Dr. Sebastian F. Koga

SPINE HEALTH

EDITORIAL BY DR. SEBASTIAN F. KOGA, NEUROSURGEON

Summer is a time of year when Louisianians are outdoors playing sports, boating, swimming, taking up new hobbies, and in better times even traveling to cooler climates. At the doctor’s office the summer season sees a drop in patient visits, but many spine injuries actually take place during this time.

Neck and back pain are very common, and almost everyone will experience these at some point in their lives. The majority of back pain is not dangerous, and does not indicate a permanent problem. Yet spine surgery is increasingly common, and many patients have unsatisfactory outcomes and continue to suffer chronic pain.

WHAT CAUSES BACK PAIN?

The spine is a complex part of the human skeleton with 24 mobile vertebrae holding us upright and protecting the spinal cord or nerves. The vertebrae are linked by discs and by facet joints located above and below each level thus allowing for bending and for cushioning of impacts. The vertebrae, the discs, the muscles, and the spinal nerves can all generate pain. They are considered connective tissue, and consist of collagen. Like the collagen in the rest of the body, they are susceptible to natural aging and decay, and therefore having an abnormal MRI is very common with age and physical activity.

The spine is subjected to mechanical stress during all activities, and besides accidental trauma I find that carrying extra weight is a major culprit of back pain. Often patients say “I was big all my life and this pain is new”, but the truth is that obesity takes a gradual toll on the spine, and is often associated with weak core muscle. The discs get compressed, the spine may even curve and shorten, the posture changes and chronic pain soon leads to doctor visits.

DOES SPINE PAIN INDICATE SOMETHING DANGEROUS?

Spine pain is very common and usually not dangerous. When the pain is limited to the central area of the neck or lower back it is likely to subside on its own. The paraspinal muscles and ligaments often cause pain which improves with rest, and with overthe-counter medications. Neck pain can also generate headaches which do not require a visit to the doctor.

The pain which get doctors worried is shooting pain radiating into the arms or legs. This indicates that nerve roots are being compressed, and over time could be permanently damaged. I often describe to patients the spinal cord as a dense clump of telephone wires transmitting millions of relays to the brain. These signals control all the pain, sensation, and movement in the body. So while pain is the first sign, most surgical problems are accompanied by loss of sensation (numbness, tingling) and sometimes loss of movement (ankle weakness, unsteady gait).

Neurons do not recover well after damage, so it is important to identify problems early before any nerve damage has occurred.

WHICH TYPE OF DOCTOR SHOULD I SEE?

Spine problems are so broad that many doctors offer treatments. It is sensible to start with physical therapy and primary care, but most patients end up seeing a spine specialist such as an orthopedic surgeon or a neurosurgeon. With minor differences both specialities offer the same range of treatments, with an everincreasing number of new devices and procedures.

Many patients spend years in the care of pain management specialists. While pain management is a huge quality of life issue, the pain is just a symptoms of a deeper problem. If it hasn’t subsided in a few months or years, it may be time to address the origin rather than just mask the pain. I encourage all patients with spine issues that persist beyond a year to see a spine specialist with training in orthopedics or neurosurgery.

MY NEIGHBOR HAD A TERRIBLE OUTCOME WITH SPINE SURGERY

The majority of stories about ‘spine surgery gone bad,’ has to do with expectations and understanding of the goals. I make all my patients fill out a detailed questionnaire which measures their level of disability in daily life. I operate when their disability rating is over 25% and never promise them that they will be pain free, but that their quality of life will improve.

We always say that “the purpose of spine surgery is to protect the spinal cord and the nerves from further damage.” If we achieve that the surgery is a success. Sometimes more is achievable, the nerves recover, feeling and strength return to a weak limb, and the pain subsides. But when patients expect a miraculous solution to all back pain, surgery does not hold the answer.

LAST WORDS

Keep a healthy weight and keep your body fat percentage low. Walk 10,000 steps per day, stretch before exercising, and focus on strong core and paraspinal muscles. Do not use narcotics for back pain. Seek a spine specialist if you have numbness and weakness in the limbs.

189 GREENBRIAR BLVD STE C, COVINGTON, LA 985.269.7676 KOGANEUROSURGERY.COM