Scott Webb (Host): Back pain can keep you from doing everyday activities and the things you love. At Trinity Health of New England Spine Institute of Connecticut, our Board Certified Fellowship Trained Orthopedic and Neurosurgical Spine Specialists offer a range of options to relieve back and neck pain. We're experts at diagnosing and treating the conditions that cause pain and offer a state of the art facility with private rooms following surgical procedures, where you'll be cared for by a staff dedicated to specialized spine care.

And joining me today to tell us more is Dr. David Kruger. He's an Orthopedic Spine Surgeon at Advanced Orthopedics New England and Attending Physician at St. Francis Hospital.

 This is Transforming Your Health, the podcast from Trinity Health of New England. I'm Scott Webb.

Doctor, it's so nice to have you here today. Uh, back pain is common as we've established. You and I have been speaking here off the air a little bit, and the chances are very likely that listeners have experienced back pain or neck pain at some point in their life. I'm experiencing it right now as we're speaking. So tell us what you hear from patients the most that come into the office.

David Kruger, MD: Well, I've had back pain too. Over 80 percent of the population will experience back pain severe enough to lose work sometime during their career. So, it's not at all uncommon. And the vast overwhelming majority of back pain is benign, like a common cold, and it goes away. Generally, quite quickly, up to 50 percent or more are improved in a week.

Host: Yeah, I'm wondering if there's different types of back pain, right? I was mentioning to you that I'm pretty sure the root cause of my back pain is probably osteoarthritis, which it may be for many folks, but is there different types of back pain, depending on maybe a person's age or occupation?

David Kruger, MD: Yeah, there are different kinds of back pain, but I don't actually think about it that way. Because for the most part, overwhelmingly, these are all what we call mechanical back pain, because identifying the exact cause of the back pain is a bit of a fool's errand, to be honest with you. There are certain people that come in that you have to be very thoughtful about.

For instance, an older person, particularly an older woman, may have broken her back from osteoporosis. Osteoporosis is a lack of bone mineral, and it's particularly common after menopause. If you've fallen from a height or had a trauma, motor vehicle accident, you could have broken your back with a traumatic fracture.

And of course, anyone with a history of cancer would be worrisome that they could have a problem with that. Someone who's been sick, they could have infections, but generally speaking, back pains, whether they're from your SI joint or your facet joint or degenerative disc disease, frankly, it doesn't matter.

And identifying the exact cause is not going to get you any further down the road. The treatment is going to be the same, which is time and a good attitude and fitness.

Host: Yeah, I'm glad you mentioned fitness because again, as you and I were speaking, you were saying that essentially with back pain is really about sort of managing it and exercise. So I want to give you a chance here, give listeners and myself, of course, tell us, you know, what do we do about it? How do we help ourselves? And when does it maybe mean surgery?

David Kruger, MD: Sure. Well, it's kind of funny. Actually, I don't even consider myself the back pain doctor, although I see tons of back pain. Back pain, again, it is rarely, rarely treated with surgery. Usually, people can go see a physical therapist or even a chiropractor and exercise and wait for it to get better.

Some people have chronic back pain. And they're ultimately going to learn to live with it. That can be augmented with things like Motrin or Tylenol. We want to avoid things like narcotics, alcohol. And as an aside, marijuana has shown to be particularly helpful for back pain. Um, it is helpful to have you fall asleep and gain weight.

But for patients with back pain, particularly with chronic back pain, is learning to understand that it is not the end of the world, trying to think of what activities can make it problematic. For instance, I can't twist. If I work on my core strength and I twist, I know I'm going to backache. And I don't bend. If you bend and you're older, I'm 65, you're likely to get a back pain. Now, some people, for instance, playing golf, an enjoyable sport, I always tell people, I'm going to guess that your swing is not as good as Tiger Wood and he has back pain. So if you want to look through your life and find the noxious things that can stimulate back pain, then you'd be well served to do that.

Some of them you may choose to give up and some of them you may not choose to give up. If you really love to golf, then you're going to golf, but you're going to have more back pain. If your spouse makes you golf, and you don't really like golfing. You think it's a big waste of time; then I'm happy to give you an excuse and tell you never go golfing again. But this is pretty much a matter of how you want to live your life.

Host: Right.

David Kruger, MD: Interestingly enough, um, there's also a correlation with obesity and the heavier people have more back pain. But what's sort of counterintuitive is exercise as a dosing agent works much better for people that are overweight.

Host: Yeah. It does seem for me, and I'm sure for many, it's this sort of risk reward, as you're saying, right? So it's like, if you love to golf, I enjoy golfing, but I know if I golf 18 holes, it's going to take me about three days really to fully recover. Right. And is it worth it? Right. Is that, one round of golf worth the three days of misery?

And I'm sure a lot of folks go through that all the time. They're always weighing it in their minds, like, is this worth it? Right?

David Kruger, MD: Right. That's why seriously, if there are things that you don't like to do. That's a good reason not to do it, but you should try and be active. And it doesn't have to be anything specific. It doesn't have to be running. It doesn't have to be pushups. It's just using and moving your body. I know two physicians actually who have just their x rays are horrific, horrific, and the only thing that keeps them comfortable is running. And I would say almost everyone with a backache hates running. So it's very individual.

Host: Yeah, and you mentioned there that surgery maybe is a last resort for many and, not, you know, really the, gold standard terms of providing relief, but let's talk about some of the surgical options. I know lumbar fusion is one of the most common types and guess I'm wondering, I don't know a lot about the fusions. Are there different types?

David Kruger, MD: Yes, and I hesitate to discuss fusions and back pain in the same sentence because it's a rare patient that I fuse for back pain. The typical indications for fusion are deformity. So if you have scoliosis, which is if you're looking at someone head on, they're crooked in that plane.

And there's a very, very common condition called spondylolisthesis, which is when your spine actually slips off. So it's not like a slipped disc, it's actually a slipped spine. And that's very common, particularly in middle aged women. And we frequently fuse their back for that. The main reason I operate on people is because their nerves are pinched.

And sometimes when their nerves are pinched, if they have a deformity such as a spondylolisthesis or a scoliosis, they'll get an associated fusion. Sometimes people who have had multiple operations like discectomies will get a fusion. The problem with fusing for back pain is it can be quite unpredictable, and it should be left as an unusual indication for fusion.

Host: It sounds to me like that you get a good patient history, right? So you get patients in the office, you really listen to them, find out, you know, obviously, as you say, if you fall off the ladder, then we know the cause of your back pain. If it's more of a chronic thing, whatever it is, you're listening to patients, getting that patient history, trying to figure out, you know, how best to help them. What are some of the factors then that you consider, whether it's surgical, non surgical when speaking with patients?

David Kruger, MD: Well, actually the history is far and away the most important thing. I frequently ask patients, what's the most important thing? I'll give a multiple choice test for instance, the history, the physical examination, the x-ray, or the MRI, and everybody says the MRI, and actually the most important thing is the history.

So if I can talk to you for five minutes, I pretty much know where that story is gonna go. If you're a normal healthy guy, you've never had a problem, you don't have any history of cancer and you bent down to pick up a bowling ball and you have sudden onset of back pain, boom, that's the story. I mean, generally speaking, that's going to go away days to weeks.

If you have a history of lung cancer and you bent down to pick up that bowling ball, there's a good chance something bad happened. The patients we like to see, as surgeons, are people with extremity pain, because that's what we're best at getting rid of. If you have a pinched nerve, basically my job is to un pinch nerves, and then there can be associated fusions with the un pinching.

So if you have horrible leg pain going down your leg, or if you have, when you walk your legs get tired and heavy, so called claudication, then we can do things about that very successfully surgically. And that is the mainstay of surgical intervention.

Host: Yeah, when we think about the types of interventions that you do, the surgeries you do, be they, you know, a surgical spine procedure or spinal fusion, whatever it might be, the most common, you know, the greatest hits, if you will, what's recovery like for patients?

David Kruger, MD: Sure, that totally depends on what operation they're getting. For instance, the quickest recovery is if you have an osteoporotic compression fracture. That is typically an older woman who has bad bones, she's postmenopausal, and breaks her back. We can do an operation called kyphoplasty, which they're actually better in the recovery room, they're essentially no recovery.

A typical recovery, like a lumbar discectomy, that's a herniated disc, with a pinched nerve; that recovery, again, depending on what you want to recover to, is days to week. So, if you just ask me, Doctor, how long is it going to take to recover from a lumbar discectomy? The answer is six weeks, but that's not really the answer.

If you have a white collar job where you're free to sit and stand and don't have to drive, you could be working in a few days. If you have to go to the office, you drive there and the boss yells at you if you're not working hard, that's six weeks. But if you're, you know, laying cement or tar or a roofer and you're going to do six weeks plus physical therapy, and it's going to be closer to 12.

Recovery from fusion is a similar thing. It depends what you want to get back to. So if you have a cervical fusion, which is a very common operation, most people, white collar workers, particularly if they can work from home; they'll be back to work in a few weeks. The average Joe, I say three months, but it's usually less than that.

And again, if you're a heavy duty worker, it's going to be longer. The things that really take a long time, for instance, if you have scoliosis, which I think a lot of people know what that is, you're crooked. If you look at someone, you're crooked in that plane. That's six months to a year. I mean, that's a commitment.

Host: You know, Doctor, many of the health related topics we talk about here on Transforming Your Health, the bottom line is it's always best to speak with your own doctor, your own provider, right?

And find out what's the best treatment plan for you, whether it's to then move on to speak with Dr. Kruger or someone else. Just final thoughts, takeaways, , for listeners who may be suffering from back, neck pain, all the above.

David Kruger, MD: Sure, don't panic. It'll probably go away. If you have a significant medical history, you should see someone promptly. Avoid narcotics. Controlled activity. Take some Motrin, take some Tylenol, get up and move around. And then if it doesn't go away in a few days, you should probably contact your primary care physician. Or if you have a relationship with an orthopedic surgeon or a physiatrist, that can be helpful.

Host: Perfect. Well, Doctor, thanks so much for your time today. Preface this before we got rolling that, some topics are closer to my heart and in this case, my spine than others. So for me, always great to learn from experts, find out what options I have. Thank you so much.

David Kruger, MD: You bet!

Host: That's Dr. David Kruger, and for more information, go to TrinityHealthofNE.org/back. I'm Scott Webb, and if you found this information helpful, please share it with others, especially on your social media. Thanks for listening to the Transforming Your Health podcast from Trinity Health of New England.