Back Pain: What you should know about spinal surgery

With some 90 percent of the North American population projected to experience a back problem that will require them to seek professional help, The Network Journal turned to a leading spinal surgeon for some basic answers on common back ailments and spinal surgery.

In an exclusive interview, Daveed D. Frazier, M.D., of Long Island College Hospital in Brooklyn, N.Y., said professional help might initially come from a chiropractor, orthopedist, physical therapist or some form of alternative therapy, rather than a spinal surgeon. ?I would say I operate on fewer than 30 percent of the patients I see,? he says, stressing that not everyone with a back ailment is a candidate for spinal surgery. ?For the average person, back pain, the most common spinal problem, will get better in a few weeks. For 90 percent of these cases, avoiding any lifting and taking some anti-inflammatory medicine (such as aspirin) are all that?s needed.?

Even if the pain persists, appropriate exercises with a physical therapist may be your next step, rather than a surgeon. ?Surgery, though effective, should be a last resort,? Dr. Frazier insists.

Consider the causes of, and treatments for, sciatica and herniated discs. ?Sciatica is actually a layperson?s term for lumbar radiculopathy, irritation of the sciatic nerve,? Dr. Frazier says. The sciatic nerve actually comprises five distinct nerves that join together and run down the back of the leg. In sciatica, only one nerve is usually irritated. ?The major cause of sciatica is a herniated disc in your lower spine, pressing on to the nerve roots,? Dr. Frazier says. Herniated discs can develop at any age, but generally occur in the twenties from trauma, or after 50 from degeneration. If rest, exercises and other conservative treatments do not help, then surgery could be the answer.

The traditional surgery for herniated discs is an operation called a discectomy, in which the back is opened to give the doctor the greatest scope to assess the injury and repair what needs to be fixed. A discectomy is a fairly complicated procedure and entails a relatively long recovery period. Equally effective, though much less invasive, says Dr. Frazier, is a procedure called an endoscopic discectomy, which is offered at Long Island College Hospital. This is only one of several relatively new and less invasive spinal procedures that offer exciting options for surgeons, Dr. Frazier says. ?There is less tissue damage and they offer faster recoveries to the patient,? he notes.

He cautions, however, that because these minimally invasive procedures are newer, they are less tested, and complication rates can be higher. For this reason, he urges patients to make sure their doctor carefully evaluates a new technique for its benefit to them (the patient) and not to the surgeon who wants to make an addition to his or her ?toy of the month? portfolio. ?Ask why he wants to use this procedure instead of an older technique,? Dr. Frazier says.

He cites the procedure called kypholasty as an example of a less invasive procedure that can offer major advantages. ?Kyphoplasty is designed to treat compression fractures, usually caused by the bone loss of osteoporosis. Untreated, these fractures can lead to the deformity seen in elderly women called ?dowager?s hump?,? he says. Ten years ago, he explains, the spine surgeon would treat this condition by inserting a metal rod to pull up the spine. ?It was fairly complicated and age eliminated many patients as candidates for surgery,? he notes.

With kyphoplasty, however, ?the doctor inserts a needle into the spine and inflates a balloon. Some cement is then inserted and the fracture is fixed,? Dr. Frazier says. The whole thing takes about an hour and can be done on an outpatient basis. Its relative ease allows doctors to fix compression fractures in a much wider range of patients.

But the benefit of kyphoplasty is not only an aesthetically straighter spine, but also the elimination of a severe risk, says Dr. Frazier. ?For every one compression fracture not treated, you have five times the risk of more developing,? he warns.