If you’re experiencing low back pain – and 80% of the population will at some point – surgery is not your only option. In fact, it’s the last option you should consider.
“We work with patients from the start, aiming to avoid surgery if possible through physical therapy and rehabilitation,” said Dr. Joseph Zuhosky, a physiatrist with Novant Health Spine Specialists in Huntersville, North Carolina. "The goal is to minimize pain and maximize function.” (A physiatrist is a physician who treats conditions affecting the spinal cord, brain and physical movement.)
In Zuhosky’s practice, surgeons and nonoperative specialists work together to determine the best treatment plan for patients. The clinic offers the complete spectrum of care, and everyone’s goal is to maximize nonsurgical options.
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Dr. Mark Hartman, an orthopedic surgeon who works with Zuhosky, said the team – which already includes physical therapists, physiatrists, and neurological and orthopedic surgical spine specialists – recently added a pain management expert. “By adding a pain management specialist, we can help that subset of patients who, despite everything we do, don’t respond to treatment,” said Hartman. “You have to have an avenue for every type of patient. You want to try to make their quality of life as good as possible.”
Finding out the source of back pain usually begins with an X-ray or MRI. From there, at-home exercises, physical therapy, injections and activity modification are among routes clinicians will typically recommend before discussing surgery.
One of the nonsurgical treatments, epidural steroid injections, reduces inflammation at the source of the pain in the spine. Zuhosky often recommends an injection, which can be given on-site at his clinic, as a precursor to physical therapy.
Even if you’re referred to a surgeon, it doesn’t mean you’re destined for surgery.
“The vast majority of patients with low back pain don't need surgery,” said Dr. Chase Bennett, a spine surgeon at Novant Health Brain & Spine Surgery in Bermuda Run, North Carolina, west of Winston-Salem. “We operate on less than a quarter of patients who come to our clinic. Treating low back pain is really a collaborative effort between the patient, the primary care doctor, an interventional anesthesiologist, physical therapist, physiatrist and maybe a surgeon. There are a lot of things we can do to help patients stave off or avoid surgery.”
Minimally-invasive surgery options
But if surgery is determined to be the best course of action, ask your surgeon if a minimally invasive procedure is an option, Bennett said.
“The outcomes (for minimally invasive spine surgery) compare favorably to traditional open spine surgery,” said Bennett. “We know that there is less blood loss, lower rates of infection, lower rates of complication and faster overall recovery.”
Bennett helped introduce the minimally invasive procedure called the extreme lateral interbody fusion, to the Winston-Salem market last year. It’s a big improvement over open fusion surgery, in which a surgeon fuses two vertebrae. That involves larger incisions, muscle tearing, a higher rate of complications and a longer recovery time.
Extreme lateral interbody fusion (XLIF)
With XLIF, most patients are walking almost immediately after surgery and are discharged from the hospital within a day or two.
When it comes to back surgery in general, some patients may need rehab or physical therapy after surgery. But there’s good news on that front, too. “Oftentimes insurance plans, including Medicare for the most part, pay for in-home rehab,” Bennett said.
While a certain amount of back pain is often inherent in the aging process, Bennett’s patients range from teens to people in their mid-90s. “Even in younger patients, therapy can play a pretty significant role in helping get them back as close to 100% as soon as possible,” Bennett said.
No matter what method or combination of methods you and your doctor choose to address low back pain, the team at Novant Health is always working to ensure patients get the least invasive treatment that’s appropriate for them.
Zuhosky said the model his practice uses works because surgeons trust their nonsurgical colleagues to manage and identify those patients who do need surgery. “That’s the thing we’re most proud of,” he said. “That we’re able to work so collaboratively.”