Back pain hits eight out of 10 people in this country at some point in their lives, and is the single biggest culprit behind missed work and disability, according to back and spine experts from the Health Center’s New England Musculoskeletal Institute during a recent Discovery Series event.
But they said, there are both non-surgical and surgical treatments that can ease the suffering and help people get on with their lives.
Having surgeons, medical doctors, and researchers work together can help ensure appropriate care for those suffering back pain, said orthopedic surgeon Dr. Jay Lieberman, director of the Musculoskeletal Institute. The Institute brings together experts in treatment and research to address problems affecting bones, joints, muscles, and connective tissue.
Presenters at the event included Dr. Syed Hasan, a physiatrist who specializes in physical and rehabilitation medicine or non-operative treatment for the back; Dr. Alexander Mohr, an orthopedic surgeon whose specialty is operative treatment of spinal disorders; and Dr. Patrick Senatus, a neurosurgeon with expertise in treating movement disorders as well as acute neck and back pain.
“Our goal is to identify and treat the underlying cause of the pain,” said Hasan. Sources of back pain can be the disc, which acts like a shock absorber, the vertebra body or bony front part of the spine, the facet joint that locks the vertebrae together, or the sacroiliac joint between the base of the spine and the pelvis.
Once the source of pain is identified, treatment may include lifestyle modifications, therapeutic exercises, medications – sometimes injected directly into the spine, and treatments with electrotherapy and ultrasound.
Hasan said alternative therapies can also be useful in treating back pain. These include massage therapy, acupuncture, and yoga and pilates to strengthen muscles around the spine.
The cervical spine performs a remarkable set of functions, said Senatus. It is a conduit for the spinal cord and nerve roots; it allows flexion and sideways bending; and it supports the head, which weighs more than a gallon of water.
Mohr said surgical approaches should only be tried if non-surgical approaches are not effective.
For some painful conditions, such as spinal stenosis, caused by a narrowing of spaces in the spine that increases pressure on the spinal cord or the nerve roots, treatment may be a laminectomy.
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This involves trimming part of the vertebra to relieve pressure on the nerves, or fusing two or more vertebrate to prevent slippage or curving of the spine.
A more recently developed treatment uses an implant, called an x stop, to provide more space between the vertebrae to reduce pressure on the nerves.
“It can be quite effective in reducing pain,” Mohr said.
Vertebral compression fractures are most often the result of osteoporosis, which affects 24 million Americans. A treatment called kyphoplasty uses a special cement to stabilize the fracture and restore the height of the vertebrae.
“It’s important to remember that most spinal surgery requires good quality bone, which is not always available in patients suffering from osteoporosis,” Mohr said.
Vertebral compression fractures related to osteoporosis can set patients on a downward spiral, he said.
Pain reduces a patient’s mobility and results in less activity, which increases bone loss.
That, in turn, can lead to more curve in the spine, which can increase abdominal compression and result in a loss of appetite.
Patients often try to counteract the stooped spine by bending their knees.
That unfortunately can result in changes in balance and increased risk of falling.
All the physicians emphasized the importance of a healthy lifestyle for a healthy back, especially not smoking, maintaining an ideal weight, and doing appropriate exercise.