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Your Aching Back – What Could Be Causing Your Back Pain and When is Surgery Really the Answer
Back pain is a significant source of frustration for many people. It’s a leading cause of disability and is one of the most common medical problems, affecting millions of Americans. What causes back pain and what are some of the most common sources of spine problems? Is it time for surgery, and if so what can I expect?
Featured Speaker:
Learn more about Lee Buono, MD, FACS
Lee Buono, MD, FACS
A board certified neurosurgeon specializing in minimally invasive spine surgery, Dr. Buono treats patients dealing with the full spectrum of spine conditions including degenerative diseases, vascular disorders, spinal injury, spinal tumors, and infections of the spine.Learn more about Lee Buono, MD, FACS
Transcription:
Your Aching Back – What Could Be Causing Your Back Pain and When is Surgery Really the Answer
Alyne Ellis: When something is wrong with your back, sometimes it’s a procedure called minimally invasive spine surgery is an option here to tell us more about when this procedure is the right one and talk about its advantages is Dr. Lee Buono, the Director of the Center for Spinal Disorders and Spinal Oncology at Capital Health. This is Capital Health Headlines, a podcast from Capital Health. I'm Alyne Ellis. Dr. Buono, it's great to have you here today. So let's begin with what is minimally invasive spine surgery?
Dr. Buono: In the olden days, spine surgery was a big deal. It required a pretty large incision and the surgery times were hours and hours and hours and hours. So through the years with our technology and techniques, we've come up with minimally invasive surgery. And it certainly, it doesn't mean it's not invasive, minimally invasive surgery just means you're making a smaller incision and the surgery is much faster with lower risk. So it mitigates with a larger incision, the risks of surgery are basically the time, what we call time on target. The longer you're under anesthesia with a big open wound and the bigger the surgery, the higher the risk of infection and complication. So with minimally invasive surgery, we can do it much faster with lower risk and quicker outcomes. So the patients who are usually having these surgeries nowadays as an outpatient.
Host: Wow. So what kinds of things can be addressed with this procedure? What kind of spinal issues?
Dr. Buono: The folks out there need to realize that most patients with spine problems or back pain for just in general, don't need surgery. In fact, the numbers are 78% of surgeries and treatments are actually aren't even needed. 86% of spine problems will resolve on their own. So nowadays, if you have a diagnosis of a spinal problem, a lot of patients will come to my office and be seen by myself. And they shortly realize you don't even need surgery, or you've never even had a diagnosis. So it's important for your listeners to realize that when you have a back problem, your doctor should be able to come up with a diagnosis and explain to you why you have the problem so that you understand it. And then once you have that diagnosis, you can move forward with treatment and the treatments nowadays with minimally invasive surgery, we can treat things like spinal fractures, which are actually, a lot of patients are born with spinal fractures, disc herniation’s tumors and the like, but there's a myriad of conditions we can treat with minimally invasive surgery. It's just important for the patient to realize that, get a second opinion if you're not confident with the physician or the diagnosis, or certainly if you don't understand the problem, then your physician has failed you and you need to get a second opinion.
Host: And in order to diagnose that problem, what tests would normally be done?
Dr. Buono: Well, it depends on the problem itself. I'll have patients come to my office with generalized back pain and stiffness in the morning and they have no imaging studies. And I'll say, you have arthritis. You don't need surgery. You don't need a neurosurgeon. You just need some arthritis medication. And they're very happy with that. And a lot of patients are sent to me as second opinions and their previous physician says that they need some big, huge spinal fusion. And I tell them, actually, you don't, you just need a little MRI and we'll do a little foraminotomy minimally invasive surgery, which takes about 15 to 20 minutes and you'll go home the same day. So the idea has changed over the years of doing these big surgeries and the patient needs to focus on. There's got to be a better way. You can do this quicker, smaller surgeries, the goal, and the ultimate goal. If I can cure a patient without doing any surgery at all, is the ultimate end result.
Host: Well, looking this up, for example, when I was trying to educate myself a little on it, one of the things that I saw that this might take care of as spinal infections and spinal instability, is that correct?
Dr. Buono: There's a bunch of trick terms that we docs use, big words I say to the patients. So there's a different type of problem. If you have spondylosis, that just means bone spur. That's our fancy word for bone spur. And that just means you have arthritis. Spondylosis usually doesn't need to be treated with surgery. Spondylolisthesis means that your bones have slipped and they're unstable or moving around. And sometimes that does require surgery or stabilization. Spinal infections usually can just treat without surgery, just some antibiotics through either an IV or some pills, but the deformity surgeries where people have either a crooked spine or an unstable spine or spine where the bones move around too much. It's usually treated with surgery. And a lot of instances when the patient is older, say above the age of 50, and they have a, what's called a spondylolisthesis where the bones are slipped and they have narrowing of the spine, what we call stenosis. So again, all these big fancy words, if you put a patient like that, just through physical therapy, more often than not, they'll feel better, especially nowadays with COVID lying around the house and your back is starting to hurt a lot more it's cause you're not active. So get up and move around. You'll feel better.
Host: Now is this particular surgery then usually done on people who are younger as opposed to older?
Dr. Buono: No, we treat any age from 16 to 90, for an example, most patients who have undergo a spinal fusion, if you're unstable, that surgery is between six and 12 hours, depending on who does it. If we do a minimally invasive what's called an X lift or a D lift surgery, that same surgery can be total time, 30 minutes and be done as an outpatient.
Host: So, I think the good news that you're telling us besides how this procedure works is that there are things you can do to keep your back from hurting, or if it is hurting things you can do, and maybe it could run over what those things might be briefly in terms of exercise or heat, or what would you suggest in most cases?
Dr. Buono: Yes. That's the biggest problem. I think in medicine today, if someone's referring a patient to a spine surgeon, whether that's or neurosurgery, but that's the old saying when all you have is a hammer, everything looks like a nail. When you're a surgeon, you're looking for surgical cures, but the patients need to understand that the vast majority of spine problems do not need surgery. If you have arthritis, get some physical therapy, work on your range of motion and your flexibility and get out there and do a little bit of exercise. Take some arthritis medicine. There is no cure for a simple disc herniation. The cure for that is either time because most of those disc herniations will go away on their own 86%. And if it's not fixed at time, then you can have a little surgery, but things to keep your back healthy are obviously you don't want to gain a lot of weight. Some people can't avoid that just due to genetics itself. So losing weight a little bit exercise and stretching with a couple of Advil in between is a really good thing.
Host: Well, this is really good news. Would you like to add anything else?
Dr. Buono: Mostly the point that I tell all of my patients, when they come to see me, is that your doctor, if you're seeing a spine doctor, I take a great deal of time. Teaching the patient had to read their own MRI or their own x-ray or their own bone scan, because it's not hard to read these films. And once they read them, it sounds a lot different than the report, because they're told that they have multiple disc herniations or compression or this or that. And once they learn how to read their own film, they realize that's not true. Or if they do have a problem, they'll understand the pathophysiology that look, there's the disc right there. It's pushing on the nerve and that's what needs to be fixed. So my advice is if you're not getting good advice or sound advice from your doctor, from your spine surgeon, if you don't understand the problem when you leave that office, then you need to get a second opinion.
Host: Thanks, so much Dr. Buono, this really helpful information today.
Dr. Buono: Thank you so much.
Host: Dr. Lee Buono is the director of the Center for Spinal Disorders and Spinal Oncology at Capital Health. Thanks for checking out this episode of Capital Health Headlines. To make an appointment with Dr. Buono call (609) 537-7300. To learn more about the Capital Institute for Neurosciences, visit Capitalneuro.org.
Your Aching Back – What Could Be Causing Your Back Pain and When is Surgery Really the Answer
Alyne Ellis: When something is wrong with your back, sometimes it’s a procedure called minimally invasive spine surgery is an option here to tell us more about when this procedure is the right one and talk about its advantages is Dr. Lee Buono, the Director of the Center for Spinal Disorders and Spinal Oncology at Capital Health. This is Capital Health Headlines, a podcast from Capital Health. I'm Alyne Ellis. Dr. Buono, it's great to have you here today. So let's begin with what is minimally invasive spine surgery?
Dr. Buono: In the olden days, spine surgery was a big deal. It required a pretty large incision and the surgery times were hours and hours and hours and hours. So through the years with our technology and techniques, we've come up with minimally invasive surgery. And it certainly, it doesn't mean it's not invasive, minimally invasive surgery just means you're making a smaller incision and the surgery is much faster with lower risk. So it mitigates with a larger incision, the risks of surgery are basically the time, what we call time on target. The longer you're under anesthesia with a big open wound and the bigger the surgery, the higher the risk of infection and complication. So with minimally invasive surgery, we can do it much faster with lower risk and quicker outcomes. So the patients who are usually having these surgeries nowadays as an outpatient.
Host: Wow. So what kinds of things can be addressed with this procedure? What kind of spinal issues?
Dr. Buono: The folks out there need to realize that most patients with spine problems or back pain for just in general, don't need surgery. In fact, the numbers are 78% of surgeries and treatments are actually aren't even needed. 86% of spine problems will resolve on their own. So nowadays, if you have a diagnosis of a spinal problem, a lot of patients will come to my office and be seen by myself. And they shortly realize you don't even need surgery, or you've never even had a diagnosis. So it's important for your listeners to realize that when you have a back problem, your doctor should be able to come up with a diagnosis and explain to you why you have the problem so that you understand it. And then once you have that diagnosis, you can move forward with treatment and the treatments nowadays with minimally invasive surgery, we can treat things like spinal fractures, which are actually, a lot of patients are born with spinal fractures, disc herniation’s tumors and the like, but there's a myriad of conditions we can treat with minimally invasive surgery. It's just important for the patient to realize that, get a second opinion if you're not confident with the physician or the diagnosis, or certainly if you don't understand the problem, then your physician has failed you and you need to get a second opinion.
Host: And in order to diagnose that problem, what tests would normally be done?
Dr. Buono: Well, it depends on the problem itself. I'll have patients come to my office with generalized back pain and stiffness in the morning and they have no imaging studies. And I'll say, you have arthritis. You don't need surgery. You don't need a neurosurgeon. You just need some arthritis medication. And they're very happy with that. And a lot of patients are sent to me as second opinions and their previous physician says that they need some big, huge spinal fusion. And I tell them, actually, you don't, you just need a little MRI and we'll do a little foraminotomy minimally invasive surgery, which takes about 15 to 20 minutes and you'll go home the same day. So the idea has changed over the years of doing these big surgeries and the patient needs to focus on. There's got to be a better way. You can do this quicker, smaller surgeries, the goal, and the ultimate goal. If I can cure a patient without doing any surgery at all, is the ultimate end result.
Host: Well, looking this up, for example, when I was trying to educate myself a little on it, one of the things that I saw that this might take care of as spinal infections and spinal instability, is that correct?
Dr. Buono: There's a bunch of trick terms that we docs use, big words I say to the patients. So there's a different type of problem. If you have spondylosis, that just means bone spur. That's our fancy word for bone spur. And that just means you have arthritis. Spondylosis usually doesn't need to be treated with surgery. Spondylolisthesis means that your bones have slipped and they're unstable or moving around. And sometimes that does require surgery or stabilization. Spinal infections usually can just treat without surgery, just some antibiotics through either an IV or some pills, but the deformity surgeries where people have either a crooked spine or an unstable spine or spine where the bones move around too much. It's usually treated with surgery. And a lot of instances when the patient is older, say above the age of 50, and they have a, what's called a spondylolisthesis where the bones are slipped and they have narrowing of the spine, what we call stenosis. So again, all these big fancy words, if you put a patient like that, just through physical therapy, more often than not, they'll feel better, especially nowadays with COVID lying around the house and your back is starting to hurt a lot more it's cause you're not active. So get up and move around. You'll feel better.
Host: Now is this particular surgery then usually done on people who are younger as opposed to older?
Dr. Buono: No, we treat any age from 16 to 90, for an example, most patients who have undergo a spinal fusion, if you're unstable, that surgery is between six and 12 hours, depending on who does it. If we do a minimally invasive what's called an X lift or a D lift surgery, that same surgery can be total time, 30 minutes and be done as an outpatient.
Host: So, I think the good news that you're telling us besides how this procedure works is that there are things you can do to keep your back from hurting, or if it is hurting things you can do, and maybe it could run over what those things might be briefly in terms of exercise or heat, or what would you suggest in most cases?
Dr. Buono: Yes. That's the biggest problem. I think in medicine today, if someone's referring a patient to a spine surgeon, whether that's or neurosurgery, but that's the old saying when all you have is a hammer, everything looks like a nail. When you're a surgeon, you're looking for surgical cures, but the patients need to understand that the vast majority of spine problems do not need surgery. If you have arthritis, get some physical therapy, work on your range of motion and your flexibility and get out there and do a little bit of exercise. Take some arthritis medicine. There is no cure for a simple disc herniation. The cure for that is either time because most of those disc herniations will go away on their own 86%. And if it's not fixed at time, then you can have a little surgery, but things to keep your back healthy are obviously you don't want to gain a lot of weight. Some people can't avoid that just due to genetics itself. So losing weight a little bit exercise and stretching with a couple of Advil in between is a really good thing.
Host: Well, this is really good news. Would you like to add anything else?
Dr. Buono: Mostly the point that I tell all of my patients, when they come to see me, is that your doctor, if you're seeing a spine doctor, I take a great deal of time. Teaching the patient had to read their own MRI or their own x-ray or their own bone scan, because it's not hard to read these films. And once they read them, it sounds a lot different than the report, because they're told that they have multiple disc herniations or compression or this or that. And once they learn how to read their own film, they realize that's not true. Or if they do have a problem, they'll understand the pathophysiology that look, there's the disc right there. It's pushing on the nerve and that's what needs to be fixed. So my advice is if you're not getting good advice or sound advice from your doctor, from your spine surgeon, if you don't understand the problem when you leave that office, then you need to get a second opinion.
Host: Thanks, so much Dr. Buono, this really helpful information today.
Dr. Buono: Thank you so much.
Host: Dr. Lee Buono is the director of the Center for Spinal Disorders and Spinal Oncology at Capital Health. Thanks for checking out this episode of Capital Health Headlines. To make an appointment with Dr. Buono call (609) 537-7300. To learn more about the Capital Institute for Neurosciences, visit Capitalneuro.org.