Welcome to our "Ask the Doctor" section. Each month we cover the question most frequently asked of Dr. Roger and share the answer with you. Please feel free to submit a question of your own.
Question: I have leg pain that gets better when I bend forward. Could this be coming from my back?
Answer: Absolutely. As the spine ages, it is normal to develop bulging disks and bone spurs that could lead to narrowing around the nerves, also know as spinal stenosis. Spinal stenosis typically causes pain in one or both legs, although sometimes only in the buttock area, that is usually worsened by standing or walking, and improved with sitting down or bending - say, over a shopping cart. Nonoperative options include medications, chiropractic care, physical therapy, traction, and epidural injections (shots). When these no longer work and the pain is significantly affecting your quality of life, then it may be time to consider surgical options. Traditional surgeries such as laminectomy have a great success rate, but newer, more minimally invasive techniques such as "spacers" can offer equal relief of pain with a smaller surgery and quicker recovery.
Question: I have had back surgery before and I am still in pain. Where do I go from now?
Answer: This is a very difficult question. There are essentially two types of back surgery. The so-called "small surgeries", such as the laminectomies or diskectomies, are done to take the pressure off the nerves to relieve shooting leg pain. If you have had the "small surgery" and are still in pain, them you may need a larger surgery. Large surgery is used when arthritic bones and disks are fused together. This surgery relieves back pain, and is called fusion. If you have had one or more fusions and are still in pain, then you will need to see a surgeon with expertise in redo surgery. This is part of the advanced training I received at the Cleveland Clinic. There are essentially three options. If the bone has not taken (failed fusion) then a redo fusion is an option. If your spine is wearing down above or below the fusion, then an extension of the fusion may be helpful. If you still have pain, even though the fusion is solid, and the levels above and below are good, then a spinal cord stimulator may give you excellent pain relief.
Question: What about arm and neck pain? What can be done for that?
Answer: Yes, herniated or bulging disks in your neck can be a problem. A pinched nerve in your neck can cause shooting arm pain. The disks may also be pinching your spinal cord and cause difficulty with balance and walking, leading to falls. Finally, a pinched nerve may also be causing severe neck pain, sometimes even with headaches. After trying conservative options, there are excellent, minimally invasive surgeries to relieve the pressure on the nerves or spinal cord, with great results and quick recovery.
Question: Should I wait until the next big advancement before having my surgery? Have there been any big advancements recently in back or neck surgery?
Answer: There are always some advancements happening but only very rarely are there such ground breaking advancements such as computer assisted surgery. (click here for more info on Computer Assisted Spine Surgery)
Eric P. Roger M.D.