Issue link: https://viewer.e-digitaledition.com/i/709194
BY CARRIE DIULUS, MD Spine Disorders: Treat the Cause, NOT JUST THE SYMPTOMS 1 2C L I N I C A L S E C T I O N : O R T H O P E D I C S TR ADITIONAL SPINE CARE focuses on medication, physical therapy, surgery, injections and in some cases, manipulation therapy. However, recent studies have shown that treatment practices continue to move further away from accepted guide- lines. Despite these evidence-based guidelines, many patients are subjected to unnecessary imaging scans and narcotics, and are not provided treatments that have been shown to be e¥ective. This has resulted in expensive care with inconsistent outcomes and low patient satisfaction. Getting to the root cause of a person's condition, rather than just treating the symptoms, often involves a comprehensive eva luation. Such a n in-depth eva luation ca n dra matica lly improve a patient's spine hea lth as well as their overa ll well- being. For exa mple, obesity places increased stress across the spine, which can lead to increased pain. Other systemic conditions like diabetes and autoimmune diseases can cause nerve conditions that can imitate or complicate disc herniations a nd lumba r stenosis. Treating the end symptoms without addressing the underlying causes may help relieve symptoms temporarily, but may unfortunately not provide lasting relief, which can lead to future flares. In the spine practice, we see many patients who a lso have diabetes a nd/or pre-diabetes a nd have elevated ma rkers of systemic inflammation. If we are able to e¥ectively help patients reverse these conditions with lifest yle modifica- tions — including diet, exercise, supplements and sometimes medication — we often secondarily improve their spine and nerve conditions as well. Inactivity a lone can be a significant contributing factor to spine-related pain. Prolonged sitting has clearly been shown to increase not only spine pain but a lso morbidity associated with other chronic hea lth conditions. Sitting too much can quite litera lly shorten your life and increase your pain. Our spines need to be moved to gain nutrients, stay supple and heal. Strong core and back muscles provide support for the back and the neck as well. Without this streng th, we can have pain even when attempting to maintain normal posture throughout the day. Working with patients, who are on the road to recovery, to pla n a long-term fitness progra m helps not only prevent recurring spine problems but a lso helps patients improve their overa ll hea lth. It is a lso not uncommon that we see patients su¥ering from low-back pain and even leg pain, who have failed to improve with other treatments — we sometimes discover they actually have a problem with their sacroiliac joint. Patients with prior lumba r spina l f usions a re a lso at risk for sacroiliac joint dysfunction. Fortunately, using a comprehensive approach, we are able to significantly improve and often resolve the pain associated with this condition. Expanding the "toolbox" to include a ll of the treatments that have been shown to be e¥ective in spine care can often more e¥ectively and more quickly help a patient ta ke control of their spine hea lth. Many times, combining tools results in better outcomes than the individual tools themselves. Examples include combining physical therapy with medication supplement therapy, massage therapy and yoga. Additiona lly, using tools that treat a ll of the factors a patient has a¥ecting his or her spine improves outcomes. For exa mple, using tools to improve weight a nd sleep can positively impact a patient's spine hea lth. I am often asked, " Why would a spine surgeon want to use an expanded toolbox and not just discuss surgery as an option when ta lking to patients about surgery?" While surgery can be ver y e¥ective for some circumstances, it cer tainly does not address a ll spine problems. Additiona lly, when surgery is necessary, if we use additiona l tools from the spine wellness toolbox, we get better outcomes from surgical procedures with fewer complications. Using a "patient-centered" approach, with the expanded spine wellness toolbox, helps to provide patients with a faster, more comprehensive approach to achieving spine wellness and can also improve their overall health. Dr. Carrie Diulus is a board-certified spine surgeon, fellowship trained at the San Francisco Spine Institute, and practicing with Crystal Clinic in Akron, Medina, Hudson and Cuyahoga Falls, Ohio. ■ 1 2