The human spine is a marvelous structure, consisting of 33 bones stacked neatly one atop the other. It provides a flexible yet strong scaffolding for the body, allowing you to stand upright, bend and twist all while also protecting your spinal cord — the communications highway that threads a huge network of nerves from your brain to all other corners of your body. Tendons, ligaments and muscles also connect into the spine in various locations, a concert of cleverly evolved design that’s purpose-built for the day-to-day challenge of being a functional human being.
The spine is a complex system, with lots of moving parts, which means it’s relatively easy for one piece to shift out of optimal alignment or incur an injury. There’s a long list of maladies that can all cause pain, tingling sensations in the extremities and loss of mobility or dexterity that can negatively impact your quality of life. They include: sprained ligaments or muscles; joint inflammation; slipped, ruptured or compressed discs; sciatica (pain radiating from the lower back into one or both upper legs) and scoliosis (an abnormal sideways curvature of the spine); fractures and dislocations; osteoarthritis and osteoporosis (a condition that causes bone loss); sports or work-related injuries and pinched nerves.
[See: 5 Bodyweight Exercises to Fix Your Posture.]
Although most cases of back pain are acute, lasting just a few days to a couple of weeks, for many people, back pain can become a chronic problem leading to disability. The National Institute of Neurological Disorders and Stroke reports that “about 80 percent of adults experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed work days.”
Spinal injuries can also be acute or chronic and may require immediate medical intervention depending on the severity of the damage. The National Spinal Cord Injury Statistical Center at the University of Alabama at Birmingham reports that about 17,700 new spinal cord injuries occur each year, and estimates the number of people living with SCI in the United States currently at about 288,000. Motor vehicle crashes are the leading cause of these injuries, followed by falls.
In addition, normal wear and tear over time can lead to back pain and spinal issues. Degenerative conditions related to aging are the ones that most often end up requiring surgery, says Dr. Francis Farhadi, a spinal neurosurgeon at the Ohio State University Wexner Medical Center. “By far the most common condition that results in spinal surgery is spinal aging. As the spine ages, the discs wear out in the low back or the neck. With the discs wearing out, they lose their water content and ability to cushion the spine.” This can lead to the development of pain and loss of mobility.
Farhadi says patients may also develop arthritis of the spine, which can cause “pain in the neck and back or extremities — either in the arms or legs. It can cause a number of other symptoms, such as numbness, weakness and balance problems.” Osteoporosis, a degenerative disease that causes bone loss, can result in painful spine fractures that may land you in the office of a spine specialist, too.
Although back and spine issues are common, most do not require surgery. Most doctors prefer taking a conservative approach, exhausting all non-operative routes first before beginning a discussion about surgical options. “Many studies have shown that a course of physical therapy, nonsteroidal anti-inflammatory medications and sometimes injections will alleviate low back pain,” says Dr. Ronald A. Lehman, Jr., chief of degenerative, minimally invasive and robotic spine surgery at New York-Presbyterian‘s Spine Hospital. “If a patient has numbness, weakness, tingling or pain in the leg that does not improve with three to six months of conservative care, then some patients require operative intervention to decompress the nerves to alleviate the pressure.”
[See: 11 Ways to Cope With Back Pain.]
For some patients who are experiencing severe pain, being told to wait can be unwelcome news. “It’s important that patients realize that sometimes we don’t have an answer right away,” Farhadi says, “and we’re not able to relieve their pain with surgery right away because we want to be conservative. We know from experience that waiting it out is effective in most situations, it’s just sometimes difficult to say to patients who are in pain that 85 percent of the time, in three months you’re going to be fine even without surgery.”
He also notes that even when surgery is recommended, it can’t guarantee full resolution of the problem. “Even in the best of circumstances and the best of hands, surgery is not 100 percent effective. It has a very high success rate, probably around 90 percent when patients are selected appropriately, but we always are careful to specify that medicine is a science for sure, but it’s an art as well.”
If you’ve exhausted your other options and it’s time to select a spinal surgeon, it’s important to do some research and make sure you’re working with a well-qualified doctor who has a lot of experience in treating the specific issue you’re having. “Many surgeons today complete a fellowship in spinal surgery,” Lehman says, and these fellowships may be focused in a specific area, such as degenerative spinal surgery, minimally invasive spinal surgery and spinal deformity such as scoliosis and kyphosis (also called round-back or hunchback). “All orthopedic spine surgeons are required to complete a fellowship in spine, which is usually one additional year of training, while neurosurgeons typically are not required (although many do) because they have extensive spine training during residency,” Lehman says.
If your doctor says that you are a good candidate for spinal surgery, Farhadi says it’s important to ask “why is this surgery necessary? Whenever I hear a patient ask that, I know we’ll have a great relationship.”
As with any doctor, you also want to be sure your personalities mesh and you’ll be able to communicate well with your surgeon. “First and foremost, when you select somebody make sure you have a good relationship with the physician,” Farhadi says. Lehman notes that “like all people, all physicians have different personalities. Patients should certainly seek a physician or surgeon who is compassionate, caring and candid. The personal relationship with one’s physician is a large component of the treatment paradigm, and it’s imperative that the patient and their family have trust in the physician rendering the care.” He says being comfortable that the surgeon has your “best interests in mind, has proper training, and gives [patients] a transparent discussion about the risks and benefits of each intervention or surgery prior to their planned procedure” is critical.
[See: 10 Ways Poor Posture Can Harm Your Health.]
Farhadi adds that it’s important to make sure you understand what treatment is being proposed and that “there’s good justification in your mind” for the procedure.” And he says it’s important that you understand what the doctor aims to do. “You want to make sure the surgeon who’s advising you of a certain procedure can explain it in easy-to-understand terms.”
Lastly, “word of mouth is applicable to any doctor, including the spine surgeon,” Farhadi says. Lehman agrees. “One of the main things that patients should seek out when attempting to find an orthopedic or spine surgeon is to ask friends, family members or colleagues if they know of a surgeon whom they had a great experience with during their care.” And he cautions you to do your homework. “It is important for patients to be cautious with advertisements on the internet, and to seek out several opinions” before making a selection of surgeon.
Keep Your Back Strong and Healthy to Help Avoid Surgery
Prevention is always preferable to intervention, especially when it’s related to keeping your back and spine healthy. To reduce the chances that you’ll end up having back pain or needing spinal surgery, remember the following:
— Eat right and maintain a healthy weight. Obesity puts significant strain on the body, especially the spine. Making sure you’re getting enough calcium and vitamin D can also help you maintain strong bones, which means a stronger, healthier spine.
— Exercise regularly and maintain a strong core — abdominal and lower back muscles — to help stabilize and protect the spine.
— Avoid slouching and make sure your work station is arranged ergonomically to avoid putting undue stress on any one part of your body.
— Lift with your legs when moving heavy objects rather than your back, and avoid twisting your spine while moving heavy items.
— Quit smoking. Smoking has been linked to higher rates of back problems.
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How Can I Find the Best Spinal Surgeon? originally appeared on usnews.com
