Oh, My Aching Back! with Edward Benzel, M.D.

WebMD Live Events Transcript

Join neurosurgeon Edward Benzel, MD, to discuss surgical and non-surgical approaches to lower back pain and lumbar spinal stenosis.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD LIVE! Our guest today is Edward Benzel, MD, and the topic is "Oh, My Aching Back!". Edward Benzel, MD, is the director of Spinal Disorders at the Cleveland Clinic Foundation. His clinical interests include the management of Chiari malformations, spinal instrumentation, instrumentation design and complex spinal pathology. He is a member of the American Association of Neurological Surgeons.

Dr. Benzel: Thank you for inviting me.

Moderator: When should a person seek a neurosurgeon vs. an orthopedic surgeon?

Dr. Benzel: Currently, in the year 2000, the neuro and orthopedic surgeon are thought of the same, in terms of surgery. Therefore, neurosurgeons intervene surgically and non-surgically in the disorders that cause backache. Usually, the first line of defense for the management of back disorders is the individual's primary care physician. If the primary care physician is uncomfortable with the management of this disorder, or if the patient is concerned about the problem, it is best to see the surgeon. These are cases of deep, persistent pain in the back that hinders upright posture or daily activities, and are relieved by bed rest. This is the type of pain a surgeon may help. Pain that extends into the legs may be of concern and addressable by a neurosurgeon.

Moderator: Can a cause often be found for back pain?

Dr. Benzel: Unfortunately, we cannot often find a cause. There are often no anatomical findings on X-ray, CT, or MRI scans. But the most common cause is overuse. This is most commonly superimposed on a deconditioned back. The back and abdominal muscles are relatively weak. Lifting a heavy object can exacerbate this, inducing an episode of back pain. Most often, such an episode is best treated non-operatively.

Moderator: Dr. Benzel, how important is the type of bed or pillow on which a person sleeps?

Dr. Benzel: This is a difficult question. If you ask a number of surgeons, you may get a variety of answers. In my opinion, the type of bed and pillow doesn't matter significantly. In general, a relatively firm mattress and small pillow are best for managing this pain. But, it may be wrong to spend a lot of money on a specialized mattress with no proven value.

Moderator: Are there alternatives to surgery?

Dr. Benzel: There are many alternatives for the majority of patients. We must break spinal disorders down into their causes. Relatively few patients have an "instability" that would benefit from a surgical fusion procedure. Furthermore, few patients have disc herniations that require surgery. So, the majority of cases don't require surgery. Those that have refractory symptoms are the optimal candidates for surgery.

Moderator: How successful are alternative medications for treating back pain?

Dr. Benzel: Herbal meds and supplements haven't been shown in studies to improve the pain in the back or leg. Most physicians don't prescribe these. Still, they aren't harmful, and if they're helpful, the individual can take them without significant risk. But, there is no proven efficacy among these treatments.

Moderator: How prevalent is back pain?

Dr. Benzel: Indeed, it is. It is the 2nd most common cause of lost work days in the US, after the common cold. This is because, in part, of the labor and activities most people perform. For example, a dog walks on all four extremities, and disperses the load on the spine. But when we lift heavy objects, we put all the stress on the back. This is common when individuals are deconditioned, meaning, they don't have strong backs and aren't used to heavy lifting, so when they do, they strain uncommonly used muscles, beginning an episode of back pain.