When to See a Spine Surgeon
Many people suffer from back pain on a daily basis. How do you know when your back pain warrants a conversation with a spine surgeon? Learn from Dr. Charles Sansur, a spine surgeon at the University of Maryland Medical Center and member of the UM Spine Network, what a spine surgeon does, how to find a great one, when you might need to see one and much more.
Featured Speaker:
Charles Sansur, MD
Charles Sansur, MD is a spine surgeon at the University of Maryland Medical Center and member of the UM Spine Network. He was named a "Top Doctor" in the specialty of Neurosurgery and Spine Surgery by Baltimore magazine in 2020. Dr. Sansur is an expert in revision spine surgery and the correction of spinal deformities such as scoliosis. He also has extensive experience with cervical disc replacements, cervical fusions, spine, trauma and minimally invasive spine surgery. He is frequently invited to tech other neurosurgeons and orthopedic surgeons throughout the country at various national meetings. Dr. Sansur earned his medical degree from the University of Maryland School of Medicine and obtained a Master’s degree in clinical research from Duke University. He completed a clinical research training program fellowship at the National Institutes of Health. His neurosurgery residency training was at the University of Virginia. He then completed a combined Orthopedic and Neurosurgical Spine Fellowship at the University of Virginia. Transcription:
When to See a Spine Surgeon
Caitlin Whyte: 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 podcast is sponsored by the UM Spine Network.
Many people suffer from back pain on a daily basis. But how do you know when your back pain warrants a conversation with a spine surgeon? Today, we'll learn from Dr. Charles Sansur, a spine surgeon at the University of Maryland Medical Center and member of the UM Spine Network. He'll tell us what a spine surgeon does, how to find a great one and when you might need to come into the office.
Well, to start us off today, doctor, can you just describe some of the signs or symptoms that would let a patient know it's probably time to see a spine surgeon?
Charles Sansur, MD: So the signs and symptoms that are concerning in terms of when to come in and see a spine surgeon would consist of prolonged back pain, prolonged arm or leg pain or neck pain. If the pain has been persistent for over six weeks, it's at that point where one should contemplate coming in to see a spine specialist. The other thing to worry about would not just be pain and this would be important to come in as soon as possible, if the patient's experiencing foot drop or severe weakness or loss of balance, bowel and bladder incontinence. Those are the kinds of problems where the attention of a spine surgeon should be obtained immediately.
Sometimes we may have our accidents at home where you'd fall or have some kind of sudden traumatic event and weakness can develop, immediate attention is needed. If it's mostly pain, you know, that potentially can wait and make it better with conservative treatment. It's important to see your primary care doctor if it's just pain that has persisted for a week or so, that way you can get an evaluation by a clinician. I think at the discretion of the primary care doctor, should the pain or that mild weakness, if that's persistent for a period of six weeks or more, it's at that point where some plain x-rays should be ordered with or without an MRI and a spine specialist referral should be made.
Caitlin Whyte: So now that we know those symptoms, how do we know if for sure that we've exhausted all of our non-surgical options?
Charles Sansur, MD: There's not an obvious answer to know whether or not you've exhausted all surgical options. But one of the most important things to determine is whether or not you have any weakness. And weakness can be detected on physical exam and very often requires an in-person visit, whether it's with your primary care doctor or with a spine specialist. And it's important to be evaluated to rule out things such as weakness and accentuated reflexes. If you have accentuated reflexes, that's a concern for the possibility of spinal cord compression, if you have weakness that could either be related to spinal cord compression or nerve compression.
It's not unusual for a primary care doctor to request a plain x-ray. Plain x-rays by themselves won't be able to make the diagnosis of spinal cord compression. However, they're very useful in helping us determine whether or not the spine has satisfactory alignment. And they're also very useful in helping us see whether or not a disc space is collapsed. If a disc space is collapsed, that's a sign that the nerve exit site, or also known as the foramen, that the foramen does not have the normal amount of space that it should have when the disc space is collapsed. So that by itself can be an indicator to have us get more sophisticated imaging, such as a CT scan or an MRI.
Caitlin Whyte: Now, is there ever a point where you're too young or too old for spine surgery?
Charles Sansur, MD: So in general, we err on the side of caution in dealing with younger patients with spine pain. Sometimes, however, our hands are forced into spine surgery in the younger patient population. There's are sometimes situations where a younger patient may get injured in an athletic competition or there are times where the patient will develop a disc herniation and develop a significant weakness and that necessitates surgery. Sometimes patients have congenital disorders such as a congenital non-union of a part of the anatomy called the pars, the pars interarticularis. That congenital defect will result in instability of the spine. So in the younger patient population, we err on the side of caution and try not to pursue surgical measures, but sometimes they're necessary. The other case of the younger patient population where spine surgery is relatively common is the setting of scoliosis if the curvature exceeds certain threshold.
Caitlin Whyte: Well, tell us a bit about your work as well. What exactly does a spine specialist or a spine surgeon do?
Charles Sansur, MD: So as a spine surgeon, I'm the Director of Spine Surgery for the Department of Neurosurgery at the University of Maryland. I see a large spectrum of patients. I treat patients with both simple and large problem. It could be as simple as a lumbar microdiscectomy or as complicated as a large scoliosis revision reconstruction. So I'm comfortable evaluating each patient individually in order to determine the minimum or maximum treatment that's necessary. And we provide patients with options very often that surgery is not the first thing that I recommend. I'm relatively known by my nurse practitioners to recommend the use of an inversion table, for instance. That's very often something that has not been in the armamentarium of the referring providers, as far as an additional conservative treatment measure that could be implemented prior to recommending surgery. Sometimes aqua therapy is another tool that I use before pulling the trigger on surgery.
As a spine specialist who sees both small and large cases, I feel that I can try to tailor the individual problem precisely and try to make it as minimally invasive or sometimes minimally invasive approaches are not amenable to all of the pathologies that are present in the patient and sometimes a larger open surgery is necessary. So I look at each patient on a case by case basis and try to make the best treatment plan depending upon the individual circumstances of that patient.
Caitlin Whyte: Now, someone's just starting out this journey of finding a spine surgeon. What are some tips on how to find the best one?
Charles Sansur, MD: A couple of tips might be to see if you know of people who have been treated by that surgeon and see what their experience was like during the treatment process. Another thing to evaluate is to get an idea about the types of experiences that a spine surgeon has had in terms of seeing what his or her research interests are. You know, I feel that very often a surgeon who has published in certain areas of the spine, such as scoliosis or revision spine surgery, a person who is published or given lectures on those disease processes very often is a person that has a solid experience and is going to be capable of providing the most cutting edge care. Often we're asked to speak at different conferences. And if these organizations are choosing that person to speak at a conference, chances are they're going to be capable of providing the most cutting edge care.
But, you know, sometimes I think that that's not the only thing to look for. There are many, many distinguished and very qualified surgeons who are not on the academic circuit who provide outstanding service and have extremely gifted hands. I think word of mouth and knowledge of other patients who have been treated by those clinicians can be quite useful.
Caitlin Whyte: Well, wrapping up here, doctor, are there any last takeaways, anything we didn't touch on that you want patients to know?
Charles Sansur, MD: I think the most important thing is to be weary of a situation where a surgery is recommended immediately. If you don't feel comfortable, or if you feel that the surgery is too aggressive or too invasive, it doesn't hurt to get a second opinion. There are many ways to treat spine conditions. And you may see as an example, if you go to national meetings and you look at spine surgeons and you put the same clinical scenario up on a panel of five different surgeons, there may be like three to five different ways that the spine surgeons would suggest treating the process. So there's a broad spectrum of possibilities as far as what is acceptable treatment. And so it doesn't hurt to get more than one opinion before you decide on pursuing a surgical intervention.
Caitlin Whyte: Well, thank you, doctor, for helping us out today. So we know the best time to seek out a doctor for our pain.
This episode is sponsored by 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.
Find more shows just like this one at umms.org/podcast. 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.
When to See a Spine Surgeon
Caitlin Whyte: 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 podcast is sponsored by the UM Spine Network.
Many people suffer from back pain on a daily basis. But how do you know when your back pain warrants a conversation with a spine surgeon? Today, we'll learn from Dr. Charles Sansur, a spine surgeon at the University of Maryland Medical Center and member of the UM Spine Network. He'll tell us what a spine surgeon does, how to find a great one and when you might need to come into the office.
Well, to start us off today, doctor, can you just describe some of the signs or symptoms that would let a patient know it's probably time to see a spine surgeon?
Charles Sansur, MD: So the signs and symptoms that are concerning in terms of when to come in and see a spine surgeon would consist of prolonged back pain, prolonged arm or leg pain or neck pain. If the pain has been persistent for over six weeks, it's at that point where one should contemplate coming in to see a spine specialist. The other thing to worry about would not just be pain and this would be important to come in as soon as possible, if the patient's experiencing foot drop or severe weakness or loss of balance, bowel and bladder incontinence. Those are the kinds of problems where the attention of a spine surgeon should be obtained immediately.
Sometimes we may have our accidents at home where you'd fall or have some kind of sudden traumatic event and weakness can develop, immediate attention is needed. If it's mostly pain, you know, that potentially can wait and make it better with conservative treatment. It's important to see your primary care doctor if it's just pain that has persisted for a week or so, that way you can get an evaluation by a clinician. I think at the discretion of the primary care doctor, should the pain or that mild weakness, if that's persistent for a period of six weeks or more, it's at that point where some plain x-rays should be ordered with or without an MRI and a spine specialist referral should be made.
Caitlin Whyte: So now that we know those symptoms, how do we know if for sure that we've exhausted all of our non-surgical options?
Charles Sansur, MD: There's not an obvious answer to know whether or not you've exhausted all surgical options. But one of the most important things to determine is whether or not you have any weakness. And weakness can be detected on physical exam and very often requires an in-person visit, whether it's with your primary care doctor or with a spine specialist. And it's important to be evaluated to rule out things such as weakness and accentuated reflexes. If you have accentuated reflexes, that's a concern for the possibility of spinal cord compression, if you have weakness that could either be related to spinal cord compression or nerve compression.
It's not unusual for a primary care doctor to request a plain x-ray. Plain x-rays by themselves won't be able to make the diagnosis of spinal cord compression. However, they're very useful in helping us determine whether or not the spine has satisfactory alignment. And they're also very useful in helping us see whether or not a disc space is collapsed. If a disc space is collapsed, that's a sign that the nerve exit site, or also known as the foramen, that the foramen does not have the normal amount of space that it should have when the disc space is collapsed. So that by itself can be an indicator to have us get more sophisticated imaging, such as a CT scan or an MRI.
Caitlin Whyte: Now, is there ever a point where you're too young or too old for spine surgery?
Charles Sansur, MD: So in general, we err on the side of caution in dealing with younger patients with spine pain. Sometimes, however, our hands are forced into spine surgery in the younger patient population. There's are sometimes situations where a younger patient may get injured in an athletic competition or there are times where the patient will develop a disc herniation and develop a significant weakness and that necessitates surgery. Sometimes patients have congenital disorders such as a congenital non-union of a part of the anatomy called the pars, the pars interarticularis. That congenital defect will result in instability of the spine. So in the younger patient population, we err on the side of caution and try not to pursue surgical measures, but sometimes they're necessary. The other case of the younger patient population where spine surgery is relatively common is the setting of scoliosis if the curvature exceeds certain threshold.
Caitlin Whyte: Well, tell us a bit about your work as well. What exactly does a spine specialist or a spine surgeon do?
Charles Sansur, MD: So as a spine surgeon, I'm the Director of Spine Surgery for the Department of Neurosurgery at the University of Maryland. I see a large spectrum of patients. I treat patients with both simple and large problem. It could be as simple as a lumbar microdiscectomy or as complicated as a large scoliosis revision reconstruction. So I'm comfortable evaluating each patient individually in order to determine the minimum or maximum treatment that's necessary. And we provide patients with options very often that surgery is not the first thing that I recommend. I'm relatively known by my nurse practitioners to recommend the use of an inversion table, for instance. That's very often something that has not been in the armamentarium of the referring providers, as far as an additional conservative treatment measure that could be implemented prior to recommending surgery. Sometimes aqua therapy is another tool that I use before pulling the trigger on surgery.
As a spine specialist who sees both small and large cases, I feel that I can try to tailor the individual problem precisely and try to make it as minimally invasive or sometimes minimally invasive approaches are not amenable to all of the pathologies that are present in the patient and sometimes a larger open surgery is necessary. So I look at each patient on a case by case basis and try to make the best treatment plan depending upon the individual circumstances of that patient.
Caitlin Whyte: Now, someone's just starting out this journey of finding a spine surgeon. What are some tips on how to find the best one?
Charles Sansur, MD: A couple of tips might be to see if you know of people who have been treated by that surgeon and see what their experience was like during the treatment process. Another thing to evaluate is to get an idea about the types of experiences that a spine surgeon has had in terms of seeing what his or her research interests are. You know, I feel that very often a surgeon who has published in certain areas of the spine, such as scoliosis or revision spine surgery, a person who is published or given lectures on those disease processes very often is a person that has a solid experience and is going to be capable of providing the most cutting edge care. Often we're asked to speak at different conferences. And if these organizations are choosing that person to speak at a conference, chances are they're going to be capable of providing the most cutting edge care.
But, you know, sometimes I think that that's not the only thing to look for. There are many, many distinguished and very qualified surgeons who are not on the academic circuit who provide outstanding service and have extremely gifted hands. I think word of mouth and knowledge of other patients who have been treated by those clinicians can be quite useful.
Caitlin Whyte: Well, wrapping up here, doctor, are there any last takeaways, anything we didn't touch on that you want patients to know?
Charles Sansur, MD: I think the most important thing is to be weary of a situation where a surgery is recommended immediately. If you don't feel comfortable, or if you feel that the surgery is too aggressive or too invasive, it doesn't hurt to get a second opinion. There are many ways to treat spine conditions. And you may see as an example, if you go to national meetings and you look at spine surgeons and you put the same clinical scenario up on a panel of five different surgeons, there may be like three to five different ways that the spine surgeons would suggest treating the process. So there's a broad spectrum of possibilities as far as what is acceptable treatment. And so it doesn't hurt to get more than one opinion before you decide on pursuing a surgical intervention.
Caitlin Whyte: Well, thank you, doctor, for helping us out today. So we know the best time to seek out a doctor for our pain.
This episode is sponsored by 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.
Find more shows just like this one at umms.org/podcast. 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.