Do you really need neck or back surgery? David Barranco, MD, neurosurgeon at Barrow Brain and Spine talks about neck and back conditions, treatment options and when to consider surgery.
Q: Dr. Barranco, tell us, why are we seeing so many more people with neck and back pain?
A: There are many reasons, but in fact back and neck pain have always been one of the most common conditions treated by primary care physicians. More than 80 percent of Americans will suffer significant discomfort or pain at some point in their lives and as we live longer, have higher incidences of obesity and don’t care for our bodies we sustain more wear and tear on our spines.
Q: What should we do if we see our primary care doctor and they say I need surgery?
A: Probably the most important thing to do is NOT to panic. In reality, the overwhelming majority of patients with neck or back problems do not need surgery. What most people don’t realize is that more than 80 percent of patients with significant back or neck pain will get better with conservative treatment usually within 10-12 weeks. Even more will improve over a longer period of time. So even if you have very bad pain, and an MRI scan shows an abnormality, that is not an indication for surgery. What is important is for the patient to see a qualified specialist who can asses their symptoms, do a thorough neurological exam and review the films to see what types of non-operative treatments are reasonable.
Q: What kinds of non-surgical treatment options are available for neck and spine conditions?
A: There are multiple treatment modalities available to help patients and not all of them work for everyone. Some will only work for certain types spinal conditions. Obviously one of the principal treatments may include medications. This can include anti-inflammatories, pain medications and muscle relaxants. There are also some nerve specific drugs we use in specific circumstances. Physical therapy is also a mainstay of treatment. One thing to consider when starting therapy is that there are therapists who truly specialize in spinal care and others who may be more experienced treating other problems like hip, knee or shoulder issues. There can be great difference in success rates depending upon the qualifications of the therapist. Injection therapies may also be indicated. This includes such things as epidural blocks, nerve blocks, and facet injections. What is very important however is that the type of injection, where it should be administered in the spine, and how often it can be done needs to be analyzed correctly. It is not uncommon for us to see patients who did not respond to an epidural and when we get the report we discover it was not performed at the best location to succeed. There are other treatment options that can also be considered such as chiropractic care, acupuncture, etc.
Q: When should I consider surgery?
A: Surgery is usually considered in two main categories. The first and most important group are those patients who have any significant neurologic deficit that may be an indication of nerve damage. Although this is the minority of patients they need to be treated urgently. Most patients have pain or numbness but everything is working properly. A small subset of patients have evidence of nerve damage or dysfunction on their physical exam, for example a foot drop or weakness of the arm or hand. That is why it is important to see a trained neurosurgeon who can perform a detailed neurologic exam looking for evidence of nerve damage.
The second group of patients who should consider surgery are those who have failed a coordinated well thought out conservative treatment program and have too much pain or discomfort to perform their usual daily activities and functions whether at home or work.
If you are interested in scheduling an appointment with a Barrow Brain and Spine physician, please call 602-406-8450.
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