The saying that an ounce of prevention is worth a pound of cure is never more true than with back pain.
And it is true, Dr. Reed Fogg says, even though the treatment of back pain has seen dramatic changes and improvements in the past 20 years.
Fogg, director of the Intermountain Spine Institute at The Orthopedic Specialty Hospital, believes it is very important for people to maintain a healthy weight, stay in good physical condition and take care when they lift heavy objects.
"It is the angle we lift at, not so much the weight of what we lift," he said.
Back pain from preventing it to treating it is the topic of Saturday's Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Fogg and Dr. Terry Sawchuk, who is board certified in Physical Medicine and Rehabilitation with a strong emphasis in interventional physiatry, will take phoned-in questions. The number is 1-800-925-8177. Or you can e-mail questions to firstname.lastname@example.org and the experts will answer some of them online Saturday morning at www.deseretnews.com.
There are times when back pain begins to intrude on a patient's life and it becomes necessary to seek treatment. There are a number of options. Many cases of back pain can be managed without surgery. However, when non-surgical alternatives fail, or when there is progressive weakness in the legs, Fogg said, it is time to consider surgery.
"I think that surgery, and especially spinal surgery, has a bad reputation," he said. "But the success rate has greatly improved."
There are three primary types of surgery, Fogg said. They are the removal of a herniated disk, correction of spinal stenosis and fusion. Spinal stenosis is the narrowing of the spinal column, which can cause pain in the lower back, buttocks, thighs and legs. This is seen most often in people over the age of 60.
Spinal fusion is used to relieve discogenic pain pain that does not involve the sciatic nerve and stems from the movement of one or more disks in the back. In this case, surgeons will permanently connect two or more discs, thus preventing the movement.
Some people put off seeking treatment, thinking the pain will go away on its own. However, Fogg said, patients who experience severe back pain paired with motor weakness or the sudden loss of bladder and bowel function should seek treatment as soon as possible.
Magnetic resonance imaging has increased the ability to diagnose back problems and determine if surgery is needed. In addition, surgical techniques have improved immensely, Fogg said. Even the instruments that are used are better, including the use of titanium metals in the screws, rods and spacers that are an integral part of surgically fixing back problems. Not only does this lead to better success, it also decreases the healing time.
"Most people are up the same day," Fogg said.
The typical hospital stay is two days down from one to three weeks in the past. After surgery, patients can finish healing at home, with limited activity. Physical therapy starts three weeks after surgery, and most patients can resume normal activity after six weeks.With complications, or for people who work in heavy construction, it may be four to six months before the patient is able to return to work.
Saturday: A non-surgical approach