Our backs are in bad shape. And not getting better. According to the Centers
for Disease Control (CDC), each year 28.1% of the adult population—
almost 70 million people—reports experiencing low back pain. That
rate increases to 32.1% of Americans aged 45 to 64. And despite better
education about core strength and how to lift heavy objects, rates across
age ranges have remained constant since 1997.
“From my perspective, the back is just a weak link in our anatomy,”
says Tiffany Rogers, MD, an orthopedic surgeon with the Torrance Memorial
Physician Network. “Nearly everyone has had a back or neck problem
at some point in their lives. What’s changed,” she notes,
“is that our ability to diagnose, treat and surgically repair these
problems has advanced dramatically in the past 50 years.”
Dr. Rogers’ mother had back surgery about 55 years ago, “and
she was bedbound for six months,” Dr. Rogers recalls. “She
had to be turned with a sheet because she had a fusion procedure. Back
casts and confinement were attempts to get the bones to grow and fuse.
Now we can put supports inside. She actually healed and did well, but
I could have done the procedure in less than an hour, and she would have
gone home the next day. Our advanced technology is phenomenal.”
Together with the other orthopedic surgeons of the Torrance Memorial Physician
Network, Dr. Rogers will be safeguarding Torrance Memorial’s place
at the forefront of orthopedic care in Los Angeles and the South Bay in
particular. “I’m really excited to be offering something this
special to our community,” Dr. Rogers says. “With a state-of-the-art
orthopedic and spine center right here in the South Bay, no one will need
to travel to get the care they need.
“I’ve enjoyed all the aspects of private practice, but working
within this network I have an opportunity to be part of something bigger:
that’s Torrance Memorial, which has top-notch surgical, nursing
and patient care services from those involved at all levels of care.”
THE EVOLUTION OF SPINE CARE
Surgeon Randy O’Hara, MD, is a colleague of Dr. Rogers, specializing
in the spine, and was born and raised in the South Bay. He has been practicing
here for 23 years, and also has seen tremendous growth in what he says
is less invasive spine surgery. “Our goal is to accomplish fusion,
disc replacement and other procedures with less trauma to the tissues.
And we focus on getting the patient out of bed and into rehab much sooner.
There’s a real team effort between the doctor, the nurse, the physical
therapist and pain control after surgery. Occupational therapy is crucial,
too, working on simple everyday living—you have to make sure the
patient is ready for that.
Artificial disc technology is another innovation Dr. O’Hara finds
promising: “The discs are made of materials like titanium and polyethylene,
and the idea is to stabilize the area but allow motion, as a way to prevent
degeneration, which can happen with a fusion.” One of the things
“everyone is talking about” is stem cell therapy for spinal
injuries, “but it’s not yet evidence-based,” Dr. O’Hara notes.
“The joint program at Torrance Memorial has gone very well,”
he adds, “And we’re working together to establish specific
protocols for all orthopedic surgery, to make everything go more smoothly.
That kind of coordination and organization is better for the patient.”
A SYSTEMATIC IMPROVEMENT IN CARE
Orthopedic surgeon Keri Zickuhr, MD, welcomes what she views as the future
of health care: system-wide efficiency and standardization of care using
fact-based approaches. The joint replacement unit at Torrance Memorial
is already the fourth busiest in Los Angeles County, and Dr. Zickuhr,
who specializes in foot and ankles, sees this systematic uniformity as
essential under the auspices of developing a center of excellence. “Better
communication translates to better patient care,” says Dr. Zickuhr.
“When the patient can be treated as a whole person and doctors have
access to direct communication within their network, the patients win.
Torrance Memorial does a great job of supporting physicians and giving
them the tools and resources they need.
“For instance,” Dr. Zickuhr adds, “I had a patient recently
with an ankle fracture who saw a doctor she just didn’t click with.
She came to me to do her surgery, but needed medical clearance quickly.
Our physician network liaison was able to get her in to see a primary
care doctor within 24 hours and we did the surgery right away. Torrance
Memorial focuses on the patient.”
Dr. Zickhur says she became a surgeon because she likes to build things.
“Orthopedic surgery is one of those specialties that can take someone
who is unable to perform because of an injury and improve their situation.
It’s very satisfying to me. I like getting my patients back to what
they like doing the most.”
Excited also about working within the Torrance Memorial Physician Network,
Dr. Zickuhr says, “Our office had a discussion a few years ago,
when we realized it was just a matter of time before we joined a hospital
affiliated physician network or a big 300-person medical group. Torrance
Memorial has always been such a great hospital and close ally, it was
a natural move to work with them.
“What’s important is that patients find doctors who listen
to them and who they trust. Our orthopedic surgeons, spine surgeons, sports
surgeons, are all at the cutting edge of technology,” Dr. Zickuhr
continues. “For example the technology for ankle replacements is
getting better every year, and we aren’t sitting on our laurels
just watching. We are doing everything we can to stay ahead and keep our
FOCUS ON CARE
Stephen Nuccion, MD, has been practicing orthopedic surgery—with
a focus on sports medicine and shoulder and knee surgery—in the
South Bay since 2003. He definitely has noticed an increase in knee replacements,
arthritis and other overuse conditions and injuries as the population
ages. “People are living longer and staying active over the course
of their lives, which means they develop issues earlier than the previous
generation,” says Dr. Nuccion. “Knee replacements are very
common, especially in our active South Bay population, and patients are
getting them earlier. With shoulders it happens later in life.”
Like other Torrance Memorial orthopedic surgeons, Dr. Nuccion is a big
believer in physical therapy and other exercise modalities to preserve
or protect a joint. “The trend I see is certainly toward prevention
of surgery and to maintain good outcomes after surgery.”
Indeed, in addition to the systematic pain management protocol, the Torrance
Memorial orthopedic department has also adopted a pre- and post-operative
program. “Many surgical outcomes can be improved if a patient restores
motion and maintains strength before the procedure,” Dr. Nuccion
says. “So a pre-op routine that doesn’t aggravate but supports
the joint is often prescribed. Usually a physical therapist will guide
the program and demonstrate the exercises so the patient can do them on
their own. The idea is to be preemptive,” he adds. “The stronger
you are going in, the stronger you are coming out.”
Surgical procedures have evolved as well, Dr. Nuccion says. “Probably
the biggest change has been the minimally invasive surgeries for joint
and tissue replacements.” Also he adds that the department doctors
are starting to use growth factors such as platelet-rich plasma (PRP)
injections, which are prepared using patient’s own blood. The platelets
are filtered, then injected, releasing growth factors that increase repair
and speed healing. “PRP can be appropriate for certain types of
surgeries when we need to stimulate the healing response—such as
for a ligament graft—and can even be used to avoid surgery. I’ve
seen [the procedure] be successful for rotator cuff tears and arthritic
knees. If we can stimulate healing, restore function and minimize intervention,
it’s a win-win for everyone.”
“Torrance Memorial is so far-reaching in its plan for the future,”
Dr. Nuccion adds. “It’s committed to providing a stable base
of health care for the community. I’m grateful to be a part of this
THE NOT-CUTTING EDGE
Ironically while most of the doctors who make up the Torrance Memorial
orthopedic team are
surgeons, they don’t consider surgery their main mission. “The
vast majority of people I see do not need surgery,” says Tiffany
Rogers, MD, “Just about 1 in 100. The other 99 need the right diagnosis
and management of their condition, which means physical therapy, activity
modification, core strengthening, sometimes weight loss and tips on how
to avoid making it flare up again.”
Much of what Dr. Rogers counsels stems from her master’s degree in
physical therapy and also from her life. While she was an all-American
basketball player at the University of Utah, she herniated a disc. “My
doctor didn’t send me to physical therapy. I suffered off and on
for years, and every time I tried to play, my back would go out. I ended
up going to PT school and learned how to treat it with certain exercises
and habits. My experience really gave me the insight to understand from
the patient’s perspective. Accepting limitations is no fun.”
Dr. Rogers’ physician assistant (“my sidekick”) Jeff
Satterfield, PA-C, shares her background in PT, and has worked in PT and
rehab for 10 years.
“My focus is educating patients and training them to take care of
themselves,” Satterfield says. “Most do not need surgery.
But those who do often have a fear of spinal surgery. There has been lots
of negative feedback from older surgical techniques. I help patients who
need surgery not be so afraid of the ‘s’ word. With our new
techniques and high-powered microscopes we can do a lot, conservatively
and with minimal invasion.” Spinal surgeon Randy O’Hara agrees.
“During surgery we can actually monitor the spinal cord itself,
and if there are any changes, we know and can respond immediately. That
has made surgery much safer.”
BACK ON THE SLOPES
For Palos Verdes real estate developer Paul Mayhack, the road toward surgery
was miles, decades actually, long. “I had back issues for many years,”
he recounts. “One morning I was lying in bed and felt this big sneeze
coming. I held my nose … and blew out my L4 and L5.” Mayhack
went to Torrance Memorial and saw Dr. Rogers, who got him in for surgery
immediately. “I was in and out of surgery the same day. Dr. Rogers
put me on PT right away, working on core strength and stretches. It took
awhile, but I got back on skis the next season. And I was so glad I got
the surgery. I don’t have a back issue anymore. Dr. Rogers saved
Like many, Mayhack was afraid to have back surgery. “It felt like
getting brain surgery,” he jokes. But for so many years he was constantly
tearing his back and then taking Vicodin for the pain, a debilitating
cycle. “I’m off the pills completely now and haven’t
taken any since right after the surgery. And I’m skiing better than
ever. I don’t jump off cliffs like the young skiers, but I go all
the way to the top [at Mammoth] and back down.”
Mayhack also admits he’s getting more exercise and taking better
care of his body these days, thanks to Dr. Rogers. “She’s
an athlete and really knows her stuff,” he says.
That ability to relate to patients is evident throughout the department.
Dr. Zickuhr, for instance, has been athletic all her life “and I’ve
had five knee surgeries, shoulder problems, hip problems and Achilles
tendonitis. So I understand what it’s like to be on the patient side.
“Because we’re in California, I get lots of runners and dancers
who just don’t get an adrenaline rush from anything but their favorite
activity,” she continues. “So I try to modify it or find something
that’s close so we can give them that same satisfaction. And I understand
how frustrating it can be for the body to heal more slowly than they want.
Other doctors might have blown them off saying, ‘Oh, you’re
fine.’ My goal is to get them back to their previous level of activity.”
A runner himself, Dr. Nuccion also stays fit coaching his daughter’s
basketball and son’s flag football teams. Dr. Rogers shifted her
passion for basketball to surfing, and Satterfield, a semi-pro and collegiate
soccer player, now does a bit of everything: cycling, swimming, skiing.
“Someone who is an athlete will definitely find someone sympathetic
here,” he says.
He’s referring to the hospital, of course, but “here”
also is the South Bay; all of the doctors are locals. “Part of the
fun,” Dr. Rogers concludes, “is taking care of my neighbors.”
THREE SIMPLE BACKSAVERS
“So much of it is what your mother told you,” says orthopedic
surgeon Tiffany Rogers. “Don’t use your back to lift heavy
objects and keep your core muscles strong.” To be specific, here’s
what she recommends:
Strengthen Your Core: Pretend someone is going to sneak up on you and punch you in the belly.
Prepare for that punch. It’s a simple way to start the process of
strengthening your core muscles.
Avoid a Lot of Sitting: Yes, sitting is the new smoking. “It really compresses your discs,”
says Dr. Rogers. If you work at a desk, get up and walk around every 30
to 40 minutes. Set a timer and stick to it. On long car rides, pull over
every 90 minutes and take a quick run around the car.
Stay at an Optimal Weight: Your Torrance Memorial doctor can help you with this.