Affecting approximately 80 percent of the population of the United States at one time or another, back pain is a common ailment that can have a serious impact on quality of life—but seeing a back pain specialist can help. When discomfort shifts from occasional aches to persistent pain, it’s time to consider visiting a specialist, such as an orthopedic surgeon. The purpose of seeing this type of doctor is to fine-tune a treatment plan, which doesn’t necessarily have to include surgery, likely to provide meaningful relief.
Non-Specific Low Back Pain
Low back pain is the most common type of back pain since the middle part of the spine has stronger structural support. LBP, often triggered by muscle strain, is also the type of pain that tends to go away on its own without further medical intervention. When LBP is affected by certain movements and starts to have an overall quality of life, however, it’s time to see a doctor. Before being referred to a back pain specialist, most patients will be encouraged to try non-surgical remedies for their back pain, including:
- Over-the-counter pain relievers
- Customized physical therapy sessions
- Prescription anti-inflammatory drugs
- Chiropractic manipulation
- Modification of activities
- Strengthening exercises
There are often multiple sources of low back pain not linked to a specific source. Realistically, surgery doesn’t even become an option for relief unless a specific anatomical cause is identified and confirmed through image testing.
Degenerative disc disease is the term used for symptoms related to age-related wear of the spongy discs that support the bones of the spine. Everyone will experience some degree of disc-wear with age, often without severe pain. It’s only when the discs wear down to the point where there is friction against adjacent discs or inner disc material pushes through outer disc material, referred to as herniation, that pain is typically experienced. An orthopedic surgeon will assess your level of disc degeneration based on:
- A comprehensive physical exam
- A review of image tests, such as x-rays, MRIs and CT scans
- A description of movements that trigger pain
- Input from a patient’s primary care physician
- An evaluation of a patient’s medical history
Spinal stenosis, a narrowing of the open spaces within the spine, is one of the most common spinal deformities that may require surgical intervention at some point. However, the first line of treatment often includes activity modification, PT, medication, bracing and epidural injections. The effect the narrowing of the spine has on adjacent nerves is often what determines if surgery is an option.
Typically occurring in children, scoliosis is an abnormal curvature of the spine. Surgery is usually necessary if the curvature of the spine is severe enough to produce leg weakness or numbness and difficulty walking. In some cases, conditions like degenerative arthritis can contribute to the onset of scoliosis in adults, frequently linked with pain resulting from nerve compression. How much the curvature worsens over time is often what determines if surgery is necessary.
While most people associate seeing an orthopedic surgeon as an indication that spine surgery is the next logical step, that’s not always the case. In some instances, patients are referred to orthopedic surgeon in an effort to get a fresh opinion. The trend in back pain treatment today is to save surgery, even when it’s a fairly reliable procedure, as a last resort. The decision as to whether or not to have surgery is often based on:
- The level and duration of pain experienced
- The overall ability to function
- Whether or not there are still viable non-surgical options available
- A patient’s overall health and whether or not they have other conditions that may result in surgical complications
Spinal osteoarthritis is the most common condition that directly affects the joints of the spine. Characterized by a breakdown of the cartilage that supports discs in the lower back and spine, osteoarthritis produces growths called spurs that press on nerves, which can result in weakness and pain that radiates to the arms and legs. An orthopedic surgeon will use a combination of diagnostic tests and an evaluation of a patient’s medical history to determine how much osteoarthritis has affected joints. Before surgery is considered, the condition is often treated with:
- Heat or cold compresses
- Transcutaneous electrical nerve stimulation (TENS)
- Strengthening and range-of-motion exercises
- Epidural steroid injections
Some joint-related spine pain is related to lifestyle. For instance, excess weight and a lack of exercise can place added pressure on joints and weaken supporting muscles. If no specific structural source of joint pain can be discovered, an orthopedic surgeon may recommend lifestyle adjustments to relieve pain, including a diet consisting of green, leafy vegetables, fish rich in omega-3 fatty acids and lean meats like pork and regular exercise, which can include low-impact activities such as cycling and water aerobics.
Even with spinal deformities and conditions like osteoarthritis, many people can successfully manage their back pain with non-surgical treatments. It’s often the sciatic nerve, the longest single nerve in the human body that goes from the lower back into the legs, that’s the source of discomfort felt in other areas beyond the lower back. Surgery may be necessary for nerve-related back pain when:
- Severe pain radiates to the legs, arms and shoulders
- Pain is accompanied by tingling and numbness
- Bowel functions are also affected
Most instances of back pain respond well to conservative treatments, such as the application and heat and cold and physical therapy. It’s only when back pain becomes progressively worse or lasts beyond 5-6 months that it’s worth considering surgery; and even then, not every patient is going to be considered a suitable candidate for surgery.
If you have been dealing with any type of back pain, contact our office today to schedule an appointment with a back pain specialist. Our doctors will seek to provide you with extensive care that improves your overall quality of life, and will use minimally invasive treatments whenever possible. Feel free to call our office and ask us any questions you might have about our treatment options.