Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Today, I'm sitting down with Dr. Michaux Kilpatrick, and we're going to be talking about back pain. And is there ever a time when you're too old for spine surgery? So before we get started, I would love to know how spine surgery became a passion of yours, Dr. Kilpatrick, and what made you want to become a Neurosurgeon?

Dr. Michaux Kilpatrick: Well, it started early in my college years. I was really interested in neuroscience and psychology, the neurochemicals that cause different behaviors, and that prompted me to pursue a PhD in Neurobiology. while I was going to medical school. And so it was that love of neuroscience that ultimately transitioned into a practice of Neurosurgery.

Host: So why in particular did you decide to go into Neurosurgery? Because surely there have to be easier pathways to become a doctor.

Dr. Michaux Kilpatrick: I think it was a combination of the love of neuroscience and the joy of being in the operating room. I really enjoyed the culture and being in the OR. Being able to help patients directly with surgical techniques, and seeing people wake up from surgery almost sometimes with the immediate improvement, that's very rewarding.

Host: Wow, I bet that would be amazing. A lot of people experience back pain, as we know. Is surgery the best option? Should patients see a pain specialist to start off with?

Dr. Michaux Kilpatrick: Surgery is one of the options. I always say pain in general is a symptom, a symptom of something else going on. And so the first thing you should do when you're experiencing back pain is have either a consultation or visit with your primary care provider or someone who can help discern what that pain is coming from.

The majority of back pain tends to be musculoskeletal from the spine, but there can be other non spine conditions that lead to back pain. So, first and foremost, if you're experiencing back pain that's not going away, within a couple of days or so, you should seek help from either your primary care provider or urgent care to help discover where that pain is coming from. And then once it's determined that it's coming from your spine, surgery is not usually the first step.

Host: So a lot of people believe they're just too old for a spine surgery and they just have to live with the pain. Is that true?

Dr. Michaux Kilpatrick: No, I would hope that no one would decide that they would have to live with pain no matter what age, gender, pain can be debilitating. And if you're suffering from debilitating pain, there is help out there.

Host: Dr. Kilpatrick, if not age, like we said, what determinants are you looking for to see if a patient is a good candidate for spine surgery?

Dr. Michaux Kilpatrick: It's really like almost putting a puzzle together. You're trying to make sure that their pain is coming from something that's surgically treatable. And if you've discovered that there's something causing pain that can be treated with surgery, and other non surgical options, more conservative options, aren't beneficial, then surgery is a good next step.

Host: And what's the most common question or misconception you receive from patients?

Dr. Michaux Kilpatrick: Most people wonder whether or not they're going to be better after surgery. There is this misconception that a significant amount of people can be worse after surgery. I don't find that to be true. I find that the majority of patients who undergo spine surgery, are better after spine surgery. And I've had some patients even go as far as to say they wish that they had not delayed it as long as they did.

Host: So let's be honest, there are a lot of spine surgery horror stories out there, usually passed down from a father or grandfather or an uncle, somebody. Can you explain how spine surgery has evolved over the years, how it's better today than even say 20 years ago?

Dr. Michaux Kilpatrick: Right. Well, technology has helped us. There's advances in spine surgery, in our imaging techniques that'll allow us to see things better. There's intraoperative technology that allows us to do things less invasively through smaller incisions with less tissue destruction. And again, when I talked earlier about putting those puzzle pieces together, you know, as a result of advanced technology, we're able to determine who's a better surgical candidate.

Host: And how long is the recovery process? Do you recommend prehab or rehab?

Dr. Michaux Kilpatrick: It depends. Definitely if you are significantly deconditioned before surgery. Surgery does take stamina, and so prehab could be beneficial. Most people, too, even after surgery, if you haven't gone through prehab, I find requires some form of post operative rehabilitation, even if it's something as simple as going on a short walk every day after surgery, making sure you're getting up and moving. I find that early mobility allows patients to recover faster. So the sooner you're able to get up and move about, walk about, the faster your recovery can be.

Maggie McKay (Host): Is that what prehab is? Exercising ahead of time, eating a healthy diet, sleeping?

Dr. Michaux Kilpatrick: Yes, building your muscle strength, building your stamina, and eating a healthy diet is beneficial both before and after surgery. There are certain foods that can increase inflammation. Inflammation can be a source of pain. So making sure that your diet is such that you're decreasing inflammatory triggers can be beneficial.

Host: What else are you doing to ensure a good outcome?

Dr. Michaux Kilpatrick: Well, one of the things we're doing is collaborating with patients' providers. We're making sure their primary care practitioners are involved. That helps us to be certain that someone doesn't have an underlying medical condition that could put them at increased risk in and around surgery. Most patients are being screened by our anesthesia team prior to surgery to make sure, make certain that they're going to be able to tolerate general anesthesia.

And again, it's that collaboration that's grown out over the years that helps to keep our patients safe.

Host: And what's the Spine Navigator Program?

Dr. Michaux Kilpatrick: We do have a Spine Navigator that will call patients ahead of time and walk them through the surgical procedure, walk them through what will happen when they come in for surgery, what happens while they're in the hospital, and what to expect after surgery. I think that's a big concern patients have and can lead to some anxiety, is just not knowing what to expect, not knowing what to anticipate.

Host: Right. That's always the scary part with surgery, right?

Dr. Michaux Kilpatrick: Correct.

Host: Could you share your best advice for patients who are considering spine surgery? What do you tell them?

Dr. Michaux Kilpatrick: Talk to your surgeon. Make sure that your questions are being answered. Make sure that you're comfortable with the procedure. You should know why you're having surgery. Why is surgery being offered and what you can expect as an outcome from surgery.

Host: Is there anything else you'd like to add that maybe we didn't cover in closing?

Dr. Michaux Kilpatrick: One is just not to be afraid to reach out to your health care provider and ask questions. You won't know unless you ask and there are no silly questions. Knowledge is power and the more you know, the more you can advocate for yourself.

Host: So true. Thank you so much for sharing this invaluable information. We appreciate it.

Dr. Michaux Kilpatrick: You're welcome. Thank you.

Host: Again, that's Dr. Michaux Kilpatrick. And if you'd like to find a physician, you can visit NovantHealth.org. And for more health and wellness information from our experts, visit HealthyHeadlines.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Meaningful Medicine from Novant Health.