A Pat on
the Back
One of many e-mails
from our patients.
" I am a patient of
Dr. Fedder's and
recommend him to
others whenever
I have the opportu-
nity. I've found him
to be very candid
and friendly, with a
sense of humor, and
I appreciate that.
But most impor-
tantly, he listened.
When you develop
that kind of rapport
and mutual respect
with a physician,
it means a lot."
Next to the common cold, back pain is probably the most common reason patients give for visiting the doctor’s office. Understanding back pain can be the first step to recovery. Dr. Ira Fedder, orthopaedic spine surgeon at Orthopaedic Associates, answers some frequently asked questions about back pain.What is the reason for most cases of back pain?
Most people have back pain without any identifiable cause. There is frequently no history of a specific injury or trauma. If there is an identifiable event, it is not unusual for the pain to begin 24 hours later. There are many structures in your neck and back which at times can be painful; these include the muscles, ligaments, discs and joints. Because of the location of these structures, it is hard to tell which structure actually hurts.
Does severe back pain mean that something is dramatically wrong?
This is a logical assumption, however it doesn't have to be true in the case of back pain. A patient can have severe back pain and even leg pain and have a normal physical examination and nearly normal MRI. More importantly, this severe pain can be resolved without any specific treatment.
I am having severe back and leg pain. Do I need an X-ray and a MRI?
A person who sees a back specialist may get an X-ray on the first visit. However, if the pain has only been present for a short period of time (less than 2-4 weeks), and your doctor has no reason to believe you have a fracture (for example, osteoporosis, trauma, history of cancer, etc) then even an X-ray may be postponed until a later time. In the event of neurological problems such as weakness, paralysis or loss of bladder control, an X-ray as well as an MRI or myelogram may be ordered.
I’ve been told I have a disc herniation. Is that the same as a slipped or ruptured disc?
YES. Don't be confused by your doctor's jargon! A disc is a large structure made of cartilage. Most people think of the disc as a shock absorber, shaped like a jelly doughnut. The disc functions more like a universal joint. It is a cartilage structure that is attached to two bones (vertebra) that holds the bones together, but allows controlled motion in all directions. The disc plays a large role in spinal stability and shares this mechanical load with the facet joints and the surrounding soft tissues.
Possibly. If you have a disc herniation in your neck or your back, you may have neck and/or back pain as well as pain in your arms or legs. People who have pain in their extremities may improve with conservative or aggressive-conservative care. The vast majority of people with a disc herniation will improve with time and will not need surgery. Anyone with a worsening set of symptoms, i.e. increasing pain, weakness, paralysis, loss of bladder or bowel control, poor coordination of the hands, or an unsteady gait, need urgent, if not emergent, evaluation by a spine surgeon.
What does conservative and aggressive-
conservative care mean?
Most people want to be treated in the least invasive manor possible. These terms describe the use of medications, exercise, and physical therapy, as well as more aggressive interventions such as epidural injections. These techniques allow you to be more comfortable during the early phase of a painful spine problem. They are not curative, rather they are designed to give you relief while waiting for the symptoms to settle down. In the long run, I believe that a consistent, but not necessarily aggressive aerobic exercise program will help people decrease the frequency of the spine symptoms. In addition, it is important to understand the basic rules needed to protect your back while staying active. This may help prevent recurrences.
If I need surgery for a lumbar herniated disc what should I expect?
Most disc surgery involves a small incision in the back, a 45-90 minute surgery and usually a one-day hospitalization.
What is spinal stenosis?
This is another confusing subject. Spinal stenosis usually occurs in people over 50 but can occur in younger persons. Spinal stenosis is usually caused by degenerative arthritis or wear and tear arthritis. This type of arthritis is also called osteoarthritis and is NOT related to osteoporosis. The joints in this condition get larger and sometimes change shape. Just look at a person’s hands as they age, the same thing happens in the spine. As the joints get larger they begin to squeeze the nerves in your spine. This happens very slowly, over many years. Eventually, a person develops symptoms that frequently include heaviness in the legs, fatigue, leg pain, numbness, and weakness. Most of these symptoms get worse with walking and get better with a short period of rest. Surgery is frequently needed to treat spinal stenosis.
For more information about neck and back problems, please visit our website at www.orthopaedicassociates.com or contact your physician or one of our spine specialists at the Orthopaedic Associates’ Scoliosis and Spine Center, 410.337.8888.
