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Back Pain: Prevention, Treatment & Surgery

Dr. Mark Nolden June 05, 2013 2:00 PM This chat has ended. Thank you for participating.
Brenna (Moderator) - 12:49 PM:
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Brenna (Moderator) - 1:52 PM:
Welcome! Today’s chat, Back Pain: Prevention and Treatment, will begin in 10 minutes. Please start submitting your questions and Mark Nolden, MD, will starting answering as soon as we get started. While you are waiting for the chat to begin, feel free to visit our Spine Center webpage We will do our best to answer all of your questions, but because this is a very popular chat, Dr. Nolden may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

aneta (chicago il) - 1:59 PM:
I am 35 y/o with chronic (11-12 years) lower bavk pain/sciatica. Have herinated 3 lumbar discs 1 sacral (moderate per MRI 2013). Did tones of pt, cranio sacral therapy. Did 2 sei this year with mild to no relief but pt is somewhat helpful. What other options do i have before surgery?

Dr. Mark Nolden (NorthShore):
It appears you've explored a lot of conservative options for your pain already. In most instances, time and these conservative measures allow for improvement. If there hasn't been any improvement over the course of 11-12 years it would be best for you to be evaluated and have your MRI looked at by a spine surgeon to see if there are viable surgical options for you. It would probably in your interest to hear what those options may be. A spine surgon would also be able to discuss with you nonsurgical pain management options and refer you to a pain management specialist for these options if you so choose. Otherwise, nonconventional alternative treatments can be explored.

Linda Hamilton (Chicago, illinois) - 2:03 PM:
There is a physician in San Francisco reversing spinal fusion and replacing the actual discs. What is your view on this?

Dr. Mark Nolden (NorthShore):
Once a spinal fusion has been performed it is indeed irreversible. I am unfamiliar with what this surgeon is proposing, but I can assure you that the treatment is not conventionally accepted. There are alternatives to fusion, such as disc arthroplasty (disc replacement) that may or may not be a viable option for a patient's condition. However, once again fusions once performed are not reversible. We do however, modify fusions with corrective osteotomies if required and deemed necessary to control peoples' pain and posture.

Lorenzo gunn (Chicago il) - 2:07 PM:
I just received my results from a MRI on my back and I was told it is a slipped disc that is pinching a nerve! What would you recommend to fixing the problem? Thanks in advance!

Dr. Mark Nolden (NorthShore):
A slipped disc is a colliquial term for a disc herniation. What happens is the soft core of the disc is pushed out from a tear in the lining of the disc and can hit a nerve or nerves. Most people with disc herniations over the course of 3 months will improve on their own. We often times will treat people initially if there is no lower extremity weakness with physical therapy and injections. If these are ineffective, then a minimally invasive surgical procedure can be curative. This procedure is called a microdiscectomy and can be done as an outpatient (you can go home the day of the procedure). If you have weakness anywhere in the lower extremities, you should be evaluated as soon as possible.

Dennis Roszak (Chicago, IL) - 2:11 PM:
Hi, I have had a bulging disc for about 15 years. Most of the time, my back is sore, but I am able to function, even play sports. Lately, I have been getting siatica on right side mostly in the buttox, but not all the time. Is my disc getting worse? Should I be concerned? Thanks

Dr. Mark Nolden (NorthShore):
Bulging discs per se are not pathologic (abnormal). If a disc is bulging to a degree that it is displacing or compressing a nerve then it can be problematic. Buttock pain is a very common presentation for L5 or S1 nerve compression, which can result from a disc bulge or herniation at either of the two lower lumbar discs. If your pain is not persistent and is tolerable and not activity limiting, there is no need to worry. If at any time your pain becomes constant and relatively intolerable, you should have your back reimaged to have your discs evaluated once again to discuss your options. In summary, as long as your pain is tolerable, no need to worry.

Diana (Chicago,IL) - 2:15 PM:
How can one deal with random spasms in upper back after physical therapy from a car accident?

Dr. Mark Nolden (NorthShore):
Stretching is the most effective treatment for episodic spasms. We often times will prescribe antispasmodics (medication) if they cannot be controlled with simple stretching. If the spasms persist and you have not had any advanced imaging (MRI or CT scan) then one of these studies should be done, preferably an MRI. Nonetheless, spasms are usually muscular related and are not particularly worrisome. They can however be the result of another underlying problem, which could be detected by advanced imaging. To summarize, the treatment that is most effective for muscle spasms are stretches and antispasmodic medication. Over time, most spasms will resolve on their own.

John Nyanti (Evanston, Illinois) - 2:21 PM:
I'm 52 years old, I had no injury before, but my back from my waiste hurts every 6 months. I went to the Evanston Hosp E.R. and the Dr prescribe iboubrufin 500mg, I have been taking it for almost 2 months now but things still the same. What can I do?

Dr. Mark Nolden (NorthShore):
You should first seek medical evaluation for your low back pain outside of the emergency department. Physicians in the ER usually will not work up low back pain given its commonality and the fact that it's usually nonemergent. This would include a physical exam and plain radiographs. Based on the findings of these, further imaging, such as an MRI, may be indicated. You could either start with your primary care physician or call the spine center for an appointment here at Nortshore. The above simple workup would give us all the answers we need to steer us in the right direction for treatment.

Romi (Evanston, IL) - 2:25 PM:
I am overweight and trying to lose the weight by eating healthier and exercising. The fitness activities that I enjoy, running and zumba, aggravate my back pain. What are some fitness activities that will not worsen my back pain while helping me lose weight?

Dr. Mark Nolden (NorthShore):
Losing weight is going to be quite beneficial for your back pain. I congratulate you on your effort. There are many people that are in your situation and what we recommend first is a low impact aerobic exercise regimen. Good, effective lower back cardiovascular exercises include walking at a brisk pace on a treadmill or outside, use of an Exercycle, such as in spinning classes, elliptical machines, stairmasters, and most of all swimming. Often times cross training with the use of all of the above activities keep your workouts interesting. In the absence of high impact activities like running, jogging, and jumping, such a regimen should be tolerable for you.

Joyce (Schaumburg, Il) - 2:30 PM:
Is there any other help for spinal stenosis. Epidurals failed, the tightness was too great.

Dr. Mark Nolden (NorthShore):
The most effective treatment for spinal stenosis is surgery. As you probably already know, stenosis means narrowing and spinal stenosis is a narrowing of the spinal canal, usually secondary to arthritic changes. In most people we can effectively treat spinal stenosis with minimally invasive decompression techniques. These surgical procedures are highly effective, safe, and very rewarding to perform given how well people respond. I would advise you to seek surgical consultation so that a surgeon can look at your images and discuss such options. Good luck.

Cary H (Decatur Il) - 2:34 PM:
I had endoscopic surgery in Florida on the 3/4 level. MRI showed bulging disk at that level but my symptoms were 4/5. I would say I have moderate success but still a lot of pain and stiffness in lower back from side to side. Mild pain left side of calf, side of knee and hip. Wonder if we didn't get the right level even though I do have some relief.

Dr. Mark Nolden (NorthShore):
It is hard to attribute symptoms purely to one level in the absence of looking at your images. Given that there are complex referral patterns for any given nerve or nerves, no two people will present the same with similar pathology. The type of surgery that you had should not be expected to completely eliminate back pain. It will not. In most situations we are able to ameliorate leg pain and symptoms. This is from removing the pressure on the nerve or nerves involved. We cannot completely eliminate back pain. The only way to truly address your problem and give you a second opinion would be with a clinical examination and review of your most recent imaging. Whether or not you choose to be evaluated again, should be determined by your level of current discomfort and how it effects daily living.

Robin (Northbrook Il) - 2:39 PM:
What qualifications should someone look for when considering a spine surgeon?

Dr. Mark Nolden (NorthShore):
It is quite simple. You either see a board certified, spine fellowship trained, orthopedic surgeon or a board certified neurosurgeon. Both do exactly the same procedures and there is no difference between the two in this day and age. Thereafter, you go with whom you are most comfortable after your consultation.

marion (Chicago) - 2:43 PM:
Occasionally, I get excrutiating spasm in my lower back. It lasts for about a week and clears up on its own. However, during that week, I am in severe pain and movement is very limited. What is causing that and should I be concerned? It only happens perhaps once a year or less.

Dr. Mark Nolden (NorthShore):
If it happens or once a year or less, no it is not concerning. It could merely be secondary to muscle irritation. Otherwise, lower back spasms can be secondary to degenerative disc disease. This is a condition where your lumbar discs can dry out and deteriorate and result in back pain, buttock pain, thigh pain, and low back spasms. However, if these spasms occur less than once a year and last less than 1 week, they are unconcerning.

Robin (Northbrook Il) - 2:46 PM:
Can pain eminating down the front of the leg be caused by sciatic nerve irritation?

Dr. Mark Nolden (NorthShore):
Yes. "Sciatic" merely means leg pain from a low back etiology. There are many manifestations, such as pain the back of the leg and calf, to pain in the front of the thigh and shin, to simple deep seated buttock pain.

Colette (Evanston, IL) - 2:48 PM:
I have been suffering from chronic lower back pain for three years. Some days are worse than others. I had an MRI that showed some possible degeneration, otherwise inconclusive. Should I get another MRI/second opinion or is there some other testing that can be done?

Dr. Mark Nolden (NorthShore):
Usually MRI imaging of the low back is all that is necessary diagnostically to determine the source of your low back pain. If your MRI only shows what we call age appropriate or arthritic changes, then there is little to be concerned about. It is not a bad thing that your MRI is "inconclusive". This just means that nothing serious is seen. It can never hurt to obtain a second opinion with evaluation of your MRI. If you have not been evaluated by a spine specialist, it is probably best that you are. There is definitely further testing that can be done, but is not usually warranted. Chronic low back pain is very common and in the absence without significant MRI findings, should be treated simply and conservatively.

Brenna (Moderator) - 2:49 PM:
There are only 10 minutes left in today's chat. Please submit final questions.

Alex (Buffalo Grove,IL) - 2:54 PM:
I have a lower back injury (herniated L4 L5) for the past 4 years. PT use to help but does no more, my pain has been getting worse the past 6 months. The pain is very sharp from my lower back to left big toe. My doctor has mentioned surgery as a likely option at this point. My problem is that I cant afford to be out of work for very long. What surgery would suit me best and what are the recovery times for them please?

Dr. Mark Nolden (NorthShore):
If your problem is indeed a disc herniation on the left side at L4/5, a simple microdiscectomy is your best option. Your pain follows an L5 pattern perfectly and I would expect with this procedure that your leg pain will completely resolve. It would also result in substantial back pain reduction. Microdiscectomy is a minimally invasive procedure and is done as an outpatient (you go home the same day). You would need to take the day of surgery and the following day off. You could then return to work as long as you comply with lifting restrictions (nothing greater than 5 pounds on ocassion) and no high impact activity for a total of 6 weeks postoperatively. In 6 weeks, I allow most people to return to normal lifting, physical, and athletic activity as tolerated.

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