Back Pain: You Don't Have To Suffer
Listen in as Charles Levy, MD explains that the experts at Memorial Health System are trained in the most advanced medical techniques – from routine care to the most complex reconstructive spine surgery.
Transcription
Melanie Cole (Host): Many people will experience neck or low back pain at some point in their lives. This pain can vary from mild to severe; it can be short-lived or long-lasting, but however it happens, low back and neck pain can make everyday activities very difficult to do. My guest today is Dr. Charles Levy. He’s a neurosurgeon at Memorial Health System. Welcome to the show, Dr. Levy. What do you see in your office every day when people come in to you and complain of low back pain or neck pain as some of the most common injuries or causes of these types of pain?
Dr. Charles Levy (Guest): Well, thanks for having me, first of all. You know, the typical patient who comes in to see me with back or neck pain is someone who very often has a long history of sort of overuse. It may be somebody who drives a truck and does a lot of lifting on the job, a construction worker; it may be somebody who’s a day care worker or a nurse who’s frequently moving patients, taking a lot of weight; or, it may just be something that occurs, really, with no specific cause which would be called idiopathic. But, in general, those are the most frequent causes that I see, but also people who are very obese, a lot of times, that can add quite a bit of strain in the lumbar spine, in particular, and that can be a cause, as well.
Melanie: Dr. Levy, when do you tell people it’s time to maybe see a doctor and see what we can do about this pain, because people try in-home treatments and over-the-counter treatments. What do you advise as the first thing they do when they start to feel these very common pains?
Dr. Levy: Well, the very first thing that’s most important, is if it’s not pain that is disabling and it’s not in a focal neurologic pattern causing weakness in a limb or numbness in a specific region that just doesn’t get better, then, probably a reasonable choice, initially, is to try and stay active and stretching is an excellent way to initially approach this with activity and stretching, light exercise, maybe lightening up the workload a little bit, but staying active. Immobilization, like rest, in these situations, generally is not the best tactic. So, initially, it’s not unreasonable if you don’t have some focal deficit that’s really profound that you can clearly notice–that is weakness in a limb, or severe numbness, or the pain is not disabling. It’s very reasonable to stay active and try to work through this with stretching and activity and even with non-steroidal anti-inflammatories like Aleve or Ibuprofen or Tylenol.
Melanie: Dr. Levy, are you an ice man or a heat man? People like both and find both useful in different circumstances. If someone is experiencing pain in their neck or lower back, do you advise that they try ice or heat? Or both?
Dr. Levy: Usually, what I advise patients with that regard is in the morning, hot shower, IcyHot on the area that is, or some other–BenGay, something like that–on the area directly that’s bothering you, then a hot shower; and then, in the evening, while you’re watching TV after work or whatever, icing the area up.
Melanie: That’s great advice. So, then, when does it come to the point where they come and see you and say, “You know what? I do have numbness in my fingers, or in my legs. Or, I’m getting pain down my leg,” when do you want them to come see you?
Dr. Levy: Well, obviously, if somebody has tried the full spectrum of non-surgical therapy, including things they’ve done on their own such as stretching and light exercise, or they’ve been, for example, to a physical therapist or a pain management office and none of that’s working, that’s a reasonable time to come in. Another time to come in is if there is a focal deficit, like a weak foot or a weak limb or severe numbness. Difficulty with bowel or bladder incontinence is usually considered a surgical emergency and that can occur from the lumbar spine, if there’s a big enough disc herniation. Another concern is if the gait, that is, walking, is unsteady. People with an unsteady gait, that sometimes happens from severe tightening around the spinal cord, what we call “stenosis” in the cervical spine. So, anything like that would be a reasonable time to come in and be seen.
Melanie: What’s the difference between seeing an orthopaedic surgeon and seeing a neurosurgeon for back and neck problems?
Dr. Levy: It depends on the orthopaedist. The general orthopaedist most frequently does not do spinal surgery. At one time, there were orthopaedists who did the full spectrum of orthopaedic procedures and spine procedures, but that really isn’t the case so much anymore. An orthopaedic spine surgeon is someone who has had a fellowship in spinal surgery, which is usually what would be like a five-year residency in general orthopaedics, and then they might have some spine rotations, and then they would have a one- or two-year fellowship in spine surgery after that. These days, for most neurosurgeons, at least in my case, my entire residency had a lot of spine in it. I trained at the Leatherman Spine Center and Kentucky Neurosurgical Institute in Louisville and so that really was six years of spine training in addition to all the other neurosurgical problems; brain and peripheral nerve, etc. So, the approaches tend to be, sometimes can be a little bit different. The orthopaedists tend to be trained with more focus on placing instrumentation for stabilization; neurosurgeons tend to be a little bit more focused maybe on diagnostics and trying to minimalize the intervention, if possible. But, really, quite honestly, much of what’s done, either in neurosurgery or orthopaedic spine, much of what’s done would be very similar.
Melanie: Then, when does it require intervention? So, what would you do if someone comes to you? You’re going to take an MRI, you’re going to see what’s going on there. And then, what is next? Do you go to prescription anti-inflammatories? When does it require surgical intervention?
Dr. Levy: Usually, for me, I operate on a problem that is pain, principally, as an elective procedure, and I generally try to talk patients, as much as I can, out of surgery if there are no neurologic deficits, there’s no focal weakness, there are no changes in the way they ambulate, there’s no numbness that’s really severe, and they can live with the pain. We try to talk them out of having surgery. But, if somebody comes in and they’ve tried absolutely everything and they are so uncomfortable that their quality of life is really significantly affected and they can’t work but want to work; they can’t exercise, but want to exercise; and their pain is marked and I can, with the studies that I’ve ordered, and my physical exam, and their clinical history, I can determine a procedure that is going to focally fix the problem. If someone comes in and has an advanced neurologic deficit or they’ve got spinal cord compression in the neck, for example, and they’re unsteady on their feet, those are people who, for the most part, do go to surgery unless there’s some contraindication medically for me taking them to surgery. So, if somebody has really tried everything and is not finding that they’re getting any better or they have some sort of neurologic deficit that’s concerning, those are the patients I generally take to surgery.
Melanie: What are some of the most common surgical procedures you’re doing now for neck and low back?
Dr. Levy: Well, for the neck, I do quite a few anterior cervical discectomy and fusion procedures, which is where you come in through the front of the neck, remove disc material, then place a spacer, if you will, a cage in the space between the bones, and then put a titanium plate over it. I do the same sort of fusion fixation procedure in the lumbar spine, but usually from posterior. That can also include a spacer in the disc space, but from the back and also what are called pedicle screws, which are titanium screws that hold the spine straight and reduce the instability there. I do some simple decompressive procedures as well. I do quite a few procedures where I place cement in a fractured bone, which would be called kyphoplasty or vertebroplasty, depending on the situation—really, the whole range. Of course, peripheral nerve and brain operations, as well, but really the whole range of spinal surgery, I’m happy to take care of.
Melanie: In just the last few minutes, Dr. Levy, if someone has never experienced back or neck pain, sometimes, they can’t even really understand the incredible level of pain and debilitation that these cause. Please give your best advice for possibly preventing them and what you want people to know about back health.
Dr. Levy: Sure. Two of the things that can be done that are really the most important things are to stop smoking because the smoking tends to rob and reduce the delivery of oxygen and nutrients to a system, a physiologic system that already does not have a huge amount of oxygen/nutrient delivery. That’s just the way it’s designed. When you smoke, you really take that almost completely away, so any injury, the reparative ability of the body to fix some problem in the spine when you’re a smoker is very, very small. So, quit smoking. Number two, lose weight. Being heavy puts an enormous amount of stress on your spine and, certainly, over time can lead to advanced spinal pathology and, of course, when you are heavy, fixing it surgically becomes a much, much more complex issue. I would say also regular, low-impact exercise is an excellent way to prevent problems with the spine and stretching. There are a lot of books out how to do–one I like to recommend is called Back Care Basics and I think the author’s name is Mary Pullig Schatz, M.D. She’s a yoga instructor and a medical doctor and has got a lot of stretching and ergonomic information in there. But, stretching and exercise, staying mobile, staying healthy, keeping the weight off, and quitting smoking are all things that will help prevent significant spinal pathology in the future.
Melanie: Thank you so much for being with us today, Dr. Levy. It’s such important information and for more information, you can go to www.mhsystem.org/spine. That’s www.mhsystem.org/spine. You’re listening to the Memorial Health Radio with Memorial Health System. This is Melanie Cole. Thanks for listening.
