Issue link: https://viewer.e-digitaledition.com/i/837588
BY CARRIE DIULUS, MD Spine Disorders: Treat the Cause, 1 0 TR ADITIONAL SPINE CARE focuses on medication, physica l therapy, surger y, injections, and in some cases, manipulation therapy. However, recent studies have shown that treatment practices conti nue to move f ur t her away f rom accepted g uidelines. Despite these evidence-based g uidelines, ma ny patients a re subjected to unnecessa r y ima g ing sca ns a nd na rcotics, a nd a re not provided treatments that have been show n to be ef fective. This ha s resulted in ex pensive ca re with inconsistent outcomes a nd low patient satisfaction. Getting to the root cause of a person's condition, rather than just treating the symptoms, of ten involves a comprehensive eva luation. Such a n in-depth eva luation ca n dra matica lly i mprove a patient 's spi ne hea lt h a s wel l a s t hei r overa l l wel l-being. For exa mple, obesit y places increa sed stress across the spine, which ca n lead to increa sed pa in. Other systemic conditions like diabetes a nd autoimmune diseases ca n cause ner ve conditions that ca n imitate or complicate disc herniations and lumbar stenosis. Treating the symptoms without addressing the underlying causes may help relieve symptoms tempora rily, but may unfor tunately not provide lasting relief, which ca n lead to future f la res. In the spine practice, we see ma ny patients who a lso have diabetes a nd/or pre-diabetes a nd have elevated ma rkers of systemic inf la mmation. If we a re able to ef fectively help patients reverse these conditions w ith lifest yle modif ica- tions — including diet, exercise, supplements a nd sometimes medication — we of ten seconda rily improve their spine a nd ner ve conditions as well. Inactivity a lone ca n be a signif ica nt contributing factor to spine-related pa in. Prolonged sitting has clea rly been shown to increase not only spine pa in but a lso morbidity associated with other chronic hea lth conditions. Sitting too much ca n quite litera lly shor ten your life a nd increase your pa in. Our spines need to be moved to gain nutrients, stay supple and hea l. Strong core a nd back muscles provide suppor t for the back a nd the neck a s wel l. Without this streng th, we ca n have pa in even when at tempting to ma inta in nor ma l post ure throughout the day. Working with patients, who a re on the road to recover y, to pla n a long-term f itness prog ra m helps not on ly 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 suffering from low-back pa in a nd even leg pa in, who have fa iled to improve with other treatments — we sometimes discover they actua lly have a problem with their sacroiliac joint. Patients with prior lumba r spina l f usions a re a lso at risk for sacroi liac joint dysfunction. For tunately, using a comprehensive approach, we a re able to sig nif ica ntly improve a nd of ten resolve the pa in associated with this condition. Expa nding the "toolbox " to include all of the treatments that have been shown to be effective in spine ca re ca n of ten more effectively a nd more quickly help a patient ta ke control of their spine hea lth. Ma ny times, combining tools results in better outcomes t ha n t he i ndiv idua l tools t hemselves. Exa mples i nclude combining physica l therapy w ith medication supplement t herapy, ma ssa ge t herapy a nd yoga . Add it iona l ly, usi n g tools that treat a ll of the factors a patient has a ffecting his or her spine improves outcomes. For exa mple, using tools to improve weight a nd sleep ca n positively impact a patient 's spine hea lth. I a m of ten a sked, " W hy wou ld a spine surgeon wa nt to use a n expa nded toolbox a nd not just discuss surger y as a n option when ta lking ta lk to patients about surger y? " W hile surger y ca n be ver y ef fective for some circumsta nces, it cer ta inly does not address a ll spine problems. Additiona lly, when surger y is necessar y, if we use additiona l tools from the spine wellness toolbox, we get better outcomes from surgica l procedures with fewer complications. Using a patient-centered approach, w it h t he ex pa nded spine wellness toolbox, helps to provide patients with a faster, more comprehensive approach to achieving spine wellness a nd ca n a lso improve their overa ll hea lth. 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 OH. ■ NOT JUST THE SYMPTOMS 1 0 S P E C I A L C L I N I C A L S E C T I O N : N E U R O L O G Y