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They’ve Got Your Back


Doctors tout new procedures in combating degenerative disk disease

The back can be described as a tripod all the way down. “The disk is in the center and there are two joints in the back. The tripod is stable but mobile so the disk acts as a cushion and the joints give you stability,” says Dr. Kenneth Adatto, an orthopedic surgeon at
Touro Infirmary. “When a disk is out of place, a little bit of the joints get arthritis, and then you get in trouble,” says Adatto. Most people realize that the back is necessary for support, but they may not understand just how it functions. “The disks in the back are the shock absorbers that take care of the forces we feel on a daily basis,” says Dr. Alan Burshell, the section head of endocrinology at Ochsner Health System. One of the main mysteries is how the disks communicate with the bone or how the bone communicates with the disk. “Many people lose height as they get older because the shock absorbers are worn out and they get more forces of bone on bone and degenerative arthritis in the back from that,” says Burshell.

Sometimes people end up pinching off the nerves, which is called spinal stenosis. Pinching of the nerves can also cause sciatica. “We usually talk about degenerative disk disease in certain areas like the cervical area of the cervical spine or the lumbar or thoracic spine, which are locations of the disks,” says Burshell. Degenerative disk disease is sometimes used as an umbrella term. “There is some variability but the symptom complex that somebody will get in the lumbar spine is sciatica with pain going down classically from the buttocks to the legs,” says Burshell.

Spinal troubles typically increase as we age. “With aging, there is the loss of core muscle strength including abdominal muscles and paraspinal muscles that weaken naturally,” says Dr. Douglas Lurie, an orthopedic surgeon at Touro Infirmary. Trying to maintain these muscles can preserve your back health. “Degenerative disk disease is a natural degenerative process that occurs in almost
everyone to some degree but not everyone is symptomatic,” says Lurie.

The disks go through changes over time. “The disk, which is basically the cushion between the vertebral bodies, starts to lose some of its normal cushioning effect, because of the loss of water within it, and it becomes more stiff and rigid,” says Lurie. This is where the problems arise.

“As a result of that, you start to get arthritis in your lower back as the cushions disappear as a result of wear and tear,” says Lurie of this horrible cycle. “This can lead to a secondary condition that is common in older people called spinal stenosis, where the outlets for the nerves and nerve roots for the spinal cord are narrowed as a result of arthritic change in the lower back,” says Lurie. People may experience back pain as well as leg pain.

While back pain is common, it may not go away without intervention. That is why it is important to find the source. “It could be coming from the disk, arthritis in the back or a fracture,” says Burshell. Young people may have back problems like a herniated disk from a sports injury or an accident. Generally speaking, arthritis begins to occur around age 40.

If there is pain and signs of nerve damage, the doctor will find out what is mechanically pushing on the nerve. “You look at a combination of things like the history of how it happened, where the pain is, the physical examination, which can bring out the pain, discomfort or pounding on the bone or disk area doing certain maneuvers and then the X-rays, which show some information,” says Burshell.

Sometimes you need to get an MRI or CAT scan to see the areas. X-rays can see the bone but cannot tell whether you have osteoporosis. “You get a better picture of the disks when you do an MRI, and with arthritis, you do not always see it without other studies,” says Burshell. If you are found to have a problem, conservative care will be tried first. “Most doctors will say to try an anti-inflammatory, and you can do that over-the-counter.

About two-thirds will get well with medicine and inflammatory therapy. If you do not respond, you are sent to a specialist,” says Adatto. But just because you are not hurting does not mean you are okay. “If you take 100 people off the street, you will find that most of them have arthritis in the spine,” says Adatto.

Preventing degenerative disk disease comes down to looking out for your back. “Not overloading the back with certain physical activities can be beneficial, and having good abdominal muscle structure is supportive to the back,” says Burshell. If you are on the heavy side and have degenerative disk disease, taking off some weight can help.

Lifestyle choices really make a difference, because the reality is that we are all likely to get degenerative disk disease at some point. “Stay in good shape, keep your weight under control and do normal physical activity such as working out on the treadmill or at a gym,” says Adatto. The key is to maintain control of the abdominal muscles so you are in good shape to handle any obstacle that comes along. Spinal problems are more common in smokers and aggravated by obesity, injury or trauma.

It’s helpful to have good posture as well. “Your spine has normal curves in it; it is not straight up and down. You have curves in your neck, back and low back, which are built to give you stability,” says Adatto. When you sit and stand properly, you will have better muscle control.

Lurie says another important thing to consider are your shoes. “A simple thing you can do is to look at the type of shoes you are wearing and make sure you have good cushion and support,” he says. You should also consider your mattress and be sure that it supports your back.

“Sometimes the size of your pillow can make a difference,” says Lurie. A pillow that is too thick or too thin can be aggravating. “Sometimes putting a lumbar support on the seat of your chair can give you support,” says Lurie. It might not be a preventive measure, but it can make you feel better if your back is bothering you. All is not lost if you hurt your back. “Many times the back will get better on its own, but if it is causing difficulty over a prolonged period of time, you might see your primary care doctor to get a better idea of what is going on and get a referral to a specialist,” says Burshell.

Recently there have been advances in favor of the spine. “We have implants we can put in the spine,” says Adatto. This is a big leap from the past. “We used to have to take bone from the bone bank of the patient, and now we can put in implants that grow bone in the patient,” says Adatto. Patients can even be sent home the same day. Another option is total disk replacements. “It is still a work-in-progress. The way we operate on the spine, we are not using as much bone from the bone bank anymore and from the patient,” says Adatto. Technology has come a long way. “We have ways to grow bone for the patient using the bone morphogenic proteins,” says Adatto.

Sometimes you do not need to do a fusion and can just take the disk out and do a microdisectomy, which is a small incision. “There is no one answer to each patient,” says Adatto. There are many considerations when coming up with an appropriate treatment. “We do a complete thorough history of when the problem began, where the pain is in the back, neck or arms and then take X-rays,” says Adatto. If the problem persists, an MRI may be taken at the next visit before a formal treatment protocol or plan of treatment is made.

Many back problems don’t require surgery. “When you have a herniated disk, 80 percent get well without surgery,” says Adatto. If you cannot take the pain, however, a spine surgeon can fix it. The outcome is usually dependent on what shape you are in before a procedure. “The better shape you are going into it, the better chance you have of getting well,” says Adatto. Sometimes patients are provided with a certified physical therapist that will teach them how to do exercises at home. Other times, epidural steroids are done by a certified pain management doctor.

Regardless of your spinal trouble, early intervention is the best cure. You should know when it is time to see an expert. “A good time to come would be after you have tried basic things at home, such as overthe- counter anti-inflammatories, a heating pad, a couple days of rest and activity modification,” says Lurie. Sometimes scheduling a visit is a necessity. “An urgent time to come see us would be if you have a new onset of numbness or severe leg pain coming from your back that might be indicative of a pinched nerve,” says Lurie. You can definitely get better.