Almost everyone experiences back pain at some point in their life. It can be caused by a variety of things and treatment can range from “take two aspirins and call me in the morning” to surgery.
It becomes more likely to experience back pain as you age.
Dr. Dwight Tyndall, of DrSpine.com, said the incidence of back pain increases after 40. Degenerative changes are the most common causes brought on by a combination of age and physical activity.
“As we age, the discs in the spine become stiffer and also get smaller,” Tyndall said. “As a result of these changes, arthritis will develop, causing back pain. This type of back pain is worse with activities and is felt often in the morning when we first get out of bed.”
Compression on the spinal nerves causes pain when standing or walking but goes away when sitting, he said.
“In the older population, most back pain that lasts longer than a few days can be treated with physical therapy and medications. A very small percentage of patients will require surgery.
“To treat nerve impingement, a laminectomy to remove a small part of the covering of the spine can be performed as an outpatient procedure. If that fails to relieve the pain, a minimally invasive spinal fusion can stabilize the spine to prevent discomfort and relieve pain.”
Dr. Nitin Khanna, an orthopedic surgeon practicing at Franciscan Health, said the vast majority of back pain cases can be relieved with lifestyle changes, such as an improved diet, exercise and stretching, observing good body mechanics (lifting with the legs rather than the back) and having an ergonomically sound workstation.
Khanna said the three main causes of back pain are: a herniated disc, which can also cause leg pain if it is pinching a nerve; degenerative arthritis, which develops over time; and a fracture from a fall.
Of those whose back pain is severe enough to require surgery, both doctors acknowledge that spinal surgery has come a long way. “We have minimally invasive procedures for conditions that used to require hours in surgery and several days stay in the hospital that we now can do as outpatient surgery in which they go home within hours of the procedure,” Khanna said.
Tyndall added: "The ability for patients to have procedures and to return home the same day has helped patients recover faster and regain their normal pain-free lives."
Khanna said surgical procedures include shaving the bones to relieve pressure on the nerves and even removing injured discs and replacing them with metal or plastic ones to retain motion and function.
“If there is an unstable segment in the lower base of the spine, we can do a MAS PLIF procedure, which is done through a small incision as an outpatient or, for older patients with other medical issues, might involve an overnight stay,” Khanna said.
MAS PLIF (Maximum Access Surgery Posterior Lumbar Interbody Fusion) involves making a midline incision in the patient’s back, removing the damaged disc and fusing the vertebrae to reduce motion, according to Khanna, a pioneer and teacher of the procedure.
Khanna noted that Franciscan Dyer Hospital, where he practices, has O-arm stealth navigation equipment that provides X-ray vision to see where to place his instruments.
Despite these advances, prevention is still the best medicine for the back.
“The back is not meant to put up with what people put it through, Tyndall said. “The common sense thing you can do is exercise regularly, lift with your legs and don’t get overweight. But, if you get pain, rest before you resume your activity.”
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