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Anatomy of Back, Neck Pain: When is Surgery Needed?

August 14, 2019

If you suffer from neck and spine pain, you know it can be debilitating. But there are ways to help manage it.
Dr. Steve Zhou is an orthopedic surgeon at the Hartford HealthCare Bone & Joint Institute at Hartford Hospital:

Q. As we age, we can begin to feel the effects on our spine. What happens during the aging process and how does that affect the spine?
A. I believe maintaining good bone density starts in the teenage years, and this is crucial to avoid fragility fractures later in life. Fragility fractures in the spine are called compression fractures. These fractures often occur with minimal trauma such as a simple fall from a standing height, but these fractures can have profound implications for quality of life and can lead to very poor clinical results.

As we age and bone density naturally decreases, we also have a tendency to lose our balance, further increasing the risk of fractures of not just spine but other body parts such as your hip from a fall. I tell all my patients that, maintaining leg and hip strength can prevent falls and help to avoid these devastating fractures.

Q. What leads to back pain?
A. The spinal column is a complex structure comprised of 33 vertebral bodies with surrounding ligaments and muscles that provides supportive and protective functions for the spinal cord and nerves so they can safely transmit signals from your brain to the extremities. The movement of the spine derives at each spinal level from the intervertebral discs and two paired joints.

The disks act as shock absorbers and structurally they are comprised of water, collagen, hyaluronic acid and proteoglycans. The center of the disc has no direct blood supply to keep it healthy and is one of the first biologic structures to deteriorate as we age. the disc loses water and its cartilage content changes. As a result, disk bulges and herniations occur that is one of the most common reasons for patients to have back pain.

Q: When do you know you need surgery or further intervention?
A: In my practice, if medications, physical therapy and other non-operative treatment have not alleviated your back pain, then the surgery might be an option and I would say surgery is always the last resort. Surgical interventions are only recommended if I can pinpoint the exact cause of a patient’s back symptom.

Some of the indications for spinal fusion are:

  • Degenerative disk disease (the space between disks narrows; sometimes they rub together spaces).
  • Fracture (broken spinal bone).
  • Scoliosis — your spine curves abnormally to one side.
  • Spinal stenosis (narrowing of the spinal canal).
  • Spondylolisthesis (forward shifting of a spinal disk).
  • Tumors or spine infection

Q. What are some of the treatment options offered at the Hartford HealthCare Bone & Joint Institute?
A. We offer a comprehensive and team-based approach to care of the spine ranging from nutritional advice to physical therapy and rehabilitation. Furthermore, we provided services such as minimally invasive spinal fusion surgery using state-of-the art Mazor X robot and spinal navigation.

For more information about spine care at the Hartford HealthCare Bone & Joint Institute, click here