Almost everybody at one time or another has a period when their back or neck hurt to the point that it alters how they live their life. Back and neck pain is the second most common cause for taking time off from work or school. Most back and neck pain can be treated by primary care providers. It is unusual that someone needs to see a spine surgeon. But, there are many people with back problems who could benefit from the care and treatment of specialized spine surgeons. One of the keys to treatment is identifying this group of people and knowing when a specialized spine surgeon should be called.
Far and away, the most common cause of back or neck pain comes from the muscles of the spine. We call these the soft tissues or the soft tissue envelope of the spine. It is very rare that surgery can help problems of the muscles of the spine. The best way to keep the muscles pain free is to stay in good shape and maintain a normal body weight. Routine vigorous exercise should include muscle stretching, muscle strengthening and aerobic conditioning. These exercises can be done at any point in one's life. Some exercises that are good, especially for for those in their later years, are things such as yoga and Pilates. One of the main preventable causes of back and neck pain is the use of tobacco in both smoking and nonsmoking forms. Smoking cessation can decrease back and neck pain as well as decrease risk for many other medical problems.
Primary care providers are the best source of initial treatment for muscular pain of the spine. But how can you tell when the source of pain is not just the muscles?
There are three common situations in which spinal surgery can be helpful:
1. When there is compression on nerves.
2. When there is instability of the spine.
3. When there is a deformity of the spine
Compression on Nerves
This is the most well known of spinal problems. Nerves that come out of the spinal cord, or even the spinal cord itself, can be compressed by disc herniations or bone spurs. Disc bulges and bone spurs occur with everyone as we get older. Not all disc herniations or bone spurs cause problems. It is only when the disc herniations or bone spurs cause pressure on the nerves that it can result in pain or weakness. In these cases surgery can be helpful. Surgery can take pressure off the specific nerve by surgically removing the bone spur or disc material that is causing the discomfort.
Instability of the Spine
Spinal instability exists when the spine is unable to do its job as the main supporting structure of the body. Both pain and disability can occur because of abnormal movement of the spine. There are many causes for instability of the spine, but the most obvious is a spinal fracture or dislocation. These can become catastrophic if not treated appropriately. Paralysis or severe pain may result if stability is not restored to the spine. Instability can also occur if the supporting structures of the spine such as the ligaments or the discs do not function properly. This can also result in neck pain or back pain. Surgery for spinal instability involves spinal fusions to stop the abnormal movement causing the pain.
Most people understand spinal deformity as scoliosis or "hunch back." However, there are many ways the spine can be deformed. Spinal deformity can occur in childhood, the teenage years, or can develop over time with age. Spinal deformity can also happen with other medical problems such as tumors, infections, or spinal injuries. Surgery for spinal deformity is an option when there is overwhelming pain, weakness or medical problems such as trouble breathing. Spinal surgeons should be consulted when any of the above situations are present.
A few simple guidelines as to when a spine surgeon should be consulted:
1. If the back or neck pain involves pain and/or weakness in the arms or legs.
2. If back pain or neck pain is associated with changes in the way you walk or if there is bowel or bladder incontinence without any other obvious source.
3. If simple back or neck pain is not relieved after 6 weeks of physical therapy and use of nonsteroidal anti-inflammatory medications or other pain medicines.
4. If there are obvious changes in the normal curvature of the spine.
5. If there was an accident or injury with the pain does not get better with 6 weeks of treatment.
6. If a patient with cancer or other known tumors has significant back or neck pain.