Most people have experienced back pain at some point, and chronic or severe pain can take a hefty toll on your quality of life.
In the spine edition of our Orthopedic Anatomy Series: Exploring Your Body from the Inside Out, we look at the causes and treatments of common spine ailments that can cause this discomfort.
Our panel of five OrthoCarolina spine specialists partnered with the education experts at Experience Anatomy to explore the ins and outs of back pain, from when to consult an orthopedic specialist to pain injections to surgery recovery.
OrthoCarolina physiatrists specialize in non-operative spine medicine. In this case study, Dr. Alex Chasnis, MD, breaks down physiatry, pain injections and how to know when to seek a spine specialist.
CASE STUDY – Spine Conditions & Treatments
In this case study, Dr. Anthony Kwon, MD, gives us an inside look at common spinal disorders and conditions using the Anatomage, a 3D virtual anatomy table.
Our panel of spine specialists addressed audience questions during an open Q&A. Watch the complete Q&A discussion from 32:00 – 1:15:54.
Q: Are there any conditions that could prevent a patient from utilizing spinal injections?
Dr. Chasnis: Very few things prevent spinal injections. I think the better question is are we really dealing with something that will respond favorably for the situation. The biggest thing is if someone is on a blood thinner.
Q: What does an injection consist of? Does it include cortisone?
Dr. McGehee: It’s a combination of a corticosteroid, so you’re trying to decrease inflammation and lidocaine, both on the skin & nerve or joint. Sometimes we use a longer acting medication depending on what we are trying to find out.
Q: How long does it take annular tears to heal? Once healed, are those areas susceptible to tear again?
Dr. Kwon: We think of annular tears as weakening of the outer layer of the disc, similar to a pair of shoes that have been scuffed or worn down. Oftentimes patients can be totally asymptomatic and have annual tears still shown on an MRI. They heal to a degree, but it’s not like a paper cut that just heals up on its own. It’s usually a result from degenerative changes then we see on an MRI.
Q: What are the long-term effects of pain injections? Could a patient have injections done periodically over a decade or more?
Dr. McGehee: You could as long as you spread out the injections, but you wouldn’t want to do it for a very long period of time. You would need to look out for osteoporosis from longer-term use of a steroid.
Dr. Chasnis: Very common question. Yes, there are negative side effects to steroid injections, and most of the time are for patients who are taking them on a regular basis and a high dosage. You need to be cautious of the long-term effects from it.
Q: What role does posture play in leading to spine issues that might need to be addressed down the road?
Dr. Paloski: Posture that causes the pain or vice versa. Certainly there is a component to posture that’s structural, that’s the way the spine is stacked, and there are parts that are muscular that can be worked on and improved. Good posture and central balance can be important and play a part in your muscle balance and back pain. As kids get through puberty and adolescence and get out of carrying 15-pound backpacks at school, get out of a desk for 8 hours, their posture does tend to approve. Not all bad posture equals pain.
Dr. Kwon: I like to refer it to the chicken and the egg. Sometimes it’s the posture that affects the spine and other times it’s the spine affecting the posture.
Q: What are some misconceptions of spinal surgery?
Dr. Wegner: That any kind of back pain can be fixed by a surgery, and that orthopedic specialists are unwilling to anything but surgery. Surgery is the last resort. I want patients to go through physical therapy and pain injections before we consider surgery.
Q: How does a patient prepare for spinal surgery?
Dr. Wegner: There is usually a lot of anxiety around spinal surgery, which is very normal. Working around the spinal cord is a big deal. It’s important to get your questions answered prior to the surgery. Write down any questions and get those questions answered. Ask for additional literature and websites to really understand what your surgeon is doing before the surgery.
Q: What does recovery from spine surgery look like?
Dr. Kwon: It depends on the procedure. There might be a period of time that you will need to let the body recover, usually 2-4 weeks, then starting physical therapy. Bigger surgeries might need rehabilitation or in-home therapy to prepare for more strengthening and conditioning afterwards. We recommend walking to regain strength.
Q: Will I need any special equipment, like a walker or adjustable bed, once I go home from spine surgery?
Dr. Kwon: Other than a good pair of shoes, we do not typically utilize any other equipment unless there’s a special circumstance.
Q: When is surgery the right option to treat scoliosis?
Dr. Paloski: The indication for the right option is when the curve progresses, about 45 to 50 degrees. That’s when we talk about the curvature progressing into adulthood. There is no specific number, but we start having surgical discussions.
Dr. Kwon: Just because you have curvature in your spine doesn’t mean you need screws and rods to fix it. In the adult population, scoliosis is a condition of other problems like spinal stenosis, instability of the spine. For us, it’s more the pain dysfunction in adults that we discuss treatment with surgery as opposed to the degree of the spine’s curvature. We have had patients that have a 50- or 60-degree spine who have minimal problems and no pain. If there is progression, we may consider it. As long as they can do their daily tasks and be active, we generally discourage having surgery.
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For acute orthopedic injuries after scheduled clinic and urgent care hours, please utilize the HURT! App, in partnership with OrthoCarolina, for fast free access to orthopedic advice with a response time of ~4 minutes. Download here.