Selected Podcast
Back Pain
Back pain can significantly set you back. Dr. Edward Vresilovic discusses what causes back pain and how to address it.
Featuring:
In his free time, Dr. Vresilovic enjoys bicycling, skiing, fishing, and do-it-yourself home improvement projects.
Learn more about Edward Vresilovic, MD
Edward Vresilovic, MD
Edward Vresilovic PhD, MD, received a medical and doctoral degrees from the University of Pennsylvania in Philadelphia. He received a master’s degree in biomedical engineering from Northwestern University in Il and a bachelor’s degree in engineer science from Pennsylvania State University. He completed his orthopaedic residency at the Hospital of the University of Pennsylvania before completing a lower extremity joint reconstruction fellowship at the Pennsylvania Hospital, Thomas Jefferson University, and spine scholarship at the University of California San Diego. He is primarily focused on surgically treating complex problems of the spine, including degeneration, deformity, trauma, and tumors in the neck and back, and on understanding the physical mechanisms responsible for degeneration of the intervertebral disc.In his free time, Dr. Vresilovic enjoys bicycling, skiing, fishing, and do-it-yourself home improvement projects.
Learn more about Edward Vresilovic, MD
Transcription:
Bill Klaproth (Host): Back pain. What a pain in the … well, back. So, what are the main causes of back pain? And what are your treatment options and what can you do to help prevent back pain? We’re going to find out with Dr. Edward Vresilovic and Orthopedic Spine Surgeon at UPMC Pinnacle. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. Vresilovic, so let’s start with this. why can lower back pain be such a big problem?
Edward Vresilovic, MD (Guest): Well it’s a problem on two fronts. It’s a problem in terms of morbidity. It causes people, it interferes with their life, their livelihood and it’s a big financial burden in society. The amount of money being spent to take care of people’s back problems is close to one percent of the gross national product. So, it’s both expensive and if has a lot of downside for the individual.
Host: Yeah, a lot of money is spent trying to manage back pain. So, what are the main causes of back pain?
Dr. Vresilovic: Well back pain can be caused for a variety of reasons. But the vast majority of it is from the musculoskeletal system. The spine is made of 24 bones and these bones are interconnected by a number of structures including muscles, ligaments, little cushions between the bones called discs and there’s little joints called facet joints. And each vertebrae attaches to the vertebrae above and below through a disc and two facet joints. There’s 11 ligaments per every segment. So, any one of those structures can be injured and cause you pain.
Host: So, what is it that breaks down and is a lot of this just normal wear and tear?
Dr. Vresilovic: The disc is the primary culprit and it’s an avascular structure meaning it doesn’t have vessels, so it doesn’t have a great ability to repair itself. Everybody has heard about stem cells, they come to our body to an area that needs repaired via the blood circulating system and there isn’t a circulating system within the disc itself. So, it’s harder for the stem cells to migrate into that area. They do, but once they get there, they are in somewhat of a desert in terms of nutrition because most of our body is supplied with nutrition from the blood system.
Host: So, knowing this about the discs, once they start to degenerate or if a disc is bulging or there’s a ruptured disc; is that it? Is there no going back?
Dr. Vresilovic: Right now we don’t have disc replacement. There is a tremendous effort being put into regenerating discs. That’s being done in the area of tissue engineering. It’s also being done in the area of permonics where we control what the cells do. A lot of research, a lot of high end research but none of it’s come to fruition as yet. Right now, basically, surgery treats very end-stage disc disease when the disc is beyond repair. But even when we do a discectomy, we are solving the problem of that disc material pushing on the nerve. We are not restoring the function of the disc.
Host: Right, you are trying to repair what’s around the disc.
Dr. Vresilovic: That’s right. The disc when it herniates, really starts two processes. There’s a degenerative process. The herniation changes the mechanics of the disc in a way that it’s not functioning the way it should. It’s like a car tire without air in the tire. But also, the typical reason we operate on a herniated disc is because the material that comes out of the disc, the nucleus pulposus material actually is on the nerve and causes the nerve to be either dysfunctional or painful.
Host: So, can you briefly touch on the two main types of back pain, radicular and referred? So, what is radicular?
Dr. Vresilovic: Yes. Largely they break into pain of the nerves which we call radicular. So, if a piece of disc material or we pinch one of the nerves, your foot could hurt. The pain isn’t in the foot, it’s just on the nerve that goes to the foot. So, it’s like a telephone line to Seattle but somebody clicked on in Chicago, you think you are talking to Seattle. When this herniated disc hits the nerve in your back, and it’s the nerve that goes to your foot; your foot becomes painful but that’s radicular.
Host: Okay so that’s radicular and then how about referred pain?
Dr. Vresilovic: Referred pain is pain that is associated with the spine but it’s not because you are compressing a particular nerve. It can go to your back or to the back of your leg and that’s just where your brain puts the pain that is actually coming from your back.
Host: Wow, that’s really interesting. So, let’s talk about prevention. What can we do to prevent back pain?
Dr. Vresilovic: Well we can try to prevent injuring our back and I think we all know that we are supposed to lift with our legs. So, lifting heavy objects can put a lot of strain on our back particularly if our back isn’t in a balanced position where your back is straight. So, when you bend over at the waist and pick up something heavy; the mechanics are such that you are putting an awful lot of load on the disc. If you keep that weight close to you and lift with your legs rather than your back; you are a lot better off. Conditions where you are a little bit handicapped are like putting a kid in a car seat or getting suitcases out of the back of the car where you really can’t get your body under the weight. And when you are reaching out and lifting, that really puts your back in a lot of danger for being injured.
Host: Oh yeah. A lot of back strain there. That’s for sure. So, let’s talk about treatment. What are some of the nonoperative treatment options for back pain?
Dr. Vresilovic: Generally, we start by very simply trying to avoid things that hurt us. It seems very simple minded, but if you know every time you do a certain activity it hurts you and you are having back pain; we are going to have you stop those activities. But on top of that, we try to use anti-inflammatories because associated with most injury is a degree of inflammation. You know when you have a paper cut you get redness around it. that’s inflammation. And when you focus on physical therapy and there we are really trying to get the back to work better and it’s somewhat counterintuitive but people that have pain that stop moving around, weaken their muscles and then more load goes on the structures that are failing. So, by maintaining your musculature, you help prevent further injury.
Host: Wow, that makes sense. So, that why in physical therapy they are always trying to build up the muscles around the joint or the affected area.
Dr. Vresilovic: That’s absolutely correct.
Host: So, then when it comes to surgery, what are some of the common surgical treatment options for back pain?
Dr. Vresilovic: Well surgery really breaks up into two primary categories. We are either decompressing the nerves and that’s often called a laminectomy or a discectomy. We are taking pressure off the nerve whether it’s being caused by a herniated disc or spinal stenosis or a tumor or even a fracture fragment. So, that’s one thing we do. We take pressure off the nerves and the other thing we do is we stabilize mechanically unstable spines. So, if you have a slipped disc which we call spondyloses or scoliosis, or you have a fracture or possibly a tumor that’s damaged your bone; we do things to stabilize that spine and typically that involves instrumentation and fusion.
Host: So, from what I’ve heard, Dr. Vresilovic, most back pain can be managed without surgery. Is that right?
Dr. Vresilovic: I would absolutely agree with you. And it really depends on what we’re talking about. So, we’re very aggressive with neurologic injury. Once you start damaging your nerves, we’re going to try to stop that damage before it becomes permanent. So, when you have compromise of the spinal cord or the nerve roots, we may observe that for just a very short period of time before we are going to try to correct that problem. So, we’re aggressive when it comes to nerve damage because once a nerve is damaged, we can’t always allow it to return. It can’t always heal itself. In fact, surgeons don’t heal nerves, they try to prevent them from being damaged or allow the body the chance to heal them.
On the other hand, if we are talking about just back or neck pain, we’re going to try to string you out and try to avoid that and try to do conservative measures. There are times when we have to come to surgery but there’s a lot between when you get injured and when you would get surgery. And a lot of times, time is on your side, 90% of back pain will heal on it’s own in three months. So, we’re not going to drop and do surgery right away until we’re sure you are not on a path of correction on your own. And then we may intervene.
Host: Right that’s a great distinction. Thanks for explaining that. Knowing that when it comes to potential nerve damage, that’s when surgery is called for to potentially stop that from happening.
Dr. Vresilovic: That’s correct.
Host: Well this has been really informative. Thanks for your time.
Dr. Vresilovic: Well thank you for your time.
Host: That’s Dr. Edward Vresilovic. And to schedule an appointment with Dr. Vresilovic at Orthopedic Specialists of Central PA, please call 717-735-1972, that’s 717-735-1972. Or you can visit www.upmcpinnacle.com/oscp, that’s www.upmcpinnacle.com/oscp for more information. And if you found this podcast helpful, please share it on your social channels and check out the pull podcast library for topics of interest to you. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Back pain. What a pain in the … well, back. So, what are the main causes of back pain? And what are your treatment options and what can you do to help prevent back pain? We’re going to find out with Dr. Edward Vresilovic and Orthopedic Spine Surgeon at UPMC Pinnacle. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. Vresilovic, so let’s start with this. why can lower back pain be such a big problem?
Edward Vresilovic, MD (Guest): Well it’s a problem on two fronts. It’s a problem in terms of morbidity. It causes people, it interferes with their life, their livelihood and it’s a big financial burden in society. The amount of money being spent to take care of people’s back problems is close to one percent of the gross national product. So, it’s both expensive and if has a lot of downside for the individual.
Host: Yeah, a lot of money is spent trying to manage back pain. So, what are the main causes of back pain?
Dr. Vresilovic: Well back pain can be caused for a variety of reasons. But the vast majority of it is from the musculoskeletal system. The spine is made of 24 bones and these bones are interconnected by a number of structures including muscles, ligaments, little cushions between the bones called discs and there’s little joints called facet joints. And each vertebrae attaches to the vertebrae above and below through a disc and two facet joints. There’s 11 ligaments per every segment. So, any one of those structures can be injured and cause you pain.
Host: So, what is it that breaks down and is a lot of this just normal wear and tear?
Dr. Vresilovic: The disc is the primary culprit and it’s an avascular structure meaning it doesn’t have vessels, so it doesn’t have a great ability to repair itself. Everybody has heard about stem cells, they come to our body to an area that needs repaired via the blood circulating system and there isn’t a circulating system within the disc itself. So, it’s harder for the stem cells to migrate into that area. They do, but once they get there, they are in somewhat of a desert in terms of nutrition because most of our body is supplied with nutrition from the blood system.
Host: So, knowing this about the discs, once they start to degenerate or if a disc is bulging or there’s a ruptured disc; is that it? Is there no going back?
Dr. Vresilovic: Right now we don’t have disc replacement. There is a tremendous effort being put into regenerating discs. That’s being done in the area of tissue engineering. It’s also being done in the area of permonics where we control what the cells do. A lot of research, a lot of high end research but none of it’s come to fruition as yet. Right now, basically, surgery treats very end-stage disc disease when the disc is beyond repair. But even when we do a discectomy, we are solving the problem of that disc material pushing on the nerve. We are not restoring the function of the disc.
Host: Right, you are trying to repair what’s around the disc.
Dr. Vresilovic: That’s right. The disc when it herniates, really starts two processes. There’s a degenerative process. The herniation changes the mechanics of the disc in a way that it’s not functioning the way it should. It’s like a car tire without air in the tire. But also, the typical reason we operate on a herniated disc is because the material that comes out of the disc, the nucleus pulposus material actually is on the nerve and causes the nerve to be either dysfunctional or painful.
Host: So, can you briefly touch on the two main types of back pain, radicular and referred? So, what is radicular?
Dr. Vresilovic: Yes. Largely they break into pain of the nerves which we call radicular. So, if a piece of disc material or we pinch one of the nerves, your foot could hurt. The pain isn’t in the foot, it’s just on the nerve that goes to the foot. So, it’s like a telephone line to Seattle but somebody clicked on in Chicago, you think you are talking to Seattle. When this herniated disc hits the nerve in your back, and it’s the nerve that goes to your foot; your foot becomes painful but that’s radicular.
Host: Okay so that’s radicular and then how about referred pain?
Dr. Vresilovic: Referred pain is pain that is associated with the spine but it’s not because you are compressing a particular nerve. It can go to your back or to the back of your leg and that’s just where your brain puts the pain that is actually coming from your back.
Host: Wow, that’s really interesting. So, let’s talk about prevention. What can we do to prevent back pain?
Dr. Vresilovic: Well we can try to prevent injuring our back and I think we all know that we are supposed to lift with our legs. So, lifting heavy objects can put a lot of strain on our back particularly if our back isn’t in a balanced position where your back is straight. So, when you bend over at the waist and pick up something heavy; the mechanics are such that you are putting an awful lot of load on the disc. If you keep that weight close to you and lift with your legs rather than your back; you are a lot better off. Conditions where you are a little bit handicapped are like putting a kid in a car seat or getting suitcases out of the back of the car where you really can’t get your body under the weight. And when you are reaching out and lifting, that really puts your back in a lot of danger for being injured.
Host: Oh yeah. A lot of back strain there. That’s for sure. So, let’s talk about treatment. What are some of the nonoperative treatment options for back pain?
Dr. Vresilovic: Generally, we start by very simply trying to avoid things that hurt us. It seems very simple minded, but if you know every time you do a certain activity it hurts you and you are having back pain; we are going to have you stop those activities. But on top of that, we try to use anti-inflammatories because associated with most injury is a degree of inflammation. You know when you have a paper cut you get redness around it. that’s inflammation. And when you focus on physical therapy and there we are really trying to get the back to work better and it’s somewhat counterintuitive but people that have pain that stop moving around, weaken their muscles and then more load goes on the structures that are failing. So, by maintaining your musculature, you help prevent further injury.
Host: Wow, that makes sense. So, that why in physical therapy they are always trying to build up the muscles around the joint or the affected area.
Dr. Vresilovic: That’s absolutely correct.
Host: So, then when it comes to surgery, what are some of the common surgical treatment options for back pain?
Dr. Vresilovic: Well surgery really breaks up into two primary categories. We are either decompressing the nerves and that’s often called a laminectomy or a discectomy. We are taking pressure off the nerve whether it’s being caused by a herniated disc or spinal stenosis or a tumor or even a fracture fragment. So, that’s one thing we do. We take pressure off the nerves and the other thing we do is we stabilize mechanically unstable spines. So, if you have a slipped disc which we call spondyloses or scoliosis, or you have a fracture or possibly a tumor that’s damaged your bone; we do things to stabilize that spine and typically that involves instrumentation and fusion.
Host: So, from what I’ve heard, Dr. Vresilovic, most back pain can be managed without surgery. Is that right?
Dr. Vresilovic: I would absolutely agree with you. And it really depends on what we’re talking about. So, we’re very aggressive with neurologic injury. Once you start damaging your nerves, we’re going to try to stop that damage before it becomes permanent. So, when you have compromise of the spinal cord or the nerve roots, we may observe that for just a very short period of time before we are going to try to correct that problem. So, we’re aggressive when it comes to nerve damage because once a nerve is damaged, we can’t always allow it to return. It can’t always heal itself. In fact, surgeons don’t heal nerves, they try to prevent them from being damaged or allow the body the chance to heal them.
On the other hand, if we are talking about just back or neck pain, we’re going to try to string you out and try to avoid that and try to do conservative measures. There are times when we have to come to surgery but there’s a lot between when you get injured and when you would get surgery. And a lot of times, time is on your side, 90% of back pain will heal on it’s own in three months. So, we’re not going to drop and do surgery right away until we’re sure you are not on a path of correction on your own. And then we may intervene.
Host: Right that’s a great distinction. Thanks for explaining that. Knowing that when it comes to potential nerve damage, that’s when surgery is called for to potentially stop that from happening.
Dr. Vresilovic: That’s correct.
Host: Well this has been really informative. Thanks for your time.
Dr. Vresilovic: Well thank you for your time.
Host: That’s Dr. Edward Vresilovic. And to schedule an appointment with Dr. Vresilovic at Orthopedic Specialists of Central PA, please call 717-735-1972, that’s 717-735-1972. Or you can visit www.upmcpinnacle.com/oscp, that’s www.upmcpinnacle.com/oscp for more information. And if you found this podcast helpful, please share it on your social channels and check out the pull podcast library for topics of interest to you. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.