Conquering Low Back Pain
Back pain may be second only to the common cold as the most universal medical complaint. Nearly 80 percent of all adults will experience back pain at some point in their lives.
The majority of complaints are referred to as “nonspecific” backaches, usually resulting from a muscle strain or ligament sprain. In some cases, the back muscles spasm, contracting involuntarily can cause additional pain. While these episodes of low back pain can be very painful and disrupt one’s work or normal daily routine, most low back pain will improve with time, rest and non-surgical care such as medication and physical therapy.
Many people over 60 suffer from low back pain and stiffness that is worse in the morning and evening, often caused by osteoarthritis or degenerative arthritis. This type of arthritis results from the breakdown of the cartilage between the facet joints in the back as well as the intervertebral disc. Low back pain accompanied by leg pain that occurs when standing upright or walking and increases with more walking maybe caused by conditions such as lumbar spinal stenosis or degenerative spondylolisthesis. The underlying problem is the loss of space available for the nerves or spinal cord.
According to Daxes Banit, MD, an orthopaedic surgeon specializing in spine surgery on the medical staffs of Houston Medical Center and Perry Hospital, a degenerating disc may become protruded or herniated, often referred to as a “slipped disc,” meaning that the softer material at the center of the disc bulges outward through a weak point in the harder outer layer.
“A herniated disc can put pressure directly on the nerves of the spine which can cause pain not only in the lower back but pain which radiates down the leg to the foot,” explains Dr. Banit. “As a result, the pain may also be accompanied by numbness, tingling or weakness. Depending on the individual’s medical history and tolerance of pain, we can prescribe physical therapy along with non-steroidal anti-inflammatory medication, oral steroids or cortisone injections to try to avoid or postpone surgery and allow the underlying problem to subside.”
If the course of treatment is unsuccessful, then surgical treatment may be necessary. Today, surgery for this problem can be performed using minimally-invasive techniques using the endoscope or microscope. These surgeries are often performed as outpatient and typically have shorter recovery times. “Most patients experience pain relief almost immediately after a microdiscectomy surgery,” says Dr. Banit. “Patients are able to return to a normal level of daily activity quickly, and we get them started on an exercise program of stretching, strengthening and aerobic conditioning to help prevent recurrence of back pain or disc herniation. In addition, certain problems may be amenable to percutaneous techniques, which would allow even smaller incisions.”
However, many adults experience low back pain, which stems from degenerative disc disease, a condition involving the cushiony material found between the vertebrae of the spine. While this is commonly referred to as “wear and tear” disease, the process is far more complicated. The treatment is still very conservative for degenerative disc conditions utilizing medication and physical therapy. For the select few that fail conservative treatment and meet appropriate selection criteria, explains Dr. Banit, an artificial disc replacement may be an option. In this surgery, the affected disc, along with any impinging disc fragments or bone spurs, is completely removed. The disc space is increased to its prior normal disc height, and the artificial disc device is implanted into the prepared disc space. The patient can usually expect to go home within 48 hours after surgery with few limitations on physical activity.
“There are many benefits to artificial disc replacement versus the standard spinal fusion procedure,” says Dr. Banit. “A fusion procedure has potential complications associated with taking a bone graft from the hip as well as the loss of motion. The physical activity restrictions following disc replacement surgery are usually much less than with a fusion procedure.”
The artificial disc, much like implants used in total hip and knee replacement, is a mechanical device that will wear out over long periods of time. However, studies for some of the devices have shown only minimal wear after simulating ten years of wear.
Another treatment option, microdiscectomy spine surgery, is typically performed for lumbar herniated discs in patients who experience back and leg pain after trying conservative therapy. This minimally invasive procedure is performed on an outpatient basis using a microscope through a small, one-inch incision in the midline of the low back.
The key to improving patient outcomes is tailoring the treatments to each individual case.
Conquering Low Back Pain ...
P. Jeffrey Jarrett, MD
Todd E. Kinnebrew, MD
Daniel B. Wagner, DO
William B. Wiley, MD
Jeffrey C. Easom, DO
Daxes M. Banit, MD
3051 Watson Boulevard,
Warner Robins
478-953-4563
1013 Main Street, Perry
478-218-4555
J.W. Spivey, Jr., MD
212 Hospital Drive, Suite M,
Warner Robins
478-923-0153