Understanding back pain alternatives before surgery


Junior high principal Steve Pagani prided himself on being a near-scratch golfer and lifelong athlete, until a back condition flared up last year.

"A lot of pain, particularly in the arms," said Pagani.

David Fisher was an avid mountain biker who routinely road the crest of Mt. Tamalpais, until he found himself in a similar position.

"For the first three weeks, I simply couldn't walk," said Fischer.

Both sought the advice of San Francisco orthopedic surgeon Kenneth Light, M.D. While some of their symptoms were similar, Fischer was treated with physical therapy with medications. While Steven wound up having a successful, but sophisticated surgery. Light says that knowing the reasons behind the different treatment plans could help future back patients understand their own options.

"On average we like to wait at least six months to two years before recommending surgery for pain alone," said Light.

Light says most lower back pain cases resolve themselves in the first three months with a combination of rest and medication. But if the pain lasts for six months, the odds of spontaneous recovery go down to 50 percent. Still, Light says the decision to operate still rests on two key considerations.

"Number one, is the problem severe? Is the problem life-altering, do you have difficulty getting out of bed, do you have difficulty going to work?" said Light.

Next, is whether the surgeon can confidently trace the pain to a likely source using an MRI or other imaging technique. In Pagani's case, a disc replacement procedure helped decompress the section of the spine that was inflaming the surrounding nerves -- a condition that can be caused by injuries or natural deterioration.

"Between 20 and 40 years old compression of the spinal cord or spinal nerve roots due to herniations of the disc are probably the most common," said Light.

He says for slightly older patients like Fischer, a condition called spinal stenosis is more common. Bone spurs form on the inside of the spine, narrowing the canal, and can aggravate the nerves when twisted. Depending on severity, treatment can involve either surgery or alternatives such as anti-inflammation drugs.

"We simply treated him with medication. In one situation we gave him an injection and the pain resolved," said Light.

Both patients say they are pain free and are hoping to return to the activities they love most.

"I'm willing to get on a bike and give it a shot," said Fischer.

"A homerun in my world, is just to get out and play golf again. I'm about a four handicap, and plying in summer I can get down to a one. I just want to play golf and enjoy my kids," said Pagani.

If surgery is required, there have been several recent advancements, including disc replacement, which in some cases can take the place of traditional spinal fusions, leaving the back more flexible.

Written and produced by Tim Didion

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