Posts Tagged ‘Spine Pain’

Spinal Stenosis: Treatment Options

spinal stenosisSpinal stenosis is a condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed (or narrowed). This narrowing occurs most often in the lower back or neck, and can put pressure on the spinal cord and nerves, causing a “pinching” of the spinal cord and/or nerve roots. The pinching can lead to a variety of symptoms, including pain, weakness and numbness. Symptoms often start slowly and get worse over time, and typically a person with this condition complains of severe pain in the legs, calves or lower back when standing or walking. Other symptoms include abnormal bowel/and or bladder function and loss of sexual function. Depending on where the narrowing takes place, you may feel these symptoms in the lower back and legs, neck, shoulder or arms. Usually, it is relieved by sitting down, leaning over or sitting forward.

In most cases, the narrowing is caused by osteoarthritis of the spinal column and discs between the vertebrae. It may also be caused by a thickening of the ligaments in the back, as well as by a bulging of the discs that separate the vertebrae. If you suffer from any or all of the above you should schedule an appointment with an orthopaedic spine specialist to determine if you have spinal stenosis.

How is Spinal Stenosis Treated?

The preferred treatment for cases of persistent back pain from spinal stenosis is a combination of physical therapy, prescribed exercise, and medications for chronic pain. Only if you have persistent pain, or if your pain does not respond to these efforts, will your physician consider surgery to relieve the pressure on the affected nerves or on your spinal cord. Here is what you can do:

  • Exercise: Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs. This will help to improve your balance, ability to walk, bend and move about, as well as control pain. A physical therapist will identify and show you what exercises are right for you.
  • Medications: The most common treatment for chronic pain in spinal stenosis is non-steroidal anti-inflammatory drugs (NSAIDs). These include: ibuprofen (Advil, Motrin), acetaminophen (Tylenol) and Naproxen (Aleve). Your physician may also prescribe other medications to help with pain and/or muscle spasm.
  • Cortisone injections: Injections directly into the area around the spinal cord (known as epidural injections) may provide a great deal of temporary, sometimes permanent, relief. These medications include: Cortisone (Celestone, Kenalog) and methylprednisolone acetate (Depo-Medrol, Medrol).
  • Surgery: In some cases you may need surgery to relieve spinal stenosis, particularly if a disc fragment is lodged in your spinal canal and is pressing on a nerve, which can cause significant loss of function. Some patients with severe or worsening symptoms (but who are otherwise healthy) may be candidates for what is known as a decompression laminectomy. This surgery removes the bone spurs and buildup of bone in the spinal canal, freeing space for the nerves and the spinal cord. This may be done in conjunction with a spinal fusion to connect two or more vertebrae and better support for the spine. It should be noted that while surgery may bring some relief, it will not cure spinal stenosis and symptoms may recur.

Living With Spinal Stenosis:

Spinal stenosis can be a real challenge day to day, but certain steps can be taken to ease some of the symptoms. Some treatment options include:

  • Get moving. If you’re capable, regular exercise is very important and you should do it often – at least three times a week for about 30 minutes. Start slowly and as you begin to feel stronger, add walking or swimming to your plan.
  • Modify activity. Don’t do anything that can trigger or worsen pain and disability such as lifting heavy objects or walking long distances.
  • Hot or cold packs. Some symptoms of cervical spinal stenosis may be relieved by applying heat or ice to your neck.
  • Canes or walkers. In addition to providing stability, these assistive devices can help relieve pain by allowing you to bend forward while walking.

About Dheera Ananthakrishnan, MD

Dheera Ananthakrishnan, MDDr. Ananthakrishnan trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, she practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University, where her focus is on adult and adolescent scoliosis.

In 2009, Dr. Ananthakrishnan co-founded Orthopaedic Link, a non-profit dedicated to improving orthopaedic care in the developing world by mobilization of unused implants from the United States. She is also a candidate member of the Scoliosis Research Society. Although Dr. Ananthakrishnan routinely performs complex spinal reconstruction surgery, an injury in 2012 caused her to reevaluate her own approach to musculoskeletal health. Her practice philosophy now focuses on strengthening, stretching and general conditioning as an adjunct to surgical care of her patients.

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Spinal Stenosis: Diagnosis and Symptoms

Spinal StenosisAs the baby boomer population ages, approximately 2.4 million Americans will experience lumbar spinal stenosis by 2021, according to the American Academy of Orthopaedic Surgeons.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases describes spinal stenosis as the narrowing of the spaces in the spine. This results in pressure being applied on the spinal cord and nerve roots. This narrowing condition can happen in three parts of the spine:

  1. The canal in the center of the spinal column, which holds the spinal cord and nerve roots
  2. The canals at the base of nerves that branch out of the spinal cord
  3. The openings between the vertebrae, which the nerves leave through to spread to the rest of the body

Sometimes this narrowing of the space inside the spinal canal produces no symptoms. However, if this places pressure on the spinal cord, cauda equina (a bundle of spinal nerves and nerve roots at the base of the spinal column), or nerve roots, there could be a slow onset and progression of symptoms. The neck or back may or may not hurt. Most often, people suffering from spinal stenosis experience weakness, cramping, numbness or pain in their arms or legs. If the pressure is mainly on a nerve root, they could experience a shooting pain down their leg, also known as sciatica.

If the spinal stenosis is severe, people may have issues with their bowel and bladder function, or even disorders of the foot. Cauda equina syndrome is an extremely rare, but serious form of spinal stenosis, and can cause loss of control of the bowel, bladder, sexual function, and/or loss of feeling, weakness or pain in the legs. This is a serious condition that requires immediate medical attention.

Because of the range of severity and symptoms, it is important to get a proper diagnosis from your doctor. They can use several methods to diagnose spinal stenosis and to rule out other conditions:

  • Questions about your medical history: you may have to explain details about any injuries, conditions or general health problems that could be causing these symptoms.
  • Physical examination: Your doctor will examine you to determine your range of movement, to see if you have pain or other symptoms when you bend backwards, and if you have normal neurologic function (sensation, muscle strength, and reflexes) in your arms and legs.
  • X-Ray: An x-ray of your back may be taken to find signs of an injury, tumor, or other problem. It will show the structure of the vertebrae and if there is any calcification.
  • MRI (Magnetic Resonance Imaging): An MRI can produce cross-sectional 3D images of your back, and can detect damage or disease of the soft tissues in your spine, and can show enlargement, degeneration or tumors.
  • CAT (Computerized Axial Tomography) Scan: This method can also show cross-sectional and/or 3D images, but can also display the shape and size of the spinal canal, what is in it, and the structures around it.
  • Myelogram: This is a liquid dye that x-rays can’t go through. It is injected into the spinal column and circulates around the spinal cord and nerves, which show up as white on the x-ray film. It can show the doctor if there is any pressure on the spinal cord or nerves from herniated disks, tumors or bone spurs.
  • Bone Scan: Your doctor may inject radioactive material that can attach to bone, especially where the bone is breaking down or being formed. This helps detect fractures, infections, tumors and arthritis (though it’s hard to tell between them). So a bone scan might be done along with other tests.

If you feel any of the symptoms outlined above, contact your doctor for a diagnosis. Though there is no complete cure for this ailment, with the guidance of your physician, steps can be taken to reduce pain and discomfort, and improve flexibility.

About Dr. Howard Levy

Howard Levy, MDDr. Levy is an Assistant Professor in the departments of Orthopaedics and Physical Medicine & Rehabilitation at Emory University School of Medicine. Dr. Levy specializes in non-operative spine care and focuses on helping patients achieve their best functional level. Dr. Levy started practicing at Emory in 1993.

Related Resources

Orthopedics at Emory

8 Types of Low Back Pain that Mean You Should Visit Your Doctor

What is the Sciatic Nerve? What is Sciatica? 

When Does Back Pain Call for an Epidural Steroid Injection? 

90% of Back Problems Can Be Resolved Without Surgery

The thought of having to have spine surgery is terrifying to most people. The good news is that only about 10% of patients who have back or neck problems are candidates for surgery. At Emory Orthopaedics, Sports & Spine, we have non operative as well as operative physicians who specialize in the diagnosis and treatment of acute back and neck pain injuries. The non-operative physicians, physiatrists, only recommend surgery in the cases where it is absolutely necessary. There are many non-surgical spine treatment options that may fix back problems before opting for surgery. These non-surgical back treatments include anti –inflammatory medication, ice, heat, gentle massage, physical therapy, orthotics, and injections.

Patients should only consider surgery if all of the conservative treatment options have been exhausted. In this short video below, Emory’s non-operative sports medicine and spine physician, Dr. Oluseun A. Olufade describes Emory’s approach to caring for active individuals with back or neck pain. It is important to note that if your physician immediately suggests you have back surgery before giving you other options for your care, it may be a good idea to get a second opinion.

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About Dr. Olufade
Oluseun Olufade, M.D.Dr. Olufade is board certified in Sports Medicine, Physical Medicine & Rehabilitation and Interventional Pain Medicine. He completed fellowship training in both Interventional Pain Medicine and Sports Medicine. During his fellowship training, he was a team physician for Philadelphia Union, a major league soccer (MLS) team, Widener University Football team and Interboro High School Football team. Dr Olufade is also the team physician for Emory University and Blessed Trinity High School.

Dr. Olufade employs a comprehensive approach in the treatment of sports medicine injuries and spinal disorders by integrating physical therapy, orthotic prescription and minimally invasive procedures. He specializes also in treatment of sports related concussions, tendinopathies and platelet rich plasma (PRP) injections. He performs procedures such as fluoroscopic-guided spine injections and ultrasound guided peripheral joint injections. Dr. Olufade individualizes his plan with a focus on functional restoration. Dr. Olufade sees patients at our clinic at Emory Johns Creek Hospital.

Dr Olufade has held many leadership roles including Chief Resident, Vice-President of Resident Physician Council of AAPM&R, President of his medical school class and Editor of the PM&R Newsletter. He has authored multiple book chapters and presented at national conferences.

About Emory Ortho, Sports and Spine in Johns Creek and Duluth
Emory Orthopaedics, Sports & Spine has recently opened two new clinics, one in Johns Creek and one in Duluth. Emory physicians, Kyle Hammond, MD, and Oluseun A. Olufade, MD see patients in Johns Creek. Mathew Pombo, MD and T. Scott Maughon, MD see patients in Duluth. Our new clinic locations care for a full range of orthopedic conditions including: sports medicine, hand/wrist/elbow, foot/ankle, joint replacement, shoulder, knee/hip, concussions, and spine. To schedule an appointment call 404-778-3350.

Could Yoga be the Solution for Your Chronic Low Back Pain?

Yoga for Low Back PainIn September, we shared with you some resources on the health benefits of practicing yoga, in honor of Yoga Awareness Month. Make sure to check that resource out, as a new study has recently found that participating in weekly yoga classes is equally as effective as regular deep stretching in relieving symptoms of low back pain. The study, from which findings were published in the Archives of Internal Medicine, followed over 200 people for up to 26 weeks, making it the largest study focusing on yoga’s effect on low back pain.

Of the 228 followed, subjects participated in weekly classes in which they practiced either yoga or deep stretching and also practiced the same thing at home, with the help of instructional CDs 7 DVDs for 20 minutes, at least 3 days a week. The outcomes for the group who practiced yoga and the group who practiced deep stretching in classes were compared to a “control” group, whose members were given a book with tips and best practices for relieving chronic low back pain. The results of the study showed that both yoga and deep stretching were equally as useful in easing or relieving low back pain, as long as either the yoga or stretching were practiced regularly.

Couple these results with the fact that 80% of people will suffer from low back pain at some point in their lives with the fact that Americans spend at least $50 billion each year on low back pain 1 and it becomes obvious that yoga could evolve to be an easy and fairly cost-effective method for alleviating chronic low back pain with potential to be as beneficial for improving pain as it is for reducing stress and improving flexibility and breathing.

Has your low back pain been improved by practicing yoga? If so, we’d love to hear from you in the comments below!

Can Osteoarthritis Be Prevented?

preventing osteoarthritisIf you’re starting to feel the twinges of pain or stiffness in your joints or spine, you may be wondering what’s causing it and whether you can prevent it from getting worse. One common contributor to joint and spine pain is osteoarthritis. Osteoarthritis is a common joint disease that is caused by degeneration of the cartilage, the cushiony substance between the bones, and if severe, it can then affect the bone itself. Osteoarthritis most commonly affects the weight-bearing joints (hips, knees, and spine).

The chance of developing arthritis increases with age. Although some people may have it as early as their 20s and 30s, it is more likely to develop osteoarthritis in your 50 and 60s and older. There is no cure for osteoarthritis, so prevention is the key. There are some risk factors that you can’t change, such as your genes (heredity) and your age. The goal is to decrease risk factors that you do have control over to help prevent osteoarthritis. These include:

  • Weight – obesity increases risk of arthritis
  • Trauma
  • Performing repetitive-motion tasks over a long period of time
  • Weaksurrounding muscles

The same factors that will help you prevent osteoarthritis can also help treat the pain and discomfort from osteoarthritis. Extra weight puts a strain on your joints, so try to keep your weight in a healthy range or lose weight if you’re not in that range. If you’re not sure what a healthy range is for you, check with your doctor. Also, keeping your muscles strong can help decrease the weight on your joints. If pain occurs while you’re doing an activity, listen to your body and decrease your intensity. Bear in mind that repetitive activities can cause joint pain and stiffness. Repetitive activities might include working on the computer or repeated bending or lifting. Try to find other ways of performing daily activities and be sure to take frequent breaks.

If you’re experiencing ongoing or increasing pain and stiffness, it may be time to see one of the physicians at the Emory Orthopaedics & Spine Center for further evaluation and treatment.

Emory physiatrists are physicians specially trained in rehabilitation and pain management. Our physiatrists can work with you to develop a plan that includes daily strengthening and stretching exercises to reduce pain and stiffness. Because osteoarthritis can occur in different areas of your body, you want a plan designed to target the affected joint or joints. Your physician may suggest formal therapy or bracing the joint to help ease pain. Finally, your doctor can suggest an over-the-counter anti-inflammatory medication or prescribe medication to help with the pain if needed.

Do you have osteoarthritis? What do you do to ease the pain and stiffness? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

Dr. Diana SodiqAbout Diana Sodiq, DO:
Diana Sodiq, DO, is an Assistant Professor of Orthopedics and Rehabilitation Medicine. She is Board Certified in Physical Medicine and Rehabilitation (Physiatry). As an osteopathic physician, Dr. Sodiq is trained in both traditional medicine as well as osteopathic manipulative treatments (OMT). She started practicing at Emory in 2010.

When Does Back Pain Call for an Epidural Steroid Injection?

Back pain epidural steroid injectionAs a physiatrist at the Emory Orthopaedics & Spine Center, I diagnose and treat back pain non-operatively, and one of the questions I’m asked most often by patients is whether they’re candidates for an epidural steroid injection.

If you have spinal pain, whether in your neck or back, your doctor will ask you whether it’s axial pain or radicular pain. Axial pain does not radiate into the arms or legs—it’s localized in one area. Radicular pain does radiate into the arms or legs. Axial pain typically is treated conservatively, with pain medication and exercise, and does not benefit from an epidural injection. However, if you have radicular pain and conservative measures haven’t helped, you may be a candidate for an epidural steroid injection.

In most cases, radicular pain is caused by one of two conditions—a herniated disc or spinal stenosis. Herniation is when a piece of the disc becomes disclocated, or slips, and presses on a nerve. This is more common among middle-aged patients, and 80% of patients with a herniated disc will get better over time without intervention. Disc herniations shrink as the body naturally self-heals. However, an epidural steroid injection can ease the pain and make the healing process more comfortable.

Spinal stenosis usually is caused by the natural wear and tear on the spine that comes with aging. Most patients with stenosis are 65 or older. Stenosis is degenerative and can lead to spinal nerve root compression or bony stenosis, which can cause pain, numbness, and weakness. While spinal stenosis may eventually require surgery, an epidural steroid injection can be a good temporary measure if you’re not quite ready for surgery or are not a candidate.

At Emory, we used different injection techniques depending on the condition. An interlaminar epidural is similar to the epidural a pregnant woman may opt for before giving birth. In this case, the goal is to introduce the steroid around the nerve root to decrease inflammation, which, in turn, eases pain. A transforaminal epidural is a more selective injection in which we target a specific nerve root that may be compressed by a herniated disc or a bone spur. Your doctor will decide which technique will benefit you.

In most cases if you have back or neck pain, your first step should be to try conservative pain-relief measures. However, when pain medication and exercise don’t help, and you’re suffering from radiating pain, an epidural steroid injection may be a good solution. An Emory physiatrist can work with you to diagnose your pain and set you on the right course of treatment.

Have you had an epidural steroid injection for back pain? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below. If you’re interested in learning more, we have some great information on epidural steroid injections for back pain our website.

About Susan Dreyer, MD:

Dr. Dreyer is an Associate Professor in the departments of Orthopaedics and Physical Medicine & Rehabilitation at Emory University School of Medicine.  Dr. Dreyer specializes in non-operative spine care and focuses on helping patients achieve their best functional level. She has taught many national and international courses on spine care and spinal injections for sciatica and other causes of back and neck problems.  She is also active in several professional societies. Dr. Dreyer started practicing at Emory in 1992.

3 Cervical Spine Procedures that Reduce Recovery Times

John G. Heller, MDWhen people think about neck conditions requiring surgery, they usually think about cervical spine injuries. We’ve all seen those tense moments during football or other sports when a player is injured and lies motionless on the field. A dramatic example comes from a Boston Celtics basketball game back in February, when Marquis Daniels bumped into another player and then fell motionless to the floor.

Fortunately, these events are rare. Most cervical spine surgery is needed because of wear and tear that affects your discs over time. In younger adults, this tends to be a herniated disc, which compresses the nerve roots or spinal cord. And, as we age, we all develop bone spurs to varying degrees (the “gray hair of the neck”). These spurs can be a source of nerve root or spinal cord compression, as well.

Cervical spine procedures are typically performed through the front of the neck, or anteriorly. In the United States, the primary surgical technique for the past 50 years has been the anterior cervical discectomy and fusion (ACDF). Since bone spurs form at the margins of the discs as they degenerate, these operations involve a discectomy, or the removal of the entire cervical disc, plus any bone spurs that border the discs.

Over the last two decades, spine surgeons at Emory have been leading the way in performing several innovative cervical spine procedures: laminoforaminotomy, artificial cervical disc, and laminoplasty. These procedures are performed from the back, or posteriorly, and don’t require a spinal fusion, thereby allowing patients to retain range of motion in the neck and also get back to their normal activities more quickly.

How do surgeons at Emory determine if one of these procedures might be right for you?

The first, laminoforaminotomy, is reserved for disc herniations that sit far enough to the side of the spinal canal that they do not compress the spinal cord. This procedure has been performed for many years, but new technology is allowing it to now be done using a minimally invasive microsurgical technique.

The second, for patients who meet the right selection criteria, is an artificial cervical disc, which may be inserted in place of the traditional bone graft with a plate and screws. This artificial disc is a moving part that’s ready for use when the patient wakes from anesthesia. Essentially, this procedure is a “get up and go” operation that avoids most of the limitations we traditionally impose on fusion patients while they heal. The artificial cervical disc is a ground-breaking option that has been very successful in clinical trials, many of which took place at Emory. Like any novel technology, longer term follow-up is needed to fully assess the risks and benefits of artificial cervical discs. But the data thus far are quite promising.

The third procedure, laminoplasty, is most often used in patients who are older and have three or more levels of spinal cord compression that would usually take three or four fusions. During this procedure, which is performed from the back of the neck, the roof of the spinal canal is re-shaped to provide more room for the spinal cord without the need for fusion. A mini-plate device, developed by surgeons at Emory Spine Center, is used during this procedure – allowing patients to move their necks right away after surgery, speeding up rehabilitation.

If you have been told you need cervical spine surgery, I would encourage you to contact the Emory Spine Center for an appointment to learn more about these innovative procedures.

Have you had or are you going to have cervical spine surgery? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About John G. Heller, MD:
John G. Heller, MD, Baur Professor of Orthopedic Surgery and spine fellowship director, specializes in the research and development of instrumentation in cervical spine surgery, including disc arthroplasty and laminoplasty plates. He is the past-president of the Cervical Spine Research Society. Dr. Heller started practicing at Emory in 1989.

As an Academic Medical Center, Emory Provides Superior Spine Care

Dr. Scott BodenI am often asked questions like “Will YOU actually be doing my surgery?” and “Does a teaching hospital mean someone will be practicing surgery on my back?” These questions made me realize that many patients don’t understand what it means to receive care in an academic medical center, so I thought I would try to explain this in more detail.

Most of the differences in a true academic medical center, especially for a spine center, represent benefits that the patient may not even realize. First, to be a physician at an academic medical center, the surgeon also must be a professor, usually in a School of Medicine. As part of the medical school faculty, these physicians, in addition to taking care of patients, are teaching surgical techniques to the future generation of surgeons and/or performing research that is allowing for new discoveries and advancements in the field. This means that patients are exposed to the latest advances in surgical techniques and technology.

In addition, because of the teaching process, the patient will likely have a second MD assisting (helping retract and hold tissues), rather than just one surgeon and a nurse or surgical assistant. I would liken it to a pilot and co-pilot flying an airplane. Spine surgery is serious business, with little room for error, so you can rest assured that at any reputable academic center (such as Emory), the key portions of the surgery will be performed by your surgeon.

A second benefit comes from the collaborative environment in a multidisciplinary spine center. At the Emory Spine Center, one of the largest in the U.S., there are physical medicine/rehabilitation, occupational medicine, psychology, orthopaedic surgery, and neurological surgery physicians all seeing patients side by side every day. This spectrum of physicians ensures that no matter what a patient’s spine problem may be, he or she is sure to find a true expert among the staff. This environment takes the worry away from the patient about which type of specialist to see.

All of the surgical and nonsurgical physicians working at the Emory Spine Center have been fellowship trained (which means they’ve received extra training to specialize in spine care) and spend the majority of their clinical practice diagnosing and treating only patients with spine problems. This level of sub-specialization is harder to find outside an academic center. In addition, academic medical centers usually have the resources to have the latest and highest quality imaging technology—which is also very helpful in spine care.

A third benefit comes from the fact that some of the toughest cases are referred to academic centers. As a result, these physicians have more experience with the toughest problems and rarest complications, so that in the unlikely event you do experience a complication, they are very comfortable diagnosing and managing it to minimize any long-term impact on your outcome.

Most of these and other advantages of an academic medical center typically go on behind the scenes, which is probably why so few people truly understand the difference.

How have you benefitted from spine treatment in an academic medical center? We welcome your questions and feedback in the comments section below.

About Dr. Boden
Scott D. Boden, MD, Director of the Emory Orthopaedics & Spine Center and Professor of Orthopaedic Surgery, is an internationally renowned surgeon, lecturer, and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH). Dr. Boden started practicing at Emory in 1992.

Ironman Triathlete Back on Track after Lumbar Laminectomy

Dr. Tim YoonWhen it comes to spinal disorders, there’s good news for the weekend warrior who enjoys vigorous athletic training and competitive sports activities. Being in great physical shape plays a large role both in your recovery and getting you back to an active lifestyle.

Joann Pope, one of my current patients, has an impressive athletic resume. She completed the half Ironman in Panama City, Florida, 21 times straight. She qualified for the world-famous Hawaiian Ironman seven times and finished four times. But two years ago, at the age of 74, her back started hurting and she had to stop racing due to lumbar spinal stenosis.

Lumbar spinal stenosis is a degenerative condition that causes a narrowing of the spinal column in the lower back, known as the lumbar area. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord. It can also squeeze and irritate the spinal cord itself, causing pain, numbness, or weakness, most often in the legs, feet, and buttocks.

You might think that the physical stress of being a triathlete took its toll on Joann’s back, but that isn’t the case. In fact, if she hadn’t been in such great shape, her spine might have begun degenerating long before it did. For more than 20 years, Joann has been running, biking, and swimming. She was 47 when she started running, back in 1984. After she ran the Boston Marathon, her daughter talked her into doing a triathlon, the ultimate endurance test – a grueling three-part race with no stops.

So, thanks to her level of fitness, it’s as if Joann has the body of someone 20 years younger. Despite her active lifestyle , the lumbar stenosis progressed, and Joann’s pain, which came on slowly, continued to get worse.

Before Joann came to see me, she’d been experiencing lower back pain for a year. To address it, she’d been taking pain pills twice a day and was undergoing physical therapy, the first line of defense for lumbar stenosis. But when therapy didn’t ease her pain, her physical therapist told her she needed to see a surgeon. She chose to come to the Emory Orthopaedics & Spine Center.

In July of 2010, I performed a lumbar laminectomy and fusion on Joann. This procedure, also called a decompression, relieves pressure on the spinal cord or spinal nerve by widening the spinal canal. In Joann’s case, I removed the portion of the bony roof of the spine, or lamina, that was pressing on her lumbar nerves. Then I fused the two lowest lumbar vertebra, L4 and L5, with screws. When she woke up, the pain she had before surgery was gone.

Because Joann had been in such great physical shape before the surgery, she recovered rapidly and was swimming and walking again quickly. Now she’s walking two miles a day and is working up to getting back on her bike. Joann remains pain free and plans to go back to racing.

Have you had a lumbar laminectomy, or would you like to learn how spine surgery at Emory can get you back to the active life you enjoy? We welcome your questions and feedback in the comments section below.

About S. Tim Yoon, MD:
S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and cervical spine surgery. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.

Been Told you Need Spine Surgery? Be Sure to Get a Second Opinion

If you’ve been told you need spine surgery, here are some thoughts to consider first:

1) 90% of back/neck problems will resolve without surgery.

2) Rates of recommending surgery for the same problem vary widely in different parts of the country (and world), suggesting that the indications for surgery are not always clear.

3) Some spinal conditions have a high success rate after surgery, while other spinal conditions have less predictable success rates following surgery.

4) 98% of all spine surgery is technically elective surgery, meaning it should be the choice of the patient, not something mandated by the surgeon.

Patients should always take an active part in the decision-making process for spine surgery. You need to be sure you understand the likelihood of success, the possibility of residual or worsened symptoms, the risks of anesthesia, the risks of the spine surgery itself, and chances of recurrence in the future. If your surgeon has insisted that you must have an operation or has not discussed all of the points above with you, then you may benefit from a surgical second opinion.

Have you been told you need spine surgery? Have you already had spine surgery? Let us know about your experience. We welcome your questions and feedback in the comments section below.

About Scott D. Boden, MD:

Dr. Boden is the Director of the Emory Orthopaedics & Spine Center and Professor of Orthopaedic Surgery, an internationally renowned surgeon, lecturer, and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH). Dr. Boden began practicing at Emory in 1992.