April 2014

At Loyola, we seek to balance all surgical and nonsurgical options with considerations of each patient’s individual circumstances and the goal of achieving both short-term and lifelong improvement when possible.

 

April 21, 2014

Q:

Are there treatment options for stenosis and sciatica apart from surgery? Do pain pills help the condition?

A:

There is a difference between treating a problem versus curing it. Sciatica due to stenosis is by definition compression of the nerves in the low back due to chronic changes. These anatomic changes can only be ‘cured’ by surgery because no other treatment will remove the physical compression of the nerve. However, most patients with this condition only require ‘treatment’ of their symptoms. In other words, nonoperative treatment (physical therapy, injections, medications) can often provide sufficient relief and hence, avoid the need for surgery. An important exception to this approach is when damage to the nerve is detected during an examination. Under these circumstances, surgery may be a first- line treatment.

April 21, 2014

Q:

Can a 16-year-old have brachycephaly? If not, then why is the back of his head flat and is it hereditary?

A:

From the webmaster: Your questions would best be answered by a pediatric neurosurgeon. However, you would need to schedule an office visit for a thorough exam to address all your questions about this condition.

April 16, 2014

Q:

I’m a 34-year-old woman and I have been diagnosed with a degenerative disc after experiencing ongoing pain in the neck/shoulders/upper back for the past five months. I want to get back into my old running routine but even using an elliptical is painful at this point. Any advice?

A:

Recent studies show that use of elliptical machines transmits less force to the spine than treadmills, while still retaining the same health benefit. Therefore, it appears that your pain syndrome is progressing despite your youth and obvious desire to stay fit. Once again, an evaluation by a qualified spine specialist may help determine whether in fact a degenerated disc is the culprit, or if your diagnostic and treatment options should be expanded.

April 16, 2014

Q:

Can an orthopaedic doctor diagnose and treat someone with shoulder, upper and low back and hip pain due to muscle tightness/spasms?

A:

Muscle spasms are, like a fever, more a symptom that something is wrong rather than a problem itself. Orthopaedic surgeons are experts at determining the source of such pain. Your description suggests a problem that is too diffuse to be attributed to a single joint. Even a general orthopaedist, not one necessarily specializing in spine surgery, should be able to help.

April 16, 2014

Q:

In early April I had testing done at the Loyola Health Fair bus, which showed my heart rate was at 36 beats per minute. How dangerous is that?

A:

A visit to the Health Bus can only improve your health if you investigate abnormal findings. A low heart rate, called bradycardia, should be evaluated by your primary care physician. It’s urgent that you make an appointment as soon as possible.

April 16, 2014

Q:

I can’t sleep from pain in my middle spine and neck. It is so painful that I can’t sleep until around 6 a.m. What should I do?

A:

Sleep is critically important for your overall health. Pain that interferes with sleep to the extent you describe is uncommon and should be evaluated by a qualified physician.

April 15, 2014

Q:

I’m a woman who will be 40 years old in September and heard that women can experience different heart attack symptoms from men, and can include back pain. How can women differentiate certain types of back pain from heart-attack type back pain?

A:

From the webmaster: Dr. Ghanayem and Dr. Nockels are not heart specialists. For an answer, please check out our Ask an Expert section.

April 15, 2014

Q:

What is your take on chiropractors? Should I see one when having back and neck pain?

A:

Chiropractors can help some neck and back conditions.  As with all conditions, a proper and thorough evaluation is necessary before embarking on any plan of care.

April 15, 2014

Q:

I have been told by an orthopedic doctor that I have spinal stenosis and spondylitis. He suggested getting a cortisone shot, which I am scheduled for. He said it would relieve me from pain for maybe 30 days or up to a year. I have suffered for more than a year and it interferes with my quality of life. I may be 77, but there’s still a lot left on my bucket list!!! Does this procedure take very long?

A:

Spinal injections do not take very long to perform and can take up to a week to have a positive effect.  Everyone responds differently to the injection with some people getting no relief, some getting partial or short-term relief and others getting excellent relief in the long term.  After your injection, you should return to your spine specialist to discuss the results and other options if they don’t work, or plans to prevent aggravating your back in the future if they do help.

April 15, 2014

Q:

I have major pain in my arm and into my shoulder. Lately I’ve had terrible headaches. I also have carpel tunnel and high blood pressure. Could there be any relation between the shoulder pain, headaches, carpal tunnel and high blood pressure?

A:

This is a good question, illustrating how different problems can have similar symptoms.  A shoulder problem (like arthritis or a rotator cuff tear) can cause shoulder pain, neck pain and pain into the upper arm.  Carpel tunnel syndrome can occasionally cause pain to travel up the arm from the wrist.  Cervical disc problems can cause neck, shoulder and arm pain and even cause headaches.  All of these issues individually are not dangerous, except the potential for high blood pressure being too high and causing headaches.  It’s for this reason that anyone with terrible headaches and history of high blood pressure should see their doctor right away.  The other problems that include the spine, shoulder and wrist are not dangerous and can be looked into once the blood pressure issue and headaches have been properly evaluated.

April 15, 2014

Q:

I have been having very bad back pain lately, especially in the morning when I get up. What would you advise me to do?

A:

Many people have morning low-back pain upon awakening.  Some of the simple steps to address this include making sure your mattress is not overdue for changing, and stretching your back and legs once you do get up.  Occasionally, it’s a sign of an underlying back problem that needs more specific care and a thorough spine evaluation should be completed.  It is sometimes advisable to keep an anti-inflammatory at the bedside and take it about 30 minutes before rising. This will help with the discomfort of standing up first thing in the morning.

April 15, 2014

Q:

I have tried shots and physical therapy. The shots did not work and the physical therapy had minimal effect. My back hurts all day, every day. My two lower discs have degenerated and are bulging, with three others affected higher up. Some days the pain is overwhelming. My doctors don’t want to give me pain medicine over the long term. How does someone deal with the pain long term without medicine or surgery?

A:

Long-term care for chronic back pain when several discs are involved is a challenging issue.  The cornerstone of treatment is keeping one’s core muscles in shape through a proper low-back exercise program.  The use of non-narcotic pain medicine can be helpful but needs to be individualized.  Activity modification, smoking cessation (yes, smoking harms your discs) and occasionally alternative care can be considered.  The treatment plan usually takes time to “dial in” and definitely needs to be individualized

April 15, 2014

Q:

I was diagnosed with scoliosis at age 12. It was determined that I had a 48-degree curve in my spine. I wasn’t able to get it fixed because I had stopped growing. Now I’m 21 and experiencing excruciating pain. What should I do?

A:

There are so many reasons why someone can have back pain.  The presence of scoliosis itself is not necessarily the reason one would have back pain.  In fact, younger adults with scoliosis do not have pain.  This is a good reason to make an appointment with a spine-care specialist for a proper clinical assessment of your condition.

April 10, 2014

Q:

What is the difference between having an orthopaedic surgeon and a neurosurgeon perform your back surgery?

A:

Today there is little difference between orthopaedic surgeons and neurosurgeons who dedicate themselves to spine surgery. Training in each subspecialty includes areas not associated directly with the spine, such as brain surgery in neurosurgery and hip replacements in orthopaedics. However, spine surgeons as a whole tend to focus their efforts on the same sorts of procedures, no matter their educational background.

April 10, 2014

Q:

I fell and hit the back of my head. I was in hospital for 10 days and now have a very weak arm, almost paralyzed. My speech sounds like a person who had stroke and my left leg is off target. Is there anything that I can do to improve this?

A:

You need to go to the ER immediately.

April 10, 2014

Q:

Can spinal stenosis make my legs hurt when I walk? I can’t even walk to my mailbox without them hurting and feeling real heavy. I was told about 10 years ago that I had spinal stenosis.

A:

The symptoms you describe are classic for lumbar stenosis, although you should seek a qualified medical opinion before making any assumptions. Classically, one feels fatigue and pain in the legs with walking, a condition relieved by intermittent sitting. It is caused by degeneration of the spinal canal and gradual compression of the nerves in the lower back. Many patients will find leaning forward, for example on a shopping cart, allows them to walk farther. An evaluation typically includes an MRI and treatments vary depending on the severity of your symptoms. Most patients who consider surgery are limited to walking a block or less.

April 7, 2014

Q:

After a microdisckectomy and laminectomy at l5-s1with no luck, is fusion my only option left when shots, pain management and pain management have failed?

A:

Any operation on the spine that ‘fails’ should be regarded from several perspectives before any further surgery, especially fusion, is considered. Was the initial procedure indicated, were the goals clearly defined, the surgery adequately performed, does current imaging demonstrate new or residual pathology? One must always remember that not all surgeries are successful and that not all spinal conditions require surgery. This is true even if shots and pain management have not worked. Therefore, a failed operation does not automatically mean that more surgery will provide any further benefit.  A fusion is not an operation of last resort but rather an operation that should be used only when appropriate.

April 7, 2014

Q:

Can an individual with severe cervical spinal stenosis escape surgery if there is no pain? Also, can herniated discs and bone spurs resolve themselves on their own?

A:

Ironically, pain is usually absent from patients with severe cervical stenosis because the spinal cord itself has no ‘pain fibers.’ Instead you may feel a loss of function in your hands or unsteadiness in your gait. Since pain is an unreliable indicator of severity with this condition, an objective neurologic examination is necessary. If signs are found suggesting ongoing damage to the spinal cord (called myelopathy) and subtle findings are seen on MRI studies, surgery may be necessary to prevent future problems. If surgery is not going to be performed, careful follow-up is usually required and activity modification (such as the avoidance of contact sports) may be required. Also, disc herniations can sometimes resorb but bone spurs will not.

March 31, 2014

Q:

What is the usual recovery time following surgery?

A:

This depends entirely on the magnitude of the procedure. Often there are several surgical options to treat the same condition. An effort is made to select the ‘right’ procedure based upon the highest likelihood of success and the lowest risk. Sometimes this analysis may lead to a large operation with significant recovery time. More commonly, patients can resume normal activities within a few weeks of surgery. A general rule of thumb is that the number of hours a procedure takes equals the number of days in the hospital and also the number of weeks for standard recovery.

March 31, 2014

Q:

Is surgery necessary?

A:

In almost all circumstances spine surgery should be considered elective, and only after nonsurgical options have failed to produce the desired results. Exceptions to this do exist, for instance, in cases of progressive loss of neurological function, such as arm, leg or bladder control. Even then patients may still decide to forgo an operation after considering what is best for them.