The Doctor Is In: Dealing With Back and Neck Pain

By Robert Heary
WebMD Live Events Transcript

Event Date: 8/27/2001

You've heard that death and taxes are unavoidable, but maybe back and neck pain should also be on that list. It seems we all experience it in some form, from mild to serious, sometime in our lives. Robert Heary, MD, from the American Association of Neurological Surgeons, presents the latest information on prevention and treatment options.

The opinions expressed herein are those of the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to our live event with Robert Heary, MD, from the American Association of Neurological Surgeons. Dr. Heary is here to answer your questions about back and neck pain. Before we get to our member questions, can you take a moment and tell us about your background?

Heary: Sure. My training is as a neurological surgeon, however I have also done training in orthopaedic spine surgery during my fellowship. As a result, I feel comfortable with problems that might be typically handled by either an orthopaedic surgeon or a neurological surgeon.

Moderator: What are some of the most common causes for back or neck pain, and what can the average person do to avoid injury?

Heary: The most common cause of low back pain is due to problems of the disc between the bones of the lower back. Disc problems can include either a herniated or a degenerated disc. Both can cause pain in either the leg, back, or both. As far as the neck goes, again the most common problems are related to the disc located between the bones of the neck. Problems in the neck can cause arm and neck pain, but also problems in the entire body if the spinal cord is compressed. This is a very serious situation, although it doesn't occur with high frequency.

lynne_webmd: I have had upper neck and mid-back problems all my life. The fact that I am tall and work on a computer to make my living has compounded my problems. I'll be fine for awhile, then stress my neck and back. Even with a chiropractic adjustment or two, I'm left with a stabbing pain in my back and cramped muscles. What can I do?

Heary: This problem is not uncommon. Frequently people have occupational difficulties if their work station is not ergonomically ideal. It is very important to have the work environment examined to assure that both the back and neck positions are normal and comfortable while you are working, and to make sure your hand positions are comfortable with respect to the keyboard. Any of these misalignments can lead to difficulties.

janice519_webmd: Yesterday I went in to have a steroid shot in my back. Instead the doctor did 3 nerve blocks. Is there a difference?

Heary: Often people refer to nerve blocks or a steroid block in similar fashion, but ordinarily a nerve block is different from a steroid block. Steroids may be injected around a nerve or the spinal cord itself. These are very strong anti-inflammatory medicines, utilized in an attempt to decrease pain. Nerve blocks are normally performed with a local anesthetic. The difference between a nerve block and steroid injection is that the nerve block lasts a shorter period of time.

cubs629_webmd: I sit at my desk all day long every day working at my computer. I often suffer from neck pain when I go home in the evenings. Should I see a neurosurgeon?

Heary: It is reasonable to be evaluated by a spine specialist. It may be difficult to get an appointment with a surgeon before any preliminary work-up has been done, so most patients first consult their primary doctor in order to begin the workup process. The work-up may include X-rays and possibly an MRI or CT scan, and in some situations, a course of physical therapy may be performed. If the preliminary workup identifies any specific neck problems which may be benefited by surgery, then an appointment with the neurosurgeon would be excellent at this point.

nanbi_webmd: My MRI stated "leftward eccentric bulge at l4-5" and "bulky facets contributing to borderline canal diameter and left L4 neural foraminal narrowing ..." Can a bulging disc cause the same severity of pain as a herniated disc? Thank you.

Heary: Very good question. It's a commonly seen problem. The difference between them is oftentimes how one radiologist will report a given study. Many times the two may refer to the same problem. The nerves need to leave the spine through bony holes or foramina in the spine. If the openings are narrowed, that causes problems with the nerve route. In addition, if a disc is herniated or bulging it can lead to further problems with the nerve route. As a general rule, nerve route problems show up as pain in the leg. There may also be weakness and/or numbness in the leg as well.

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