How can I get rid of my back pain?
The very first question most people ask me when they come in for an appointment (or if they meet me at a social gathering and find out I’m a spine doc) is, “How can I get rid of my back pain?” Back pain is one of the most common and frequent issues bringing people in to see their doctors. The most typical source of back pain is lumbar strain–an acute inflammation of the muscles, ligaments or joints. The best treatment for lumbar strain is rest for 1-2 days (no lifting, minimal walking or activity), in addition to anti-inflammatory medication (i.e. ibuprofen such as Advil or Aleve, as long as you don’t have a medical condition that precludes safe use), plus heat and gentle stretching exercises. If you are unsure about which exercises to do, a physical therapist can be a good resource, or look online. One website I like that offers stretching exercises to help with back pain is www.spine-health.com.
If pain continues for more than 7-10 days or is associated with symptoms in your legs such as radiating pain, numbness, tingling or mild weakness, consult your doctor as this may be a more serious condition of disk herniation (bulging disc) or spinal stenosis (often called a “pinched nerve,” it’s a narrowing of one or more areas in your spine.)
If you develop sudden severe weakness in your legs, numbness in your buttock area or both legs and/or any loss of bowel or bladder control, seek emergency medical attention immediately as this can represent severe nerve damage and typically requires emergency surgery.
According to the National Institutes of Health, in a 3-month period, about 25% of U.S. adults experience at least one day of back pain. Of course anyone can experience back pain, but there are two factors that increase your risk substantially: age (back pain is more common as you get older), and fitness level (back pain is more common among people with weak back and abdominal muscles.) The key to prevention is daily, low-impact aerobic exercise. “Weekend warriors” are more likely to have back problems and suffer back injuries than people who make moderate physical activity a daily habit.
You can’t do anything about getting older, but you can be mindful of ways to keep your back healthy into your twilight years.
What about chiropractic?
What about chiropractic? I don’t think a day goes by without my encountering this question — and it’s a good one! Patients will often make comments to me like, “I know you surgeons don’t like chiropractors, but….”
Fortunately, that’s just not true. For years, I have believed that chiropractors — just like physical therapists, surgeons, massage therapists, primary care providers, and acupuncturists — play a vital role in the care of patients’ spines. Now we have great evidence that their care is better than many other things, like medications or surgery, for some conditions! A recent article explains that for neck sprains and activity-related neck pain or muscle spasms (the classic “Doc, I woke up with a crick in my neck” problem), chiropractic care is better at alleviating symptoms than medications or shots, and certainly better than surgery.
So go for it! Go see your chiropractor, with my permission. They are part of the team! Just remember that if it’s not working, it’s time to move on. Come see us at the Spine Center if you’re unsure and we’ll help you find an appropriate path to spine wellness.
What is Cervical Disk Replacement?
Is it Helpful for Neck Pain?
One of the most common conditions I see in our Neurosurgery Spine Clinic is neck pain and associated shoulder and arm pain due to a disk herniation. The cervical disks are the soft cushions between the vertebrae that act as shock absorbers and allow for movement of the neck. Occasionally, these disks will tear, leading to severe pain complaints or even neurological conditions with arm pain, sensory loss or weakness. When this occurs, neurosurgeons will frequently recommend removal of the ruptured disk if non-surgical treatments fail to improve things.
This surgery, called “anterior cervical discectomy,” is a minimally invasive and highly successful procedure which frequently allows patients to recover at home after an overnight stay. Most patients can return to light activity and even light exercise within a week or two. However, when the disk is removed, it is necessary to place a “structural support” between the vertebrae to keep the neck in normal alignment.
The standard structural support in the past was made by removing a small piece of your hip bone to fashion a new support. Over time, this bone (called autograft) would “fuse” to the adjacent vertebrae. Newer structural supports are made of cadaver bone (allograft) or high-grade medical plastics (PEEK cages). One issue with all three of these grafts is that by fusing to the spine, they reduce motion of the neck. Although this loss of motion is rarely noticed by the patient, the added stress on the spine can lead to degeneration of the adjacent levels many years or even decades down the road.
As such, in August of 2007, the FDA approved the first Disk Replacement for use in the United States. These disks allow for more natural motion and therefore have a theoretical advantage over fusion devises in preventing this “adjacent segment degeneration” in the years ahead.
During my training at the University of Washington, I was very fortunate to be a part of the official 2003/2004 FDA trial to study disk replacement and assisted in the placement of the very first artificial disk at the University Hospital in Seattle. Since that time, I have been a strong advocate for disk replacement and was one of the first surgeons in the US to be certified to place the disks since formal release in 2007. I have vast experience in placing these disks and have been on the forefront of obtaining authorization from insurance carriers in the private, public and labors and industries sector.
At this time, disk replacement surgery is only FDA approved for use at a single level which means if you have 2 or more disks that are torn or ruptured and need treatment, you unfortunately are not a candidate for this technology. Additionally, despite the wide base of medical literature to support disk replacement as an alternative to fusion, not all insurance carriers cover this technology. Here at the Spine Center we are experts in determining if you are a candidate and working with your insurance carrier to ensure you are covered.
Best Surgical Approach Depends on Diagnosis
I’m often asked by patients who are contemplating surgery about my approach: Will the incision be big? Is it arthroscopic? Do I use lasers? My approach is completely dependent on each patient’s diagnosis and what our experience at the Spine Center tells us gives the best result for that diagnosis. I’m interested in outcomes that are lasting and durable, and sometimes that means I have to make major corrections which necessitate long incisions.
For example, last week I had the opportunity to dramatically change a patient’s life for the better. A woman came to see me with kyphoscoliosis (abnormal curvature) of the cervical spine, which, over time, left her chin resting on her chest, slightly askew. She had restricted range of motion in her neck; she was unable to walk or get around much because she couldn’t safely see where she was going, crushing her quality of life. For some conditions of the neck, a short, minimally-invasive procedure done as an outpatient is the perfect solution. But this woman’s extreme condition took eight hours of complex cervical spine reconstruction.
I’m proud to say that today she is walking tall, looking everyone straight in the eye again. When you weigh the vastly improved quality of life with the size of her scar, the length of the incision seems irrelevant to me. So while I often perform small-incision, quick-recovery, outpatient surgery, and I realize this is what many people would prefer, what I love most is relieving your pain and restoring well-being to your life using whatever procedure necessary.
If you are interested in learning more about your own spine condition and what procedure may be warranted, I am happy to meet with you and discuss your options
Minimally invasive surgery? Laser surgery?
What are these techniques and do you perform them?
Many people at some time in their life will experience a period of severe back pain that radiates into their buttock or leg. This symptom, called “sciatica,” is typically due to a herniation of a lumbar disk that irritates or compresses one of the nerves in the lower back. Most cases of sciatica will improve with conservative, non-surgical treatment within 6 weeks. However, for those patients who do not improve, surgery may be an option. Many patients come into my office with this problem and often ask about “minimally invasive surgery” and “laser surgery” as they have seen it advertised in various places. I can understand why. Of course, minimally invasive surgery sounds less scary, implies less pain, a shorter recovery time and the thought of using a laser to perform this makes the technique appear cutting edge. At Valley Medical Center’s Spine Center I specialize in minimally invasive surgery on the spine. However, I do not use lasers in my techniques, and here’s why:
Recently, minimally invasive surgery has gained tremendous popularity as studies have shown that the less tissue disturbed during surgery, the faster patients can recover. As such, many new techniques have emerged to treat the herniated disk by actually removing the irritating fragment, without damaging the local muscles and tissues.
The most common minimally invasive techniques involve expanding what the surgeon’s eye can normally see. By expanding our vision we can make much smaller, less destructive incisions to access the disk and remove it. Minimally invasive techniques use tools such as operating loop glasses, direct 3D magnification that increases normal vision 2-5x, operating microscopes–which allow direct 3D vision to be greatly magnified (up to 60x normal vision), and the endoscope, which offers indirect 2D vision (i.e. a camera is used to project images onto a TV monitor.)
Theoretically, laser surgery is another way to reduce nerve irritation by shrinking the disk rather than removing it. Laser surgery, also called Percutaneous Laser Disc Decompression (PLDD), uses a small incision to introduce a fiber into the disk herniation. Laser energy vaporizes the water contained in the disk to shrink it. Think of a large water balloon – when you remove some of the water, the size of the balloon shrinks.
Although often advertised as a “new breakthrough in treating disk herniation,” the first clinical laser disc decompression was performed in 1986 and the technique was approved by the U.S. FDA in 1991. Despite more than 20 years of experience with this technique, there is a scarcity of literature featuring randomized clinical trials that show its effectiveness.
Currently, minimally invasive open discectomy using an operating microscope is considered to be the universal gold standard in the surgical treatment of lumbar disc herniation– that is why I choose to employ this technique at our Spine Center. We use cutting-edge equipment that allows for the best outcomes with the shortest recovery times. For patients needing surgery for this very common problem, we have had great success with this technique.