Dr. Robert Harper on relief for painful back issues

Back pain for some is a minor annoyance, yet for others it’s unbearable. The pain can come suddenly or appear gradually. The cause may be obvious, but not always. One thing to know is you’re not alone – 4 in 5 people experience back pain at some point in their lives.

“There are many disorders that cause or contribute to back pain – from strains and sprains to compression fractures, disc issues, osteoarthritis and conditions such as spondylolisthesis,” said fellowship-trained spine surgeon Robert Harper, MD, during a free online health lecture. “Luckily, there are many options for pain relief.”

____________________________________________________________________________

Watch: “Relief For Painful Back Problems"

______________________________________________________________________________

Common spinal conditions & symptoms
Dr. Harper began the lecture by describing the most common spinal conditions he addresses:

• Herniated disc - also known as slipped, ruptured or bulging spinal disc. Spinal discs are rubbery cushions between your vertebrae and act as shock absorbers, helping you move, bend and twist comfortably.
  
  “A herniated disc occurs when there’s a rupture or an extrusion of disc material into the spinal canal. The rupture compresses, or pinches, the nerve in the canal or at the exit,” Dr. Harper explained. It often results from a sudden injury or strain. “For about 90% of people, herniated disk pain improves on its own.”
  
  When it occurs in the lower back, symptoms include pain down one or both legs, numbness or tingling in the legs and or feet, and muscle weakness. Symptoms can worsen with sitting or standing.
   
• Degenerative disc disease - arises from the gradual wearing down of a spinal disc over time and is linked to the natural aging process. When these cushions wear away due to aging, the back can be painful. The pain is often worse with sitting for long periods of time. "With complete disc collapse, nerves can become pinched as they exit the spine," explained Dr. Harper.
   
• Lumbar Stenosis – a narrowing of the lower spinal canal that puts pressure on the spinal cord nerves. Pain is felt down the legs, and numbness and tingling often occurs when walking. “The pain worsens with standing and walking and feels better when sitting or leaning forward as it widens the lower spinal canal,” Dr. Harper said. “Lumbar stenosis can result from degenerative disc disease, lumbar arthritis or disc bulging.”
   
• Spondylolisthesis - occurs when one of your vertebrae, the bones of your spine, slips out of place onto the vertebra below it. “With this,” explained Dr. Harper, “you can have either a defect in the back of the spine or severe arthritis of the joints where the cartilage wears away leading to slippage and ultimately a pinched nerve.” He added, “Similar to stenosis, numbness and tingling often occurs when walking. The pain feels better when sitting or leaning forward.”
   
• Adult degenerative scoliosis – arises in adulthood and is defined by a sideways “S-shaped” curve in the spine. Dr. Harper stated, “It’s more common in post-menopausal women and can occur due to asymmetric disc degeneration, disc collapse, facet arthritis or vertebral body collapse from osteoporosis.”
  
  He added, “The symptoms, beyond the ‘S-shape,’ include an imbalanced feeling, leaning forward, severe back and leg pain and leg numbness.”

Non-surgical treatments
Treatment varies depending on the cause and symptoms. “Generally,” said Dr. Harper, “we start with non-operative treatments.” These include:

• Ice and/or heat - typically reduces the pain
   
• Physical therapy (PT) - strengthens muscles
   
• Cognitive behavioral therapy - changes mental attitude and behavior with the goal of reducing pain
   
• Non-steroid anti-inflammatory drugs (NSAIDs), Tylenol (acetaminophen) or prescription drugs - relieves pain
   
• Epidural steroid injections - reduces swelling and inflammation
   
• Radiofrequency ablation - uses an injection and heat to stop pain signals from reaching the brain

Surgical treatments

You may need surgery if your symptoms aren't getting better. Dr. Harper’s philosophy is to use a minimally invasive approach for most conditions to preserve the tissue structure and accelerate recovery.

• Herniated disc - There are multiple surgical techniques Dr. Harper uses for relieving pressure on the spinal cord and nerves, including microdiscectomy surgery. This involves making a small incision to free the affected nerve by removing the herniated disc fragments.
   
• Lumbar stenosis – Dr. Harper performs minimally invasive decompression surgery to widen the spinal canal. He may also stabilize the lower back when motion is the source of pain by fusing together some of the vertebrae. In some cases, he uses fusion along with decompression. Interbody fusion surgery is a type of spinal fusion that removes degenerative discs and replaces them with spacers, creating more room for spinal nerves.
   

• Spondylolisthesis – “Decompression surgery alone may not work as well as it does for lumbar stenosis,” Dr. Harper warned. Like surgery for lumbar stenosis, decompression and fusion or interbody fusion can improve stability and decrease pain.
   
• Adult degenerative scoliosis surgery – “Everything from small decompression to large reconstructive surgery may be considered. Surgery helps to restore alignment, improve balance and relieve pain,” according to Dr. Harper.

Schedule an appointment
If you have any questions or would like to schedule an appointment with Robert Harper, MD, at BoulderCentre for Orthopedics & Spine – a BCH strategic partner – call 303.449.2730.

Click here to view/download a PDF of slides shown during the lecture.

Want to receive notification of special events and lectures?

Sign up to receive email notifications.