Back on Track
Treating Common Back and Spine Disorders
By Bob Sullivan
A variation of the article originally appeared in The Indianapolis Star April 19, 2006
Dr. Joseph Riina, M.D., orthopedic spine surgeon with OrthoIndy and a physician with the St. Francis Joint and Spine Center in Beech Grove, treats victims of back pain every day. "A lot of patients can be treated non-surgically, with physical therapy and activity modification," Riina said. "When necessary, we may prescribe pain medications."
Several back conditions, though common, may require surgical intervention at a specialized facility, such as the Spine and Back Center. Two such conditions are disc herniations and scoliosis.
A disc herniation occurs most commonly in the cervical spine (neck) or in the low lumbar spine (lower back). "A disc is made up of two parts," explained Dr. Riina. "It has a jelly-like center (nucleus pulposus) surrounded by a thick fibrous ring of tissue (annulus fibrosis). A disc herniation is a rupturing of the nucleus out through the fibers of the fibrosis, and into the spinal canal, compressing the nerve root." Common symptoms include back pain combined with weakness, tingling, or numbness in either an arm or leg.
If a patient does not get better after 12 weeks, surgery becomes an option. "Surgery does not give a better long-term outcome than non-surgical treatments. However, it may get the patient back to work or functioning at a faster rate," explained Dr. Riina. "For the lower back, we can perform a microdiscectomy, which is opening a small window in the spinal canal, removing the disc herniation and leaving the remaining healthy disc. The disc will never go back to being a normal disc, but it will still function.
"With herniations in the neck, we can perform what's called a discectomy fusion, where we remove the entire disc with the herniation, and insert bone graft between the bones and a small plate."
Scoliosis is an abnormal curvature of the spine. The most common type, idiopathic scoliosis, often strikes adolescents, and is slightly more prevalent in girls. "We usually observe scoliosis curves to about 25 degrees," said Dr. Riina. "Around 25-30 degrees, we will consider a brace. If a curvature reaches 50 degrees before a child is mature, we need to consider surgical intervention."
Surgery may involve entering through the front of the chest and releasing certain tethers on the front of the spine to make it more flexible or adding screws and rods to stabilize the spine. The surgeon inserts bone graft to fuse the spine. "By fusing across the spine, we prevent the curve from progressing," explained Dr. Riina. "Using advanced technologies, all indications are that the patient should go on to live a normal life." He cautioned that the most recent techniques have not yet been conclusively tested over time.
What to do when you overdo it
According to Dr. Joseph Riina, M.D., "Most of us will deal with an episode of back pain. It's extremely common to bend, twist, or try to pick something up the wrong way."
Transient back pain-the result of muscle sprains or strains caused from repetitive motion or an increase in physical activity-can last a couple days to a couple weeks. "Most such episodes are treated with activity modification-not bed-rest, but taking it easy, combined with using over-the-counter medications for discomfort. After a couple days of restriction, you should increase your normal activities and get back into the 'normal swing of things,' so that you start to use the muscles in your back and feel better."
For more persistent episodes, you may need to call your doctor or the OrthoIndy Acute Injury Clinic. "A physician can prescribe stronger pain medications, or start you on physical therapy, aimed at increasing your range of motion while decreasing your pain."