Back & Neck Pain

Back and neck pain is the most common type of pain problem in this society being present in 80% of the population with incidents amongst men and women about the same.  The pain leaves about a third of these people unproductive for varying lengths of time.

Nearly a third of the patients with significant back pain will also develop sciatica or severe leg pain felt along the course of the sciatic nerve.  During a course of time 90% will experience recurrences.  Findings from an industrial survey demonstrate the severity of the problem. 

"About 25% of the days lost from work were due to low back disorders. Of individuals out of work for more than six months only half are were able to return. The average industrial disability claim was 25.5 days: the average for back disorders was 123 days."

Awkward posture, poor musculature, overweight and flabby muscles are among the causes of back pain especially among industrial workers and other heavy laborers.  Rupture or herniated discs are most commonly related to bad work habits and improper lifting such as outreach lifting with the back in a flexed rotated position.

With corrective treatment, proper posture and education in body biomechanics about 20% of the patients with symptomatic disc disease relieved of all symptoms and can resume all Activities.  Surgical treatment is required by other 10-20%.  The remainder need to modify their activities and learn to live with a tolerable degree of discomfort. 

Cervical spine disorders also produce pain which may be felt in the neck or other areas including arm, shoulder and scapula.  Pain may arise from the herniated disc or malfunctioning joints.  These disorders cause irritation of the nerve roots or spinal cord itself and account for 1-2% of acute care hospital admissions. 

As a rule compression of a central nerve root may initially produce severe pain or a pins and needle type sensation and may also produce loss of reflexes.  With corrective treatment, pain may abate but prolonged compression sometimes leads to weakening of the muscles which may be permanent.

Sometimes the decision not to operate is more important than deciding to operate.  The surgical decision should be clearly thought out after a careful neurologic exam.

All appropriate tests should be done.  A frank discussion between the surgeon, the patient and the families should include possible complications and limitations and alternatives. 

Other painful back and neck problems can also be diagnosed and treated by a multi disciplinary effort between the neurosurgeons, orthopedic surgeons, family physicians, anesthesiologists, physical therapists, psychologists and nurses. 

One of the most disturbing and difficult painful condition is due to cancer.  This pain can be controlled if not completely relieved by several neurosurgical procedures and implantation devices ranging from time released morphine pumps to electrical stimulation of the spinal cord.  Some patients can also be greatly helped by pituitary surgery which relieves the pain of infiltrating cancer by some very complicated phenomenon.