A spine surgeon explains the most common problems — and when to seek treatment
Back pain is one of the top reasons people see a physician; about 80 percent of adults experience it at some point, according to the National Institute of Neurological Disorders and Stroke. Yet the causes tend to vary greatly. “You might hear that your neighbor has the same problem, but I rarely see two people with identical spinal issues,” says Rony Nazarian, MD, a spine surgeon at Robert Wood Johnson University Hospital (RWJUH) Hamilton and a member of the RWJUH Hamilton Medical Advisory Panel. Here, Dr. Nazarian explains common back problems and treatments.
What back problems do you treat most often?
I see many patients with disk herniations, in which the jelly-like substance that cushions spinal disks leaks, irritating spinal nerves. I also treat spinal stenosis, which tends to affect adults over 50. With this condition, the spinal canal narrows, putting pressure on spinal nerves and the spinal cord. The symptoms of these conditions are similar: pain that radiates to the legs or arms and is often associated with numbness and tingling or muscle weakness.
When is nonoperative treatment, such as physical therapy, appropriate?
Most of the time, patients can benefit from physical therapy (PT). There are only a few instances in which PT is not appropriate: if you have cauda equina syndrome, in which significant pressure on spinal nerves leads to a loss of sensation in the groin and a loss of bowel and bladder control. This is considered a surgical emergency. Another time PT isn’t the right move: if you have cervical myelopathy, or severe compression of the spinal cord in the neck. Symptoms include a loss of bowel and bladder control; the inability to coordinate the hands.. and difficulty walking. Also, patients who have tumors or traumatic injuries often aren’t candidates for PT.
When should a patient consider surgery?
Patients might consider surgery if they’ve undergone an appropriate course of conservative care, such as PT, anti-inflammatory medications and epidural injections, and their quality of life is still suffering. The purpose of surgery is to improve quality of life and function.
What are the advantages of minimally invasive spine surgery?
With minimally invasive surgery, we leave behind a smaller “footprint,” meaning we cut less muscle and disrupt less tissue. This leads to less surgical blood loss and a quick er procedure, as well as less postsurgical pain and a faster recovery. Many of these operations can be done on an outpatient basis, which allows you to recover in the comfort of your own home.
If you have back pain, when should you see a physician?
If you develop back pain and don’t have any neurological symptoms (such as numbness and tingling or weakness), the best way to cope is to take anti-inflammatory medications (if your doctor recommends this), stretch and stay active. If the pain persists beyond two to four weeks and your symptoms progress, causing you to miss work or interfering with your daily activities, then consider seeing a physician. Similarly, if you develop symptoms such as pain, numbness, tingling or weakness in the extremities, consider seeking medical attention sooner.
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