The spine surgeon at Novant Health Brain & Spine Surgery - Kimel Park in Winston-Salem said, for most patients, there are other treatments to try for an aching back before surgery should be discussed. His desire to try conservative treatments first works out well, since most patients would rather forego surgery.
He lives and works in Winston-Salem and runs a clinic once a week in Novant Health’s new clinic in Mount Airy, North Carolina. “The medical team and support staff there are tremendous,” he said. “There’s a great need for specialty spine care in the community. We provide an access point for people even further afield; it’s not uncommon for patients to come from Virginia.”
We talked to Nimmons about spine health, including what people can do to avoid back surgery.
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How can people protect themselves so they avoid needing back surgery down the road?
There are three big things people can do to maintain healthy joints and an overall healthy back.
The first is maintaining an ideal body weight, which is different for everybody. As we put more weight on our bodies, that puts more stress on discs and joints, which makes them wear out faster.
The second thing is maintaining an active lifestyle as much as possible. That means at least 30 minutes of moderate activity three to four times a week. It doesn’t necessarily have to be every day, but it’s important to get your heart rate up, work up a sweat. Whatever your passion is, do that – and do it to a point where you're breathing a little hard. That goes a long way in maintaining a good, healthy spine.
The third is avoiding nicotine products as much as possible. I know we live in North Carolina and tobacco is part of our culture around certain parts of the state, but avoiding nicotine products is certainly a way to maintain a healthy spine. Nicotine creates some enzymatic reactions, which is another way of saying it causes our bodies to age prematurely.
Those three are important because they’re things people can modify.
What role does genetics play?
Unfortunately, there are other factors that play into back pain, and genetics is one. Our moms and dads have a lot to do with what our backs will do over the course of a lifetime, how quickly they age and how much pain we have as it relates to degeneration, wearing out of the discs and joints.
There are certain genetic inflammatory conditions that can cause back pain. Degeneration, or wearing out of the discs and joints, can be genetic. As we’ve grown in our knowledge of medicine and spine health, I think we’ve come to appreciate more and more the significant role genetics plays.
Another factor out of our control is previous injury, which can cause your body to wear out faster.
Are there common behaviors among people who have back pain?
That’s challenging to address. There are people who smoke, for instance, who don't have back pain, and there are others who don't smoke who do. Behaviors don’t necessarily drive the pain.
I like to focus on what patients can control. I counsel them on maintaining a healthy and strong core. And I could do a better job of that myself. Many of us are in the same boat as it relates to our core strength because so much of our lifestyle has become sedentary due to our work. That means bad posture starts to creep in.
A lot of people think of their core as just abdominal muscles, but there are also those back muscles that wrap around and go close to the spine. If we have painful joints, painful discs in our back, a lot of times the back muscles bear the brunt.
As long as we stay active, we may not feel as much pain. People who have weak cores may experience more back pain. That’s one of the first things I recommend to patients with spine complaints – physical therapy with the aim of addressing core strength.
What questions do you commonly get about back pain?
The main one is: How can I make it stop?
We’ve got a good way of approaching that question in our group because we’re multidisciplinary – we have a group of specialists. You may come to see me – a spine surgeon – but we also have people who specialize in injections, and there’s a great physical therapy team. If you’re struggling with your weight, we have a team that can help with weight management. Being able to direct people to other specialists is one way we can get you feeling better, sooner – and hopefully without surgery.
If it comes down to surgery, we can discuss that at the right time. But most people would like to avoid surgery, at least initially. And we’re well positioned as a group to help patients do just that.
As for other questions, people have asked: Is this something that will get worse by exercising? A gentleman came in a few weeks ago who loves basketball – loves playing it, loves refereeing it. He’s got a standing basketball game with his friends every Thursday morning. He asked if basketball could be making his back pain worse. And my answer, for the most part, was “no.” If you have a stable spine – and most patients I see in clinic, do – then you may experience a little more discomfort or a pain flare-up, but you are absolutely not making things worse. There’s really no downside to exercise.
Are there myths about back pain you want to dispel?Yes. I’ve noticed a common fear when people come to see me is that their back pain could lead to paralysis. A lot of patients are fearful and anxious because someone, somewhere along the way, has told them that if they don't get this taken care of tomorrow, they’re going to be permanently paralyzed. And while it's not necessarily a myth, that risk is overstated.
There are certainly circumstances where there is urgency with back pain. But if someone has some compression of the nerve roots, we can try and treat it with things like physical therapy, injections and medicines. We’re taking a more holistic approach rather than jumping straight to surgery.
If you are having frequent and severe back pain, it’s important to be evaluated by a specialist because there are some things that are urgent and even emergent that may need to be addressed.
Even though you’re a surgeon, you don’t sound overly eager to get into the operating room.
I trained with some wonderful surgeons who showed me that there are usually very clear indications for surgery, and I try and emulate them. In certain contexts, surgery is absolutely the right answer. But in other contexts, the decision to pursue surgery is one that should be made from an informed perspective between the surgeon and the patient. That discussion, in my opinion, should be driven by the patient’s goals.
If a patient tells me that now’s not a good time – because of work or because of their daughter’s wedding or some other big event is coming up – it’s not my job, in my opinion, to try and convince them surgery is the right answer, right now.
When conservative methods don’t work, what are some types of back surgeries you perform?I do all different types of surgery, and I particularly love those involving the cervical spine and spinal deformities. But most patients don’t need that scale of operation.
We can do surgeries that focus on taking pressure off the spinal cord or nerve roots that can sometimes cause arm or leg pain, such as sciatica. We can do surgeries that take pressure off the back that’s caused by arthritis or a herniated disc.
I also do a fusion-type procedure when the joints aren’t quite holding the way they used to and causing the patient a lot of pain. In these cases, we can see there's actually movement between the bones. So, we go in and reestablish the stability with rods and screws, and ultimately bone grafts to try and get everything to heal together as one block of bone.
Other times, the alignment of the spine isn’t particularly good and it’s causing shooting pains down the legs. Or the patient may get tired just from standing. Sometimes, we do corrective surgeries to get people in better alignment and hold them there over time.
There are all different iterations of those surgeries. Each patient’s story is a little different, and we cater their treatment to what's ailing them most.
Recovery from back surgery has gotten much easier, correct?
Historically, people used to be stuck in bed for weeks and months after back surgery. Now, we encourage patients to get up and walk as soon as they’re able. It’s not uncommon to have patients get up later the same day or first thing the day after surgery. And this helps with their pain, helps avoid some complications that can come with surgery and kick-starts their recovery process. We have great therapists that help us facilitate that.
Another thing that’s gotten a lot better are the minimally invasive techniques and instruments we use now that allow us to do things that weren't possible 20, 30 years ago. Overall, we’re trending in the right direction.
Same-day care for back pain is now available at Novant Health. Click here to find a clinic near you.
From the football field to the OR
Nimmons played center on Rice University’s offensive line as an undergraduate. And it was during his college football career that he decided to go into healthcare. “No one in my family had gone into medicine,” he said. “But one of our team physicians – an orthopedic surgeon – took a liking to me and invited me to come to his clinic. The experience really solidified that medicine was the right career for me.”
But that doesn’t mean he followed the typical route. “I figured I’d have an entire lifetime to perfect my scientific knowledge,” he said. “I wanted to delve deeply into something other than science for the four years of undergrad. So, I majored in political science and studied international relations – diplomacy, international conflict, comparative politics. It was fascinating, and we benefited from having an on-campus think tank called the Baker Institute, after James A. Baker, the former Secretary of State.”
While at Rice, Nimmons met world leaders including the Dalai Lama, former President Bill Clinton and Colin Powell.