Neck, Arm, Back and Leg Pain:Facts and Mythsby Scott Hodges, D.O.http://micronavspine.com

Center for Sports Medicine and Orthopedics

2415 McCallie Avenue, Chattanooga, TN 37404

800-757-2696 / 423-624-2696

Copyright 2012, Scott Hodges, DO and VoxMD

ForewordThank you for taking the time to do one of the most important things you can do to help with your neck, arm, back and leg pain – seeking information. One of the most difficult things to understand is, simply, why does my back, neck, arm or leg hurt? In this eBook, we'll look at some of the causes and conditions of pain, and some of the treatments available. But rest assured that we won't cover all of them. And in the next few or many books you read on neck, arm, back and leg pain, you still won't find all the answers.

I've looked in bookstores and online and seen many titles promising “Back Relief in 5 days” or “Dummies Guides” for neck, arm, back and leg pain, and countless exercise books. All of these books promise to help you or heal you. I can tell you with absolute certainty that no book – including this one – holds the answers. They may hold wise information, they may hold worthless information, but none of them hold THE ANSWER.

MYTH: There are books available online that can heal my neck, arm, back or leg pain!FACT: A book cannot heal your neck, arm, leg or back pain. It can only give you advice that is (a) general and (b) may not help you and, in some instances, could hurt you.

The answers and treatments can only come from one source: the engagement between you and your doctor. Every patient is different, every condition manifests itself differently with every person, and everyone responds to treatments differently. The most effective treatment specifically for you comes from the relationship between you and your doctor. The destination to a better quality of life is down a road that has many twists and turns. There are many “miracle cures”, salves, equipment, and options that all promise pain relief that will distract you from the journey. But the wise old saying - “if it sounds too good to be true, it probably is” - is appropriate for most of these. Don't follow these roads, as they only lead to dead ends.

Educate yourself, talk to your doctor, follow the course of treatment, and never be afraid to ask questions. The more you know, the better you can understand me and relay information to me. If you are my patient, you won't be alone on your journey and I'm happy to guide you.

How To Use This eBookThis book is intentionally brief. Read the sections and at the end of each one you will find a Next Steps action. Think of this as your homework. Follow the suggestions and learn as much as you can about the topic. Remember, no one book can give you all the answers. They can, however, add to your education about conditions. Your homework helps add to your knowledge and helps you communicate better with your doctor, as well as understand what he says to you.

What is Neck, Arm, Back and Leg Pain?Understanding pain and being able to describe your pain to your doctor is key to a successful diagnosis and measurement of treatment effectiveness. This section will help you understand some of the key terms used to describe pain.

Acute, Chronic, and Neuropathic PainAcute pain is sudden and sharp pain that is directly related to tissue damage. It's the sensation felt when a hand is caught in a door or a head is bumped. The pain felt during childbirth is also acute pain. It can subside instantly or last three to six months. Acute pain is often the symptom of injured or

diseased tissue, and it disappears when the tissue heals or is treated. If acute pain is not relieved, it can lead to chronic pain.

Chronic pain continues even after an injury has healed and lasts more than three to six months. The source of chronic pain can be something identifiable, like an ongoing injury, or something unidentifiable, like when no injury is present. Chronic pain is described as an aching, deep, burning or dull feeling that carries into the extremities.

Neuropathic pain occurs after signs of injury to tissue are no longer visible. With this pain, nerve fibers may be damaged or dysfunctional, causing them to send incorrect pain signals to the brain. Neuropathic pain, or neuropathy, could be placed in the chronic pain category, but the sensations felt are very different from musculoskeletal pain. Neuropathic pain is described as severe, lightning-like, burning or cold, with ongoing numbness, tingling, or weakness. Neuropathy may be felt traveling along the nerve path from the spine down to the arms and hands or legs and feet. Phantom limb syndrome is one example of neuropathy. NSAIDs like ibuprofen and opioids like morphine are usually not effective in treating neuropathy. Certain medications, nerve "block" injections, and a variety of chronic pain treatments are used for neuropathic pain.

Next Steps:Look up some of the terms mentioned such as acute pain, chronic pain, and neuropathic pain. Find diagrams such as Wong-Baker.

Where does it hurt?Isolating the pain isn't as easy as it sounds. Learning the anatomy of your body can help you articulate to the doctor a more precise location.

BackBack pain is one of the most common reasons for a trip to the doctor. Overstretched muscles or ligaments are the cause of most back pain. Some causes of acute back pain include improper lifting, strenuous physical effort, poor sitting or standing posture, sleeping position, and stress and muscle tension. Pregnancy, lack of muscle tone, and surplus weight can also cause acute back pain.

Back pain can also be caused by a structural or mechanical problem, like sciatica or a bulging or ruptured disc. Osteoporosis and arthritis are also structural problems that can contribute to back pain. Developmental problems caused by abnormal formation of the skeleton, like scoliosis or kyphosis, can also cause back pain. Tumors, trauma, and inflammations and infections can also contribute to back pain.

NeckNeck pain isn't necessarily serious, as it is often caused by poor posture from hunching over or leaning towards something. Arthritis can also contribute to neck pain. Neck pain can be serious however, if it shoots down shoulder or arms, causes numbness or weakness in arms or hands, and causes bowel or bladder problems. Muscle strain, worn joints, or nerve compression can cause neck pain. Trauma and diseases can also contribute to neck pain.

ArmArm pain may actually be caused by pain in the cervical section of the spine. This may be due to disc degeneration, which can cause bones spurs and spinal stenosis. Spinal stenosis and bone spurs can put pressure on nerves that travel elsewhere, like the arms.

LegLeg pain may actually be due to pain or degenerative problems in the lumbar section of the spine. Trauma, genetics, and the aging process can all damage or put pressure on intervertebral discs. This can compress nerves that lead to other areas of the body, like the arms and legs. Sciatica is an example of leg pain caused by problems in the lumbar spine.

Next Steps:Look up anatomy models online. Try to determine exactly where your pain points are. Write down what causes pain flare ups and what positions give relief. Determine if pain is present more often while lying down, sitting, standing, walking, etc.

The Degenerative CascadeWe all expect something to happen as we grow older. Many people “shrink” as their height decreases. Back pain, neck pain, arm and leg pain can occur as we “wear out”. It is true that not all of our parts come with a lifetime warranty, but the degeneration, or “wearing out”, is not always tied to age.

When we speak of the degenerative cascade in spine, we are referring to the problems caused within the spinal structure that are a result of parts of the spine wearing down or deforming. These decreases or deformities then create a domino-like effect, or cascade, that affects other parts.We may go a lifetime and never realize the degeneration that has occurred. Many people have spinal issues that cause no pain at all, yet the same degenerated structures can cause intense pain in other people. This is where the degenerative cascade is unique to every person.

Your degenerative cascade has it's own clock. It may start early in life, or later in life. Your age does not definitely indicate a stage of degeneration, however it offers a probability of degeneration. For example, if you are 30 years old, its far less likely that your degeneration is as severe as an 80 year old individual. But it doesn't mean that you can't have significant degeneration, either. Age is just one factor in the degenerative cascade. Your lifestyle – healthy or not – and family genetics, smoking habits, weight, stress, and other environmental factors all contribute.

An example of a degenerative cascade is the shrinking of spinal discs. The discs between each of your vertebrae are composed of a watery gel enclosed in a tough fibrous layer. As your degenerative cascade progresses, the water in these discs dry out. The discs begin to flatten out. And as the discs flatten, they lose height and you begin to “shrink” or lose your height. Your vertebrae, seeing the discs flattening and spreading, begin to grow bony protrusions to keep the disc covered and protected. Its possible these bony protrusions may press, or impinge, on nerves in your spine and cause pain. Or, as the disc loses

height and your vertebrae get closer to one another, the nerve opening called the foramen may close upon nerves and cause pain in the back or leg. Or... nothing may happen. You can experience degeneration and feel no pain at all. It's unique to every individual.

MYTH: As we grow older, we wear out and get back pain.FACT: Back pain, and degeneration of spine, can occur at any age. It is a natural process that can be triggered by unhealthy influences, genetics, or other causes.

Understanding the degenerative cascade is important to you as it is the foundation of many spinal conditions.

Next Steps:Search for articles about degenerative cascade. If you have had x-rays or MRIs made, you may send them to me via my website at http://micronavspine.com.

ConditionsThe degenerative cascade, as well as deformity from birth or later development, can cause neck, arm, back and leg pain. In this section, we'll look at a number of the most frequently seen conditions. This is not a comprehensive list; many spine conditions exists and variations in severity of these conditions. This list is not intended to help you self-diagnose – leave that to your doctor. The conditions presented in this section are some of the most common conditions and deformity. You should review these to get an understanding of how conditions are indicated, what tests might be used, and what treatment options exists.

Next Steps:Review the conditions below. Visit my website at http://micronavspine.com for more conditions and descriptions. If you have been diagnosed with any of these conditions, read my articles and visit reputable websites like the American Academy of Orthopedic Surgeons at aaos.org to learn more.

Degenerative Disc DiseaseOverview and Causes:Degenerative Disc Disease (DDD) is the term used to describe the normal changes in the spinal discs as the body ages. Vertebrae, which make up the spine, are separated by the soft disks. These discs act as shock absorbers. This condition occurs when one of these disks weakens.

Despite the name, it is not actually a disease. But that does not mean the pain it causes is less real. It can be very painful and can affect quality of life to a great extent. Disc degeneration is a normal part of aging, but for some individuals, it can cause severe and chronic pain.

Following are some of the causes of degenerative disc disease:• The loss of fluid in the discs can be a cause. This makes the disk less flexible and reduces its

ability to absorb shocks. This also reduces the distance between the vertebrae.• Annulus or capsule (the outer layer of disc) may be damaged or cracked. As a result the nucleus

(jelly-like material inside the disc) may be forced to flow out of the cracks or tears. This may cause the disc to rupture, break into fragments or bulge.

• A sudden injury to the disc can start disc degeneration

• Smoking, heavy physical work and obesity can also cause degeneration.

Symptoms and Diagnosis:• Pain in lower back which radiates to hips• Symptoms of degenerative disc disease include:• Pain in thighs or buttocks while walking• In some cases, irregular tingling or weakness through the knees• Pain in upper spine which may radiate to shoulders, arms and hands

This condition is diagnosed with a physical examination and a review of medical history. During physical examination, the surgeon looks for tenderness and changes related to nerves, for example changes in reflexes, numbness or tingling. Other conditions such as tumors, fractures and infections are also checked.

If symptoms of degenerative disc disease are suspected after initial examination, imaging tests may also be performed for diagnosis. These tests may include X-rays, MRIs or CT scans. Imaging tests are usually considered if the symptoms develop after injury or damage to nerves.

Treatment:Usually this condition can be successfully treated with non-surgical treatments. One or a combination of treatments like chiropractic manipulative therapy (CMT), physical therapy and anti-inflammatory medications can often provide relief.

Surgical treatment may be recommended if the non-surgical treatments fail to provide relief within two to three months. It may also be recommended if pain in legs or back restricts normal activity, if it is difficult to stand or walk, or if there is numbness or weakness in legs. Surgical treatment options include Anterior Cervical Discectomy with Fusion, Intervertebral Disc Arthroplasty, etc.

Herniated DiscsCondition and CausesIn between the vertebrae of the spine are cushions called discs. Theses discs contain an inner core, called the nucleus pulposus, and an outer wall, called the annulus fibrosis. If the annulus degenerates or tears, the nucleus can seep into the annulus and cause the disc to bulge and protrude. This bulging disc may press against nerves and cause back, neck, arm or leg pain. When the inner core pushes through the annulus fibrosis, it's called a herniated disc. The tear in the annulus fibrosis created by this bulging of the inner core causes back pain. That pain may spread to a different area of the body if the now protruding disc is putting pressure on a spinal nerve.

Symptoms and DiagnosisThe main symptom of a herniated disc is sharp and acute pain, often described as a "deep pain," which increases in severity as it moves down the affected leg. Pain onset may occur suddenly, or be preceded by a snapping or tearing sensation in the spine. This sensation may be attributed to the annulus fibrosis suddenly tearing.

There is often a limited range of motion present in patients with herniated discs, and patients will often lean to one side when bending over. Walking will often be painful, with patients attempting to alter

their gait by straightening the affected leg to avoid putting too much weight on it.

Magnetic Resonance Imaging (MRI) is often used to diagnose a herniated disc. CT scans are also helpful for providing better images of the source of pressure if a nerve root is being pressed upon by the herniated disc.

TreatmentRest, medication and physical therapy are usually successful when treating a herniated disc. Medications like anti-inflammatory drugs, analgesics and muscle relaxants may be prescribed to help with pressure and pain.

Surgery is not often needed for a herniated disc, but if a patient doesn't respond to rest, physical therapy and medications over a long period of time, surgery may be recommended.

Spinal StenosisOverview and CausesSpinal Stenosis is a condition that refers to narrowing of the spinal canal, typically caused by age and degeneration of intervertebral discs and facet joints. Arthritis is the most common cause of Spinal Stenosis, as it causes facet joints to expand, leaving little room for nerve roots. As the disc degenerates, they dry out and weaken, reducing in height. The load on the vertebrae shifts, putting more demand on the facet joints. The facet joints can weaken and inflame, causing the openings to shrink and press on nerves. Bone spurs may also develop and grow into the spinal canal. Ligaments around the joints can also increase in size, causing additional irritation and pressure on nerves.

Symptoms and DiagnosisMany of the symptoms of Spinal Stenosis are consistent with other spinal conditions:

• Leg Pain - This may or may not occur and many people with Spinal Stenosis feel pain in their extremities rather than in their back. This is known as "referred" pain.

• Numbness/Tingling - The pressure on nerves may cause sensations in extremities that feels like an electric current or a lack of sensation in touch.

• Burning/Aching Pain - Nerve pressure can cause a radiating pain down the extremities. This is often referred to as sciatica. This pain can extend its reach based on location of degenerative condition.

• Weakness/Instability - As pressure on nerves increase, the extremities can lose strength and ability to maintain grip or balance. Lumbar Spinal Stenosis can cause "foot drop," where the patient's foot drops or drags while walking.

• Decreased Pain in Sitting Position - Leaning forward while sitting can cause the stenosis to temporarily shift itself back into a more normal position that opens the nerve space, providing relief. Standing and walking causes more pain than sitting in stenotic conditions.

Your doctor may perform tests on you to determine if you have Spinal Stenosis, and how severe it is. These tests may include patient history, X-rays and MRIs to get background and images of your spine. Additional tests may include CT scans and myelograms to determine where the condition is occurring and if nerves are being compressed.

TreatmentTreatment for Spinal Stenosis ranges from conservative to surgical. Your doctor will work with you to

develop the most effective treatment path.

Non-surgical options include physical therapy, lumbar stabilization and traction devices, anti-inflammatory medications, steroidal injections and/or other non-surgical treatments.

Surgical options range and are decompressive in nature. The surgical options depend on severity of condition and may or may not include discectomy, or removal of damaged disc. Discuss your options with your doctor.

SpondylolisthesisCondition and CausesThe spine is made of 33 bones called vertebrae. When one of these bones slips forward on the adjacent neighboring vertebra, this is called spondylolisthesis. This condition can cause back and leg pain, as well as other symptoms. Spondylolisthesis may be hereditary, or it may be the result of stress placed on the spine. It can also be due to spinal degeneration. This condition can gradually cause a deformity of the lower spine, and it can narrow the vertebral canal.

There are five different types of spondylolisthesis:• Dysplastic spondylolisthesis occurs when a defect in the facet allows the vertebra to slip

forward. This type is congenital, meaning the patient is born with it.• Isthmic spondylolisthesis occurs when there is a defect in a portion of the vertebra called the

pars interarticularis. This condition can be caused by repetitive trauma, and it is more evident in athletes who may hyperextend, like football linemen or gymnasts. However, if there is no slippage of a vertebra, the patient has spondylolysis. Isthmic spondylolisthesis can be further divided into three categories:

• Type II A: Often called Lytic or stress spondylolisthesis, this type is likely caused by repeated micro-fractures due to hyperextension. This type is more common in males and is called a "stress fracture" of the pars interarticularii.

• Type II B: Likely also occurs from micro-fractures in the pars interarticularii. This type is different from the preceding type in that the pars interarticularii stay intact, but stretch out as new bone fills in the fractures.

• Type II C: Caused by an acute fracture of the pars interarticularii. This type is very rare, and may require nuclear imaging to firmly establish diagnosis.

• Degenerative spondylolisthesis is caused by arthritic changes in the vertebral joints due to cartilage degeneration. This condition is more common in older patients.

• Traumatic Spondylolisthesis is caused by injury or direct trauma to the vertebrae. In this type of Spondylolisthesis, a fracture of the lamina, pedicle or facet joints lets the front part of the vertebra to slip forward.

• Pathologic Spondylolisthesis occurs when the bone is made structurally weak due to a disease, like a tumor or another bone disorder.

Symptoms and DiagnosisLower back pain is the most common symptom of spondylolisthesis. The pain is often made worse by bending forward and relieved by bending back. The amount of pain experienced does not correlate to the degree to which the vertebra has slipped. Leg pain may also be felt, which may be due to narrowing

of the space where the nerves leave the spinal canal.

Half of patients with spondylolisthesis will associate the onset of their symptoms with an injury. Often a patient will lay the groundwork for the injury earlier on in life by developing a lesion. This lesion may not develop into spondylolisthesis until much later in life.

There is usually little deformity detectable, and range of motion is not usually impacted. Often, tightness of the hamstring muscles is the first physical sign of spondylolisthesis. Back pain may occur at irregular intervals, particularly when arching the back. If a nerve is being pinched by spondylolisthesis, a patient may display symptoms similar to those seen with a herniated disc, including muscle weakness of the legs, numbness or tingling in the feet and leg pain.

TreatmentTreatment varies, depending on if the type of slip, the patient's age and symptoms, and whether pressure is being put on nerves. For those whose nerves are not affected by the vertebral slippage, treatment starts with non-surgical treatments like medication and physical therapy. Bracing may also be recommended. If symptoms are manageable and the slip is small, the treatment will likely be observation. Activity restrictions may be necessary for children, like abstaining from certain sports.

If the slip is more severe or symptoms of nerve compression are present, surgery may be recommended. Surgeries for this condition include spinal decompression, where bone is removed to make room for the nerve being compressed, or spinal fusion. These surgeries are often done at the same time.

Adult ScoliosisCondition and CausesAdult Scoliosis is a result of untreated adolescent scoliosis that has become worse, or as a result of degenerative spine conditions.

Scoliosis occurs when the spine curves abnormally in one or more places. These curves may affect balance and alignment in the body, and can limit a person's ability to move normally.

Two percent of people are affected by this deformation of the spine, which frequently develops before puberty. It can be hereditary, or it can occur due to one of several causes:

• Secondary: Developed as a reaction to other spinal conditions that change spinal alignment and balance, like degenerative disc disease or osteoporosis. Degenerative adult scoliosis is the term used to describe scoliosis that develops from spinal degeneration.

• Congenital: Existing from birth• Myopathic: The muscles around the spine do not work properly due to muscular or

neuromuscular disease, like cerebral palsy or muscular dystrophy.• Ideopathic: Arising spontaneously, or from an obscure or unknown cause.• Paralytic: The vertebrae in the spine may become unbalanced when the muscles around the

spine no longer work due to spinal cord injury.

Symptoms and DiagnosisWhen scoliosis is present, several signs occur. These include uneven shoulders, shoulder blade

protrusion, uneven waist or elevated hip.

A diagnosis can be confirmed using diagnostic tools including X-rays, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). The Cobb Method can be used to measure the extent a curve has progressed. This method categorizes in terms of degrees. A curve is viewed as significant if it is greater than 25 to 30 degrees. Forty-five to 50 degree curves are viewed as severe and usually require more aggressive treatment.

TreatmentMost people don't need treatment. Early detection is important because medical observation can ensure that the curve doesn't worsen. If intervention is needed, a brace may prevent curvature, but in some cases, spinal fusion surgery made be needed to straighten and stabilize the spine.

Your doctor may consider spinal surgery if the condition hasn't responded to any other, more conservative treatment, or if your curve advances to more than 40-50 degrees. Other considerations for spinal surgery to treat scoliosis include progressive neurological changes including weakness, tingling or numbness, or if the deformity has become unbearable for physical or aesthetic reasons.

Treatments for Neck, Arm, Back and Leg PainTreatments for neck, arm, back and leg pain range from conservative to radical to absurd. Determining the best course of treatment is something you and your doctor will discuss, execute, and measure.

MYTH: Surgeons like to cut things out and fuse your back to remove pain.FACT: Surgeons are more likely to recommend conservative treatments rather than surgery.

The above Myth is one of the more common ones. The word “surgeon” usually suggests complicated operations with scalpels flashing, organs and blood spattering, and monitors beeping. In reality, a surgeon is a physician who is highly trained in a discipline, such as orthopedic spinal disorders, who can perform surgery if needed. The key word is “if”. Depending on the severity of your condition, a simple physical therapy program may strengthen your muscles enough to support your spine and remove the pain. And in the event that surgery is necessary, always as a last resort, there will be beeping monitors but the new minimally invasive surgical techniques keep pain and surgery to the smallest incisions possible.

Next Steps:Visit my website to learn about Minimally Invasive Spine Surgery at http://micronavspine.com/minimally-invasive-approach. This, and other articles on the site, help you understand the newest, safest, surgical techniques.

Goal of TreatmentsWhether its surgical or non-surgical, the goal of treatments should be to correct an imperfection that is causing pain. In the event of a degeneration, the treatments goal is usually to decompress vertebrae that may have slipped or shifted due to degeneration of discs. Physical therapy and chiropractic massage can often help relieve muscle tension and build up muscle strength to support spinal structures.

Deformity may be corrected through physical therapy and bracing if pain is present, or simply observation if no pain exists. If surgery is necessary, it is used to straighten and align spinal structures.

The goal of many non-ethical miracle cures or gadgets and gimmicks is to cure back pain by lightening your wallet. If you've ever been to a physical therapist, you know the time they take to get to know you. They examine your gait, your range of motion, your age and health, and other factors to determine what you can and cannot do, and they then create a program specifically for you. A book or website cannot do this. If a gadget or gimmick is not found within a doctors office or a physical therapists office, why would you think it would work as a course of treatment?

MYTH: There are miracle cures for neck, arm, back and leg pain available that your doctor doesn't want you to know about.FACT: If it was a miracle we'd all know about it and it would be widely available. And you'll be hard pressed to find a prescription drug with the word “miracle” on the label. As a surgeon, I want you to know what works for you and the only way to know that is to work with you on a course of treatment. There are no miracles, but there are certainly goals we can achieve together.

Achieving the goals of treatments requires a plan that usually begins with a simple option that progresses to a complex option. The nature of your plan is based on the severity of the condition, and the alternatives are always presented to you by your doctor.

Non-surgical TreatmentsNon-surgical treatments for spinal conditions, also known as conservative treatments, include physical therapy, yoga, pilates, and other forms of physical exercise designed to strengthen muscles in your core and support structures. Massage and manipulation techniques help loosen muscles and may be performed by chiropractic and massage therapists. If pain is persistent, injection therapy may be used where nerve blocks and other injections are used to minimize pain.

Conservative treatments, just like surgery, should be pursued with supervision. Improper exercise techniques can compound your conditions. You should always consult your doctor first before pursuing any form of exercise if you have pain.

Surgical TreatmentsOn my website are many surgical treatments at http://micronavspine.com/patient-education/treatment-options. I provide this as a resource for patients who will need one of these treatments. You may or may not be a candidate for one of these surgeries, but they serve as a reference to the types of treatments that are available. Again, I state that these are not all the treatments available, and depending on the severity of your condition, we may perform variations of these surgeries if, and only if, needed.

You will notice that some of the treatments are referred to as “open”, and others are referred to as “minimally invasive”. What you won't see, however, is a “laser” surgery option. Let's look at these three types of treatments and why they might be performed.

Open ApproachWhen surgeons first began treating deformity and degeneration of the spine, they had to make incisions to reach the affected area. When an incision is made, skin and muscle is cut and pulled apart to reveal the affected area. Treatment is performed on the affected area and the muscles and skin are sewn back together. While this sounds very clinical in nature, it also sounds painful. A paper cut is painful, so an incision is certainly more painful. We seek to control this pain with medications and the smallest opening possible.

The open approach is used because (a) this is how the surgeon was taught and is all they know, (b) there is no minimally-invasive option for the type of surgery, or (c) there is no minimally-invasive option known by the surgeon. I have had the fortune to learn and master minimally-invasive surgical techniques, so I use them as often as possible, but there are times when only an open approach will work. In my practice I base the approach on the course of treatment, not my lack of training. The question you have to ask your doctor if surgery is indicated, is whether he or she can perform a minimally-invasive approach for your procedure.

MYTH: Open approaches are necessary for some surgeries.FACT: Open approaches might be necessary, but you should always ask if your surgeon can perform minimally-invasive surgery.

Minimally-invasive ApproachMinimally-invasive approaches use small incisions. A series of tubes are threaded through these incisions that dilate, or spread, the muscles. This creates an opening without unnecessary cutting of muscle tissue. This means less pain and faster recovery. The downside is that the opening is still very small and special implants and tools must be used. Visibility of the affected site is also compromised, so training, tools and experience is critical to achieving an optimal outcome.

Minimally-invasive approaches typically have a faster healing rate of the soft tissues so can get back to work faster. While this sounds like what you would always want, it isn't always appropriate. If you have a severe spinal condition that requires large rods and constructs to support your spine while it heals, you may not have a minimally-invasive choice. Always ask if there is a minimally-invasive option and the doctor's experience in these techniques.

In my practice I use imaging techniques and microscopes to help me “see” into the patient and guide my instruments. These imaging techniques use special tools and computers that give me a visualization of what is going on inside your body. This allows me to see what I'm doing from all angles, while performing minimally-invasive surgery, something that would be impossible without this technology.

Next Steps:Learn more about microscopic, minimally-invasive image guided surgery on my site at http://micronavspine.com/minimally-invasive-approach/micronav.

Laser SurgeryYou've probably seen the ads for Laser Spine Surgery – they're everywhere. And you've probably seen Star Wars and other science fiction shows. They have lasers as well. Let's look at the myths and facts of Laser Surgery:

Myth: Lasers can be used to perform spine surgeries.Fact: Hammers can be used to perform spine surgeries. A laser is a tool, not a solution.

Lasers produce waves of electromagnetic radiation. Laser is short for Light Amplification by Stimulated Emission of Radiation. The beam produced is a series of tiny electromagnetic waves that produce heat. A larger version of these waves are known as microwaves. Many different types of lasers exist, but their primary use in any medical procedure is to produce heat. Because of the heat variation and lack of control, lasers are rarely used in surgery. Instead, a Bovie instrument is used which uses electric current to produce heat and cauterization precisely.

Myth: Lasers are used in many types of spine surgeries.Fact: Lasers are rarely used in spine surgeries.

Spine surgeries often require excise and trimming of bone. A laser powerful enough to cut bone produces a huge amount of heat and can cause “thermal injury” - a polite way to say cooking the surrounding tissue.

Those doctors who elect to use a laser can only use it in very specific procedures that eliminates symptoms, but rarely cures problems for a long term outcome. For example, some procedures involve insertion of a percutaneous rod through a small cut in the neck of the patient. The rod is inserted into a disc that is herniating. A short burst of laser vaporizes some of the nucleus creating a vacuum and pulls the herniation back into place. This is called a percutaneous laser disc decompression. But lets look at the facts in this case: you removed part of the disc in order to pull back in the herniation. This means you now have a disc that still has lost height, possibly even more. The damage to nerves and bone still exists, and the condition is now a degenerated disc that isn't herniated. It is still a problem and can become a worse problem.

Myth: Lasers are used to fix facet joint pain. I saw it on a website.Fact: You found the one procedure that actually claims a laser. And its not a laser.

There is a spinal practice that advertises and brands themselves with the word “laser”. If you examine their treatments offered, you'll see a lot of reference to “endoscopic” and “minimally-invasive” but only one laser treatment. This is referred to as a facet thermal ablation. This is not a procedure performed on vertebrae but on the facet joint tissue and, specifically, the nerves around them. The “laser” is a laser in only the broadest sense of the term. Its correct name is radiofrequency ablation. It is a procedure that uses electromagnetic radio waves to heat and cauterize the nerve endings of the facet joint.

SummaryThere are many possible treatment options available to you for neck, arm, back and leg pain. The course of treatment that will work best for you is not found in a book, a website, a gadget, or an infommercial on late-night television. The treatment path is determined by you and your doctor. And your knowledge of the treatment path and your condition is critical to success.

There are technologies that exist that can help minimize pain and produce outstanding results with minimally-invasive techniques. And there are technologies that are nothing more than snake oil, a sham designed to take your money. If you have questions or concerns about your course of treatment, your doctor's recommendation, or surgical treatments you've read about, I highly encourage you to contact me, and to visit my website at http://micronavspine.com/.

Your road to a better quality of life begins with you making the decisions to seek help and treatment.

Scott Hodges, DOCenter for Sports Medicine and Orthopedicshttp://micronavspine.com800-757-2696email: info@micronavspine.com