The following article is sponsored by University of Utah Health Care
By Jennifer Dobner
When Erica Bisson takes a close look at a patient’s spine to identify the source of pain, one of the things she’s searching for is a sign of what she likes to call “grey hair.”
“We all age,” says Bisson, M.D., a neurosurgeon at University of Utah Health Care who specializes in treating spinal disorders. “Our tissues naturally degenerate which is why we get grey hair and wrinkles. It’s the same with our spine, so what I tell most of my patients is, it’s my job to decide if what we see on an MRI is a result of the normal aging process, or if there’s a more serious issue that’s causing you symptoms.”
The answer to the question could mean the difference between easing a patient’s neck or back problems with treatments like physical therapy, heat or ice, anti-inflammatory medications, strengthening exercises or possible surgery.
In truth, much of what Bisson and other University of Utah Health Care specialists see is routine back or neck pain brought on by a weekend of aggressive or vigorous outdoor play.
“It’s the weekend warrior we think of; the 40-plus age range people who get out there and do something or lift something and then get some discomfort or pain,” she says. “Some people call it “wrenching” their back.”
In most cases there’s a non-surgical fix —albeit one that requires some hard work and commitment. Bisson steps in when patients don’t improve after six to 12 weeks of treatment, or when there’s an apparent nerve impingement.
“Usually it’s because they have neurological symptoms like pain shooting down the arm or leg, numbness and tingling in the arms and legs, or weakness in the arms and legs,” she says. “All of these are signs of neurologic dysfunction.”
Also common: Spinal stenosis, narrowing of the open spaces in the spine that puts pressure on the spinal cord and the nerves that run through it. The condition, which can be caused by the presence of bone spurs or overgrown joints, can trigger serious pain and result in problems like dropping things and difficulty with balance.
“The signals aren’t quite getting from the brain to the limbs in a coordinated fashion,” Bisson says.
When tests reveal a patient’s problems are linked to spinal tumors, infection, deformity or any other complex condition, Bisson says she recommends surgery.
A surgical fix would also be recommended when pinching on the spinal cord results in a progressive loss of neurologic function, she adds.
But in most cases, Bisson says, degenerative spine diseases can be treated without an operation. Many herniated disks, for example, typically go away on their own, without invasive measures, but instead with the so-called “conservative management” treatment of ice or heat, physical therapy or modified exercise and occasionally steroid shots.
“I always tell my patients: It’s not the physical therapy that shrinks the disk and it’s not the medicine that makes the pain go away. It’s your body that does that, and time,” says Bisson. “All those things are aimed at managing your symptoms while your body is doing the job it needs to do to heal itself.”
One common mistake Bisson often sees: Patients in pain want to — and often do —stop moving.
“That’s actually very counterproductive to improving the pain syndrome,” she says. “The less you move, the tighter your muscles get, and then the harder it is to move and the more restricted your motion becomes. So it’s a vicious cycle.”
Bisson says her patients are routinely amazed at the improvements they can make on their own after a bit of hard work and patience. One woman with a herniated disk followed Bisson’s advice, lost 100 pounds over a period of six to nine months and found herself no longer in need of either surgery or a doctor.
“The pain was completely gone,” Bisson says. “I can tell you that it happens frequently. I have a good 50 percent of patients, even with symptoms of nerve pinching, that go and do physical therapy and take ibuprofen and two to four weeks later they come back and say, ‘Doc, I don’t need you anymore.’ “
For those hoping to avoid ever making a trip to Bisson’s office, she recommends a regime of regular exercise with a focus on developing core strength and healthy weight management, so that the back isn’t taxed by carrying extra pounds. And developing core strength includes working both the abdominal muscles and the lower back, Bisson says, which will properly support the spine and help patients maintain good posture when sitting and standing.
For those that do end up in the exam room, Bisson cautions against the belief that there is any sort of “quick fix” for back and neck pain problems.
“Patients come in to see me and they want me to have the hammer to hit the nail, to be the tool that’s going to immediately and indefinitely get them out of their current situation,” Bisson says. “Try not to be dazzled by the promise of the quick fixes and recognize that often spine problems are things that need to be helped with hard work and time.”
Even when surgery is the right option, the best outcomes will also depend on a recovery that includes changes in lifestyle and habits to help patients move their future life in a productive way and realistic expectations of what the procedure can do.
“That does not necessarily mean you’re going to be 20 years old again,” says Bisson. “It means I’m going to do everything I can to change that spine and decrease the pressure on that nerve in a way that’s going to improve your functional ability to move through your life. It’s not going to turn back time and it may not mean you’re 100 percent symptom free. It may be you’re at 90 percent, and that’s a win.”
