THE CLINIC: Staving off Spinal Surgery

Fri, 24 May 2013 - 10:11 p.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

My spinal canal has an excess of bone built up, and several of my discs have worn down. I’d like to avoid surgery but the decreased space between vertebrae is obviously problematic—I’m at significantly increased risk of herniated discs. Can you recommend non-surgical interventions for what I’ve been diagnosed with specifically, diffuse idiopathic skeletal hyperostosis (DISH)? My doctor also said I have spondylosis. As my spine gets weaker I have neck pain but have experienced little if any increase in actual bone weakness. I did see some improvement with a regular swimming regimen and medication, and I intend to take up swimming again. I also plan to incorporate a lot of stretching. Will these interventions help me avoid surgery in the long run? And what are the outcomes surgically speaking, if worse comes to worst?

Kerri Young

Bradford, MA

ANSWER:

I specialize in providing non-surgical care to a variety of orthopedic conditions, and a significant number of my patients are spine sufferers. We all have discs which lie between the vertebrae of our spine to cushion the blows of everyday life. At birth, these discs have strong walls, and are filled with a gelatinous fluid, providing shock absorption to the adjacent bones in upright postures. Our bone-to-bone connections (joints) have a continuous production of internal joint fluid, to lubricate the joints. Periodic movements relieve the internal pressures on our joints, releasing some of this fluid.

As we age, gravity and the lifting demands on our spine squeeze out the fluid in the discs, and cause the bones to progressively lie closer to one another. The rubbing of bones together produces spinal pain. In the end, as a result of the natural aging process, gravity's influence, or of the physical demands of our lives, our ligaments are loose, the discs are deflated, the bones are experiencing high frictional rubbing against one another, and in severe cases the crowding of structures around the nerve channels becomes stenotic and strictured. The bone/disc/ligament abnormalities are associated with neck pain and stiffness. Nerve irritation yields arm pains/numbness/weakness. Nerve injuries are often irreversible.

Surgery is at the end of the treatment chain, and attempts to change the anatomical relationships of the above structures in patients with chronic unremitting pain levels, or in individuals who are experiencing nerve function loss. And generally, surgery can only be performed if the injury/arthritis is confined to a small area.

In your case, you have neck pain which seems only tolerably better with regular swimming and meds. I would be surprised if you had DISH, since it is defined by abnormally accelerated spur formation along the spine at multiple levels, usually semi-fusing the spine gradually all along its length. These patients are very stiff from neck to bottom. I would suspect that the spur formation in your neck is more probably just at the level of disc injury/degeneration, and in time these spurs can and often do fuse together. 

If you can't stand the pain, then surgeons can speed this process along by stimulating your body to fuse the painful neck joint levels quicker, and can implant a plate and screw system to reduce the joint motion significantly. Do keep up the swimming, and take an occasional aspirin, Motrin, or Tylenol. 

In a sense, all surgeries mimic real-life biologic activities. If no surgery were performed on individuals with disc degeneration, where bones are rubbing painfully against one another, the constant biologic drive within our body is to grow bone spurs from one bone to another, bridging the gap. In time, years typically, the adjacent bones will fuse together, thereby eliminating altogether the painful joint. 

Before reaching surgery as an option, keep generally active or swim, to "pump" out the joint fluid in our spine in a natural way. Repetitive low-impact exercise pushes out the joint fluid, and makes other activities that follow more tolerable. I can't emphasize this point enough, since swimming is at the core of all arthritis interventions. The process of simply moving your joints relieves joint fluid build-ups and related pain levels. So swim away or pursue simple walking on soft surfaces. Any low-impact repetitive activity is fine. And on the other end of the scale, avoid high impact, torsional loading to your spine.

John Schnell, MD

Cleveland, OH

 

 

(RUNNING & FITNEWS® September / October 2011 • Volume 29, Number 5)

 

 

 

 

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