Dr. Miller: Is it time to see a spine surgeon for your back and neck pain? We're going to talk about that next on Scope Radio.
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Dr. Miller: Hi, I'm Dr. Tom Miller and I am here with Dr. Erica Bisson and she is a neurosurgeon in the neurosurgery department here at the University of Utah. Erica, tell me a little bit about when it might be the right time for a person with neck or back pain to see a spine surgeon?
First Steps: Treating Neck and Back Pain at Home
Dr. Bisson: What I tell most of my patients is that getting neck or back pain is a very common entity. A lot of people go out and do a lot of yard work or do excessive sporting activities wake up the next morning and feel like they have, what's considered a 'crick in the neck' or have a low backache.
Again, most of that is muscular in nature. It can be muscle spasm or some inflammation. Most of that is treated with what we consider conservative measures. This means things like anti-inflammatory, some Motrin, some Aleve, exercise or rest. Everybody is a little bit different which is better. We tend to tell people not to do strict bed rest because that's counterproductive in getting the muscles to move. Then also you can do things like heat and ice, which also help.
Relieving Pain Without Surgery
Dr. Miller: Now, what percent of patients actually get better with those conservative treatments?
Dr. Bisson: I would tell you about 90-plus percent patients get better with just those things alone.
Dr. Miller: In a week? Two weeks? A month?
Dr. Bisson: Most patients get better within a few days, but it's not unreasonable to think that it may take up to two to four weeks to see improvement with those conservative things.
Dr. Miller: So I would think that many of these patients would be best served by seeing their primary care physician or someone like a physical therapist who could help them work through some of the pain issues.
When to See a Doctor for Back and Neck Pain
Dr. Bisson: Absolutely. In fact, that's what we would recommend is first maybe try some of these things at home on your own and then if it's not getting better go see your primary care because they can often help with some of the advanced treatments, again, not surgical, like physical therapy.
Dr. Miller: So for our listeners, should they also have the time they present with their neck or back pain, a study like an MRI that actually looks at their neck? Or a CT scan? What's your thought on that?
Dr. Bisson: Actually, an MRI, a CT scan and even simple X-rays are not indicated in somebody who simply has neck or back pain that we think is muscular in nature. Now, it's very important that when somebody sees their primary care and talks about these issues, that they be asked questions about any neurologic dysfunction, which we think of as maybe some numbness and tingling in the arms or legs or pain going down the arms and legs, bowel and bladder dysfunction. These are things that we consider red or yellow flags, or reasons that we would want to get imaging studies.
Dr. Miller: So bladder dysfunction would be the inability to urinate, I'm assuming. Is that what you mean?
Dr. Bisson: It is what I mean. We can have also urinary retention, which means you can't empty your bladder properly.
Dr. Miller: That would indicate a fairly serious back problem.
Dr. Bisson: Yes, it would.
Neck and Back Surgery: A Last Resort Treatment
Dr. Miller: Of the patients that end up seeing you, what percentage of those patients actually has surgery?
Dr. Bisson: Believe it or not, even as a surgeon, only about 10-15% of the patients that I see in my office go and end up having surgery.
Dr. Miller: So a great take-home message is that much of back pain, neck pain, can be cured with conservative measures. That's what we should focus on.
Dr. Bisson: Absolutely. In fact, I tell my patients even if they come to me with a problem that can be fixed with surgery, I still always try the maximum medical management. Meaning, all of the things I talked about, anti-inflammatories, physical therapy, maybe even some injections because I know that a good deal of those will get better without surgery. Even if I could do surgery, I tell my patients, "I'd rather you take credit for it than me take credit for it."
Dr. Miller: That's perfect. So basically, the majority of people with back and neck pain will get better in time. There are some worrisome signs and symptoms that relate to muscle weakness or numbness. Those folks should be seen rather urgently and imaging is unnecessary unless you have some of those very specific findings.
Dr. Bisson: Absolutely.
Dr. Miller: Thanks very much, Erica.
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