Scott Webb (Host): Back pain is a common reason why people head to the doctor's office for evaluation. And in many cases, non-surgical related treatment can bring relief. However, the right treatment may depend on the cause of your back pain. And I'm here with Dr. Brian Dial, spine surgeon with EvergreenHealth Spine Back and Neck Care, to discuss spinal conditions that may require surgery, as well as debunk any misconceptions around the procedure.

Hello and welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. Dr. Dial, thanks for joining me.

Dr. Brian Dial: Yeah. Thanks for having me.

Scott Webb: Yeah. Well, it's nice to have you here. As I mentioned before we got rolling, I'm one of those people who suffers from back pain and chooses not to do anything about it, mainly because spine surgery seems so daunting and scary, but that's kind of why you're here. As we said, we're going to kind of debunk some things, some misconceptions. So, I just want to start here, ask you about the symptoms that patients might experience when they're suffering from more than just back pain.

Dr. Brian Dial: Well, you're not alone. So, back pain is incredibly common. Fifty to eighty percent of patients or people will at least see a doctor once in their lifetime for back pain. And it's second only to like the common cold for why people will see a doctor. So, it's very common. And because it's so common, it's kind of important to know what is just, you know, some achiness in my back that's going to get better versus what is something that I should be seen for to your point.

So, we have what we term red flag symptoms within back pain, and these are things that, if you have them, you definitely want to seek out a provider. You know, if you have back pain and that's associated with having a fever, having chills, that's a reason to see a doctor. If you're having a lot of night sweats with back pain, that's a reason to see a doctor. If you have trauma, you know, that's pretty self-explanatory. If you were to fall off a ladder and all of a sudden your back hurt, that's a good reason to go to the emergency room as well. And if these symptoms are ever associated with more than just back pain, so you have back pain and leg weakness or back pain and difficulties urinating or going to the bathroom, those would definitely also be reasons to seek out a physician, whether that's your primary care physician or someone here at EvergreenHealth in the Spine and Neurosciences program.

Host: Sure. Yeah, as you say, if you fall off the ladder, well then, that's obviously the cause of your back pain. But it is, as we were talking about, sort of debunking things, you know. If your back pain is associated with other things, that list you gave us there, then that's probably time to really reach out to a provider, a specialist perhaps. And let's talk about surgical treatment. This is the part that scares me and maybe others the most, but what are some of the spine-related conditions that may require surgical treatment?

Dr. Brian Dial: Sure. Most people coming in with back pain don't require surgery. It's a small percentage of people with back pain that actually benefit from surgery. And it's actually more of those patients that have back pain with really severe leg pain. When someone has severe leg pain with their back pain, it means that one of the nerves in their back is being compressed. Typically, we call that a radiculopathy. And in those settings, patients will respond incredibly well to surgery. The majority of spine surgery is what we call minimally invasive surgery. So, it's outpatient surgery, you come in, it's a general anesthetic. You do go to sleep for surgery, but you go home that same day. And these are surgeries that are done through two-centimeter incisions and tubes. They're tubular dilators and a big microscope. So, we're able to do a lot of work through small incisions with, you know, relatively quick recoveries. By two weeks, you're doing a lot, lot better. And by six weeks, you're back to full activity. So, types of conditions where we commonly utilize these techniques. If you have a disc herniation, we can treat that very effectively, very quickly. And you'll get better just as fast. You know, most patients, if you have a big disc herniation are waking up from surgery and they already feel that improvement and by two or six weeks. They're back to full activities.

Host: Yeah, I love hearing that because I picture like just something really old school, you know, giant scalpel and just, you know, again, debunking my own things in my head and probably debunking a lot of things other people have as well. So yeah, minimally invasive does seem like it's becoming the standard of care, the gold standard, if you will. And I love hearing that. Let's talk about some of those misconceptions. Let's debunk them about back surgery.

Dr. Brian Dial: Every day, I'll talk to patients, and they frequently will bring up they know someone who it didn't go well. And depending on what You're treating, I think the most important thing, and this is my job to do not necessarily the patients, but the most important thing is to do back surgery on people who are going to get better from surgery. I tell people every day not all roads lead to back surgery, right? You can have back pain for lots of different reasons, and some of them are treatable with surgery and some of them aren't. So as long as you're having the diagnosis that's going to respond to surgery, you're going to do quite well. Some of these diagnoses are lumbar stenosis. And what that is, is just compression of the nerves in your low back. If you have a decompression surgery, that's an outpatient MIS surgery for lumbar stenosis, the outcomes are about 88% successful, which is incredibly well for surgery. A lumbar disc herniation, which is a piece of a disc in your low back, dislodges from where it's supposed to be and is pressing against the nerve. Going in and removing that, again, minimally invasive surgery, the outcomes or successful outcomes about 90%. So if you're going in for surgery for one of these diagnoses that responds really well to surgery, you're going to have a good outcome.

Where people start to fall into a little bit of trouble is when they have really severe chronic back pain that hasn't responded to many things. And we're now a little bit outside of the realm of what we typically are treating with surgery. And sometimes it works really, really well and sometimes those patients still have a little bit of pain, but the most important thing is finding the right diagnosis that surgery can treat well.

Host: Yeah. Just want to finish up here. This has been good stuff. I knew it would be. You know, after surgery is determined, let's say is the best treatment option, as you say, it may not be appropriate for everybody or in all cases, but for those cases where it is the best treatment option, what can patients expect from the process? Recovery time, getting back to normal, golfing, pickleball, whatever it might be.

Dr. Brian Dial: Here at EvergreenHealth, I think the process is very smooth and very patient-friendly. So after surgery, there'll be some recovery period. Usually, two weeks if you're having a decompression and no fusion; six weeks if you're having a decompression with fusion, we'll start physical therapies typically around that six-week mark. Start increasing your level of activities at that point. Things like pickleball, running, tennis. We usually reserve to closer to three months for a fusion. If there's no fusion, six weeks again, so you're back to those pretty quick.

And what I'll tell all patients is at the end of the treatment period. So whether that's three months or six months, I always let everyone go back to full activities or whatever those activities are that they want to do. The whole reason for the majority of elective spinal surgery is to improve people's quality of life. And if we're not letting them get back to the things that create their quality of life, then we're not really doing them the service. So, I do let them get back to those things.

Host: That's great. Thank you so much.

Dr. Brian Dial: Thanks for having me. Happy to be here.

Host: The team at EvergreenHealth Spine Back and Neck Care, part of the Eastside Neuroscience Institute, helps improve the quality of life for people living in need of comprehensive spine care and related conditions. To learn more and to make an appointment, visit neuro-spine-ortho.com. I'm Scott Webb. And please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.