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Online Chat - Oh, My Aching Back!

Online Chat - Oh, My Aching Back!

Tuesday September 28, 2010

Dr. Squires:
Hello everyone. I am Dr. Jason Squires, a spine surgeon who specializes back and neck pain. Today our topic is about back pain but I would be happy to answer any question on neck pain as well.

Comment From Xander Harris:
I tend to get a sore back from normal walking more than bending/lifting. Could this be a problem of bad posture?

Dr. Squires:
It could be lumbar stenosis...symptoms of this are increased and leg fatigue with walking improved by bending/leaning over/sitting.

Dr. Squires:
This is something that can be evaluated by your primary care physician.

Dr. Squires:
They will refer you to an orthopaedic surgeon if needed.

Spectrum Health:
FACTS: Back pain is more common the older you get. You may first have back pain when you are 30 to 40 years old.

Comment From Theresa:
What type of rehab do you recommend after a lumbar fusion.

Dr. Squires:
Not all patients after a lumbar fusion require rehab...if you are experiencing leg weakness PT maybe prescribed for leg strengthening.

Dr. Squires:
If you are having a hard time weaning from your brace or have a physically demanding job you may be sending to PT for core strengthening.

Dr. Squires:
It really can depend on the surgeons preference.

Comment From Nancy Dobry:
I am having trouble with Sciatica, pain/discomfort in my left buttock area and the pain radiates down into my left leg above my ankle. What can I do?

Dr. Squires:
Nancy - start by seeing your primary care physician.

Dr. Squires:
They can treat acute sciatica. If your symptoms become chronic or recurrent, or if you develop numbness or weakness of the leg it is likely you will be referred for surgical consult.

Spectrum Health:
FACT: Back pain is more common in people who have poor physical fitness.

Dr. Squires:
I am often asked about treatment of leg and back pain. We generally treat conservatively initially, possible for several months.

Dr. Squires:
...Prior to considering surgical intervention.

Dr. Squires:
Treatments include oral anti-inflammatory, pain meds, specific physical therapy customized for your diagnosis, and injections.

Dr. Squires:
Surgical intervention is considered more readily if there are neurologic signs of compression which are weakness of the legs, numbness, loss of fine motor skills or gait, and loss of normal bowel/bladder function.

Comment From Melinda Sharp:
What is a compression fracture and how would I know if I had that vs. something else going on?

Dr. Squires:
A compression fracture is a fracture of a vertebral body in which there is loss of height of the vertebrae. Typically, this is from a fall or impact injury and is common with patients that have osteoporosis. Pain is typically in one area of the spine, although on occasion there is radiating pain.

Dr. Squires:
Compression fractures typically are diagnosed with x-rays. Pain is usually severe at first and then slowly improves over 4-6 weeks.

Comment From Nancy Dobry:
And the Primary Physician can prescribe those treatments, or will he refer to a specialist?

Dr. Squires:
Nancy, your PCP can commonly prescribe the recommended treatments but if he is not comfortable he may refer you to a specialist.

Dr. Squires:
He may refer you to a Physiatrist, Pain Management physician Orthopedic Spine Surgeon or a Neurosurgeon, all of which could treat this initially.

Comment From Nancy Dobry:
Signing off, Dr. Squires. I will take your advice. Thanks very much!

Comment From Guest:
How does the quality of things, like mattresses and footwear effect the health of the spine?

Dr. Squires:
Guest, mattresses and footwear can affect spine pain but there are no hard and fast rules for which types are the best. My advice it to try several types and find some that work. These will not likely affect the long term spine health though in terms of arthritis or degeneration.

Dr. Squires:
Back pain is a very common problem for people. over 90 percent of people will suffer from back pain in their lives at some point.

Dr. Squires:
The good news is that for the majority of people, the condition is self-limiting, meaning that they will recover without any specific treatment.

Dr. Squires:
The best ways to prevent back pain are to

1. stay fit and active with an aerobic exercise program.

2. use good posture

3. lift smart - the saying "lift with your legs not with your back" is excellent advice

4. maintain a healthy weight

5. do not smoke.

Dr. Squires:
Smoking and back problems do not get a lot of press compared to lung cancer and heart disease but it has been implicated as a important cause of degenerative disc disease, even if you smoked for only a short period when you were young.

Comment From Betty Sabo:
I have been having neck and shoulder pain and not sure what is the main source of the pain is....how would I know?

Dr. Squires:
Betty, neck and back pain can be from a variety of causes. the majority of neck pain is muscular and not related to discs. the only way to tell for sure it to be evaluated by a physician. if you experience numbness, weakness, or shooting pains in the arm it could be a cause of a more serious condition though.

Comment From Ana:
Some people say that chiropractors are a croc and some swear by them. What's your professional opinion on chiropractic treatment?

Dr. Squires:
Ana, chiropractors are used by many patients, and some get a significant amount of relief from them and swear by them. My professional opinion of them is that they are generally harmless and if you experience relief then they are a good option for symptom control. There are some chiropractors out there though that makes unrealistic claims in their ability to treat your pain or cure certain conditions.

Comment From Ana:
One more question...I wear high heels a lot....my mom says it's bad for my back is that true?

Dr. Squires:
High heels are not necessarily bad for your back. they are worse for your feet because they can cause bunions or other foot problems.  A good rule of thumb is that if it does not bother your back to wear high heels then it is OK.  Your body will let you know when there is a problem.  the same does not hold true for your feet though. you can stretch out the ligaments on the sids of your feet and it may not hurt if it is slow. by the time your feet start to hurt, your feet may be significantly deformed.

Spectrum Health:
FACT: A diet high in calories and fat can make you gain weight. Too much weight can stress the back and cause pain.

Comment From Andy:
My spinal specialist said he would be using implants in my spine. Is this really necessary?

Dr. Squires:
Andy, implants may be necessary for your spine. It really depends on the type of implant and the condition he is attempting to treat. There is nothing to fear about appropriate use of implants though.

Dr. Squires:
There are a number of implants that have not been proven to work though and for a patient it is very difficult to figure out what these are. Cages which are used between the vertebral bodies are used very commonly as are pedicle screws and rods.  Other types may not have the proven track record as these and should be approached with caution.

Comment From Jay:
I have heard people talk about the pain associated with harvesting bone from the hip. Does this happen to everyone and how long does it last?

Dr. Squires:
Jay, Harvesting bone from the hip is a controversial topic. I harvest bone from the hip very commonly.  It is the gold standard when doing a fusion and there is nothing that surpasses it.  There are many physicians who do not like to harvest it for a variety of reasons. They have published papers stating that it causes much long term pain.  This is simply not true. While it may be painful for several weeks, none of my patients complain about it at six weeks post operatively.

Dr. Squires:
The alternatives to using it are substandard and have higher failure rates. There is no question that I would have it on my own surgery.

Spectrum Health:
FACT: Some causes of back pain, such as ankylosing spondylitis, a form of arthritis that affects the spine, can have a genetic component.

Comment From John:
Dr.  Squires, is there a danger to taking over the counter pain meds like Tylenol or Aleve regularly to help with back pain?

Dr. Squires:
John, There are some dangers associated with using over the counter pain medication.  Tylenol can be very dangerous to the liver it too much is taken. for people with normal livers, 4 grams can be taken per day.  Anti-inflammatory can cause problems with the kidneys.  and if you recently had a fusion or have a broken bone can cause problems with bone healing.  if used at the recommended doses though, they are generally very safe.

Dr. Squires: 
Steve, I do see sports medicine injuries in my practice.  A need for a referral is generally determined by your insurance though.

Spectrum Health:
FACT: If you have to lift, push, or pull while twisting your spine, you may get back pain. If you work at a desk all day and do not sit up straight, you may also get back pain.

Comment From Haruka:
What are my surgical options for severe back pain?

Dr. Squires:
Haruka, Your surgical options for back pain are several and it depends on the cause of your back pain.  if your surgeon determines that a surgery would help you, he would likely be recomending a fusion.  there are numerous ways to do this though depending on your surgeons skills and preferences.

Comment From Jay:
Ok great. Are there any potential complications with harvesting bone from my hip?

Dr. Squires:
Jay, harvesting bone from your hip does not have any common complications. The more uncommon complications would include infection, long term pain or numbness due to nerve injury, or very rarely blood vessel injury.  Complications though are probably less than 1 percent.

Spectrum Health:
FACT: Your body may not be able to get enough nutrients to the disks in your back if you smoke. Smoker’s cough may also cause back pain. People who smoke are slow to heal, so back pain may last longer.

Comment From Jan:
What are some of the complications associated with fusion surgery?

Dr. Squires:
Jan, complications from fusion surgery would infection, injuries to blood nerves, dural tear, incomplete relief of back pain, hardware failure, or failure of you bones to fuse.  The complications are generally rare with the most common probably being continued pain.  Infection is less than 1-2 percent and failure of your fusion to take and dural tear are around 10 percent.  Neither of those will necessarily have long term consequences though.

Comment From Monyka S.:
Do shorter people experience more back pain since they often have to do more reaching? I know that sounds silly, but at work I often have to reach above my head and stand on my tip-toes and at the end of day I am usually sore

Dr. Squires:
Monyka, height does not have much to do with back pain although if you are not able to maintain good posture due to ergonomic problems at work then it may be a cause for your pain.  Although it may cause you pain, reaching is not a common cause of back pain. it usually results in more shoulder pain.

Dr. Squires:  
Thank you for participating today in this online chat. I hope that I have been able to answer all of your questions. It is sometimes difficult to determine what is going on with just a simple description. Being evaluated in the office is the best way to determine the appropriate treatment plan.

If you think you need to see a Spine Surgeon, talk to your primary care physician or you can call my office, located at 4069 Lake Drive, Suite 315, at 616.464.2860.

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