Ezriel (Ed) Kornel, MD, FACS
Q. If I have severe back pain, will I need surgery?
A. Not necessarily: There are plenty of effective non-surgical solutions for back pain, and over 80 percent of people with back pain respond to non-invasive treatment. When you first see a medical provider—whether it’s your primary care provider, a chiropractor, a physiatrist, a neurosurgeon, or an orthopedist—you’ll undergo a thorough examination. For most patients, a care provider will recommend over-the-counter anti-inflammatory medicines (naproxen, ibuprofen), a program of stretching and exercise, and perhaps modalities such as heat massage, muscle stimulation, and physical therapy.
Q. What if my back still feels lousy after a week or two?
A. For the one in five patients who don’t respond to non-invasive treatments, a medical care provider may recommend an MRI or a CAT scan to determine whether a disc—the rubbery cushioning between the vertebral bones of the spine—is pressing on a nerve in the spine, or if arthritic changes are causing the problem. If the imaging doesn’t reveal any problems, you may get a prescription for stronger anti-inflammatory drugs or painkillers. For some patients, an epidural injection of steroids (an injection directly into the spine) may help calm inflammation that’s triggering pain even if it is from a herniated disc or arthritic spurs.
Q. What if I have disc problems and my pain won’t go away?
A. When there is a lot of arthritis in the spine, a patient’s mobility may already be limited and fusing the vertebrae is sometimes the best choice. However, if the spine is relatively healthy, an artificial disc will help preserve natural motion and reduce the chance of deterioration of adjacent discs, compared to fusion surgery. The artificial disc is made of a soft plastic center placed between metal alloy plates. This is commonly performed in the neck (cervical spine) and less commonly in the low back (lumbar spine). Minimally invasive spine surgery is now available. These new techniques limit damage to surrounding muscles and nerves, and as a result, patients may recover much faster and may have less residual pain. The surgery can be done on an outpatient basis, and the risks are low. This is most frequently performed in the lumbar spine for the removal of herniated discs that are compressing nerves and for the removal of herniated discs in the neck as well. After a week or two of soreness, patients begin physical therapy and most are back to normal activities in less than six weeks. I recall one of my first artificial cervical disc replacement patients who came in for her follow up 10 days after surgery. Her arm pain was completely gone with very little residual neck pain and she had already stopped taking pain medications. Every patient is different, of course, but the vast majority of patients experience significant improvements post-surgery.
Learn More About Dr. Kornel
Director, Orthopedic and Spine Institute
Northern Westchester Hospital
Read Past Topics from Dr. Kornel:
Whiplash and Traumatic Brain Injury
Expert Solutions For Back Pain
â€‹Northern Westchester Hospital is a proud member of Northwell Health (formerly North Shore-LIJ Health System).