Anatomy of an Intervertebral Disc


Intervertebral Disc pic

Intervertebral Disc

As an anesthesiologist and pain interventionalist at Amoskeag Anesthesia in New Hampshire, Dr. Brian Klagges assesses and treats patients with a variety of pain conditions. Particularly experienced in the use of minimally invasive treatments for the lower back, Dr. Brian Klagges draws on a detailed knowledge of spinal and intervertebral disc anatomy.

Between most pairs of vertebrae in the spine, a structure known as the intervertebral disc provides protection from the shock of everyday impact. It is a fibrocartilagenous structure that includes a strong exterior, known as the annulus fibrosus, and a gel-like interior or nucleus.

Both parts of the intervertebral disc are made of up of collagen, water, and proteoglycans, also called PGs, which are specialized proteins found in extracellular matrices, connective tissues, and cell surfaces. Able to attract and organize water molecules, the PG functions as a key component of the intervertebral disc’s nucleus.

Together with collagen fibers, the PGs and water within the nucleus form a mucoprotein gel. The percentage of water within this gel can change according to the amount of pressure placed on the disc. As a person ages, and there is less moisture available to the disc, the amount of shock that the disc can bear begins to decrease.

The ring-shaped outer layer of the disc deteriorates over time as well. This deterioration can ultimately lead to a rip in the disc’s core, which in turn can cause the material of the nucleus to herniate and press on the nearby nerves.


ASA Study Finds Fentanyl Epidurals Do Not Affect Breastfeeding


Fentanyl Epidurals pic

Fentanyl Epidurals

Dedicated physician Dr. Brian Klagges serves as both the director of interventional pain management at Elliot Hospital and an anesthesiologist and pain interventionist with Amoskeag Anesthesia. With an MD from the SUNY Buffalo School of Medicine and Biomedical Sciences, Dr. Brian Klagges belongs to the American Society of Anesthesiologists (ASA), a research, education, and scientific organization for anesthesiologists.

In November 2017, the ASA released a study on the effects of fentanyl on breastfeeding. This study was published in the ASA’s peer-reviewed medical journal, Anesthesiology.

Led by Robert J. McCarthy, a Northwestern University Feinberg School of Medicine research professor, the study involved 345 women who were at least 38 weeks pregnant and planned to breastfeed. These women were randomly assigned to receive an epidural solution of either bupivacaine; bupivacaine and 1 microgram per milliliter of fentanyl, an opioid; or bupivacaine and 2 micrograms per milliliter of fentanyl. The doses that included fentanyl are commonly used during labor.

According to the results, breastfeeding rates at six weeks post-partum were 97 percent of those who received a dose of bupivacaine alone; 98 percent of those who received 1 microgram of fentanyl; and 94 percent of those who received the 2-microgram dose of fentanyl. Based on these results, researchers concluded that breastfeeding was not negatively affected by epidurals containing fentanyl. Further, fentanyl does not appear to have any negative effect on infants’ nervous systems.

A Brief Overview of the Three Types of Knee Arthritis


Knee Arthritis pic

Knee Arthritis

Dr. Brian Klagges studied medicine at the State University of New York at Buffalo. For the past decade, Dr. Brian Klagges has worked as a physician and anesthesiologist at Elliot Hospital in Manchester, New Hampshire. In this role, he performs many procedures, including genicular nerve ablation for patients dealing with severe knee arthritis.

The knees may be impacted by three distinct types of arthritis. Osteoarthritis (OA), the most prevalent form of knee arthritis, is a progressive condition that typically begins in middle age. People dealing with OA must address the issue as soon as possible, as untreated OA will continuously wear away at joint cartilage.

Rheumatoid arthritis (RA), meanwhile, can affect individuals at any age and involves episodes of severe inflammation. RA is an immune system disorder, and its cause is unknown.

The third form is post-traumatic arthritis, which is a direct result of blunt force trauma to the knee. Post-traumatic arthritis is most common following an injury that leads to a torn meniscus, ligament damage, or broken bones. However, knee arthritis does not always occur immediately after an injury; the condition may take years to develop.

What Is a Lumbar Microdiscectomy?


 Lumbar Microdiscectomy pic

Lumbar Microdiscectomy

Over his more than 15-year career working as a physician, Brian Klagges, MD, has focused his practice on anesthesiology, providing pain relief to patients during surgery. As an experienced medical practitioner, Dr. Brian Klagges’ expertise is sought after by a number of medical firms such as Vertos Medical and Mini SURG. He offers his services as a consultant on specialized surgical procedures, such as minimally invasive lumbar decompression.

Decompression surgery is aimed at relieving pain caused by pinched lumbar nerves. The most common cause of this condition is disc herniation or discs that have moved from their initial alignment in the spine, but cysts and cancers can also cause it. In the case of disc herniation, there are a number of procedures that can relieve the pain. Due to advances in surgical technology over the years, there are minimally invasive decompression procedures available.

The lumbar microdiscectomy is among the least invasive, requiring just a 1-to-1 ½-inch incision into the spine. The portion of bone that is pinching the nerve is then removed. Between 90 and 95 percent of patients undergoing this procedure report significant alleviation of pain. Furthermore, due to its minimally invasive nature, this surgery can be performed as an outpatient procedure, allowing patients to return to their normal lives quickly.

Isoflurane and Nerve Communication in Anesthesia

Anesthesia pic


A board-certified anesthesiologist, Dr. Brian Klagges cares for patients at Elliot Hospital in Manchester, New Hampshire. Dr. Brian Klagges also practices with Amoskeag Anesthesia, providing general as well as local and regional anesthesia.

General anesthesia is an extremely complex process. A combination of drugs renders a patient unconscious and insensible to pain, while his or her body continues to function at a basic physiological level. How this works remains largely unknown to medical science, although current research is beginning to solve a few of anesthesia’s cellular mysteries.

Researchers at Weill Cornell Medical College, for example, recently identified the key function of the commonly used inhaled anesthetic isoflurane. Building on the established knowledge that the drug interrupts cellular communication in the brain, scientists have found that this occurs due to the reduction of calcium ion flow into cells. Calcium ions allow cells to release the neurotransmitters that enable communication, the absence of which prompts the reduced consciousness and pain response in anesthetized individuals. Researcher Dr. Hugh Hemmings, Jr., and his team hope that this discovery may help developers to maximize anesthetic effectiveness and minimize side effects.

Neuromodulation – An Introduction

As director of interventional pain management and the Interventional Spine Center at Elliot Hospital, Dr. Brian Klagges performs a variety of procedures to relieve patients’ pain. In doing so, Brian Klagges, MD, draws on an in-depth knowledge of such advanced techniques as neuromodulation.

A treatment for intractable pain since the 1960s, neuromodulation uses implanted devices to manipulate nervous system activity. Many such devices are known as neurostimulators, which means that they work by altering the electrical impulses that govern the nervous system. One common such technique is spinal cord stimulation, which requires a surgeon to place an electrode in the body next to the spinal cord. This electrode generates a gentle current that blocks pain signals along the spinal cod.

Physicians may also place such electrodes along the sacral nerve, which is located in the pelvic area and responsible for many forms of pelvic pain. Intraspinal nerve root stimulation, which involves an electrode placed near the nerve root of the spine, addresses pain in the pelvic region as well as in the abdominal area. A final type, peripheral nerve stimulation, may offer relief for more distal processes.

There are also a number of neuromodulation processes that involve targeted medication delivery rather than nerve stimulation. These require the implantation of drug pumps rather than electrodes and allow for the deliver of significantly smaller doses. Such dosing may also reduce the likelihood of side effects, while potentially leading to more effective pain relief.

A Quick Look at Epidurals During Childbirth

Anesthesiologist and pain interventionalist Dr. Brian Klagges, MD, currently administers treatment to patients at Elliot Hospital in Manchester, New Hampshire. One of the procedures that pain interventionalists like Dr. Brian Klagges are licensed to perform is the epidural, which is commonly used to aid women in the process of childbirth.

An epidural is a type of regional anesthesia that temporarily blocks the activation of pain receptors within a woman’s lower spine. Though epidurals administered during birth are designed to diminish the pain associated with labor, they are not designed to completely quench feeling.

In order to administer an epidural, an anesthesiologist locates the spinal membrane and inserts a needle into the back of the woman in labor. This needle is larger than standard needles in order to allow a catheter to pass through it. Once the catheter is inserted, it is taped in place and the needle is withdrawn. Leaving the catheter in the back allows the anesthesiologist to administer additional pain medicine as needed during the delivery.