Back pain? Neck pain? What are your options?
A friend of mine is an avid cyclist. When I met him, he had just turned 55 and just completed his fourth ‘century’ (100 miles) ride. He came to me experiencing numbness in his right arm and fingers and persistent but manageable pain above the shoulder area of his neck. An MRI revealed two ruptured discs in the region of the neck known as C5-6, and C6-7. The diagnosis was not a surprise. The ruptures occurred right where the neck receives lots of pressure from turning the head up to peer over the handlebars for rides that lasted all day.
His initial consultation was also not a surprise, at least to me. The first spinal surgeon to examine him recommended spinal fusion.
Spinal fusion has been around for about 70 years. It was created to solve a broad range of issues by literally fusing vertebrae together to immobilize portions of the spine that needed treatment. While this procedure is still in use and serves many patients well, fusion has never been a perfect solution for all patients and in all cases.
For one thing, fusion is major surgery that can take up to seven hours and requires up to 4 months of recovery, as long as there are no complications. Obviously, the direct result of the surgery is severely decreased mobility from reduced flexibility of the spine. In some cases, depending upon the extent and location of the fusion, there is also an increased chance of complication. Some patients require surgical revision in as little as five years from the first surgery.
It’s also a procedure I would be very reluctant to recommend for someone as active and as young as my friend. And yet, had we met ten years earlier, his options would have been very limited, and spinal fusion probably would have been in his future.
However, a lot of development has occurred in the last ten years. Depending upon the patient’s structural anatomy, age, bone density, and health assessment of joints; depending upon the location of pain and numbness that often result from nerves that are “pinched” in various locations of the spine; the surgeries that treat these conditions are very different.
For instance, if symptoms are the result of a protruding disc or a bone spur, I can relieve the patient with a very quick outpatient microsurgery procedure that takes 40 minutes. The procedure is performed using an endoscopic type tube equipped with a fiber optic microscope. Patients don’t lose even more than a tablespoon of blood. It is very safe, and they are back to their usual active lifestyle within eight weeks or sooner.
Similarly for the neck, if there is pain in the shoulder blade and it radiates down into the arm, I may recommend microforaminotomy, which is also another minimally invasive microsurgery procedure.
If there is more axial pain or pain down the center of the neck, around the sides or in the mid to low back down the middle or across down into the tailbone, then I may recommend disc replacement, decompression, or in extreme cases, fusion.
Artificial disc replacement is a relatively new procedure. The discs themselves are replaced by artificial implants, thus preserving flexibility of the spine while relieving the cause of pain and numbness. Moreover, recent studies clearly show superior outcomes over fusion in every measure tested: from neck pain, arm pain, neurologic outcomes, and reduction in surgical revision. Depending upon the location of the procedure, an artificial disc replacement may take up to 2 hours, and the recovery is about two months.
Fusion may even be needed in some cases where degeneration is very advanced. In these cases, I have combined fusion with an artificial disc to maintain as much flexibility and range of motion as possible.
With the exception of fusion, these options were simply not available ten years ago.
But the best option is no surgery at all. In most cases, I’ll start with nutrition, exercise, wellness screening, and a bit of pain management when needed. I’ve written about this in previous articles and posts.
Chronic back and neck pain is not the end of your life. Surgery is not the end of the world; it’s not even the best option. Movement is life because activity and movement are vital to life. Being proactive about the condition of our health keeps our options open and produces the best outcomes attainable.
That’s how we can be greater than better.