Ask Dr Jost

Ask Dr Jost

Ask Dr. Jost

Sarah Jost, M.D., a neurosurgeon with the Swedish Neuroscience Institute, is one of many physicians at Swedish with a particular interest in caring for patients with back pain and spinal problems.

Question:
What could be causing my back pain?

Answer:
Back pain is the second-leading medical problem treated by physicians in the United States, and approximately 80 percent of the population experiences low back pain or neck pain at some point in their life.

When patients complain of back or neck pain, often their primary-care physician sees them first. This physician will typically order diagnostic tests that include X-rays, CT scans or an MRI. If a spinal problem is noted, the primary-care doctor will send the patient to a specialist, often a neurosurgeon or orthopedic surgeon.

In this article, we highlight these two common problems: herniated discs and spinal stenosis.

Herniated disc
A herniated disc (also called a “slipped” or “ruptured” disc) is a fragment of the central part of the disc (cushioning material between each of the bones of the spine) that is pushed into the spinal canal through a tear or rupture. The spinal canal has limited space, which is often not enough for both the nerve and the displaced disc fragment. The disc presses on the nerve, often producing pain, which may be severe. Sometimes this pressure also causes neurological symptoms of numbness or weakness.

Fortunately, the majority of herniated discs do not require surgery. The initial treatment is usually conservative and includes a lessening of activity, anti-inflammatory medications, physical therapy and sometimes steroid injections. Surgery is only necessary if significant numbness or weakness is noted, or if pain does not respond to conservative measures.

Spinal stenosis
Spinal stenosis is the most common indication for surgery in people over the age of 60 in the United States. Spinal stenosis is caused by degeneration of the bones and soft tissues of the spine, with overgrowth of bone, ligament and joints, resulting in a narrowing of the space where nerve roots have to travel.

Symptoms include leg pain, particularly with walking and standing, and often numbness or heaviness of the legs. Symptoms get better with sitting down or bending forward. Again, many patients can initially be treated conservatively, with the same kinds of measures described above. If the patient’s discomfort limits quality of life, or if conservative measures fail, then we consider surgery.

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Did you miss the recent CME offering on Spine Management for primary care physicians? Click here to view presentations.