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CHOOSE WELL: A Quarterly Newsletter from Heartland Spine & Specialty Hospital, Spring 2009
How to determine if you need back surgery: Spine surgeon offers helpful hints
Back pain will affect more than 80 percent of all Americans at some time in their lives. But orthopedic spine surgeon, Dr. John M. Ciccarelli, says spinal surgery should almost always be the last resort. Ciccarelli's practice, Premier Spine Care in Overland Park, KS, is made up of fellowship trained orthopedic spine surgeons with advanced training in spinal surgical problems. Ciccarelli performs surgery at Heartland Spine & Specialty Hospital.
He suggests people with back pain explore other treatments before consulting a spinal surgeon. "In our practice, we are very conservative. Spine surgery is always the last option," he says.
Five Steps to Assessing the Need for Back Surgery - Ciccarelli offers these tips on how to know whether you need to see a spine surgeon, or whether your back pain may be treated by other methods.
1. If the pain is caused by muscle strain, your primary doctor can help. In many cases, back pain comes from soft tissue or muscular problems. Ciccarelli says your primary care physician can help assess whether this is the case. If it is, you'll probably be advised to modify the activities that make your back feel worse, which, as Ciccarelli points out, most patients tend to do naturally.
2. The treatment for most back pain is medication, exercise, and time. Your primary doctor also will probably suggest anti-inflammatory medications, muscle relaxers, or even mild narcotics that will treat your symptoms. You may also be advised to try physical therapy, exercise, or chiropractic care. 'Maybe the best advice,' Ciccarelli says, 'is to give it time. Our bodies have a tremendous healing potential and they are built to heal their own injuries.' Back pain that does not respond to time and these modalities may indicate a more severe problem that needs further evaluation.
3. If there are symptoms of a nerve problem, an MRI can aid with the diagnosis. While most back pain will heal itself with time and a little help, pain that radiates into the arms or legs may suggest nerve pressure. If your primary care doctor thinks this is the case, you'll probably be advised to avoid strenuous activities or exercise because these can sometimes make the problem worse. Pain, numbness, and tingling may also be indications that something beyond muscle strain is involved. Getting an MRI is usually the best initial test to see what is going on, Ciccarelli says. Your family doctor may refer you to an orthopedic spine surgeon for further evaluation of your MRI.
4. Another step before surgery may involve epidural injections to treat nerve pain and inflammation. These injections are done as an outpatient procedure and typically combine a corticosteroid (anti-inflammatory medicine) with a local anesthetic type of medicine. Ciccarelli says they both reduce pain and shrink inflammation. "This gives your body a period of rest to try to heal itself. These injections can help in a majority of individuals," he says. Epidural steroid injections are usually done as a series of three injections and are administered by an anesthesia pain specialist.
5. Surgery is typically the last resort, but can be necessary in some cases.While surgery is usually not the first option for back or nerve pain, it is sometimes appropriate. Ciccarelli says abnormalities involving nerve pressure from spinal discs, bone spurs, or loss of spinal stability may require a surgical approach.
Dr. John Ciccarelli
Co-founder of Premier Spine Care
5525 West 119th Street, Overland Park, Kansas, www.premierspinecare.com