Back pain is one of the most common reasons Americans seek medical attention. It has a variety of causes related to muscles, discs, nerve compression and more. For most patients, back pain goes away on its own, but pain that lasts more than a day or two or comes with neurological symptoms like numbness or weakness is cause for concern.
In this episode of San Diego Health, host Susan Taylor welcomes guests James Bruffey, MD, head of orthopedic surgery at Scripps Clinic Torrey Pines, and his patient, Mark Erwin, a former triathlete who was sidelined by chronic back pain at age 40. They discuss the conditions –spondylolisthesis and spinal stenosis –that led to Erwin’s back surgery, the specific minimally invasive spinal fusion surgery itself, and his road to feeling better than he has in decades.
Dr. Bruffey also has some tips on what you can do to preserve your back before problems occur, such as strengthening your core, keeping your weight down and using caution when lifting things.
Dr. Bruffey: Most back pain episodes are self-limiting. They go away on their own. Most patients kind of know what's a strain and what's probably more significant and if they don't, it's probably reasonable to seek some medical attention with their primary physician at least, depending on the severity of their symptoms.
Most self-limiting back pain episodes are about 24 hours to 48 hours. They start to feel better within that period of time.
Dr. Bruffey: It can be muscular. It can be the joints of the spine. You can have nerve compression from arthritic conditions and from other things. There are a variety of reasons why the back would hurt.
If there's a neurological change in your status you need to go see the doctor right away. Numbness, weakness, change in bowel or bladder function, those are the kind of the red flags that we look for when we do an exam and take your history.
Erwin: The first orthopedist who looked at my back said I looked like I had a congenital back defect. I had vertebrae that weren't formed totally. I was taking more pounding than normally someone (with a healthy back) would take. But I was used to it. Like Dr. Bruffey said, things kind of come and go away. So I thought ,'Well, I'm not going to run. I'm not going to play golf. I can give that up. I can still swim and ride my bike. I can still ski. As long as I can still do those things'. The trouble was if I had to go to an event and stand for any period of time. Shopping was like, 'Kill me first. I don't want to go shopping. Find me a place to sit down'.
Over time it got to the point where I was really limited. Getting in the pool and swimming and moving my arms above my head hurt. It was obvious that something had to be done.
Dr. Bruffey: It's really quite common. There are varying patterns of the way we develop wear and tear on our backs. Mark had a fairly common version of that in his lower back. Conditions words that you'll hear if you see your doctor may include spondylolisthesis which is a shift in your spine and generally resulting from arthritic changes in your back. Mark had one of those changes where the spine bones had shifted due to long-term arthritic changes. And unfortunately as a byproduct of that Mark also had what we call stenosis which is the narrowing of the nerve canal, where the nerves come out of the spine. So his spine was actually compressing on his nerves through that arthritic process.
Dr. Bruffey: For Mark's condition, we attempted to do a lesser operation to just make room for the nerves. But the shifting process actually won the battle and actually recreated the symptoms. So we got two years out of a non-fusion operation but for Mark, his main problem became the instability from his arthritis. So what we did for Mark, to fix his spine, to get it back to where it was, we had to do realigning.
For his surgery, we went through the front of the spine because it gave us access to the disc spaces. That's where we can achieve our best effect in terms of getting our fusions to heal and getting his spine realigned to its more anatomic position.
Mark Erwin: I was walking the same day. I was in the hospital about three days. I was able to go downstairs. I'd say that the most challenging part about the recovery wasn't so much the surgery, it was the anesthesia. But I was walking down the street within a couple days, around the block within a week. Within two weeks, I was out of the woods. It was still healing a lot but I really didn't have no pain at all.
My back has not felt this good in more than 30 years. I have to go back to when I was in my 20s to when my back felt this stable and this good. It's a miracle.
Dr. Bruffey: Previously, you could be in the hospital for a week or two. We would shorten the hospital stays depending on the technique. Obviously we've all gotten better. The recovery time has been shortened dramatically. The hospital stay time has been shortened with the better technology we have available and the better techniques.
Mark Erwin: I don't really feel I have limitations at this point...As far as the things I want to do, I swim Masters (a post-college organized swim team workout program) four or five days a week. It's a pretty demanding program. I could easily go back to skiing if I wanted to. I've been going to Maui instead of skiing and swimming in the ocean.
I'm conscious of not wanting to put too much pounding on my back. I'm conscious that I've got my back back so to speak and I'm not going to do anything that really would hurt it.
Dr. Bruffey: I try and encourage my patients to go back to what they liked to do. Obviously for Mark, we were forced to stabilize his spine. We had to fuse levels. So it's a compromise. We can't restore the anatomy. There are certain limitations. We can't replace the native spine. I can't make it like it was when he was in his 20s.
What we're trying to do (with spinal fusion surgery) is to create stability where your body has developed arthritic instability. So we're restoring the bone alignment but we're taking away the motion so that makes the spine stiffer now. For Mark obviously that trade-off created an enormous amount of symptom relief and that's pretty typical for most patients. They'll generally trade the stiffness they feel on their back for the pain and the nerve compression.
Dr. Bruffey: You can run. You can golf. I have patients that do that all the time. There is a caveat. So once you've had a level of your back that's had to be fused or operated on, even if you don't fuse it, you are putting stress either at that level because it still moves or now you're transferring stress to the other levels that are doing the work that the fuse one no longer does because you've taken away that motion. Theoretically you will place the other levels of your spine at a slightly higher risk of developing that same degenerative change and ultimately become symptomatic and bother you again. So you'd have to have potentially other surgeries done.
Dr. Bruffey: Exercise becomes key. You have to make sure you're doing the right things from an exercise and flexibility standpoint on a routine basis.
You have to take a vested interest in your own health and really start to do things that help your back stay strong and flexible. You work on keeping your weight down. That's obviously very important because you're putting less load on the structures. If something hurts while you're doing it reassess that. If something you're doing is painful you probably need to rethink it.
As for stretching, I think everybody picks their own stretching routine. Yoga is a great activity for getting flexibility and strengthening. Pilates is another one.
If you're having pain see your doctor, we can get you into our physical therapists so that they can work with you and your individual needs and then come up with a program at home that you can then do.