Surgical and Nonsurgical treatment options for Spine disorders.

I love Seattle! I really feel blessed to live in an area of the country where we have access to so many resources about healthcare and well-being. One of the resources I recently discovered is the collection of community education seminars put together by the Swedish Medical Center. These seminars are open to the public and almost always free. Check Swedish’s web site for details (http://www.swedish.org/).

Last week, I attended a seminar put together by the Orthopedic Institute about surgical and non-surgical treatment options for Spine disorders. I see a lot of clients complaining about back pain in my practice. I thought it would be quite interesting to hear what orthopedic surgeons' take on the problem was.

The presentation was delivered by Dr. Alexis Falicov, an orthopedic surgeon for Proliance Surgeons. Dr Falicov went through a set of slides describing the basic anatomical structures making up the spine. He then covered some of the traditional symptoms associated with spinal problems and the most common spinals disorders encountered. He then reviewed non operative treatment and prevention options before explaining in detail the different surgical procedures available.

Far from being an advertising for surgery, Dr Falicov really emphasized that surgery should be your last recourse and should not be considered lightly. He mentioned that the United States performs 3 times as many surgeries as other ‘industrialized’ countries, primarily because it is a very lucrative industry (this is probably a good topic for another entry). His message was clear: surgery is a traumatic event for the body and should really be avoided if possible. This is definitely a message I agree with.

The section about nonoperative treatment options and prevention methods was particularly interesting to me.
The prevention message was clear: exercise is the fountain of youth when it comes to your spine. Flexibility and conditioning training such as yoga and Pilates are amongst the best thing you can do to maintain a healthy back. Also critically important is the use proper lifting techniques.
One statistic worth repeating was that 90 to 95% of all back problems can be treated without surgery. The secret: patience! It may take months and sometime years for the symptoms to completely disappear. Also, most back pains are a result of muscular problems along the spine which surgery will not help. Massage therefore can help a lot!

Dr Falicov’s approach to spine problems is rather simple: plenty of prevention, 48 to 72 hours of rest after a flair, use of heat and ice to calm to muscle spasms (or what I call contrast therapy), patience, the use of over the counter medications (if it cannot be avoided) and talking to your primary care physician.

It was also interesting to hear him talk about the use of corticosteroids injections. He said that the injection’s primary role is to hide the pain, not to accelerate the healing. The healing speed is the same with or without the injection. What changes is the patient’s comfort level.
When surgery is the only option, Dr Falicov outlined some general principles to remember:
· Arm and leg pain are more often relieved than neck and back pain
· Pain and weakness respond better to treatment than numbness
· Surgery is a physical stress and trauma to the body
· Psychosocial stressors dramatically modify pain and do not respond well to surgery (ie: if you are under a lot of stress at the moment, chances are it is the cause of your pain).
· It is difficult to restore motion. You more than likely sacrifice motion in the back to regain function in the limbs.

Another interesting fact I learned during the seminar is nerves actually can regrow. The process is extremely slow (about 1mm per day) and the recovery is rarely complete.

I highly recommend those seminars. They are truly a wonderful resource to help us take ownership of our health!