Think You Need Back Surgery? Listen to Your Leg Pain
It’s almost a certainty that each and every one of us is going to experience back pain at some point or another in our lives. The most commonly quoted statistic says four out of every five people will suffer some sort of back problem. But despite its prevalence, the causes of back pain are complicated and even mysterious at times, making treatment difficult.
Another commonly accepted statistic is that 85 percent of the time the origins of back pain cannot be determined. Some people injure their back by doing nothing more than getting out of bed in the morning. Muscle strains from accidents or physical activity can have their roots in the lifestyle choices we make, or can be brought on by mental and emotional stress.
The back is a huge system of muscle, bone and nerves performing a vast array of tasks for the body. We as humans sit a lot but we’re meant to move. Our core muscles deep in the pelvis and spine get weak because we don’t use them. You sit at your desk all week and then during the weekend you injure your back trying to move a TV or a refrigerator down the stairs. Maybe you experience the pain right away or you might not feel the effects until a week later.
So much of the back pain is just muscle strains or tears or inflammation — what medical professionals call soft tissue mechanical back pain. There’s no real surgical treatment that can help muscles. The ligaments, tendons and muscles get sore or cranky from overuse and they need rest or medicine to get better. Back surgeries only account for about 15 percent of my practice, in fact. But there is an easy way to tell when a surgical procedure can fix your back, and it starts with paying attention to pain in your legs.
In general, the surgeries that work best for the spine are ones that alleviate the pain, weakness, tingling or numbness in any part of your leg from your rear end down to your feet. Sciatica is the all-encompassing name for this kind of nerve pain, and many patients feel it in their legs long before it starts to affect their back. It’s very easy to detect with an MRI test. Often the pain will map out from the lower parts of the backbone right down the nerve roots like one of those diagrams you see in medical books.
A herniated disc is the most classic cause of sciatica. The inside of a disc is like crabmeat or putty and, if the disc tears, that material begins to push out and hit the neighboring nerves causing this terrible pain in the legs. Sometimes it will go away on its own; sometimes it could lead to an even worse back condition. But all orthopedic surgeons are trained to perform the straightforward operation that can quickly cure the pain by removing the extruded fragment and relieving pressure on the nerve.
Another back problem that leg pain could be warning you about is spinal stenosis, or tightening of the spinal canal housing the spinal cord. This is a condition where little joints in your back, called facet joints, swell up around the spinal canal. Think of how the waist of an hourglass gets narrower in the middle before widening again and that paints a pretty close picture. These facet joints also sit right next to the leg nerves, so the narrowing will cause aching or weakness in the legs usually with walking. Unlike the immediate pain of sciatica, spinal stenosis occurs more slowly, so over a long period of time you may find that you can’t walk very far without feeling it.
Some people have a congenital or developmental abnormality that can cause spinal stenosis at an early age but the condition usually occurs when people reach their seventies or eighties. In either case, once an MRI determines the exact location of the narrowing, the procedure to remove the bone and ligaments around the nerve is straightforward and the resulting relief from pain comes quickly.
One of the only times that back pain can be relieved by surgery is with a compression fracture. These mainly occur in older people suffering from osteoporosis. An x-ray can see right away if one vertebrae has compressed down. About 10 years ago, a new procedure called kyphoplasty became available to surgically relieve pain from compression fractures. Through puncture wounds, small cannula are placed into the compressed vertebral fracture. Small balloons are inserted through the cannula and inflated to elevate the compressed vertebrae. Then the balloons are deflated and removed and replaced with liquid bone cement. This hardens in ten minutes, relieving most of the pain and improving curvature of the spine.
While some orthopedic surgeons do go on to specialize in complex back procedures for advanced conditions or severe spinal injuries, these simple procedures are part of every orthopedist’s training, and don’t require patients to travel to large centers that specialize in treating backs in order to get relief. If you’re experiencing leg pain or back pain that is lasting longer than several weeks, the first step is talk to your primary care physician. He or she can order an MRI to determine whether back surgery is a viable option and then refer you to a local orthopedist accepting patients in need of back surgery.
Jon Thatcher, MD, is a board-certified orthopedic surgeon with Southern Vermont Orthopaedic & Sports Medicine, which also includes Dr. Elizabeth McLarney, Dr. William Vranos and Robert Feinberg, P.A. He can be reached at 802-254-6211.