Three spine surgeons discuss the most common complaints they receive from patients and how they resolve them.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Question: What is a common spine patient complaint and how do you respond?
Michael J. Musacchio, Jr., MD. Spine surgeon at NorthShore University HealthSystem's Neurological Institute (Chicago): When patients present with specific complaints of radiculopathy or mechanical pain associated with a mobile spondylolisthesis, the treatment paths tend to be more clear and discreet. Typically, we follow an initial conservative course of physical therapy and anti-inflammatory modalities. When this fails, or neurologic deficits exist, a path to surgery is typically straightforward.
However, more times than not, patients present with more generic complaints of back pain, in which case the etiology can be more multifactorial or less clear. Pain doesn't show up on imaging, so we are left to make correlations between findings on imaging and patient complaints. In many cases, there is simply no clear answer as to why someone hurts, therefore no straightforward treatments. It typically begins with physical therapy and anti-inflammatory modalities. My approach to this begins and ends with educating the patient and helping them to understand the concept of pain without a specific cure.
The traditional model of surgeons acting alone and trying to be everything to their patients is not always the best approach. A multidisciplinary approach involving pain management, physical medicine and rehabilitation, therapy and more is better for the patient because it provides more options and perspectives for treating pain.
In the absence of specific pathology, managing chronic pain can in some ways become trial and error. Endlessly chasing the cause of pain can often be a fruitless endeavor. Instead, it is better to focus on treatments that cover a wide variety of conditions. This can include core conditioning, postural rehabilitation, weight loss, NSAIDs, injections, manipulations, integrative modalities and acupuncture.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: A common complaint I have is that I am too restrictive on patient's postoperative activity. I am in transition right now from being uber-conservative to more liberal when it comes to what patients can do and not do in the perioperative period. I respond by letting the patient determine their level of activity in certain cases. What I do for the majority of patients is outline a very specific, graduated program of activity. I have a return to golf program, return to cycling program and, for one patient, a return to drumming. Having a customized patient program really helps let them settle in as they recover.
Matt Chapman Jr., MD. Spine Surgeon at OrthoCarolina Spine Center (Charlotte, N.C.): Back and leg or neck and arm pain are some of the most common complaints that we see. Thankfully, a significant portion of them will improve with conservative, not operative care. I tend to begin initial management with oral medications and physical therapy. For patient symptoms that are recalcitrant to this, the addition of injections is usually beneficial and will resolve the majority of the patient's complaints. Sometimes, the symptoms are so severe that patient cannot tolerate medications, therapy and/or injections or they do not get adequate benefit to allow them to return to an acceptable level of functioning. In these cases I try to offer them relief with surgical intervention. We always try and reserve operative management of spine pathology as a last step. Again, the majority of the spine-related complaints will improve significantly with nonoperative care.