Scott Webb: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Spine Network connected by the renowned University of Maryland School of Medicine.

The UM Spine Network is home to the state's leading spine experts. With convenient locations throughout the state, UM Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve.

And I'm joined today by Dr. Khalid Kurtom. He's a neurological surgeon and clinical assistant professor in the Neurology Department at the University of Maryland School of Medicine. So doctor, thanks so much for your time today. We're talking about degenerative spine conditions, which I think I have, so a little free medical advice for the host today, which is great.

Let's start here. What are degenerative spine conditions?

Dr. Khalid Kurtom: So degenerative spine disease is an aging of the spine that occurs in people as they get into their 50s, 60s, 70s and basically the wear and tear of the structures in the spine, whether it's the disks or the joints or the vertebra or the ligament. The bottom line is, as things age, the wear and tear process causes problems for people and that's in general what constitutes degenerative spine disease.

Scott Webb: Yeah. So it does sound like it's just the natural aging process, the wear and tear of living 50, 60, 70 years. So what are the symptoms of degenerative spine conditions?

Dr. Khalid Kurtom: Most people, they start off with back pain, typically aching when sitting and a lot of times with activities and then it progresses to mechanical pain where people have trouble with walking long distances or exercising. And then as they progress further and you get more compression of the nerves and their neural structures, you get symptoms down the legs and arms in terms of weakness, numbness, tingling and, in severe cases, people start having issues with bowel and bladder dysfunction and mobility. A lot of people will start using canes and walkers. In really severe cases, they sometimes are even wheelchair-bound.

Scott Webb: Yeah, it sounds like there's a range of symptoms that we all experience. So I guess I'm wondering, the natural follow-up is how are these degenerative spine conditions treated?

Dr. Khalid Kurtom: They're not acute in nature. What I mean by that, they're not as a result of a sudden onset of trauma and neurological compromise. As such, they develop over a long period of time. So you have time to treat it conservatively and my approach and most of my colleagues usually are extremely conservative when it comes to degenerative spine disease.

There's a variety of methods that you can go through with conservative management and surgery is only reserved as a final resort when all else fails. And people fail all conservative management and are having a significant dysfunction of their daily activities, that's when surgeries are reserved.

Scott Webb: Yeah, I see. These are not necessarily acute conditions, they really are chronic. So that gives you lots of time. So maybe let's just start here then with the non-surgical approaches, what is, as you say, your conservative approach, the non-surgical approaches, what are they?

Dr. Khalid Kurtom: A lot of people first start with physical therapy. They go to physical therapy as a structured way to start exercising and that helps them with their mobility and their core strengthening. And they supplement that with their own exercising between the sessions. People can sometimes go to their primary doctors and they get started on pain medications. Typically, nowadays we try to avoid heavy narcotics and we try to moderate the pain medications. Anti-inflammatory medications, to take away some of the inflammatory processes in the ligaments and the joints.

People sometimes resort to chiropractors and get manipulation treatments, which some doctors are against because of the issue whether that causes instability or not. But majority of degenerative spine disease is not due to instability, so I don't have an issue with chiropractors.

Sometimes people get various injections in their back, whether it's epidural or joint injections. Sometimes they get trigger point injections, which can sometimes help. People use TENS units, which deliver electrical stimulation to the muscles and the superficial tissue that helps traction units. There's methods of ultrasound to kind of break down the scarring and decrease the inflammation in the tissue. Massage therapy is another one.

There's various methods and they all can be undertaken simultaneously and most well-trained physiatrists know how to develop a plan for each patient that's right for the patient. Some patients are allergic to different medications and they need to have that plan altered, but it's usually a multi-modality approach to treating these conditions.

Scott Webb: Yeah, I love that. I love the multi-modality approach and it does sound like the conservative approach, if you will, as you were saying, that there are a lot of options for patients, which are great. But let's say they've tried everything, all the modalities, everything they can do and they still find themselves in a lot of pain, this chronic pain. So when do you consider surgery? Whose decision is that? Is that always the patient's decision? Do you recommend surgery in certain situations after you've tried everything else?

Dr. Khalid Kurtom: So initially, the people present with the symptoms and the symptoms are usually presented to their primary doctor, primary care doctor. And the primary care doctor makes the diagnosis of this is most likely degenerative spine disease, and they start these different modalities. And after a period of time, usually in terms of weeks and month, people as their results are not promising, the primary doctors and the treating physicians then move into diagnostics.

So the next step is to actually obtain diagnostic imaging and most offices initially start with an x-ray. An x-ray shows wear and tear of the joints and the degenerative things that you see in x-ray. But an x-ray is usually a gross way of looking at the spine. So the step after that is to get an MRI scan of the area effected whether it's the neck, the mid-back or the low back and MRI scan has a clear definition of the anatomy and it gives you a precise diagnosis.

And what I mean by that, there's a variety of diagnoses that are under the same umbrella of degenerative spine disease. You want to know whether it's the disc or the joint or the ligaments or is it spinal canal narrowing, or is it that the joints are getting a loose and there's a little bit of instability in the spine.

Once you kind of finalized the diagnosis, then the referral usually gets to the spine specialists, whether it's an orthopedic surgeon or a neurosurgeon. And that's when I see the patients in my office. And ideally, these are patients that have exhausted all treatment options and I'm their final resort and I have an image in front of me that kind of shows me the pathology clearly.

At that point, your goal as a surgeon is to devise a treatment option, a surgical approach that you can present to the patient that's minimal disruption to the spine that can take care of the issue without causing a long recovery and a destructive process as far as the surgery. But that's kind of the way I think about it.

Scott Webb: Yeah. And it does seem like, because it is chronic and we're talking about a long period of time, perhaps over decades, by the time patients see you, they've tried just about everything, if not everything, all the modalities. You've got all the imaging. So you're making a really informed decision, which is great. And I guess I'm curious, what are some of the concerns people have and are there some possible negative outcomes from surgery that people should be aware of?

Dr. Khalid Kurtom: Surgery in my mind is always a last resort. Anytime that you put somebody under general anesthesia and you do any operation on them, you're putting them at risk. And anytime you operate on people's spine, there's obvious risks involved with infection, bleeding, nerve injury. And anytime they had a general anesthesia, there's chance of stroke, heart attack or even death.

Having said that the risks are now much more tolerable and very low, but they still exist. Surgery is not to be taken lightly. And I always emphasize that to the patient. But more importantly. most people are concerned about their recovery and a lot of them are concerned about their age and whether they're even good candidates for surgery. And what I say to that is most of the surgeries that I do, in fact, almost all of them are minimally invasive.

And what I mean by that is minimal tissue disruption, minimal blood loss, risk of infection is almost zero. And that the plan is devised with the surgery is to attack the problem in the least destructive way possible to take care of the issue without causing a major problem. So, as it turns out, most of these surgeries end up being outpatient and the age limits that used to exist 15, 20 years ago because of the excessive blood loss and excessive risk of infection are now almost entirely gone. Operating people in their 80s, sometimes early 90s, depending on their functional status, because these operations have become a lot safer and a lot more minimally invasive than they used to be.

So a lot of the questions that I get from patients have to do more with recovery and how long is the recovery? And "When can I return back to work? And when can I return back to playing tennis?" Even people in their 80s nowadays are extremely functional and they want to be active again and they want to get back to work. People are working a lot later in their lives now than they used to.

So most people are concerned about how fast can I recover and how fast can I get back to my life. And those are the questions I get from people in my office.

Scott Webb: Yeah, and those are good questions. And as you say, people just are working longer than they used to. People are more active well into their 80s and perhaps even their 90s. So really amazing, both the conservative and non-surgical approaches and surgery when absolutely necessary as a last resort.

I think one of the questions I have is there any evidence that there's a family history or a genetic component to degenerative spine conditions or disease?

Dr. Khalid Kurtom: You know, a lot of people have this misconception that there is, because they know an uncle or an aunt or a family member that had an issue with their back. And yeah, it has to be genetic, but the truth is most of the studies that have been published had showed no link to genetic involvement. But fact of the matter is it's so frequent to have degenerative spine disease, that it's very likely that there's multiple numbers of each family that is going to have this issue. So people are kind of misled that they're thinking that it's genetic, but it's actually just very common.

Scott Webb: Yeah. And as you say, very common degenerative spine conditions, disease even, very common and highly treatable, which is good to know. So doctor, as we wrap up here today, anything else you want to tell people about degenerative spine conditions, the latest treatments, anything else? What are the takeaways?

Dr. Khalid Kurtom: I think, for me, the psychological impact that this has on people is significant. You know, people that are highly functional, career-oriented, family-oriented, love life, because of the pain that they experienced, they feel very locked in and very desperate and it changes even their human interactions with each other.

So I find that a lot of people, after they have this operation, it's not necessarily the pain that they're happy about getting rid of, it's the psychological impact, the lack of sleep. They get their sleep back and they feel like they got their life back. So the impact on people's lives is a much greater than just fixing their nerve pain or their back pain. And people tend to be very grateful for the outcomes that they get if they follow the process appropriately,

Scott Webb: Yeah, that's great. And I think so many of us, we do deal with chronic pain. And for so many of us, there is help available whether it's non-surgical and conservative or, you know, surgical, but minimally invasive. So doctor, thanks so much for your time today and you stay well.

Dr. Khalid Kurtom: Thanks. You too.

Scott Webb: And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.