Relief for Low Back Pain

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and today we'll be talking about the causes of back pain and how to treat it. Our guest today is Dr. Stephen Huo, an orthopedic surgeon with MemorialCare Orange Coast and Saddleback Medical Centers. Welcome, Dr. Huo.

Stephen Huo, MD: Thank you, Deborah. Thank you for having me today.

Deborah Howell (Host): My first question to you is low back pain affects a large number of people regardless of age. What are some of the things that can cause lower back pain?

Stephen Huo, MD: Low back pain is indeed quite prevalent, and is one of the most common reasons that patients go to see a doctor in America today. Causes of back pain are many and can arise from a specific movement such as lifting something heavy or from long-term arthritic degeneration. One of the most common reasons for low back pain is from muscle soreness, from overexertion in which the muscles can get stretched or injured. Patients can also have pain from injury to the spinal disc or from arthritis and slippage of the vertebra. And for various reasons, such as disc collapse or bone spurs that develop in response to arthritis, the space around the nerves in the spinal canal and the spinal cord can become narrowed, a condition called spinal stenosis, which can give rise to pain and numbness going down the legs. Finally, less common causes can include scoliosis, tumors, and fractures.

Deborah Howell (Host): Okay, all of them rather unpleasant. So what are your recommendations on ways to prevent injury to the lower back?

Stephen Huo, MD: So unfortunately there isn't a single magical remedy that will prevent lower back injuries, and a lot of it comes down to just daily healthy life choices, such as healthy eating and a balanced diet, maintaining a healthy weight, daily stretching exercises and simple exercises to strengthen the core and back muscles.

Deborah Howell (Host): Daily stretching. Aha. Some people say 3 to 5, but you're... you're really on it.

Stephen Huo, MD: Yeah, I see a lot of patients who are quite tight, and I think there isn't... you can't really hurt yourself from just simple daily exercises.

Deborah Howell (Host): And how many minutes a day do you need to put in?

Stephen Huo, MD: Um, really it's not that much. Maybe 5 to 10 minutes should be sufficient.

Deborah Howell (Host): Okay. Just have a nice carpeted area and a maybe a mat to roll out and do your stretches, it could save a lifetime of pain.

Stephen Huo, MD: Yeah, it's a small price to pay, right?

Deborah Howell (Host): Exactly. Now, do all patients who suffer from chronic low back pain end up needing surgery to find relief?

Stephen Huo, MD: Fortunately, the vast majority of low back patients will resolve spontaneously or with non-operative management alone. Most patients will have improvement in pain in the span of a few days to several weeks anywhere in the 80 to 90% range. Treatment will depend on the cause of low back pain, but standard conservative regimen may consist of medications such as Tylenol or non-steroidal anti-inflammatory medications, a short sparing use of narcotics, certain activity modifications, physical therapy and chiropractic manipulation.

Deborah Howell (Host): I see. The physical therapy part I had a question about. Whether you're able to do those daily stretches when you're once you are already injured and on the medication.

Stephen Huo, MD: So that might be a little bit more tricky, and that you will have to tailor treatment with a therapist, and you can still do daily exercises that are within your comfort zone, and of course depending on your injury, you may be more limited in what you can do.

Deborah Howell (Host): Okay. Now, doctor, if the first line conservative measures don't work for a patient, what type of surgical options are available to them?

Stephen Huo, MD: So as there are many different causes of low back pain, the surgical options to address them are just as if not more numerous. And I think that makes the field of spine surgery so challenging and unique. Um, generally speaking, what we as spine surgeons can do for our patients are three things really. One is to decompress the nerves and spinal cord when it's under pressure, number two is to correct any structural deformities, and three is to stabilize the spine. Now how we go about doing these can vary significantly from one patient to another and really requires a patient-specific approach to tailor an appropriate surgical solution based on the patient's problems.

Deborah Howell (Host): Okay, well now understandably many people hear the two words together, spine surgery, and of course they're hesitant to proceed, even when they're suffering and are in a lot of pain. What would you tell patients who are considering surgery?

Stephen Huo, MD: Um, I agree, spine surgery can be scary. I don't blame patients who think so because understandably a lot is at stake. Um, but I am a firm believer that for patients in which we can accurately pinpoint the spine issues causing their symptoms, can do very well if they undergo the appropriate operation. So aside from the various technical aspects of the operation, one of the most important predictors of a successful outcome is following the right surgical indication. It's crucial to have an accurate workup diagnosis of what is causing the problem so that your doctor can come up with the right treatment plan. And yes there are risks associated with any major operation, and spine surgery is definitely no exception. But a well-executed spine surgery done with the appropriate indications can dramatically improve the quality of life and provide significant relief.

Deborah Howell (Host): Absolutely. On the other side, life looks a lot different. What are some surgical spine emergencies that may need immediate treatment?

Stephen Huo, MD: So luckily that's a very short list, and only a handful of spine conditions require emergent surgical intervention. But they're important to identify because if left untreated, they can cause permanent neurologic damage or sometimes even death. So one example is cauda equina syndrome, a condition where there's severe compression of the nerve sac in the lower spine that causes progressive leg weakness, numbness classically in the saddle distribution along the inner thighs and sacral region, loss of bladder and or bowel control. Now stenosis is a common problem, but if the neural elements come under severe compression, this can become an emergency requiring surgical decompression. Other emergencies include infections of the spine which can involve the vertebra or develop pus in the spinal canal that can cause direct nerve compression, traumatic fracture dislocation of the spine, spinal cord injuries, and that can lead to partial or complete paralysis, and tumors that may compromise stability of the spine.

Deborah Howell (Host): Okay. All right. Now, if there are any new innovative changes in the field of spine surgery, it would be great if you could share them with us now.

Stephen Huo, MD: Sure, there are many, they're continuing to evolve, but for example, one is a cervical disc replacement, which is a relatively new FDA-approved treatment that is a great alternative to the standard cervical fusions for appropriate patients, and this allows patients to maintain a more natural neck motion and have a similar relief of pain from neurologic compression as the previous standard fusion operations while potentially limiting the breakdown of the adjacent disc levels, which could translate to less spine surgery for the patient in the future. And another exciting technology we utilize here at Orange Coast Memorial is the use of navigation technology, such as the O-arm, to use advanced imaging to basically build a virtual spine image that we can use in real time to more accurately and safely place screws and other spine hardware.

Deborah Howell (Host): Well, that is an awesome development. I do have a final question for you, doctor. Treatment for low back pain is done through the Spine Health Center at Orange Coast. What are some of the unique features of this particular program that it offers to its patients?

Stephen Huo, MD: Uh so this is a the Spine Health Center has a great comprehensive program that just started recently that gathers all of the medical staff and professionals involved in taking care of patients with spine problems to provide the patient with a systematic and a streamlined process to receive timely and exceptional care. So patients who are introduced to this program will first speak with one of our spine concierges to obtain all the necessary history and relevant imaging of their spine problem, after which a physician will review the information and determine the best course of treatment. Then the algorithm moves on to a patient navigator who will then facilitate this treatment, whether it's directing patients to the physical therapist, physiatrist, pain specialist, or the spine surgeon. I think this is a great program that I'm also excited to be a part of, especially because the focus is on providing excellent spine care to patients in an efficient manner, using standardized protocols to ensure that the high standard of care is maintained. So the physicians in this program meet regularly throughout the year to review the patient satisfaction scores and clinical outcomes and constantly look for ways to improve itself. I think it's a great asset for the patients.

Deborah Howell (Host): It must be just so heartening for you as a physician to see people come in in intense pain and leave after their procedure or their treatment, just new people.

Stephen Huo, MD: Of course, that's one of the reasons I chose this field and something that you know I really try hard to come up with an appropriate treatment plan to help my patients whether it's through non-operative or operative means.

Deborah Howell (Host): Well we thank you so much Dr. Huo for your time today. We really appreciate it.

Stephen Huo, MD: My pleasure. Thank you very much.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please visit memorialcare.org. That’s all for this time. I'm Deborah Howell, thank you so much for listening and have yourself a great day.