Tackling the Cycle of Pain, and Winning

Living longer doesn’t mean surrendering to chronic neck and back pain.

No big news: pain comes with aging. You may not be aware, however, how pain may lead us into a cycle that creates conditions for more injury and additional discomfort.


When we feel pain, we want to back off and stop moving. Of course we do. It’s a natural reaction; common wisdom. There are many other people whom I’ve met at my practice in Beverly Hills, CA who fell into the false sense of security that by “easing off” they can protect themselves from possible additional injury. They can’t help it, but when it comes to neck and back pain, backing away is the last thing they ought to do.


I’m not saying that everyone should behave like wrestlers and “fight through the pain.”  I encourage awareness of pain, but I also want people to manage it, rather than allow it to manage us. The longer we rest and take it easy, the greater (not less) the risk becomes for additional injury. That’s why I call it the “cycle of pain.”


I encourage patients to find other ways to remain active. Like the elderly couple from Thousand Oaks who, despite hip and neck problems, continue their daily course of walking at least three to five miles a day and swim several laps in their pool, weather permitting. I have a patient who is a cyclist with two herniated cervical discs. Eventually, he’ll need surgery, but in the meantime, he still makes 40-60 mile rides but on a recumbent bike to protect his neck from further injury.  


Of course, people want longevity with the highest quality of life possible. People want to delay surgery for as long as possible, but they also want to live pain-free, at least most of the time. Patients who follow my prescriptions and recommendations often can do these things. I also want them to be careful when they work through pain that comes with stiffness, but then seek care when they really need it. Again, we want to manage pain and not allow pain to manage us. I believe this is the way it can be done.  


However, there’s another class of patient who is also on the cycle of pain. These are patients who have undergone a cervical (neck) spinal fusion and believing themselves “cured,” end up right back to where they started with another cervical disc failure and what they fear most: another fusion. In truth, if you are a fusion patient, you’ll be fine for a while. Many fusion patients re-engage their former lifestyles with no problem. But eventually, about six to seven years later, quite a few them experience what we call adjacent disc failure.


If you imagine the spine and how it is constructed, you see the bundle of nerves (spinal cord) that run down the center of a column of bones called vertebra. The semi-flexible sponge-like discs between the bones maintain the structure of the column and prevent hyperextensions that could damage the spinal cord.


When discs are damaged or herniated, vertebra becomes misaligned. This leads to pinched nerves as the spinal column moves. To prevent pinching (nerve compression), surgeons may recommend fusion surgery for two or more of the vertebra. What this means is that they’ll surgically install steel rods and screws to prevent the vertebra from moving. A bone graft is added between the vertebra to cause them to grow into one solid bony structure.


Now, reimagine the column of bones in movement after two of the bones are fused. There’s an imbalance of pressure that’s communicated directly onto the discs above and below the fused level. The additional pressure is enough to cause subsequent herniation. This is an example of how adjacent disc failure, together with spinal fusion, perpetuates the cycle of pain.


As was the case in my cervical fusion and those of several of my patients, one fusion often—not always—leads to additional fusions. The cycle continues until either there are no more stress areas to fuse or the patient stops moving. Either way, it’s not a good situation to be in. Twenty years ago, fusion was our only option. Since 2007 in the U.S., surgeons can now replace herniated discs with artificial ones that will last more than 70 years, even with the imbalance of pressure from a fused level.


I’ve embarked on a campaign to not only promote the efficacy of artificial disc replacement surgery but also to advocate fusion reversals. The formal name of the procedure is “restorative motion surgery”–restoring movement that has been taken away by fusion. I’ve completed several such procedures on patients who have fusions that were done ten years ago or more. I’m successfully drilling out the bone grafts and replacing the fusions with artificial discs. With this advanced procedure, my goal is to remove patients from the cycle of pain permanently.


Restorative motion surgery is off-label. What that means is that the procedure, while not approved by the FDA, is allowed for surgeons who have the wherewithal to create customized treatments for their patients. I have the background that qualifies me for such a procedure: practicing neurosurgery for 25 years, a research clinician, and a member of the Cedars-Sinai Institute of Spinal Disorders in Los Angeles, CA. However, the most critical aspect of my care is a deep desire to give patients a better choice and a better future.


Here’s to being greater than better.

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