By Oren Blam, M.D., Orthopaedic Surgeon, Spine Specialist
A lot of what we do in medicine—including in the treatment of back or neck pain—involves managing chronic conditions. For example, high blood pressure is rarely cured but rather is managed with diet, exercise, and medication. So too, do people with back or neck problems want their symptoms managed so as to reduce their pain.
Yet, there are cures for many people with certain conditions of the spine. Surgical procedures can actually correct an anatomical problem that may underlie many people’s acute or chronic neck and back pain.
The most common curable condition of the spine that can cause spinal pain that extends into the arms or legs is spinal stenosis. With stenosis, there are anatomical structures constricting the nerves in the spine—oftentimes thickened ligaments, enlarged joints, and/or protruding disks that are a result of “spinal arthritis” and that consequently take up too much space. Since stenosis can be asymptomatic, a trial of nonsurgical care for painful spinal stenosis is appropriate; but when pain persists, surgery for stenosis has very high success rates.
This finding is not new. In a 2009 scientific study published in orthopaedic surgery’s prime peer-reviewed journal, researchers found: “Compared with patients who are treated non-operatively, patients in whom degenerative spondylolisthesis and associated spinal stenosis are treated surgically maintain substantially greater pain relief and improvement in function for four years.” (Weinstein, et. al.; JBJS (Am) 91(6):1295-304)
Similarly, in a top neurosurgery journal in 2014, researchers reported: “comprehensive medical [that is, non-operative] management did not result in sustained improvement in pain, disability, or quality of life for patients with surgically eligible degenerative lumbar spondylolisthesis, stenosis, or disc herniation…[in patients for whom] 6 weeks of conservative therapy failed.” (Parker, et.al.; J Neurosurg Spine 21(2):143-9)
Spinal instability (most often spondylolisthesis but sometimes scoliosis or other conditions) can also be cured surgically with high success rates when initial nonsurgical management is failing to relieve symptoms adequately.
In fact, an outcomes study published in 2014 showed that success rates in terms of reduction in pain and improvement in function (also known as health-related quality of life) following spinal surgery for spinal stenosis and/or instability are on par with results of total hip or total knee replacement surgeries. (Rampersaud, et.al.; Spine J 14(2):234-43)
The key in knowing when surgical management may be curative and when nonsurgical care is no longer likely to help is to get a comprehensive and honest assessment from physicians knowledgeable about both operative and non-operative techniques. At OACM, spine surgeons and non-operative spinal care doctors are available to help patients navigate the plethora of treatment options for neck and back problems—up to and including minimally invasive and open spine surgeries, when appropriate.
More information on spine surgery can be found at www.mdbonedocs.com or by calling Orthopaedic Associates of Central Maryland at (410) 644-1880.
