Maggie McKay (Host): Welcome to the Live Greater podcast series; information for a healthier you from the University of Maryland Medical System. I'm your host, Maggie McKay. Joining us today is Dr. Khalid Kurtom, Clinical Assistant Professor of Neurosurgery at the University of Maryland School of Medicine and Neurosurgeon at UM Shore Regional Health, to discuss what causes back or neck pain and when should we see a spine surgeon. Thank you so much for being here. I can't wait to learn more about this.

Khalid H. Kurtom, MD, FAANS, FACS: Thank you, Maggie, for having me.

Host: Absolutely. So back and neck pain are incredibly common. What are some of the most frequent causes you see in your patients?

Khalid H. Kurtom, MD, FAANS, FACS: So a lot of times it's just simple injury. People are very athletic and very active. They end up injuring their neck or their back while lifting, heavy lifting or having poor posture and doing some sort of activity, a lot of times they actually just wake up with it. So there's a lot of reasons to have it.

It's one of the most common things that people go to the emergency room with, back and neck pain. So it's can be challenging to figure out, what's surgical and what's not and, what should they be concerned about and how to proceed when you do have the symptoms because it can be very severe.

Host: A lot of people assume pain automatically means something serious. How can someone tell the difference between everyday strain and something that might need medical attention?

Khalid H. Kurtom, MD, FAANS, FACS: So it's interesting. I'll start backwards because you know, in my office, most of the patients that come to my office, are in severe pain and they truly believe that it's surgical and they come to me because I do majority of my surgery is minimally invasive, fast recovery, quick back to work, et cetera. So that appeal is what brings a lot of people in the office immediately. They think that, this is a light switch that I can just take care of it and they can get back to work within a day or two. And when they come to see me, what they realize quickly is that, I'm an extremely conservative surgeon. I don't operate on the majority of people that come to my office. Majority of the time, it's time spent getting the right diagnosis, figuring out what the actual cause of the pain and, giving them the right treatment options. And most of those are conservative. So causes of back and neck pain, majority of it is musculoskeletal inflammation. Majority of the symptoms that people have coming in here is something got inflamed, whether it's muscles, ligaments, joints, nerves, experienced inflammation. And that inflammation can be severe, can feel like you broke your neck or you broke your back. And sometimes it leads people to the emergency room. It's that severe. So that's kind of the symptoms that people present with. And yes, in rare occasions it's because of a herniated disc. It's because of something that's actually surgical. So in, in a nutshell, that's what the general, causes of neck back pain and the symptoms that people have.

Now I think people should be alarmed if they come in and they have pain shooting down the arm or pain shooting down the leg, or they have weakness in the arm or weakness in the leg, or trouble with bowel and bladder function, trouble going to the bathroom, these are serious symptoms and those are symptoms that definitely warrant further investigation.

Host: And what are the most common lifestyle factors like posture, work habits, fitness level that can contribute to back or neck pain?

Khalid H. Kurtom, MD, FAANS, FACS: So I tend to be not very popular when I bring this up in my office, but I bring it up to almost every patient, about weight. There's a huge problem that we have as a population of being overweight. So being overweight definitely has a factor when it comes to neck and back pain. Having a sedentary lifestyle where you're not exercising, you're not taking care of your body. And people confuse that with, like, I work all the time and I'm always active. That's not the same. Actually doing a workout. Do sweat and get your blood flowing and get your blood pressure high and your heart rate high for 30 minutes three times a week.

That's very different than just working hard at a labor intensive job. So I think that, and of course, eating habits, now add to it, people's mechanics when they're lifting, twisting, turning, and how to do that properly and how to engage your core. These are kind of the general gist of things that can lead people to have back and neck pain.

Host: And how does age affect the spine and when does normal wear and tear become a problem worth addressing?

Khalid H. Kurtom, MD, FAANS, FACS: I'm surprised recently because more and more the older people are doing much better than younger people these days. They're much more active. I can tell you, I have so many patients that come in and they're playing tennis. They're in the gym all the time. They're swimming, they're doing yoga. Whereas the young people who are yeah, it's right. They have the time and they have the space and they know the importance of it. I think, I'm seeing more and more younger people, like people in their thirties and forties who are busy with their families, busy with their kids, busy at work, are neglecting their bodies and neglecting their health. So I think age. They always say that 60 is the new 20 or whatever it is, there's so much truth to that. But I don't have any biases towards older people. I think older people that take care of themself, they do very, very well. And younger people, if they don't take care of themself, they're in trouble.

Host: So when is back or neck pain a sign of something more serious? You mentioned, uh, herniated disc or nerve compression. What red flags should people watch for?

Khalid H. Kurtom, MD, FAANS, FACS: If you have weakness in your arms and legs, that's an automatic. You should see a, you should see a neuro, you should get imaging. You should get the full workup and get a neurosurgical evaluation. And, I don't mean just neurosurgical because a lot of orthopedic surgeons do spine surgery as well.

So, you should see a spine surgeon for that. So weakness, numbness, trouble with walking, like I said, bowel, bladder dysfunction. These are the things that I think warrant, immediate kinda attention, management, workup, et cetera. I think if you have severe pain, even though in your mind you think it's severe, severe, a lot of times it's inflammatory and a lot of times that just gets better with conservative management.

So I think in those situations, if it's just pure neck or back pain, it's worth giving conservative management a trial before you elevate it to a, a surgical discussion.

Host: Before someone even thinks about surgery, what are the typical first steps in treatment?

Khalid H. Kurtom, MD, FAANS, FACS: So aside from the major red flags, so unless you have spinal cord compression, like if you have a neck issue that could lead to spinal cord injury, that you really can't wait or try different things for, that needs to be surgically addressed, significant weakness in arms and legs that can lead to atrophy, right?

So the longer that you wait to take care of that surgically, the worse the outcome is going to be. So aside from those major red flags, the majority of things should be handled conservatively. And, I'll start with the over-the-counter anti-inflammatories, the oral steroids that people prescribe, pain medications, muscle relaxants, nerve medications. There's a couple of nerve medications that people can take that can help with nerve pain. Heat, cold, ice packs or heat pads, can help. Now physical therapy is always a thing that I recommend, and most people say at least four to six weeks for physical therapy. And that can always be done by the primary doctor. They can order the physical therapy for the patients. And then when it gets really the next level of, invasiveness is injections. Sending somebody to a pain management doctor that does injections and does different trigger point injections or epidural injections, that's the kind of escalating care and that covers the conservative management that you can recommend to people.

Host: What about those patches that make your neck feel like it's on fire? Are those just temporary relief?

Khalid H. Kurtom, MD, FAANS, FACS: For inflammation, it can actually work, you know? And then they have ones that also have fentanyl patches where you can put a patch on and has fentanyl that diffuses through the skin, that also can help. They have now CBD ointments that you can actually put on the skin that helps with the neck and the back pain. To me, I always say to somebody that, that does not one of the red flags for surgery, that does not need immediate surgery.

Those patients, I tell them to try everything. Like I said, I'm extremely conservative, so I tell people to try anything and everything. Some people say a chiropractor helps them, fine try it. Some people say acupuncture helps them, fine. Try it. Meditation. I've heard it all and I don't have any dogma or bias towards any of that.

If it works for you, try it. And I've heard that it works for a variety of people, so, it does work for some people. So you should try it before you think of surgery for sure.

Host: Dr. Kurtom, when is it time to see a spine surgeon? What symptoms or situations make surgery the right or the only option? I know you've touched on it a little bit, but I think it's worth lookinginto even deeper.

Khalid H. Kurtom, MD, FAANS, FACS: Yeah, so like I said, minus the red flags, so minus the weakness, the bowel bladder dysfunction, the trouble with walking, minus those symptoms, a good first step would be a primary doctor. Go to your primary doctor, get an evaluation. Usually you're, then you're started on the conservative management.

Usually you're started on the, some sort of either pain medications, muscle relaxants, anti-inflammatories. They start you with that and they usually get you started with physical therapy. That's a really good first start. Now you do all of that, and within four to six weeks, if you don't see results with all of that, then obviously at that point it's warranted for you to get imaging. You get an MRI scan of your neck or your lumbar spine and if that shows anatomical issues, then you see a spine surgeon. So that's usually the sequence that happens. Now some people go out of sequence.

Some people come straight to me, like I said earlier, cause I do a minimally invasive surgeries. I think that should be the first option. They can come straight to me, but they end up going back through the algorithm that has described. And some people, go to the emergency room instead of their primary doctors. That's unfortunate because, they end up waiting in the emergency room for a long time. It's not an ideal situation, and usually what they're given is nothing that lasts more than a day or so. So usually I think, having a good primary care and having a good primary care follow-up is a good idea as a first step.

Host: A lot of people fear spine surgery. Understandably. What advances have made spine surgery safer and recovery faster in the past? What do you tell your patients?

Khalid H. Kurtom, MD, FAANS, FACS: So all comers, spine surgery is much safer now because we have a lot more technology, a lot. We see a lot of the anatomy, clearly, with the imaging studies that we have pre-op, we know exactly where we're going and what the anatomy is that we're going to encounter. And then there's a lot of technology that we use intraoperative that actually help us, if we have to put screws or rods, there's navigation tools that we have now. A lot of micro instruments, a lot of microscopic advancements that have been developed. For my practice, all of my surgeries that I do, the majority of them are minimally invasive surgeries, and what that means is that I'm not cutting people's back wide open, not cutting the muscle. I'm operating through small holes to complete the decompression and effusion through that so that saves the tissue and minimizes scar tissue. Minimizes blood loss, length of stay. Most of my patients are outpatient surgeries. And most of my patients get back to work within two weeks and sports. So, definitely different than when it used to be. It used to, when I was in my training, and I won't tell you that when that was, we used to keep people, we used to keep people in the hospital for like weeks, and bedrest for months. So that a very different situation right now for sure.

Host: Thank goodness. What's your advice for people who want to stay active and protect their spine health long term?

Khalid H. Kurtom, MD, FAANS, FACS: So I always say have a long-term vision. Don't look at like what's going to happen the next week, the next month, that even the next year. I think if you're planning this out, plan a healthy life for yourself for the long run. Don't try to lose a ton of weight quickly. Just adjust your diet just slightly to make it appropriate. If you are overeating, cutting it down by 10, 15% of the volume. If you're eating something that's super unhealthy, maybe cut that one thing out. If you are over drinking, cut back on your alcohol. If you've never exercised before, maybe exercise one day a week.

Start slow. Just gradually get into a lifestyle that fits your needs and keeps you healthy. And definitely build in not just working out like traditional like treadmill or weightlifting, but also range of motion, like actually sitting on a mat and doing stretches and getting your body mobile and increasing your range of motion. There's a lot of value in that as we get older. Because we lock up when we get older, your range of motion decreases. You are just stiff. And that can cause injury. So a lot of range of motion things. But overall, don't make it all a task that you have to check off in a day or in a short period of time. Make it a long term, deal so they can last your lifetime.

Host: Lifestyle. When it comes to managing back and neck pain, what's one thing you wish more people understood about that?

Khalid H. Kurtom, MD, FAANS, FACS: That's a good question. I think people think it's because of the degree of pain that they have, that it has to be something that needs to have surgery, the amount of pain that people get into, especially I see it in a lot of very muscular guys that come in or athletic guys that have been athletic all their lives. They come in and say, there's something, there must be something wrong with me. There must be something that needs to have surgery. And I just want to point out like less than 5% of patients that have that situation ends up to have surgery. So the majority of time, no, it's actually just inflammation and as severe as you feel it, it still can be just inflammation, and I promise you, I spent, I had office hours today, so I spent the majority of the office today talking about inflammation. You would think you were coming to a, a neurosurgeon, a spine surgeon. I spent the majority of the day talking about nonsurgical management of back pain. So, I wish that people more and more knew that no matter what the extent of the pain is, it could still be just inflammatory.

Host: That's good to know. Because when you're in it and you feel so bad, you think, oh, it can't just be that. But you're saying it is. For somebody living with chronic discomfort, what's the most important message of hope or reassurance that you'd like to share?

Khalid H. Kurtom, MD, FAANS, FACS: There's a lot of tools out there. There's a lot of help. So even if it's not a surgical issue, there's still a plethora of things that can be done. You just have to go to the right person and the right people to direct you on that. So don't feel like, because the one epidural injection that you had didn't work.

That means that's it. Or because you've seen a surgeon and a surgeon said, no, you don't need to have surgery. That means that's it. There are so many things that you can do. Whether it comes to fitness, whether it comes to body weight management, whether it comes to just diet and nutrition.

There is so much that can be done for this. So there's always hope. If you just put your mindset on it and reach the right people, I think you're going to get the relief that you.

Host: That's great. That's very helpful and hopeful. Thank you for sharing your expertise. This has been very educational. Thank you.

Khalid H. Kurtom, MD, FAANS, FACS: Thank you for having me, of

Host: Again, that's Dr. Khalid Kurtom. Find more shows just like this one at umms.org/podcast and on YouTube. 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, and please share this on your social media.