Advances in Caring for Back and Spine Pain

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here is your host, Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell and today our guest is Dr. Medhat Mikhael, medical director at Orange Coast Memorial Center for Spine Health. And today we'll be talking about you and your spine. Welcome, Dr. Mikhael.

Medhat Mikhael, MD: Good morning. Welcome. Thank you.

Deborah Howell (Host): Sure. More than 50 million people in the U.S. experience neck or back pain. When everyday activities like walking, shopping, or working become difficult and unbearable, it may be time to seek out treatment. Today we'll be talking a little bit about treatment options for spine issues and how to choose the right treatment for your specific back problem. Doctor, let's begin with this: what is categorized as spine pain?

Medhat Mikhael, MD: So any pain that comes from the spine as a structure, from the neck all the way down to the tailbone, is categorized as a spine pain. So neck, thoracic, mid-back, and lower back pain all the way down is categorized as a spine pain.

Deborah Howell (Host): Pretty long spine, okay. What are some risk factors for developing spine issues?

Medhat Mikhael, MD: So there is a lot of risk factors. Starting with congenital spine diseases. There are people that get born with spine deformities. For example, scoliosis, stenosis in the spinal canal. These are some risk factors that the patient that is born with these congenital problems will develop a chronic, long-term spine pain or spine problems. Sports injuries are very common to cause spine problems. Patients or people that practice aggressive sports tend to have spine injuries and sports injuries as well because the impact of these sports that they play can affect the structure of the spine. Work-related injuries like heavy lifting, heavy pushing, twisting while carrying heavy, long standing, long sitting, puts a lot of pressure on the spine and can expose the spine to a lot of problems and a lot of dysfunctions and put the discs into risks to herniate or bulge. Accidents like auto accidents, bike accidents, motorcycle accidents. Also a very common risk factor for developing spine problems is overweight or obesity. As you know, when you have a big belly and you have a lot of fat in your body, it puts a lot of pressure on that spine. And lack of the muscle that carries the spine around it or heavy weight that makes the spine carry a lot, puts a lot of pressure on that spine. Probably one other very common risk factor is lack of spine hygiene, fitness, and lack of exercise that strengthens that spine is considered a risk factor as well.

Deborah Howell (Host): Now you say hygiene, can you expand on that a little bit?

Medhat Mikhael, MD: Yeah, hygiene means the good exercises that you do daily to keep your spine in a good shape. Like stretching exercises, strengthening exercises that you do all the time. Some of the yoga exercises that help the spine to be maintained well. Healthy diets, weight loss, daily walking. These are all good spine hygiene measures that prevent development of a lot of spine disease and disc problems.

Deborah Howell (Host): Sounds good. Now, if someone is experiencing symptoms of spine pain, what are some of the steps they should do to seek out treatment?

Medhat Mikhael, MD: You know, as you know, a lot of the spine problems as they come, because there's a big percentage of patients that develop spine problems or pain or back problems in their life, and a lot of it is related to muscle and ligament problems. And these are simple, and usually improve with some sort of rest, use of anti-inflammatory or muscle relaxants. And it is always the case where the patient will see their primary care and seek simple treatment and improve. But my advice to everyone, if your spine pain becomes a chronic, is not something that simply came and gone within a few days, you need to speak to specialist or you need to seek something like a spine program where you will get the right care and the right referral so you don't do unnecessary steps and wasting of time and resources while you're not getting the right care.

Deborah Howell (Host): Exactly. How is a patient diagnosed, Doctor, and also treated once they contact the Center for Spine Health for an evaluation?

Medhat Mikhael, MD: The best thing that we have about the spine health program at Orange Coast now is that we have hubs that take care of that patient. What do I mean by that is we've got a nurse navigator that will be the contact person. Once the patient wants to be referred or referred to the spine program by a primary care or self-referral or by the medical group. And once the patient gets into the nurse navigator, there will be a full detailed history intake. And as long as the patient is not a bad candidate for something that needs an urgent care or emergency care, the patient will get through into our physician triage that does the diagnosis for the patient. Diagnosis is a very important step because this is the foundation where you're going to build the referral of this patient, the best treatment. Because it can be very simple by referring this patient to a neurologist, referring this patient to an interventional pain specialist, where the patient can get a procedure followed by some physical therapy and they move on with their life and nothing else needs to be done beyond that point. What the beauty about the spine program we have is that the patient is not going to get lost because there's a monitored process on the patients from the time he calls the navigator to the time he's finished with the treatment where communication between all the pieces of that spine program as far as specialists, providers, ancillary service... Communication is done by our nurse navigator making sure or ensuring that every step is followed through, done promptly, and the patient satisfaction about the care that they have is very high.

Deborah Howell (Host): That's awesome. And communication is all, as we know. Now you mentioned triage, how does the triage process differ from previous ways of treating spine pain?

Medhat Mikhael, MD: Yeah, the triage is different because you're seeing somebody who is specialized in musculoskeletal disorders. Diagnosis based on lots of history and physical exam plus possible workup that the triage person that's going to... the triage person becomes the hub who communicates with any referrals within the network or within the spine program. What makes it different is what we have now in spine care in general is that we have a lack of communication between parts. So the patient will see a physician who comes up with a diagnosis, send him to another specialist who might disagree with the diagnosis or make a different plan than the first one. And the patient keeps going into circles and always gets frustrated because this provider does not communicate with that provider that does not communicate with that provider. And at the end of the day, the patient is wasting too much time and is not clear about the plan. The triage person becomes the hub that communicates with all the referrals that are made and makes sure that the steps are followed through and make sure discussion about the diagnosis and what made the diagnosis is discussed among all the providers. Even if there is a disagreement, there is always an agreement about the plan and next step. So the patient that needs surgery go for surgery early on if we feel that the conservative measures are not worth exhausting because there is clear pathology that can be fixed or the patient that does not get surgery prematurely without really having a clear diagnosis and it becomes something irreversible or something that you regret that you went for surgery early on without really going through the steps.

Deborah Howell (Host): Right. So in this way the patient really finds relief faster than how spine pain has been traditionally treated.

Medhat Mikhael, MD: Exactly.

Deborah Howell (Host): Okay. So what are some of the treatment options for patients once they are evaluated and diagnosed?

Medhat Mikhael, MD: You know, there are a lot of modalities, a lot of options for the patients, starting with very conservative approaches. Physical therapy, chiropractor, acupuncture. Very simple modalities for spine care. Minor interventions to the spine that in a lot of times does help and does alleviate the patient's symptoms. There's also non-surgical options if the patient has problems that would be minor interventions percutaneously that the patient can avoid surgery with all the advanced technology that we have right now. And an example of that, patients with spinal stenosis, there are options now for percutaneous decompression through a very small cut and the patient goes home an hour after the procedure. Same applies where application of spacers for example for the spine to open the space, that's also a very minor procedure. So there is a lot of interventions and options for the patient, as long as you have the right diagnosis for the patient and all the moving parts of that spine health communicate together and work as one unit.

Deborah Howell (Host): It's a great new day to be a spine patient as well is what I'm hearing. So how can someone get this evaluation process started with the Orange Coast Memorial Center for Spine Health?

Medhat Mikhael, MD: So patients the best thing to do is to ask for referrals into the spine health through their primary care, through their medical group. Some of the patients can also contact Spine Health by contacting the number where the nurse navigator will be the one to discuss the beginning of the care and do all the intake and then start creating medical records for that patient with the triage physician who will start the process and start the case for that provider and make sure that the care gets done on time, promptly, and fast enough so the patient's satisfaction is high, cost is cut down, and the outcomes are always very high.

Deborah Howell (Host): Well, thank you so very, very much, Dr. Mikhael, for coming on the show today. We learned a lot and we really appreciated you being here. To learn more or to listen to a podcast of this show, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness. Have a fantastic day. I'm off to do my stretches!