I'm Dr. Joe Ferguson, orthopedic spine surgeon at MedStar Georgetown University Hospital.
And, we see patients who come in with neck or back pain, with radiating arm or leg pain, and symptoms
consistent with spinal cord compression such as hand clumsiness or weakness or balance issues.
At MedStar Georgetown, we have all the modalities and specialties to support a spine surgery, whether
that's inpatient, outpatient, or post-op recovery process. We have a large team approach to the care
of any person. We actually abide by the phrase cura personalis, which means to treat the whole person,
and that starts in the pre-operative workup process, meeting with the anesthesia team,
all the way into the hospital where, after surgery, you then work with the physical therapists. We
have medical doctors on staff that are able to help take care of any medical diagnoses
that you have, and then in the post-op recovery process, we have a team of physical therapists,
social workers, occupational therapists that can guide you through the recovery process.
My philosophy is that the patient and the physician are both partners in the
treatment of any disorder that a patient may have. When it comes to treating the neck or the
back, I think it's very important that the patient take an active role in their care,
participating in physical therapy exercises, managing their medication appropriately, and when
it comes to surgery, participate in the push-up recovery process as well. We've seen significant
advancements in the technology associated with spine surgery, both implants and the devices used
to perform the surgeries. I anticipate that's only going to continue to improve over the next 10 to
15 years, and the morbidity associated with surgery is going to decrease accordingly. What gets me
excited about coming to work every day is seeing patients who I know are in pain and having trouble
and knowing that I can help them and get them back to a more functional state of life, whether that's
getting back to work, things they enjoy, playing with their grandchildren, or just general hobbies.
A large number of causes of back pain, more than 85 percent
of initial visits to primary care physicians in this country, are
due to what's termed non-specific back pain which is usually musculoskeletal in origin.
But due to the complexity of the spine with the bones, discs, joints, muscles, and nerves, it can
be due to any number of those causes. It usually resolves in a short period of time with a course
of non-steroidal anti-inflammatory medications, physical therapy, and activity modifications.
As with many conditions, back pain can be diagnosed through a pretty
extensive history and physical, just finding out what your specific symptoms are, and then a short
physical exam investigating where your pain is and what sort of movements cause the pain or elicit
the pain or make it better can actually lead us to a diagnosis and guide your treatment plan.
The benefits of MedStar are that we have all the different specialties that can treat back
pain in a variety of ways. The initial treatment can be done by a primary care physician and can
be composed just of medications, such as anti-inflammatories, and physical therapy
to help make your back stronger and more healthy. We also have excellent pain management physicians
that can offer more extensive medication or potentially provide injections or other modalities.
If there are indications for surgery, we do have
surgeons such as myself that specialize in different areas of spine surgery such as cervical
spine surgery in the neck, minimally invasive spine surgery, or even scoliosis and deformity surgery.
With increases in technology over the last several years in all fields
of surgery, spine surgery has also seen a great benefit and the ability to perform
laminectomies, decompressions, and fusions with minimally invasive techniques. And, we can actually
approach the spine from the back, the front, and even the side to help decompress the nerves,
stabilize the bones, and decrease pain related to instability or compression in the spine.
Minimally invasive spine surgery is great in that the morbidity associated with the
soft tissue dissection is much lower, and patients typically recover much more quickly.
To a large degree, back pain can be preventable through just a general healthy lifestyle, such as
keeping your weight down, core strengthening, and flexibility, and general exercise. Some patients
do have a genetic predisposition or structural problem that may predispose them to back pain. But
even in those cases, a good healthy lifestyle can help prevent the majority of back pain.
As we know, exercise and weight management are important for any person's healthy lifestyle.
But in terms of the low back, there are only five lumbar vertebrae with the discs in between them
that provide the structural integrity in the low back. The core muscle, which is the
low back muscles and the abdominal muscles, are ultimately what provides
those lumbar vertebrae and discs with the support they need to have a healthy life.
If you think about the shock absorbers in your car, the more impact they take over the course of
the life, the quicker they'll wear out. And your intervertebral discs and your lumbar vertebrae
are very similar, and the core can help offload those structures and keep them healthy longer.
If your back hurts all the time, this may be indicative of something more serious. There
are red flag signs such as fevers, chills, night sweats, pain that doesn't respond to medication,
positioning, or even night pain where it keeps you up at night, and that's when you want to
have your back pain checked out by a specialist and perhaps with imaging such as X-rays or MRI.
Oftentimes, back pain improves after a short course of anti-inflammatories and physical therapy.
We're very diligent about that when our back does hurt, but then, as with
all things in life, we tend to fall off that pattern. If your back pain does recur,
then we go back and start the anti-inflammatories and physical therapy again. But in reality, we should
be doing core strengthening and flexibility exercises several times a week, just to keep
a healthy back in general. And that's not just for people with a history of back pain, that goes for
people who are healthy and haven't had back pain in order to prevent that in the future.
Oftentimes, people have neck or back pain that is due to arthritis.
And arthritis can cause disc bulging or bony spurs that compress the nerves or spinal cord
that the spine itself is designed to protect. When this happens,
the nerves typically send pain signals down the arm or leg to let you know that
it's experiencing the pain and that we need to do something to get the pressure off of those nerves.
The initial treatments for pain due to nerve compression is also anti-inflammatories in some
way. Oftentimes, a pain management physician may be able to offer an injection to calm the nerve down
if it's short-term. If the compression is so severe that it's causing intractable pain weakness or
numbness, that's when surgery may be indicated. So spine surgery in general should be taken
serious any time a doctor recommends it because of the complexity of the spine and nature of the
surgery itself. There are different types of spine surgery such as cervical spine surgery, scoliosis
surgery, decompression, and even fusions. All of those come with different recovery processes. The
nature of spine surgery, in general, is that it will require several weeks of protected movements and
restrictions to prevent any recurrence and to protect the surgery site itself. If it's just a
laminectomy or decompression procedure, patients can often start to get back to normal activities
around the four to six week mark. If it's a fusion procedure, that may take six to twelve weeks
before they return and are able to do a heavy lifting, repetitive movements, things like that.
As with any surgery, pain is part of the process. We do help guide patients through
the post-op recovery process from a pain perspective. And most patients, generally,
are doing fairly well somewhere between the four and six week mark from that standpoint.
Spine surgery is indicated anytime there's a neurologic deficit such as numbness,
weakness, balance, or coordination problems. This can be due to arthritis or spinal stenosis where
it's encroaching upon the nerves or spinal cord. Other conditions such as degenerative disc disease,
instability in the spine, scoliosis, may cause compression of the nerves or persistent back
pain that doesn't respond to conservative management and can be an indication as well.
Over the last 20 years, we've seen huge advancements
in the technology that we use in order to approach and stabilize the spine.
We have improved fixation techniques to stabilize the vertebrae and help them fuse.
We have tubular retractors that allow us to get down to the spine through a more minimally
invasive approach and prevent larger soft tissue dissections that cause more pain to the
patient.