Spine Care: Feature Articles

Staying Supple, Staying Strong: It’s all in Your Back

Florinda Fonesco felt fine until the day her boss switched her to anew machine at work. She bent down to pick something up and felt an intense ache in her back.

"The pain was unbearable," said the 63-year-old Naugatuck resident. "In a couple of hours, I was all bent over."

It got so bad, Fonesco said, that she had to walk backwards to get down two flights of stairs, while hanging onto the railing.

Fonesco visited a number of practitioners before Lisa Bellner, MD, an attending physiatrist at Waterbury Hospital, told her no single therapy was going to work. Dr. Bellner told Fonesco the problem was arthritis and bad posture, among other things, and she prescribed heat therapy, massage, painkillers and exercise.

More sophisticated options
Foneso is one of many patients who are benefiting as orthopaedic doctors become increasingly sophisticated in treating the spine. Often there are numerous treatment options that don't involve surgery. Yet if surgery is needed, the results are now more promising. That's good news considering that back pain in a major complaint, second only to the common cold for doctor visits. In fact, treating back pain is a $30 to $70 billion a year business in the US.

Glenn Taylor, MD, an orthopaedic surgeon affiliated with Waterbury Hospital, and in practice with Dr. Bellner at Tribury Orthopaedics in Waterbury, points to the following developments:

More attention to movement and exercise
Depending on the problem, sometimes the right exercise program makes all the difference in a patient's therapy. Dr. Bellner says. More patients are pursuing post-therapy programs, activities that come after rehabilitation. "Aquatics have become very popular. People who have a hard time tolerating land exercise do very well in a warm pool," she said.

New medication therapies
A number if drugs help patients handle initial bouts of back pain, such as the newer anti-inflamtories, which are less likely to cause gastric bleeding. Muscle and painkillers are also prescribed.

Advancements in surgery
The hundreds of thousands of surgical procedures performed on the spine each year now use highly sophisticated instrumentation. Body casts are rarely needed because instrumentation provides rigid internal support. Individuals who were once immobilized for weeks after surgery now can expect to spend as little as three days in the hospital and can resume an active lifestyle within several weeks after surgery.

Drs. Bellner and Taylor see everyone from senior citizens with arthritis, to baby boomers with sport injuries. They see simple strains and sprains as well as muscle spasms, slipped discs and degenerative disc disease. Degeneration of the normally resilient intervertebral discs is part of aging, but can be hastened by injury, wear and tear and even cigarette smoking, the doctors explained. Genetic predisposition--your family genes--may also play a role.

Every back is different
The challenge is to come up with a custom approach that works for each patient, Dr. Bellner said. "No two backs are alike. Often a combination of physical therapy, such as beat to stimulate the muscles, massage, medication, an exercise program of motion, stretching and strengthening and a maintenance program."

Surgery is important option
Surgery is sometimes necessary. But it's less threatening than it used to be, said Dr. Taylor. Such surgeries as removing a disc that is pressing into a nerve, or fusing two vertebra together to immobilize a painful disc, have become more sophisticated and successful, the surgeon explained. "In modern spinal surgery there's a whole host of advanced hardware and devices to stabilize and fix the spine. This hardware allows for high quality results."

A 'revolution' in back surgery
Surgery performed to fuse two vertebra together also uses sophisticated 'cages'-metal cylinders that are screwed into the disc and packed with bone graft that grows over a period of time to achieve a strong fusion. "Improvements in design have revolutionized these procedures," according to Dr. Taylor.

Prevention still best treatment
Of course, the best solution to back pain is to try to avoid it in the first place. The doctors' advice: Work hard at keeping your back strong. Lose weight, avoid nicotine and learn proper back dynamics for lifting and bending. Yoga and aerobic exercise may also help. "Good abdominal and lumbar muscle strength through exercise is needed to support the spine,” explained Dr. Bellner.