Not everybody can do that. Most people will try and shoot for 16 hours a day, taking it off to sleep. The bracing plan is really something that gets actively worked on and managed with both your spine surgeon, as well as an orthotist, the person who is going to be making the custom braces for you and for your child or for your patient.
Michael Bohl: 22:56
How frequently a patient needs a brace changed, how frequently they need to have it monitored really depends on whether or not their curve is progressing while they're in the brace. So initially, a rapidly progressive curve, you might check every three to six months, but if it seems like it's stable in the brace, then you may start to space that out to every six to 12 months. And then the braces are custom-made based on where the patient's curve in their spine is. The goal of the brace is to create contact between the brace and the skin at the apex of the curve, which is uncomfortable and teaches the patient to use their muscles, to pull their curve away from the brace and therefor straighten the spine out. Once the patient grows out of the brace, that focal point of contact with the skin may move. And so they may need a new brace at that time.
Michael Bohl: 23:58
But the way braces work is by creating discomfort when the patient is allowing their spine to curve over to one side, and that discomfort encourages the patients to use their muscles, to pull their spine back into a more straight alignment. That's why for many patients, when they first start wearing a brace, the brace feels exhausting to them because they're using their muscles in a way that they are not used to. And at the end of the day, they're just exhausted. But after some time and getting used to the brace, they build up those muscles and get used to it, which is why the braces work, which is why they're better able to keep their spine straight and avoid the curve from just getting worse and worse.
Sanjiv Lakhia: 24:43
Thank you for that. That's a great explanation of the role of bracing and just understanding about the timing of it and what you're looking out for. But you are a neurosurgeon and I want to get to that side of this equation. So break down for us, what are the indications in the pediatric population for potential surgery to try and address the curvature that's developing?
Michael Bohl: 25:10
So the reasons why we will recommend and go ahead with surgery for scoliosis, all come back to those three major considerations. Curves that are greater than 50 degrees, we know from good historical data are very likely to continue to be a problem and even get worse into adulthood, even after they've finished growing. And so we typically recommend surgery for curves that are severe, greater than 50 degrees.
Michael Bohl: 25:42
In kids who are still growing, if they have a rapidly progressive curve that is continuing to get worse, despite bracing, oftentimes we will try and do smaller, more focused surgeries to try and get the curve to slow down without impeding the child's growth. A lot of pediatric scoliosis surgery has to do with avoiding surgery as long as possible to allow a child to grow and develop as much as they can. Oftentimes once we stabilize a curve with surgery, we risk the spine fusing at those levels, which doesn't permit more growth. And in very young kids that can be problematic if, for example, we're treating their thoracic spine and their thoracic spine is unable to grow, their lungs and heart and things like that may not develop entirely. And so we want to avoid that at all costs.
Michael Bohl: 26:46
But if a curve just keeps getting worse and worse, despite all of our best attempts, sometimes we need to try and do smaller surgeries to get the curve to stop getting worse while still trying to permit growth in the patient. And so sometimes we'll see patients who have just a few levels treated along their spine, or they'll have what's called tethering done from the side through the chest, for example. Those are typically temporizing surgical procedures done to try and slow down or halt the progression of a curve until that child stops growing. And then they're typically converted into a larger scoliosis correction at that time.
Sanjiv Lakhia: 27:32
What's a typical rehab period look like? I'm sure it's variable, depending on how aggressive you have to be with the surgery, but is this something that takes kids out of school for an entire year or a few months, or what's the recovery time?
Michael Bohl: 27:45
It very much depends on the type of surgery. You're right. But if we just consider kind of the average teenager with the average scoliosis, I'd say that you should expect anywhere from two to five days in the hospital after surgery. And then probably about six weeks of feeling like you just had surgery. The first week is certainly the roughest. And then by the sixth week, people are starting to feel a lot better, but for those first six weeks, people are still actively recovering from surgery. Usually between six and 12 weeks, people are starting to get eager to get back to all their regular activities. And so typically around eight to 12 weeks, we will start postoperative physical therapy to start rebuilding and re-stretching the muscles around the spine that are now in their new position after surgery. And once physical therapy is done, people are typically feeling very good again, feeling like themselves and resuming all their normal activities.
Michael Bohl: 28:52
And so that whole process that I just went through typically takes about three months. It doesn't necessarily mean that if you have the surgery over winter break, for example, that you need to be out of school for three months, but it's safe to say that you should at least give yourself six, if not a full 12 weeks of time off from your regular activities.
Sanjiv Lakhia: 29:16
That's a great way to describe it and really just be transparent about it, that these surgeries aren't easy.
Michael Bohl: 29:23
No, these are big surgeries for sure.
Sanjiv Lakhia: 29:26
Yeah. But what's very exciting about it is you have the opportunity to affect an individual's life and give that person the rest of their lives, kind of a second opportunity. And that's a little bit different than with some of the adult interventions and adult degenerative care that we do that makes the pediatric work that you are doing so exciting, at least from my perspective.
Michael Bohl: 29:51
Yeah, no, I couldn't agree more. It is very, very different from adults. There's no question. And in large part it's because we're actively trying to prevent problems that we know are very likely to happen in the future. We know that if things come to surgery and we try very hard to keep them from that, but if they do surgery works very well. And so that's what I typically will remind people of is that, of course we want to do everything we can to avoid getting to the point where we need surgery, but also keep in mind that surgery is a good option and that it works.
Michael Bohl: 30:27
The nice thing about all of these conditions is that there are treatment options for them, and there are non-surgical treatment options. And if those don't work, or if things are moving quicker than we're comfortable with, then there are surgical treatment options. And for the most part surgery in recent years, recent decades even has gotten tremendously better and safer than it ever was in the past. As time goes on, this is certainly one of those fields where we continue to get better at what we're doing certainly today, much more so than just 20 years ago even. Surgical outcomes are much better. And we know a lot more about how to do these and how to make them successful.
Sanjiv Lakhia: 31:13
Well, that's great. I think I'll leave it there on a positive note. Before I let you go, though, I definitely want to pick your brain. I mean, I'm talking here to a Marine, a dedicated neurosurgeon, a family man. What are going to be your health hacks that are going to be in your upcoming book and memoir? I want to own a preview right now. What is your routine that keeps you healthy, keeps your mind clear and focused?
Michael Bohl: 31:40
I have always used running as my way to relax. I've been running sometimes competitively, but in recent years, really just for the relaxation and mental benefit. I get a lot of benefit from it. And I just love doing it. And I plan to do it for as long as I can. One of the things that I continue to learn as time goes on and as my kids get older, is for me, it's important to remember to have fun. It's important to remember that although making strong goals and being driven are very important, it's also very important to enjoy your day. Do the things that make you happy. Don't forget to have fun along the way, because what else are we doing all this for, if not to enjoy our time, right?
Sanjiv Lakhia: 32:33
Absolutely. I couldn't say it better myself. But folks, right there, that just illustrates the difference between a neurosurgeon and a physiatrist. Michael wants to run to relax. I'll take a weekend at the Grove Park Inn Spa myself and come out the other side feeling much better. So there you go. There you go.
Michael Bohl: 32:55
We'll go for a run first and then go to the spa. That's a good day.
Sanjiv Lakhia: 33:00
All right, my friend, I appreciate your time. This was a really great interview for me personally, just to get to know more about you, understand your approach to how you deal with these problems. I'm sure that the families that are going to listen to this episode are going to get a tremendous amount of value from it. And I look forward to hearing, seeing, reading great things about your career as you develop in the Charlotte area. So thank you for your time.
Michael Bohl: 33:24
Thank you so much. I really enjoyed it. And thank you for the opportunity.
Outro: 33:30
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
This podcast is sponsored by our partner, QxMD. QxMD builds mobile solutions that drive evidence-based medicine in clinical practice. Check out Read for easy access to research, personalized for you and calculate for over 500 easy to use decision support tools. Try them today at qxmd.com/apps. Again, that is qxmd.com/apps.
Intro: 00:30
Welcome, you're listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 01:04
Several episodes ago, I had the pleasure of interviewing my partner, Dr. Matt McGirt on the topic of adult spinal deformity. And it was a really good episode. I learned a lot personally and I received great feedback from the community about the episode. So today I'm really excited to follow up that episode with an interview with one of our new partners at Carolina Neurosurgery and Spine Associates, Dr. Michael Bohl. And Michael's going to take us through somewhat of a similar topic, and that is scoliosis and spinal deformity, but we're going to look at it through the lens, more of a pediatric perspective. And I know there's a lot of parents who listen to our show and are going to be interested to hear what Dr. Bohl has to say.
Sanjiv Lakhia: 01:49
Michael, welcome to the show today.
Michael Bohl: 01:51
Thank you very much. Thank you for having me. This is a wonderful program you're putting on and I'm real excited to have the opportunity to join you today.
Sanjiv Lakhia: 01:59
Michael comes to us through a residency program at Barrow Neurological Institute and he's fellowship-trained in orthopedic spinal deformity through Virginia Mason Medical Center. And you did medical school at University of Michigan, is that correct?
Michael Bohl: 02:16
Yeah, that's correct. I spent four years at the University of Michigan from 2009 to '13.
Sanjiv Lakhia: 02:22
Yeah. I'm not sure how you slipped through the recruiting process for our group, given that we do have several docs who are from Ohio. But I think it's to our benefit. And I want you to go ahead and introduce yourself a little bit to the people who are listing and the local Charlotte community as well. A little background. I think you've got a pretty unique background with your military service, but I want to let you articulate kind of how you came into the field of medicine and neurosurgery and what your military background kind of meant to you in your development.
Michael Bohl: 02:58
Yeah. Yeah, absolutely. I graduated from high school in the year 2000 and I never had any ideas at that time that I was going to end up in medicine. I ended up enlisting in the Marine Corps and left for my first day of bootcamp early in the morning, around 4:00 AM on September 11th of 2001. And just as I was swearing in and getting ready to go get on an airplane to go to Paris Island, the news reports of the terrorist attacks that day started showing up on the news. I knew from day one that my four year enlistment was going to be, I was going to have more life experiences than I had originally anticipated.
Michael Bohl: 03:39
I spent my four years in bootcamp and then later the school of infantry. I passed a screening to get into the Marine Reconnaissance Program and spent my four years from 2001 to 2005 as a Reconnaissance Marine. And on one of my deployments to Iraq, we stopped in East Africa where we did a few humanitarian aid missions and those missions felt tremendously meaningful to me. They impacted me a great deal and I think initiated a thought process and some insight that eventually led me to decide that when my enlistment ended, I was going to go back to East Africa and volunteer as a nurse's aid in a health clinic to figure out whether or not a career or some kind of job, I didn't know what, but something in healthcare, whether or not that was right for me, whether it was something I wanted to do or not because I suspected that I would enjoy it based on those humanitarian aid missions.
Michael Bohl: 04:43
So in 2005, my enlistment ended, I got honorably discharged and then immediately traveled back over to East Africa and spent several months working as a nurses aid and really loved it. I knew Swahili. I had learned Swahili while I was in the military. And that opened a lot of doors for me while I was there, including an opportunity to shadow a surgeon from New Zealand for a little while. And so it was while I was volunteering in East Africa that I was first introduced to the field of surgery. The first surgery I saw was in Tanzania. It was a C-section child delivery. I was really captivated by it. Not only was I loving just working as a healthcare provider, but spending time with this surgeon really kind of brought into focus more clearly, maybe what I wanted to do.
Michael Bohl: 05:37
So when I came home from East Africa, I went to college to get my undergraduate degree, not thinking medical school necessarily, but ended up doing really well in school. Got into medical school at the University of Michigan, met my wife while I was in college and went with her to nursing school in Rochester, New York. And then when she was finished with that, she came to the University of Michigan with me for medical school, where we started our family. And then it was in medical school that I found the field of neurosurgery. And again was just really blown away by the tremendous positive impact that the neurosurgeons I was working with were able to have on their patients' lives. I really loved that and was captivated by that.
Michael Bohl: 06:24
After medical school, I matched into the Neurosurgery Residency program at the Barrow Neurological Institute where I found the field of spinal deformity surgery and had the good fortune of working with several complex spine deformity surgeons who did training in both fields of neurosurgery and orthopedic surgery. And they encouraged me to do the same. During my residency, I sought out fellowship experiences with orthopedic surgeons and they were absolutely right. I think that as a spine surgeon who focuses primarily on spine deformities and complex spine conditions, it's really important to be comfortable with both skill sets.
Michael Bohl: 07:08
And so now I'm here, I feel tremendously lucky and honored to have this job here, where I'm focusing on adult and pediatric spine deformities and complex spine conditions. And it's been just absolutely fantastic so far.I'm convinced that I've got the world's greatest partners. Not only are they phenomenal surgeons, but they're phenomenal people. And me and my family just feel so fortunate to be here and be part of this group.
Sanjiv Lakhia: 07:36
What was it about the humanitarian work that struck a cord with you?
Michael Bohl: 07:42
I think to put it plainly, my job in the military was I was a Reconnaissance Marine, which is a specialized infantry job. And I did two combat deployments, both to Iraq. Those are fighting jobs and those experiences are very, very starkly contrast against what we were doing just several weeks after leaving, which was spending time at an orphanage, helping take care of children, delivering medical supplies to hospitals. And I think for me, the stark contrast between those experiences as a young man, I was 19, 20 years old at the time, they really brought into focus for me, the kind of impact I wanted to have on the people around me and what kind of job I wanted to have for the rest of my life moving forward.
Michael Bohl: 08:34
I started to look at healthcare as a potential career where I could positively impact people around me and try and give something back. It's not that I don't think we were doing good in Iraq. I think we certainly were. It was just through very different means. The humanitarian aid just struck a very different cord with me and made me feel like what I was doing was tremendously meaningful and impactful. And I wanted to find a job that enabled me to feel that way regularly.
Sanjiv Lakhia: 09:08
Yeah. That's actually the word that comes to my mind is what an impactful life event for you and how it's shaped you. And we're all blessed to have you in our community. And it does sound like you've upgraded from the cold weather of Michigan in Rochester, and you guys must love the Carolinas right now.
Michael Bohl: 09:26
We do. Yeah, it's funny, when I came home from my second deployment to Iraq, I told myself that I never needed to live in the desert again. And so inevitably, I imagine to a seven-year program in Phoenix, Arizona-
Sanjiv Lakhia: 09:40
Right.
Michael Bohl: 09:41
... that program was fantastic. It was really wonderful. But after seven more years in the desert, we're more than happy to be in the Charlotte climate. No question. My kids are getting to see seasons for the first time. And it's fantastic.
Sanjiv Lakhia: 09:55
Yeah. That's got to be great. All right. Let's jump into the topic today for those that are really interested in getting this information. One of the things I wanted to clear up as we get started is this idea of the terminology. Can you kind of clarify if there's a difference between the words scoliosis versus spinal deformity and kind of what those words mean?
Michael Bohl: 10:17
Yeah, absolutely. So yeah, a lot of these words get used interchangeably. The way I think about it and I think the way it gets used most often is that spinal deformity is very much an umbrella term that encompasses any condition where the shape of the spine is leading to some problem, some functional problem, pain problem, some neurological problem. And there are a lot of different types of shape problems that a spine can have. And one type is scoliosis. When we talk about scoliosis, most of us are talking about an abnormal curve in the spine when viewed from the front. So if you're looking at a normally-shaped spine from the front, it typically looks straight up and down, but sometimes the spine will look curved. Either there will be a C-shaped curve or an S-shaped curve, or even several S-shaped curves in the spine. And that is typically what we refer to as scoliosis.
Michael Bohl: 11:22
There are also problems with the shape of the spine when viewed from the side. And we have different terms for those. Kyphosis is too much forward angulation of the spine. Lordosis is backwards angulation of the spine. And the normal spine has lordosis and kyphosis in certain parts of it, but sometimes those curvatures when seen from the side are either excessive and lead to functional problems, or they're too little and that leads to functional problems.
Michael Bohl: 11:55
And then when we're talking about pediatric spine deformity, there are also congenital problems, bones in the spine that aren't supposed to be there, bones in the spine that don't fully form. And those can lead to misshapen spines as well, which are broadly defined as spine deformities. And they themselves can then lead to scoliosis or exaggerated kyphosis or hypokyphosis, any number of different problems with the shape of the spine.
Michael Bohl: 12:28
So generally speaking, I think spine deformity is really the umbrella term that refers to any problem with the spine's shape. And then scoliosis is the term we use to talk about the shape of the spine when viewed directly from the front or from the back.
Sanjiv Lakhia: 12:46
In the pediatric population, why are we concerned about scoliosis in general? So what are some of the things or problems that can develop if we're not observant of the kids' posture as they develop? Because I know the school districts will check it. And I see a lot of patients where they say, "Yes, my daughter was told she has scoliosis when she was really young." Just in general, why is this relevant? What are some of the things you're looking out for as a physician, as it relates to pediatric scoliosis?
Michael Bohl: 13:20
Yeah. So there are really three major factors that we consider. And these are also revealing of why it's important to monitor this. The first is, is there a curve present? And if so, how severe is it? It's not unusual for people to have small curves. And how big the curve is. And we measure that in angles. So if a normal spine is zero degrees, that means it's perfectly straight. Many people will have 10 degree, 15 degree curves and curves that are that small typically do not cause a problem. Obviously, a very severe curve is very different. A 90 degree curve is visibly deforming. Anybody walking on the street would notice that kind of spine deformity, spine curve. And so the severity of the curve is something that matters not only for visual aesthetics, but also because in children, we know that once you reach a certain severity of curvature, that curve is much more likely to progress and get worse into adulthood.
Michael Bohl: 14:25
And that's actually, the second important point is whether or not a scoliotic curve is getting worse over time, or whether or not it's stable. Curves that are stable, meaning they don't change, they stay the same degrees over time are a lot less worrisome than curves that get worse and worse and worse with time. Curves that are progressive and we typically keep a closer eye on and the most common type of pediatric scoliosis, which would be idiopathic scoliosis, a type that school districts screen for, and that teenagers typically find out they have. When teenagers have a scoliotic curve that is getting worse with time and they have a lot of growing left to do, we'll typically put them in braces to try and control the growth of that curve because once it reaches a certain severity, we know that the curve is much more likely to continue getting worse into adulthood, which then typically requires surgical treatment so that it doesn't become a debilitating and/or visibly deforming spine problem.
Michael Bohl: 15:34
And then the third issue is whether or not the spine deformity is causing any symptoms. Most often idiopathic scoliosis in teenagers is not symptomatic, but sometimes it is. And especially progressive curves that continue getting worse into adulthood, those can certainly become symptomatic. And there are a large number of other spine deformities that children can get that are certainly symptomatic.
Michael Bohl: 16:02
And so how severe a curve is, if the curve is getting worse over time, and if the curve is causing symptoms, whether those symptoms are pain, visible deformity, or neurological symptoms, difficulty with walking, difficulty with bowel or bladder function, nerve pain, those types of things, those are all symptoms that we consider when trying to decide how best to treat any given scoliosis. And the goal of treatment is always to keep a curve from getting worse, keep it as small as possible, keep it from getting worse, and keep it from becoming symptomatic through the most minimally invasive means possible. And so things like bracing and physical therapy and nonsurgical methods to try and control curves are always the first, second and third choice for treating these conditions with surgery, being there and being a good choice, but always being the last choice for only the most problematic curves.
Sanjiv Lakhia: 17:07
Okay, let me unpack that a little bit. You just went through quite a bit of stuff there. So let's talk about it from like a case. Okay? So let's say a mom brings in her, let's say 13 or 14 year old daughter. They've noticed a curve and she's having a little bit of back pain and you get some initial x-rays. Here's the questions that I get that I just want to present to you and get your thoughts on. Number one, parents want to know, do braces work. Number two, how often do I need to check her curve? Number three, when is this going to stop getting worse? Does it correlate with adolescence, puberty, hormonal changes? So these are the things that I think are on people's minds that I'd love to get your opinion on.
Michael Bohl: 17:51
One of the most important factors in all of this is how much growing a patient has left to do. We can make an estimation of that based on some simple history. Are they growing actively? How tall are the parents? Simple questions like that. We can also look at growth plates on x-rays. If a patient has all their growth plates are closed, then we know they've reached what we call skeletal maturity, which means their skeleton, their bones have stopped growing. And there are a number of ways to measure how open or closed growth plates are to determine how much growing somebody has left to do. So that's one major factor is, are somebody's growth plates still open because if they are, scoliotic curves tend to get the worst during periods of active growth. And so it's important to know that.
Michael Bohl: 18:43
The next thing that I would typically talk about with the parents is how severe is the curve? We know from a lot of studies going back decades, that scoliotic curves that are anywhere from 10 to 20, 25 degrees at the time of skeletal maturity finishes growing, and they have a curve that's 10 to 25 degrees. Those curves almost never become a problem later into adulthood. Curves that are at 50 degrees or more at the time of skeletal maturity, those have a very much higher risk of becoming a problem later into adulthood. And then curves that are between roughly 20, 25 degrees and 50 degrees, that's the gray zone.
Michael Bohl: 19:31
And so if a 13-year-old patient who still has a lot of growing left to do comes in with a 30 degree curve, we have an opportunity at that point to try and control that curve during that patient's growth and keep her from reaching this 45 to 55 degree range, where we know that she's much more likely to have problems further into adulthood with a progressively worsening and progressively more and more symptomatic curve. And so typically what we do for those patients is bracing. And some of the best data that we have in the entire field of spine surgery is in support of bracing for adolescent scoliosis. Very high quality data, level one data has shown that bracing works. Not only does bracing work, but the more you wear a brace, the more it works.
Michael Bohl: 20:27
And so the goal with bracing is to stabilize the curve, keep it from getting worse through a child's period of active growth of skeletal growth. With as much certainty as we know anything in medicine, we know that braces work. Curves that are in that 20 to 50 degree range in kids who are still growing, that's where braces are really their most useful. Then again, the goal is to get them through their growth curve, to get them to skeletal maturity with a curve that's less than roughly 50 degrees.
Sanjiv Lakhia: 21:05
Perfect. So, that really clears up a big question that I get about the braces. One question also, that really pops into my mind here is, does earlier intervention help? Like the earlier you can identify the issue and get bracing started, does that lead to better outcomes?
Michael Bohl: 21:21
It certainly does. Most curves, by the time we see them are usually beyond that 20 degree range. But if you can find a curve early or when it's smaller and start treating it earlier, you have a much, much better chance of getting that child through their growth with a smaller curve. So time definitely does matter.
Sanjiv Lakhia: 21:44
And what are we talking about here in terms of the brace? Someone comes into you with, let's say a 20 degree curve, how often, and how long do they have to wear that brace for?
Michael Bohl: 21:55
Braces are not fun. I certainly understand not wanting to wear a brace. The data's pretty clear though, that braces work. They work better the more they're worn. In most of the studies, including the most powered studies, there was a direct correlation with the number of hours a day that the brace was worn and the probability of that patient avoiding the need for surgery, for treatment of their scoliosis.
Michael Bohl: 22:25
So as close as you can get to 24 hours a day, you want to wear the brace. I know that that's difficult to do. Not everybody can do that. Most people will try and shoot for 16 hours a day, taking it off to sleep. The bracing plan is really something that gets actively worked on and managed with both your spine surgeon, as well as an orthotist, the person who is going to be making the custom braces for you and for your child or for your patient.
Michael Bohl: 22:56
How frequently a patient needs a brace changed, how frequently they need to have it monitored really depends on whether or not their curve is progressing while they're in the brace. So initially, a rapidly progressive curve, you might check every three to six months, but if it seems like it's stable in the brace, then you may start to space that out to every six to 12 months. And then the braces are custom-made based on where the patient's curve in their spine is. The goal of the brace is to create contact between the brace and the skin at the apex of the curve, which is uncomfortable and teaches the patient to use their muscles, to pull their curve away from the brace and therefor straighten the spine out. Once the patient grows out of the brace, that focal point of contact with the skin may move. And so they may need a new brace at that time.
Michael Bohl: 23:58
But the way braces work is by creating discomfort when the patient is allowing their spine to curve over to one side, and that discomfort encourages the patients to use their muscles, to pull their spine back into a more straight alignment. That's why for many patients, when they first start wearing a brace, the brace feels exhausting to them because they're using their muscles in a way that they are not used to. And at the end of the day, they're just exhausted. But after some time and getting used to the brace, they build up those muscles and get used to it, which is why the braces work, which is why they're better able to keep their spine straight and avoid the curve from just getting worse and worse.
Sanjiv Lakhia: 24:43
Thank you for that. That's a great explanation of the role of bracing and just understanding about the timing of it and what you're looking out for. But you are a neurosurgeon and I want to get to that side of this equation. So break down for us, what are the indications in the pediatric population for potential surgery to try and address the curvature that's developing?
Michael Bohl: 25:10
So the reasons why we will recommend and go ahead with surgery for scoliosis, all come back to those three major considerations. Curves that are greater than 50 degrees, we know from good historical data are very likely to continue to be a problem and even get worse into adulthood, even after they've finished growing. And so we typically recommend surgery for curves that are severe, greater than 50 degrees.
Michael Bohl: 25:42
In kids who are still growing, if they have a rapidly progressive curve that is continuing to get worse, despite bracing, oftentimes we will try and do smaller, more focused surgeries to try and get the curve to slow down without impeding the child's growth. A lot of pediatric scoliosis surgery has to do with avoiding surgery as long as possible to allow a child to grow and develop as much as they can. Oftentimes once we stabilize a curve with surgery, we risk the spine fusing at those levels, which doesn't permit more growth. And in very young kids that can be problematic if, for example, we're treating their thoracic spine and their thoracic spine is unable to grow, their lungs and heart and things like that may not develop entirely. And so we want to avoid that at all costs.
Michael Bohl: 26:46
But if a curve just keeps getting worse and worse, despite all of our best attempts, sometimes we need to try and do smaller surgeries to get the curve to stop getting worse while still trying to permit growth in the patient. And so sometimes we'll see patients who have just a few levels treated along their spine, or they'll have what's called tethering done from the side through the chest, for example. Those are typically temporizing surgical procedures done to try and slow down or halt the progression of a curve until that child stops growing. And then they're typically converted into a larger scoliosis correction at that time.
Sanjiv Lakhia: 27:32
What's a typical rehab period look like? I'm sure it's variable, depending on how aggressive you have to be with the surgery, but is this something that takes kids out of school for an entire year or a few months, or what's the recovery time?
Michael Bohl: 27:45
It very much depends on the type of surgery. You're right. But if we just consider kind of the average teenager with the average scoliosis, I'd say that you should expect anywhere from two to five days in the hospital after surgery. And then probably about six weeks of feeling like you just had surgery. The first week is certainly the roughest. And then by the sixth week, people are starting to feel a lot better, but for those first six weeks, people are still actively recovering from surgery. Usually between six and 12 weeks, people are starting to get eager to get back to all their regular activities. And so typically around eight to 12 weeks, we will start postoperative physical therapy to start rebuilding and re-stretching the muscles around the spine that are now in their new position after surgery. And once physical therapy is done, people are typically feeling very good again, feeling like themselves and resuming all their normal activities.
Michael Bohl: 28:52
And so that whole process that I just went through typically takes about three months. It doesn't necessarily mean that if you have the surgery over winter break, for example, that you need to be out of school for three months, but it's safe to say that you should at least give yourself six, if not a full 12 weeks of time off from your regular activities.
Sanjiv Lakhia: 29:16
That's a great way to describe it and really just be transparent about it, that these surgeries aren't easy.
Michael Bohl: 29:23
No, these are big surgeries for sure.
Sanjiv Lakhia: 29:26
Yeah. But what's very exciting about it is you have the opportunity to affect an individual's life and give that person the rest of their lives, kind of a second opportunity. And that's a little bit different than with some of the adult interventions and adult degenerative care that we do that makes the pediatric work that you are doing so exciting, at least from my perspective.
Michael Bohl: 29:51
Yeah, no, I couldn't agree more. It is very, very different from adults. There's no question. And in large part it's because we're actively trying to prevent problems that we know are very likely to happen in the future. We know that if things come to surgery and we try very hard to keep them from that, but if they do surgery works very well. And so that's what I typically will remind people of is that, of course we want to do everything we can to avoid getting to the point where we need surgery, but also keep in mind that surgery is a good option and that it works.
Michael Bohl: 30:27
The nice thing about all of these conditions is that there are treatment options for them, and there are non-surgical treatment options. And if those don't work, or if things are moving quicker than we're comfortable with, then there are surgical treatment options. And for the most part surgery in recent years, recent decades even has gotten tremendously better and safer than it ever was in the past. As time goes on, this is certainly one of those fields where we continue to get better at what we're doing certainly today, much more so than just 20 years ago even. Surgical outcomes are much better. And we know a lot more about how to do these and how to make them successful.
Sanjiv Lakhia: 31:13
Well, that's great. I think I'll leave it there on a positive note. Before I let you go, though, I definitely want to pick your brain. I mean, I'm talking here to a Marine, a dedicated neurosurgeon, a family man. What are going to be your health hacks that are going to be in your upcoming book and memoir? I want to own a preview right now. What is your routine that keeps you healthy, keeps your mind clear and focused?
Michael Bohl: 31:40
I have always used running as my way to relax. I've been running sometimes competitively, but in recent years, really just for the relaxation and mental benefit. I get a lot of benefit from it. And I just love doing it. And I plan to do it for as long as I can. One of the things that I continue to learn as time goes on and as my kids get older, is for me, it's important to remember to have fun. It's important to remember that although making strong goals and being driven are very important, it's also very important to enjoy your day. Do the things that make you happy. Don't forget to have fun along the way, because what else are we doing all this for, if not to enjoy our time, right?
Sanjiv Lakhia: 32:33
Absolutely. I couldn't say it better myself. But folks, right there, that just illustrates the difference between a neurosurgeon and a physiatrist. Michael wants to run to relax. I'll take a weekend at the Grove Park Inn Spa myself and come out the other side feeling much better. So there you go. There you go.
Michael Bohl: 32:55
We'll go for a run first and then go to the spa. That's a good day.
Sanjiv Lakhia: 33:00
All right, my friend, I appreciate your time. This was a really great interview for me personally, just to get to know more about you, understand your approach to how you deal with these problems. I'm sure that the families that are going to listen to this episode are going to get a tremendous amount of value from it. And I look forward to hearing, seeing, reading great things about your career as you develop in the Charlotte area. So thank you for your time.
Michael Bohl: 33:24
Thank you so much. I really enjoyed it. And thank you for the opportunity.
Outro: 33:30
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
