The care of patients with spinal disorders has become increasingly complex. As a result, more health care providers have become involved in caring for these patients. The spectrum of providers is wide and includes operative, nonoperative, and pain management specialists. This complexity has lead to increasing frustration and confusion for patients. The objective of this article is to introduce the individuals involved in treating spinal conditions and their role in the treatment of these conditions.
The first health care provider most patients will encounter for a back or neck problem is their primary care physician. It is his/her role to provide an initial examination and base his/her treatment on these findings. Typically, anti-inflammatory, pain and muscle relaxant medications will be recommended. Activity modifications (avoid excessive lifting, bending, twisting and turning) may also be recommended.
Physical therapists play an early, integral role in the treatment of patients with spinal conditions. They follow spine-based rehabilitation protocols depending on the patient’s diagnosis. A patient’s response to conservative treatment will often influence whether they will be referred to a specialist. Fortunately, most spinal conditions will resolve after approximately six weeks of conservative care.
During the treatment of spinal conditions, some patients will be referred for cortisone injections (epidural injections, nerve blocks, facet blocks) in order to alleviate their pain. Several different types of physicians perform these injections including anesthesiologists, physiatrists, and some surgeons.
Injections are an integral part of the treatment of this subset of patients. The injections provide diagnostic information (localizing the pain source) and will hopefully provide therapeutic (long-term) relief. The injections are not intended to remove arthritis from the spine or spinal canal or cause disk herniations to resorb. The objective of the cortisone injection is to reduce inflammation in the affected area resulting in pain relief.
For those patients who do not respond to nonoperative treatment, surgery may be recommended. One common question patients have is, “Who should perform my spine surgery: an orthopaedic surgeon or a neurosurgeon?” Patients should seek out those surgeons whose predominate field of expertise is spinal surgery. This person typically has advanced training in and dedicates the vast majority of their elective operative cases to the practice of spinal surgery.
There are certain clinical circumstances (deformity, spinal cord tumors) that are treated exclusively by either an orthopaedic surgeon or a neurosurgeon; however, these represent a small percentage of cases. A spine surgeon will be able to treat conditions of the cervical, thoracic, and lumbar spine and will be well versed with complex spinal instrumentation.
Written by Steven Zeiller, MD