Back pain: Explaining it from a neurosurgeon's perspective

Over the years practicing neurosurgery, I have found that back pain can be a confusing and complicated topic.

Many patients have been told they have “bulging discs” or “stenosis,” but what does this really mean and does it explain their pain?

With so many moving parts affecting each other, figuring out the source of back pain can be tricky.

Back pain makes almost every top 10 list for doctor visits, missed work, and health care spending. Why is that?

Our spinal columns are constantly getting used and abused. Because everything is ultimately connected to the spine, there is hardly a movement we make which doesn't stress it. This predisposes the spine to injury, and makes it slow to heal.

Diagnosis

Our bodies are amazing healers and often back pain of short duration which has an identifiable cause (for instance, a pulled muscle shoveling snow) will gradually heal and not require any special tests or treatment.

However, back pain which lasts a long time or is accompanied by other symptoms such as fever, unexplained weight loss, loss of bowel/bladder function, or arm and leg symptoms should prompt evaluation by a trained medical professional. This may involve tests to evaluate for conditions which would need treatment.

It is worth remembering that no one test is designed to scan for “pain” and there can be little relationship between results of imaging studies and your symptoms.

Just because a test comes back normal doesn't mean there is not a source of pain. Likewise, if a test comes back abnormal, it doesn't necessarily mean that abnormality is the source of pain.

While imaging studies may not always explain pain, they are very good at finding fractures, compression of the nerves, or instability of the spinal column — injuries that may benefit from surgery.

Do I need surgery?

Most of the patients I see have had back pain for a long time.

These conditions took a long time to develop and they frequently take a long time to treat. There are very few, if any, “quick fixes.”

Often, treatment begins with things like weight loss, improvements in posture and body mechanics, eating healthy, smoking cessation, and core strengthening/stretching.

Medications can also sometimes be helpful, though every medication has side effects and should be discussed with a medical professional.

Sometimes, treatments such as steroid injections can be tried.

If there is compression of the spinal cord or nerve roots or structural instability, we may offer surgery. While spine surgery can be a very important treatment option and can often address a pressing problem, it will not be able to reverse years of wear and tear and should be viewed as simply the first step in a long-term treatment plan.

Surgery advances

Spine surgery has made amazing progress in the last several decades and continues to become safer and more effective for certain conditions.

In fact, many surgeries are performed as an outpatient.

Most traditional spine surgery falls into one of two categories: decompression or stabilization (or both).

Decompressive surgery removes abnormal tissue pushing on the nerves or the spinal cord. This tends to be successful at restoring or preventing nerve problems, but can cause some loss of stability.

On the other hand, stabilizing procedures involve internal “bracing” with use of devices such as screws, rods, and bone grafts, but occur at the expense of decreasing the spine's normal range of motion, putting increased stress on the neighboring structures.

Although there are always new and improving devices and procedures, it is critical that surgery be viewed as one part in a larger treatment plan which includes long-term lifestyle and activity modifications.

Moving forward

Most back pain is treatable; we can't reverse all the effects of aging, but we can maintain control of our lives.

Again, this means a healthy lifestyle, a good understanding of the problem, and setting realistic goals. Enlisting the assistance of a trained medical professional can be of great benefit.

Having the ability to modify back pain through healthy choices, exercise, and strengthening is an opportunity.

While the idea of “getting fit” in the midst of experiencing pain can seem overwhelming at first, this still allows the patient to be in the driver's seat to impact his or her medical outcome. Not all medical problems allow us such control.

For more information about the neurosurgery team at Northwestern Medicine, visit www.nm.org or call (847) 535-7271.

• Dr. Michael Walsh is a board-certified neurosurgeon with the Department of Neurosurgery at Northwestern University Feinberg School of Medicine and sees patients at Northwestern Lake Forest Hospital and in Grayslake. Twitter @mtwalshmd and on Instagram @walshlab_neuro. His website, mtwalshmd.com/, features 3D educational videos and interactive anatomy models. This article is meant to be general information regarding various causes of back pain and is not meant to be taken as direct medical advice. If you have a question or concern regarding back pain, speak to a medical professional.