My Aching Back: The Evolution of Spine Treatment and Surgery

One minute you are out in the yard mowing your lawn and the next minute you are hunched over in pain. It’s your back. And you can’t figure out what happened. Rest assured. You are not alone.

The good news for you, hunched over in your yard, is that most episodes of LBP resolve themselves with non-surgical treatment, which can include exercise to optimize trunk or “core” strength and improve general flexibility and cardiovascular endurance; application of heat and/or cold; acetaminophen or non-steroidal antiinflammatory drugs (NSAIDs) for pain relief; and possibly muscle “relaxants” or narcotic pain relievers to facilitate sleep. In some cases, physical therapy, pain management, coping skills and alternative medicine may also be used to help alleviate pain. Fifty percent of episodes nearly completely resolve within two weeks, and 80 percent by six weeks. But what happens when back pain doesn’t go away? Depending on the diagnosis, surgery may be in your future.

 
Although there are recorded instances of rudimentary spinal surgery dating back as far as 1550 B.C., spinal surgery today bears little resemblance to that practiced even fifty years ago. Due to limitations of diagnostic testing and available procedures, surgeons did not even understand the cause of many common problems. The last half-century has seen marked change and improvement.

 
The technological boom that allowed NASA to put a man on the moon in the 1960s also led to the first microscope built for use in the operating room. Physicians also developed imaging concepts, such as the computer assisted tomography (CAT) scan and magnetic resonance imaging (MRI) scan, that would revolutionize spinal surgery and medicine, in general. The first advances in bone fusion were made with the discovery of chemicals that cause bone to fuse — called bone morphogenic proteins (BMP).

In fact, only since the 1970s have technological advances in diagnostic imaging, a greater understanding of spinal biomechanics and bone growth physiology, and the development of spinal fixation instrumentation allowed for exponential growth in the field of spinal surgery. Today, there are approximately 400,000 lower back operations performed annually in the United States.

William Dillin, MD, a spine surgeon, says that much of his current surgery schedule involves a mixture of both the new and the tried and true — utilizing the most beneficial minimally invasive or maximally invasive technique to accomplish the surgical goal of returning patients to normal function.   Continue »

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