Ask the Doctor at Saint John’s: Oh, My Aching Back!

Q: When is surgery a good option for back pain?

By Robert Bray, M.D., neurosurgeon and director of the Spine Institute at Saint John’s Health Center.

Only after you’ve run through a conservative course of care – several months of physical therapy, strengthening exercises, pain management and steroid injections. We try really hard not to operate on the spine.

If we get to the point where surgery is indicated, the good news is that advances in techniques, tools and devices for spinal surgery have progressed tremendously. Many procedures are minimally invasive and are done on an outpatient basis.

Most people will have back pain at some point in their life, and most of the time it will go away on its own, but it may take awhile. As a spine surgeon, the most common back problem I see is a ruptured disc, but I also treat spine issues caused by bone spurs, osteoporosis or injuries from trauma, accidents and falls - anything from the base of the skull to the tail bone.

I specialize in microsurgery. This means I’m able to make a small incision, put long skinny tools down a tiny tunnel and use a powerful microscope to magnify the problem area and perform an operation.

After 26 years of experience in this field, I have to say that the microscope has been the biggest advance in spinal surgery. It used to be that back surgery required a large eight-to-10-inch incision down the back, lots of blood loss, six to eight weeks in the hospital recovering, and a high risk of complications. It was very dangerous.

Today, we make a tiny incision - often an inch or less. Patients lose two or three teaspoons of blood at the most, and the patient stays one or two nights in the hospital. They’re up and moving around much faster.

New developments are consistently improving spine surgery. We have advanced
instruments to access the spine, enabling us to make smaller incisions. We have a new generation of implants that work better, and even a miracle bone protein substance that makes patients’ bone grow so they heal faster.

At the Spine Institute, we’re participating in two FDA studies investigating new devices. For degenerative disc disease, we’re using a new motion stabilization device that goes around the spine like scaffolding, holding it still without actually fusing it, allowing the spine to retain some flexibility.

The other device we’re studying is like a little pillow. We pop it in between discs to cushion the spine. It’s done as an outpatient procedure, requiring local anesthesia. A patient could come in for the surgery and go home several hours later.

Robert Bray, M.D., is a neurosurgeon and director of the Spine Institute at Saint John’s Health Center. For more information about Dr. Bray and other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

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