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More than 80 percent of the adult population in America suffers from back pain at some point in their lives. Consequently, back pain is the number one reason, after the common cold, for which patients visit their Primary Care Physicians. The causes of back pain are wide and varied but some of the most common reasons include lumbar muscular strain/sprain, Degenerative Disc Disease and inflammation of other spine joints (arthritis). Other pain triggers we see less frequently, but are very important nonetheless are tumors, infections and fractures resulting from trauma or osteoporosis.
If the pain is consistent for more than two weeks or if it creates significant weakness or disability you should go see a specialist. Our job as neurosurgeons is to pinpoint the problem with the appropriate imaging studies, such as an MRI, CT scan or x-rays, which can usually reveal the root of the pain. Following those tests we can determine whether the patient is a surgical candidate or if non-surgical treatment is a better option.
The most important thing to consider, whether you need surgery or not, is that prevention is the most effective way to avoid neck or back pain. A regular exercise regimen is very important in order to keep your back healthy and strong. Fitness activities such as aerobic conditioning and strengthening exercises, such as pilates and yoga are great to build up your core and relieve pressure from your back. Believe it or not, good posture is important in reducing back pain as well. Maintain a healthy weight and follow a nutritious diet to avoid additional strain on your lower back. Smoking accelerates the degeneration of discs and increases your risk for developing osteoporosis (bone loss), which in turn increases your vulnerability for compression fractures.
When the discs in your spine are healthy, they are spongy and keep the spine flexible, but when a disc is damaged it can bulge or rupture, this is called a herniated disc. The symptoms of a herniated disc depend on the structure they affect. Lower back (lumbar spine) disc herniations create pain by straining the ligaments or by inflammation of the swollen torn disc. Shooting buttocks and leg pain (sciatica) is caused by the pinching or compression of a nerve by the ruptured disc. This can also create numbness or weakness. Indicators of a neck (cervical spine) disc herniation include neck pain, shooting pain to the shoulder and down the arm with possible weakness, numbness and tingling.
Initially, the recommended plan of action for the majority of patients with disc herniations is conservative treatment. Conservative measures include anti-inflammatory medications, physical therapy or involvement in a pain management program, which can include epidural steroid injections and facet injections. Surgical intervention should only be recommended when adequate conservative measures fail to provide adequate relief or the patient’s symptoms progressively worsen. When a particular condition warrants surgical intervention, the appropriate procedure is determined based on the patient’s symptoms. If we are dealing with a pinched nerve, a Microdiscectomy is indicated. On the other hand, a torn disc causing back pain requires a fusion.
Quite simply it refers to the wear and tear of the discs in the spine that causes them to stop functioning properly and cause pain; it is not actually a “disease.” As the name implies, it is a degenerative process which tends to progress over time due to the aging process. Genetic factors, as well as environmental contributors such as smoking, heavy physical labor, and excessive weight also contribute to the degeneration of discs. Much like disc herniations, DDD is treated with conservative treatments such as physical therapy to strengthen the muscles around the neck or back.
This is a minimally invasive surgery using a microscope to remove the disc material compressing the nerve. This procedure is usually done on an outpatient basis and the patient usually goes home within 2 to 3 hours following the completion of the surgery.
The surgical treatment for back pain is called a fusion. During this process the damaged disk is removed and replaced with bone, eliminating motion, thereby eliminating pain in that joint. Most of the movement and ability to bend forward of the lower back depends on the function of the hip joints, so movement in the lumbar discs is minimal. Therefore, for most patients, the loss in the overall range of motion is not significant and the benefits far outweigh the minimal loss at the fused levels.