Tag Archives: surgery

Back pain and the realities of surgical recovery

Statistics show that 80% of us will have at least one episode of low back pain during our lifetime. This is especially important when you consider these factors will increase your risk: obesity, smoking, age, female, physically strenuous work, sedentary work, stress, job dissatisfaction, anxiety or depression.

healthnetThere are four main regions of the back: Neck: seven cervical vertebrae (C1-C7), Upper back: 12 thoracic vertebrae (T1- T12), Lower back: five lumbar vertebrae (L1-L5), and Base of spine: sacrum, coccyx (S1- S4). Low back pain is most commonly found in the L4, L5 and S1 areas. However, most people (>85%) have “nonspecific low back pain,” which means there isn’t a specific disease or abnormality in the spine clearly causing the pain.

Causes of low back pain include: degenerative disc disease (wear and tear causing breakdown of spinal discs or loss of fluid in the discs), facet joint arthropathy (arthritis in joints connecting the vertebrae to one another), spondylolisthesis (one of the vertebrae of lower spine slips forward), herniated disc (outer covering of disc is torn, soft inner tissue extrudes), lumbar spinal stenosis (open space inside the vertebrae is narrowed), and spinal compression fractures.

Symptoms include: radiculopathy (nerve root becomes irritated, causing radiating pain, numbness, etc.), sciatica (one of the five branches of the sciatic nerve becomes irritated), neurogenic claudication (pain runs down the back to buttocks, thighs and lower legs, often on both sides and may cause weakness and limping).

Diagnosis: Imaging studies including X-rays, MRI, CT scan. It’s interesting to note that a patient may have an abnormality on imaging and actually experience no symptoms.

Treatment: Remaining active helps to relieve muscle spasms and prevents loss of muscle strength. Also helpful: heat, pain meds, exercise to increase back flexibility and strengthen core muscles, physical therapy, chiropractic manipulation, acupuncture, massage, trigger point injections into the soft tissues of back or epidural injections, traction, ultrasound, electrical nerve stimulation, low level laser therapy.

Surgery is only recommended if more conservative treatments fail. Options include spinal fusion (fusing two or more vertebral bodies together), lumbar disc replacement (may help preserve normal range of motion), discectomy (removes part of/entire disc to relieve pressure on the nerve roots), open discectomy (standard surgical incision), micro discectomy (smaller incision to remove of disc fragment).

Spinal fusion recovery. Pain should decrease gradually. Usually the worst is over by four weeks. However, some patients have pain for three to six months after surgery. Avoid bending, twisting or lifting anything over 10-15 lbs. If a back brace is recommended, wear it for six weeks to three months after surgery. Driving may be allowed after four to six weeks. Outpatient physical therapy may be started at six weeks.

At three to six months’ post-surgery, exercise is the central component of the recovery process. Focus should be on strengthening your back and core muscles for support. Complete recovery may take up to eight months. Bone continues to evolve for 12-18 months.

SUSAN LOCKE, MD is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Questions to ask before surgery

Susan Locke writes that it’s necessary to ask many questions before surgery . . .

Susan Locke

Susan Locke

Millions of Americans undergo surgery each year. All surgeries have risks and benefits, and the more you familiarize yourself with the procedure, the better.

Smart patients arm themselves with vital information about the surgery, whether it’s an elective surgery or an emergency surgery. Before undergoing any surgical procedure, make sure you understand why the surgery is recommended. Once you have reviewed why surgery is necessary, you should start asking questions prior to undergoing the procedure. Consider taking notes as you may want to compare them with a second opinion.

• What are my alternatives to surgery and what are the outcomes of these alternatives?
• What if I don’t have the surgery?
• Are there different ways to perform the surgery? Could you tell me about the pros and cons of different techniques? Ask about minimally invasive surgical options.
• What are the risks and the complications of the surgery?
• How many of this type of surgery have you done?
• How many of these surgeries are performed by this hospital every year?
• How do your results compare to other surgeons?
• Can surgery be done as an outpatient?
• Where will the surgery be done?
• What pre-operative preparations will be needed?
healthnet• Based on the medications/health conditions I have, what adjustments will be necessary. How do I best prepare for the surgery with the medications I take?
• What are the dietary restrictions before or after surgery?
• Can surgery be done under local anesthesia? What type of anesthesia will be used?
• How long will surgery take?
• How long will I be in the hospital?
• What complications are likely based on my history?
• How much pain can I expect and how will it be treated?
• How long will I be in bed?
• Will I need any special adaptations when I return home?
• Will I need any physical therapy?
• When can I drive?
• When will I be able to return to work? Normal activities?
• How long will it take my incision to heal? Will I have a scar?
• Will I need additional treatment for my condition?
• What post-operative symptoms warrant a call to your office?
• Who should I call if I have a problem? How do I reach them?
• How many post-operative appointments will I have?

Prior to surgery, contact your insurance company to confirm whether the surgery will be covered by your policy. Taking an active role in your health or having someone close to you advocate for you is always a good idea.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org