From left: Dr. Philip Louie, Dr. Venu Nemani, and Mary Gutierrez
By Dr. Philip Louie, Dr. Venu Nemani, and Mary Gutierrez, ARNP
Virginia Mason Franciscan Health
“This is just part of getting old!”
“Don’t worry, I’ll get better soon!”
“I have too much to do, I don’t have time to go to the doctor!”
“I never feel comfortable with my doctor when I visit them!”
“I am really hurting, but I don’t know where to go!”
“I don’t want spine surgery … I’m fine!”
“I know my body; this isn’t a spine problem!”
These are the statements that we grew up listening to and continue to hear from our families and friends in the AAPI community. You are smiling because it’s true. We all know people in our lives that simply will find any reason to suffer through problems with their body, including their neck and back, and avoid going to the doctor. Based on our experience and years of medical research—most problems with your neck and back do not need solved with surgery and can be treated effectively using simple and safe treatments.
That doesn’t mean that you should simply avoid seeing a doctor or a specialist when you have neck or back pain, numbness, tingling, and weakness in your arms and legs. Sometimes these problems, when recognized and treated early, essentially can be resolved (or managed). Problems left undiagnosed or untreated, however, can slowly lead to loss of function and take away from your ability to spend time pursuing activities you love with family and friends. While we reserve surgery as a last resort for the vast majority of spinal problems, sometimes surgery is the only option to avoid a lifetime of pain, suffering, and disability. All of us have seen family members and friends in the AAPI community suffer in this way.
Inflamed nerves can sometimes lead to pain
Spine problems
Lower back/legs – The lumbar spine “sciatica”
We use the term “spinal stenosis,” which means that there is not enough space for the nerves in your spine. Commonly, this could be from arthritis or a “herniated disc.” Often, there may be no symptoms with spinal stenosis, or the symptoms can come and go. However, inflamed nerves from spinal stenosis can sometimes lead to pain (Figure 1a). When spinal stenosis involves the nerves of the lower back, in addition to back pain, you can experience:
- Legs, back, or buttocks that are sore, numb, tingling, or weak
- Pain that worsens with walking or standing and decreases when sitting or bending forward
- Cramping in legs
- Pain that shoots into one or both legs, similar to “sciatica”
- Unable to control your bowel or bladder movements (this is an emergency!)
X-rays and MRI scans can be helpful to understand the possible reasons for these symptoms.
Treatments often include different types of medications, physical therapy, exercises, heat/ice, and injections. Surgery can also be an option if your symptoms continue despite having tried multiple treatments.
Cervical spine symptoms can include neck pain or pain that runs down the arm.
Neck/arms – The cervical spine
Spinal stenosis can affect the nerves of the cervical spine as well. Cervical spine symptoms can include neck pain or pain that runs down the arm, caused by nerve irritation (Figure 1b). Weakness, numbness, and tingling in the arms are also common. Finally, symptoms may become worse because of certain movements and can include aching or sharp, radiating pain when the neck is extended backward. Some patients also describe headaches that travel up from the neck.
Again, if you experience major weakness or can’t control your bladder or bowels, this is an emergency, and you should seek medical attention right away.
Spinal cord – cervical myelopathy
This is a neck condition that arises when the spinal cord becomes compressed—or squeezed—due to the wear-and-tear changes or a large, herniated disc. Often, symptoms develop slowly and progress over several years. In some patients, however, the condition may worsen more rapidly. In addition to neck pain, patients with spinal cord compression (myelopathy) also describe:
Tingling or numbness in the arms, fingers, or hands
Weakness in the muscles of the arms, shoulders, or hands. You may have trouble grasping and holding on to items.
Imbalance and other coordination problems. You may have trouble walking or you may fall down.
Loss of fine motor skills. You may have difficulty with handwriting, buttoning your clothes, picking up coins, or feeding yourself.
If symptoms are mild, non-surgical treatments such as physical therapy can help. However, if your condition is worsening rapidly due to the pressure on the spinal cord, we recommend that most patients have surgery to stop the symptoms from worsening.
Scoliosis and spinal deformity
Scoliosis is a condition characterized by an abnormal curvature of the spine. The most common symptom is back or neck pain. You may also notice an abnormal curvature of the spine, the entire body leaning to one side or leaning forward, difficulty holding your head upright, prominent ribs on either side, humpback deformity (abnormal forward curve), abnormal gait, and a rigid and stiff spine.
Not every patient with scoliosis requires surgical treatment. Lifestyle changes (ie. stopping smoking, weight loss, eating a healthy diet, and regular exercise) are helpful in addressing the back pain. Most cases are treated using medications, physical therapy, and spinal injections to control pain. Surgery is an option for those with severe body imbalance, a larger curvature, and/or neurologic symptoms that have failed other treatments.
When to seek medical attention and who to visit?
Primary care provider
Your primary care provider (aka “family doctor”) is a great place to start for any medical concerns, including any neck or back problems. This is generally someone that you have already had a relationship with and has worked with you on other issues. They may not know exactly what is going on, but they will certainly be able to direct you to someone that does. If you are experiencing a fever or unexpected weight loss, you should seek care soon. Looking for a primary care provider? We can help you find one online at virginiamason.org or by calling (888) 862-2737.
Spine specialist (non-surgeon) – The “Spine Clinic”
Physical Medicine and Rehabilitation (PMR) providers are non-surgical spine and musculoskeletal specialists. They are a great team to start off with if you have concerns regarding your back or neck pain, pain shooting down the arms or legs, numbness, tingling, or weakness. There are many effective treatments that may be offered that do not involve surgery, including physical therapy. The team also works closely with the surgeons in optimizing your care should surgery be warranted.
There is also a dedicated “Spine Clinic” focused on back and neck pain that addresses acute symptoms (less than 6 months). Feel free to reach out at any time online at virginiamason.org/spine-clinic or call (206) 41-SPINE or (206) 417-7463.
When do I visit a spine surgeon?
Hopefully never, but we are here if you need us! Usually, it is best to have your primary care provider or a spine specialist to reach out to us about your condition and concerns. This will help the team know more about you and ensure that you have maximized your non-surgical options.
Questions in general?
Email at any time at VMMC.Communications@virginiamason.org.