Scott Webb (Host): If you're like me, your back hurts and you aren't sure if surgery is the answer or if there are some conservative treatment options, you should try first. My guest today is here to explain the benefits of conservative options, when surgery is typically indicated and how he can help patients. I'm joined today by Dr. Bryan Schatmeyer. He's a Neurosurgeon, practicing at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's great to have you here today. I'm 57 and my back hurts, and so I, I want to know like, when do I need surgery for my spine? And I know a lot of folks are thinking, yes, that's the same question we have. So what are the most common spinal conditions people experience, and how do surgeons determine whether they're surgical or non-surgical?

Bryan Schatmeyer, MD: I think that's a great place to start the podcast. And you know, what I would tell you is that, the most common problems in the spine we actually see are degenerative conditions, you know, things like your disc herniations, what we call spinal stenosis, which is where there's tightness around the nerves, or the spinal cord itself.

It's generally just those more arthritic changes or that what, what I would call more of a general wear and tear of the spine itself. Almost everyone will have back or neck pain at some point in their life, really.

But the most important thing to know is that, you know, most of these cases do not require surgery themselves.

Host: Yeah, that's good to hear. And I do think that me and probably a lot of other folks, it's just a lot of that wear and tear like you're talking about. But let's, let's talk through that, I guess the differences between structural problems that might require surgery and maybe the pain that may come from just soft tissue or lifestyle factors. Like for me, just cutting the grass or shoveling snow, you know, that kind of thing.

Bryan Schatmeyer, MD: Sure. I'd like to start by saying too, that, you know, as surgeons, we don't really make decisions based on imaging alone though. A lot of people have, you know, abnormal MRIs, but they feel perfectly fine and that's where, and we don't see them, but surgery's really only considered when there's actually a clear structural problem and it's matching the patient's symptoms and that haven't already improved with appropriate conservative or non-surgical care.

This is like I was alluding to any kind of nerve compression or instability of the spine. When you get to your question about, you know, what kind of structural spine problems there are that involves, you know, the physiologic, compression of the nerves or the stability of the spine.

For example, you might've heard of a disc herniation. The discs, cartilaginous discs that we have are very closely associated with the nerves, and anytime there is a herniation of that disc, it could either push on a nerve or it could narrow the spinal canal.

That could cause the patient to have symptoms, that overall, you know, may or may not need surgery.

Host: Right.

Bryan Schatmeyer, MD: There are other conditions we treat such as fractures, that could cause instability of the spine. But really, most of these problems I would say can contribute to arm or leg pain. There can be numbness, tingling, weakness, or even difficulties with walking. And so I'd say that, you know, in contrast to structural problems in the spine, many people have pain that comes from other things such as, the muscles, ligaments, your joints, or even, general deconditioning, that can cause very real pain and be very limiting, but it doesn't have always a clear surgical solution.

And so these kind of cases are usually better treated with certain things such as physical therapy, activity modification, and overall, just having time allow the body to heal itself rather than undergo, any kind of specific operation on your spine.

Scott Webb: Right. Yeah, of course. Uh, time can be the great healer. Provided we have that time, of course. Just want, I just want to hear from you, get a sense from you, like what, are there some clear red flags that would suggest that someone really needs spine surgery?

Bryan Schatmeyer, MD: There are. There are a few situations where surgery becomes much more urgent. I would say definitely progressive weakness in any extremity such as your arm or leg is definitely one urgent indication for surgery. The nerves, you know, they not only innervate our arms and our legs, but they innervate our bladder as well as our bowels.

And so, certain times there can be a medical condition that's an emergency where we have incontinence. And that would always be something that if a patient knew they had these concerns for spinal stenosis, or they had acute onset or, you know, sudden, lower back pain or pain and it's shooting in their legs, that was associated with weakness or those changes in your bowel or bladder function, then that overall could be a clear, very clear or urgent in indication to do surgery. I'd say other things, that are red flags, you know, things that we treat are not common, but where there's severe instability of the spine, as I alluded to from any fractures, infection can spread to the spine, or, in certain rare instances, we can also see tumors of the spine that do need surgery. Outside of emergencies, I'd say surgery is most commonly considered when someone has persistent nerve related problems. Like I said, that radiating arm or leg pain that hasn't improved after a reasonable trial of conservative treatment and it really still affects their activity or their quality of life, as well as their ability to perform their activities of daily living.

Host: I'm thinking Doctor, about the decision-making process, right? So ultimately it comes down to the patient, maybe their family as well, but what's that process like? The decision-making process when a patient is, you know, borderline, the symptoms are serious, but maybe not quite an emergency. How do you kind of work with patients in, in those instances?

Bryan Schatmeyer, MD: It's a good question. And, you know, this is actually one of the most common scenarios that, that I do see. And, you know, in these cases, surgery is usually more of an elective process, which means that there's time to think through the decision very carefully and think about the risks versus the benefits of the procedure.

We like to look at how long the symptoms have been present as well as, you know, if they're improving or if they're worsening, and how much they once again affect the patient's quality of life and whether the conservative treatments have been tried appropriately. It's very much a shared decision-making process, I would say, and, you know, my role is to make sure that I explain the risks, benefits, and alternatives very clearly to the patient so they can make that informed decision whether surgery aligns with their goals and their expectations.

Host: Yeah, goals and expectations for sure. You had mentioned some of the non-surgical options, physical therapy, injections or whatever it might be. Maybe you can just go through that in a little bit more detail.

Bryan Schatmeyer, MD: The first one, like you mentioned is physical therapy. It is one of the most effective treatments that we do have. How does it do this? Well, it, it helps restore your strength, it helps restore your mobility as well as proper movement patterns. I would say that it's a crucial standard of care to at least have some kind of physical therapy prior to any elective spinal procedure. Other things, you know, that we sometimes knock are, are certain, even over-the-counter medications, like specifically most likely your anti-inflammatories. A lot of inflammation can be a most common pain generator for you know, lower back pain. And so to take certain things like NSAIDs, the ibuprofen or Aleve, any type of medications like that can definitely help to control symptoms that I think a lot of patients, you know, surprisingly don't even try by the time I've seen them to evaluate them for surgery.

In certain cases though, I would say that targeted injections can reduce that inflammation as well around those irritated nerves, and allow the patients to even progress with physical therapy. Lifestyle factors also do matter. I think that, you know, certain things like maintaining a healthy weight, staying active, and most important of all, avoiding smoking, plays a very major role in your overall spine health and your recovery of your pain.

Host: Yeah. Just wondering then like how long should we give? What should be our expectations maybe when it comes to physical therapy, injections, the non-surgical options, how long should we do these things, try these things before we start talking surgery?

Bryan Schatmeyer, MD: You know, for most non-emergent spinal conditions, typically I would say we recommend about six to 12 weeks of that very structured conservative treatment. Many conditions do improve with, you know, time, like I mentioned before. If we have something like a disc herniation, that's still causing, severe pain, the body very well can take care of itself and resolve it over that course of time.

That said, it's, it's not a strict rule, though. If someone's getting worse, they develop any kind of weakness, they're unable to function despite these conservative treatments; that's when I would consider surgery sooner than later. On the other hand, if their symptoms start to gradually improve, even if it's slow, slow improvement, then I would still consider non-surgical care the right choice for the patient.

Host: Okay. Yeah. And again, it's a case by case basis. It's about the patient and as you said, goals, expectations, all of that. So there's a lot to consider, and maybe more than we can consider here in a short audio podcast, but doing our best. If you could give Doctor, listeners one piece of advice about protecting their spine, avoiding unnecessary surgery. I know you mentioned smoking there, but what would it be?

Bryan Schatmeyer, MD: Mm-hmm. What I would tell the listeners is, I would say stay active and keep your spine strong. You know, movement is one of the best medicines for spine health. Prolonged inactivity, fear of movement often makes your pain worse over time than helps it.

Which is something I, I see quite frequently. The patients that are nervous they're going to make things worse. I'd say it's also important to understand that pain doesn't always mean damage. Many spine changes seen on imaging are a normal part of your just aging process. Getting good guidance early, can definitely help patient's avoid unnecessary procedures and really focus on treatments that actually may help them.

Host: Yeah. I guess maybe obvious way to finish up here today, Doctor, is just, you know, if somebody, if they're struggling right, they're struggling with back pain and they're not sure what to do, they're not sure what to do next, what would be your recommendations?

Bryan Schatmeyer, MD: First I would just recommend them to not panic overall. You know, once again, most back pain improves with time and the appropriate care. So trying to stay active within reason, avoiding prolonged bedrest. And using just basic measures like heat, stretching over-the-counter medications if appropriate.

But you know, if your pain does persist, it worsens or develops those concerning symptoms like we talked about, like numbness, weakness, I would recommend seeking evaluation from a qualified provider who looks at the picture as a whole, not just the MRI findings or the imaging findings that you may be worked up for.

The goal is not to rush into surgery, but it's to find the right treatment for the right problem.

Host: Right, exactly. Yeah. So some people it may be non-surgical. Some people it might be surgery, sometimes it might be surgery sooner than later or later than sooner. And you know, my head's spinning a little bit, but I, I think I get the point. I'm sure listeners do too. So I just appreciate your time and your expertise today.

Thanks so much.

Bryan Schatmeyer, MD: Absolutely. Yeah. No, I appreciate your time again, and I, I would just like to say like, you know, surgery itself can be life-changing, but it's only when truly needed. I'd say the best outcomes happen when it's used thoughtfully at the right time and for the right reasons.

Host: That's perfect. Thanks again.

Bryan Schatmeyer, MD: Thank you very much. Appreciate your time.

Host: And for more information, visit franciscanhealth.org and search spine care. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.