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Mini Medical School: Surgery Lends Cutting-Edge Treatment for Spinal Ailments

INDIANAPOLIS - The statistics about back pain are enough to send shivers down your spine and into your pocketbook. Back pain, which afflicts 80 percent of Americans, is the second most common ailment prompting patients seek medical attention, and is said to disable more than 10 million of our population. And the pain doesn't stop there - consumers shell out an estimated $50 billion annually in health care costs.

Most cases of spine-related back pain can be treated through changes in diet, physical therapy, medications and bed rest. Failing these so-called "conservative" approaches, patients often seek a surgical solution. That's an option Michael Groff, M.D., of the Indiana University School of Medicine says is not a fix-all or necessary for many patients.

"The reality is that surgery is only warranted for a few patients with certain degenerative spinal conditions," said Dr. Groff, co-director of the IU Spinal Cord Injury Center, speaking at the Nov. 6 session of Mini Medical School. "There are no simple surgical procedures that work for all spine-related problems, but the goals are simple - to reduce the risk of re-injury and to relieve pain."

One of the most common spinal ailments is a herniated disk, what many refer to as a "slipped disk." Disks are rubbery, soft pads found between the hard bones (vertebrae) and function as both shock absorbers and joints in the spine. Disks have a high watery content, but as people age the fluid content decreases so the disk begins to shrink and the spaces between the vertebrae narrow, making the disks less flexible. When torn, the disk material pinches nearby nerve roots.

Magnetic resonance imaging or computer-assisted tomography confirms more specifically the extent and nature of disk damage, tools that neurosurgeons rely on before a patient is prepped for the operating room. An electromyogram also is a test that looks at nerve roots leaving the spine and can detect abnormal electrical signals in the muscles, thus showing if a nerve is being pinched in areas beyond the spine.

"A diskectomy removes the damaged disk and thereby relieves the pressure," Dr. Groff said, adding that surgical procedures are becoming less invasive, thereby reducing the risk of infection and scarring. "Generally, the hospital stay is short - usually only about three days - followed by several weeks of recuperation and rehabilitation."

Another procedure is the spinal fusion in the lumbar area of the spine. The lumbar vertebrae (the building blocks of the spinal column) are located in loins, the most substantial part of the spinal cavity. The vertebrae fuse to make up the sacrum, which is held between the bones on both sides of the pelvis. Back problems frequently occur where the lumbar spine connects to the sacrum causing instability and pain.

The spinal fusion is done by grafting healthy bone from elsewhere in the body (usually the pelvis) between two or more affected vertebrae, causing them to grow together. Following the procedure, adjacent spinal segments are held immobile to allow fusion to progress, usually through implanted metal devices and/or external braces or casts.

"A spinal fusion takes away some of the patient's spinal flexibility," Dr. Groff noted, "but most spinal fusions involve relatively small spinal segments and don't limit flexibility very much."

The IU School of Medicine neurosurgeon had some additional advice to spine surgery candidates to increase the odds of their recovery. "I always strongly urge patients to quit smoking, particular those receiving a fusion procedure because nicotine is a toxin that prevents bone from forming."

Dr. Groff's appearance was the fifth in a six-week series of the fall Mini Medical School. Participants meet each Tuesday night and hear from IU School of Medicine's leading physicians and researchers.

Mini Medical School is partly funded with an educational grant from Pfizer. IU Medical Group and Indianapolis radio station WIBC sponsor Mini Medical School, which is offered by the Indiana University School of Medicine Faculty Community Relations Committee through the IUPUI Division of Continuing Studies.

Web Sites and Interesting Links:

IU School of Medicine-Neurological Surgery Section
www.iupui.edu/~neurosur/

Spinal Health-Back Pain Resources
www.spine-health.com/

Back Pain, Spinal Treatments and Video Surgeries
www.spineuniverse.com/

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