"On the list of things to do for leg and back pain, surgery should
be after the many other procedures that may relieve the pain."
Eyad Alsabbagh, M.D., back-filled that list with a number of other options,
as he spoke to a full house at a seminar on "Advances and Treatment
of Neck and Back Pain" last week in Hernando Medical Park's conference
room. During his presentation, illustrated with clear charts projected
onto a screen, he went through the lesser procedures that physicians are
using to relieve the misery of injuries and deterioration processes which
Nature can conjure up for the human spine.
Surgery is an accepted means for treating many spinal anomalies. But it
has the potential to create other problems. A patient has to have a clear-cut
indication to go into surgery -- e.g., constant pain, unstable spine or
a condition that doesn't respond to injections.
Other options can leave the plan more flexible, doing what is needed to
relieve pain and restore functioning without altering the body structure.
This allows for a future change in plan, as the patient's condition requires
it.
Finding out just what's gone wrong
When a patient
presents with back, neck or leg pain, a thorough exam is the first step.
The spine holds the human frame in position. It also protects the spinal
cord, from which radiate the nerves that control the neck, limbs and organs.
The sometimes uneasy relationship between the spine and its cord can cause
a multitude of ailments.
The second step is usually radiological studies. These can be one or a
combination of these methods:
* Spinal x-rays.
* Computer tomography -- CT (or CAT) scan.
* Magnetic Resonance Imaging (MRI).
* Myelography -- injecting a dye into the spinal fluid for contrast for
clearer imaging.
* Bone scan, to determine whether the bone structure itself is sound or
deteriorating with osteoporosis.
The spine consists of vertebrae - small components stacked on top of one
another with cartilage (discs) in between to absorb shock and prevent
friction. It's a marvelous, flexible piece of work, when it's in order.
When it's injured or diseased, it can bring an astounding list of painful
-- even crippling -- conditions, which show up all over the body.
Aging itself can sometimes cause these changes.
A section of the spine may narrow, pressing on the spinal cord that it's
supposed to shield from injury. Osteoporosis can cause pressure fractures
of the vertebrae, creating spinal deformity that brings excruciating pain
and possible paralysis.
When surgery has been done, the healing may create "post-surgical
fibrosis" -- alteration of the surrounding tissue -- which presses
on multiple nerves.
Within each vertebra are two nerve roots. When these are subjected to
pressure, they can send pain all along the nerve, far from the pressure
itself.
A disc may become herniated -- popped like bubble wrap. The soft center
may ooze out with part of it peeking between the vertebrae and pressing
on the spinal cord whenever its owner bends over, or sits or stands. Another
type of tear in the disk can cause localized back pain. The type of herniation
determines the treatment.
Upper and lower back pain can come from a mislocated disc. The effect
can extend down a limb, bringing severe pain far from its source.
There's a "failed back syndrome" which is sometimes a consequence
of surgery, which brought additional pain problems.
This is an incomplete list, but it gets the idea across. A good back is
well worth protecting.
Treatment options
Goals of treatment
are varied, depending on what the patient needs to restore quality of
life.
"I treat patients one at a time," says Alsabbagh. "They're
all individuals, with unique problems, needs and lifestyles.
"I'm from the conservative school -- one step at a time."
Many times an anomaly can be repaired or at least stabilized by minimally
invasive means. An example of the latter is a procedure in which a cement
is introduced into the center of osteoporotic vertebrae, to stabilize
hairline fractures and prevent further malformation.
Medical treatment of the osteoporosis can slow or halt the bone degeneration.
In some cases, treatment has resulted in some regeneration of lost bone
tissue.
A device exists which provides electrical stimulation to the muscles over
the nerve from which the pain originates. Called "Tens Unit,"
it relieves pain when the wearer activates it. It's very effective in
some cases but not in others.
There is an implanted neurostimulation system, which the patient can turn
on and off.
Targeted delivery of a drug to a specific spot in the spinal cavity has
become another safe and effective option for many. When the drug goes
only to the place where its effect is needed, instead of traveling through
the body to find that spot, much less medication is needed. Side effects
can be greatly reduced.
Another device can be implanted under the skin on the side of the abdomen,
and a thin tube is guided into the spinal fluid. It gives continuous pain
relieving medication and can be adjusted according to need by the doctor.
Battery life for the implanted device is four to six years. It's refilled
in a doctor's office by hypodermic needle directly through the skin into
the unit.
"We've found that addiction does not occur when these small amounts
of needed medication are used over a long period of time. Other medications
may work well before we get into narcotics," explained the physician.
Shake hands with a physiatrist
Dr. Alsabbagh
(Alsa-BOCK) is a physiatrist (fizz-EYE-a-trist). This is a physician who
is concerned not only with the biological health of the body, but also
its usability. Bringing the body's components into a condition to be used
comfortably and as fully as possible is his primary goal. His specialty
is physical medicine and rehabilitation. He has also served a fellowship
in pain management at University of Louisville, Ky.
He is new to Hernando County. He and his family live in Spring Hill.
Dr. Alsabbagh works at Neuro Center, a clinic that has offices in Brooksville,
12220 Cortez Blvd. in Hernando Medical Park, as well as in Tampa and Bayonet
Point.
For further information about pain management services, or to make an
appointment, call (352) 597-4949.