Advancing Spine Surgery and Care with Adam Back, M.D.

Spine issues, which often result in neck, mid-back or low-back pain, can make every day a challenge. In fact, spine-related pain is one of the most common reasons people contact a doctor. In this episode, MUSC Health neurosurgeon Adam Back, M.D., shares new approaches and personalized treatment plans available to MUSC patients with spinal issues. Dr. Back talks about surgical and nonsurgical ways to alleviate back and neck problems, which can also improve your overall quality of life.

“Spine issues can be incredibly debilitating, but the fortunate thing is the vast majority of them can be corrected and improved. Most of them don't need surgery, but the ones that do, we're lucky to be able to offer the gamut of spine surgeries and tailor them to patients’ issues.”
- Adam Back, M.D.

Topics Covered in This Show

• Patients with neck or back issues in Lancaster, Indian Land, South Charlotte and surrounding communities can now receive comprehensive and customized spinal care close to home through MUSC Health’s Catawba Division. Neurosurgeon Dr. Back leads these services.
• Nearly half of U.S. workers experience back pain every year, according to Dr. Back. Even a minor spinal issue can cause serious pain.
• Most spinal problems don’t require surgery. Dr. Back shares three other leading treatment options: physical therapy, anti-inflammatory and muscle-relaxing medications and injections that target the source of pain.
• When surgery is required, MUSC Health offers minimally invasive surgery. “Minimally invasive” doesn’t mean the surgery has a smaller target or is less effective, Dr. Back explains. Minimally invasive surgery means surgeons use smaller incisions to reduce recovery times and complications for patients.
• Pain, numbness or tingling in the arm or hand and clumsiness or difficulty with fine motor tasks can sometimes be symptoms of an underlying spine issue.
• The two standard procedures MUSC offers for neck pain due to spinal issues are decompression surgery, which takes the pressure off the nerves or spinal cord, and fusion surgery, which uses decompression surgery and screws, rods or plates to help the bones grow together and stabilize the spine.
• Fears or misconceptions about spine surgery can prevent patients from getting care and improving their quality of life. Decades ago, surgeries were less successful because surgeons didn’t always operate on the original cause of the pain. Dr. Back emphasizes that surgery will be successful if the source of pain is correctly identified before the operation.
• Regarding recovery after spinal surgery, patients usually begin to feel improvement around about six weeks post-surgery. By three months, they feel significantly better than they did before the surgery.

Read the Transcript

[00:00:00] Erin Spain, MS: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Spine-related disorders are among the most frequent reasons people seek out medical care. Back pain and neck pain can be debilitating for patients and complex for doctors to treat, but there are many new approaches and personalized treatment plans available to MUSC Health patients that can improve your pain and quality of life. Here with details is Dr. Adam Back. A neurological surgeon trained in complex and minimally invasive spine surgery. Dr. Back recently joined the MUSC Health neurosurgery and spine team, based in the MUSC Health Catawba Division serving Lancaster Chester, Indian land, South Charlotte and surrounding communities. Welcome.

[00:01:00] Dr. Adam Back: Thank you for having me, Erin. It's great to be here, and I appreciate you taking the time to talk with me today.

[00:01:05] Erin Spain, MS: You have a lot of experience. You're a fellowship-trained surgeon. You have a wide range of expertise. Why did you decide to come here to MUSC Health to serve these communities and the Charlotte area?

[00:01:18] Dr. Adam Back: I have to say that I'm incredibly fortunate to have been approached to start this new neurosurgery and spine service line for MUSC in the South Charlotte, Indian Land and Lancaster divisions. And ultimately, the reason I was so interested in this position is that MUSC has done a fantastic job of really trying to engage their community and the whole goal is to build a comprehensive, high quality, customizable care program for patients right here, to really be evaluated and get the care that they need, that is going to be tailored specifically to their needs.

[00:01:55] Erin Spain, MS: Tell me why a patient might find their way into your exam or operating room.

[00:02:00] Dr. Adam Back: You know, it's really interesting. We see patients with all sorts of issues, primarily focused on either neck, mid back or low back. And usually, typically, they have pain that is either acute, meaning new and just started, or it may have been going on for a long period of time. Some patients present with just pain in those locations and some patients have pains, numbness or tingling in their arms, hands or legs or feet. And these patients will show up either having a workup completed, meaning they already have images like an MRI or a CT scan, or sometimes they show up and are presenting with just the symptoms that they have and we do the workup for them. So fortunately, we are able to do a comprehensive evaluation of a patient and we meet them where they are. So whatever they come in with, we really do a true evaluation of the reasons they are having the symptoms they are having. And we really focus on trying to give them the best care they can that is individualized to their current circumstance.

[00:03:03] Erin Spain, MS: Explain to the listeners how debilitating this type of pain can be.

[00:03:08] Dr. Adam Back: So spine pain – I'm going to generalize that for the sake of the discussion today – that means neck, mid back or low back. Spine pain can be extraordinarily debilitating. I read a statistic the other day that was pretty impressive: Half of workers in the United States will have a spine problem – every year. Now, some of those are minor and, you know, take just a little bit of over-the-counter medication to cure, but half. So there is a significant number of patients that have these issues, and [for] some patients can be incredibly debilitating. A small issue in the spine can be very, very painful and can really affect their quality of life.

[00:03:46] Erin Spain, MS: Now, I mentioned at the beginning of the show that you're a neurosurgeon, but surgery isn't always the answer, and that's important for patients to know. So walk me through sort of the comprehensive treatments and procedures and how you approach each patient to see if surgery is indicated or not.

[00:04:03] Dr. Adam Back: That's a great question. You know, nobody wants to have surgery unless they absolutely need to, and our philosophy is really not focused on surgery. Our philosophy is really focused on seeing what symptoms the patient has, evaluating what their options are, working with them to direct their care. So my goal is really to get the patient's symptoms better in the least invasive way. And most of the time, we're very successful doing that with nonsurgical maneuvers. Most of that we term "conservative management." So conservative management really falls under three areas.

One, we often work with our physical therapy colleagues to help work with the patient on rebuilding some of their muscular strength, kind of work on getting the muscles to relax and really focus on trying to affect the areas where their pain is coming from. The second is medications. Now, everybody with the opioid epidemic is really concerned – oh, I don't want opioid medications. And honestly, opioids are not great medications for patients in general. They should be reserved for very specific uses. However, there are two other categories of medications: the anti-inflammatory medications and the muscle relaxers. Both of those are really the standard of care for upfront management for discomforts for spine patients. And then the third column is working with some of our pain providers, potentially for targeted injections to address more specific issues that the patients are having.

[00:05:31] Erin Spain, MS: Now, if a patient does need to have surgery, something that's really incredible is the advances made in minimally invasive approaches. Explain that to me and how it's different from the more open surgeries that people may have heard of decades ago.

[00:05:45] Dr. Adam Back: There's been a lot of advances, as you can imagine, over time, especially in spine surgery, and it continues to grow. But our focus has really been on less invasive options. Now that doesn't always mean a smaller surgery. What it means is accomplishing a smaller surgery through smaller incisions. And by disrupting tissues less, it allows for the recovery periods to be a little shorter. It allows for patients to get up and moving quicker and enhances their recovery as it reduces the amount of tissue disruption that can occur in a surgical procedure.

[00:06:21] Erin Spain, MS: Let's talk specifically about neck pain and some of the procedures that you provide to address that.

[00:06:27] Dr. Adam Back: Most often, when there's a spine issue that is a cause of neck pain, it really causes two other conditions that go along with it. Usually, it is arm or hand pain, numbness or tingling, or difficulty with fine motor tasks – clumsiness, dropping things and even balance difficulty if the spinal cord has pressure on it. So when it comes to cervical issues – we call neck problems cervical. So with cervical issues, there's a lot of different approaches. And sometimes we do surgeries from the front of the neck. And sometimes we do surgeries from the back of the neck. Traditionally, there have been, really, two focuses, which is a decompression surgery, which means taking the pressure off of the nerves or spinal cord, or a fusion surgery, which involves the decompression surgery with screws or rods or plates to kind of get those bones to grow together to stabilize the spine. However, more recently, we have added a third option, particularly for the cervical spine, which is an artificial disc replacement. So one of the things we learned over time is that with fusion patients, although it's a fantastic surgery and works really well universally, for some younger patients, fusing a patient up front can result in, long-term, potentially needing another procedure done later in life. So for our younger patients who have the appropriate conditions, an artificial disc is that happy medium that we've now developed. And it allows us to maintain motion of the spine while removing the cause of the pain and ultimately solving the patient's issues without a fusion.

[00:08:09] Erin Spain, MS: Although you are still able to help those patients who need revision spine surgeries. Tell me about that.

[00:08:15] Dr. Adam Back: Sure, so a lot of patients who have had surgery, especially in the past, unfortunately, regardless of how the surgery was done, regardless who does the surgery in the country, there is a percentage of patients who would develop a problem above or below their prior surgery. And so we see that, and nobody wants to have another procedure, but fortunately, I have the experience to really evaluate the patients, give them their opportunities to improve and address that, what we call "adjacent segment disease," and really focus on improving their outcomes. Nowadays, we're a little bit smarter, if you will, based upon the years of experience we've gained with spine surgery that we're able to really tailor surgical approaches to reduce that risk over time. But for patients who have developed an additional problem, we are well prepared to take care of those patients as well.

[00:09:12] Erin Spain, MS: I want to focus now on back pain, lower back pain, all types of back pain. A lot of people have experienced this in their lives. And there are procedures that you can offer. Go into detail on some of those for me.

[00:09:25] Dr. Adam Back: So back pain comes from a variety of causes, and one of our jobs is really to identify the cause of the patient's symptoms. There's a lot of misconceptions about spine surgery in the world, right? It gets a bad rap here and there, and that's primarily because, in the past, the definitive cause of patients' pain was not always identified perfectly. And then a procedure would be done, and unfortunately it wasn't the original cause for the pain. So what's most important is ensuring that the reason the patient is hurting is what you are treating. That is number one. If we identify the cause of the pain, and then we do the procedure to address that issue, it's incredibly successful. So patients can do very well with low back surgery or spine surgery in general, as long as the right cause is identified, they will improve. So for low back pain, there's a lot of different spine surgeries out there. There's different kinds of decompressive procedures where you can go in, take a disc out, take the pressure off the nerves and ensure that the pressure that's on the nerves that's causing the pain is removed. Or, sometimes if there's a structural problem, meaning instability, which means that the spine is moving in an abnormal way or the spinal structure has changed, occasionally we have to do a fusion procedure to correct the anatomy as well. The advantage these days is there's many different approaches to a fusion surgery. There's minimally invasive approaches. There's ways to approach the spine from not just the back. Sometimes we now come from the front or the side. And oftentimes when a patient needs a fusion, I will discuss an anterior or a lateral approach to the spine. And often I get funny looks like, Are you serious? You're trying to fix my spine. This allows me to get to the disc that's on the front part of your spine, allows me to address the issues associated with that disc and correct it in a, technically, minimally invasive fashion, even though it's an approach from either your belly or your side, is not something that would typically be thought of when you think of spine surgery. It is technically a minimally invasive way to address patient issues.

[00:11:46] Erin Spain, MS: What about recovery? I know that some of these minimally invasive approaches can help aid in recovery, but what is a typical recovery like for some of these procedures?

[00:11:56] Dr. Adam Back: It can be varied and it really depends on the cause of the pain and the procedure that we're doing. In general, regardless of the procedure, the first few weeks are going to be a little tough on the patient. And I always warn them for the first few weeks, you may have different discomforts while your body is healing. You have to remember a lot of times there's nerve pressure to begin with that often has been existing for several months, even up to a few years at times. Well, when you remove the pressure off that nerve, you get extra blood flow. And it changes the way that nerve reacts. So you can get different numbness, tingling, pain while you're in that initial recovery period. What I always tell patients, though, is that initial period is not the goal. The goal is to get you through the recovery period so that at the end of the day, we score a touchdown when we get to that two months' time recovery, so that you feel better at the end of your recovery period than you did before surgery.

[00:12:55] Erin Spain, MS: I want to talk about a condition that we often think of in adolescence, and that's scoliosis. But this is a condition that can also affect adults and cause problems as we age. Tell me a little bit about the scoliosis correction that you're able to do, these types of surgeries for adults.

[00:13:12] Dr. Adam Back: I think this is one of the growing segments that we're seeing more and more as we have an aging population with the baby boomer generation getting older. As we age, the discs in our spine between the bones degenerate, and it's a process that happens naturally over time. What I always tell patients is, This is life. It's wear and tear. And depending on the degeneration and the extent of the degeneration, patients can develop changes in the structural anatomy. So if a disc degenerates more on one side than the other, you start to develop a curve to your spine, or a scoliosis. Now, this is different than what you mentioned earlier, which is an adolescent idiopathic scoliosis. That's something that's more genetic and we see in our younger patients. But in adults, what tends to happen is that breakdown of the disc, well, it's like tires on a car. They start to wear down over time, and if it wears down more on one side than another, you get a little bit of change in the structure. Well, that's the scoliosis that develops, and surgeries to fix that really focus on correcting the disc and restoring that to a standard anatomy, so that the curve corrects itself.

[00:14:25] Erin Spain, MS: You talked about that two months after surgery is sort of a sweet spot when you're starting to assess how did things go. Tell me how lives can be changed after some of these procedures. How are people able to function and do the things that they love to do?

[00:14:40] Dr. Adam Back: It's really fun to see patients get better. It's why we do what we do. And what's really fortunate is we have patients, some wake up from surgery and they're great. They're like, Oh my gosh, I feel so much better. And like right after surgery. And those are not the average, but that does happen. The average is that at about six weeks, patients are really starting to do a lot better. And by 90 days, their lives are changed. They feel so much better than they did before the surgery. And some patients have true functional challenges associated with spine issues, from weakness to balance difficulty to difficulty using their hands. All those sort of functional things that really improve over time really make a big difference in patients' lives. And spine issues can be incredibly debilitating, but the fortunate thing is the vast majority of them can be corrected and can be improved. And like we mentioned earlier, most of them don't need surgery. But the ones that do, we're lucky to be able to offer, really, the gamut, if you will, of spine surgeries and tailor them to the patient's issues.

[00:15:50] Erin Spain, MS: Have there been certain cases where they've been able to really change their lives and embark on some adventures that they didn't think they would be able to do until after a surgery or other treatments?

[00:16:02] Dr. Adam Back: One of the good stories, if you will, that I remember from when I first started with MUSC recently: There was a patient that came in through the emergency room who had been unable to lift her arm up and really couldn't walk for a year. She then started to have trouble with controlling her bowel and bladder, and with that presented to the emergency room. I was able to evaluate her and found that she not only had a low back issue or a lumbar issue, but also had a neck issue or cervical issue. So we had to do two surgeries on her during her initial stay. We did a neck surgery first, after which she was able to lift her hand immediately over her head, which she hadn't done in a year. And it was really incredible to see how happy she was after that. Two days later, we did the low back surgery on her, and she was up walking with physical therapy the next day and, you know, was hurting but was making a lot more progress than she was before. And I saw her in clinic not too long ago, and she's gotten back to getting around with a walker and able to use her arm in a way that she had not been for an entire year. So we're fortunate to see these really incredible improvements in patients at times. And our goal is really to help coach patients through the process and root them on. I always tell patients, my job is not done right after surgery. My job is to help you through that recovery period, through the highs and the lows, to get you to be as good as we can help you be.

[00:17:30] Erin Spain, MS: It's a good reminder too that if we are having pain, don't delay getting care. Go see a specialist.

[00:17:37] Dr. Adam Back: Absolutely. It helps, you know, when we can catch things early. I always tell people it's better to catch it early before the progression. Unfortunately, when people do start to develop real weakness and real challenges, some of the time it's harder to get those back. So this story was really special because to see such a quick improvement was a bit unique, but it was a really great experience for the patient, and she's going to continue to make progress.

[00:18:05] Erin Spain, MS: What are some practical things that we can all do to improve our spine health and stay on top of this, so that we can possibly prevent these types of injuries?

[00:18:14] Dr. Adam Back: It really follows along with general good health, right? Keeping active, working out when you can, maintaining the muscles in your back and your neck and your arms and just really good general health. So eating well. Not smoking. Smoking is one of the things we see all the time that leads to degeneration of those discs and causes more problems. Controlling weight. Higher weight puts more stress on those discs and that causes other problems. So, really it fits with just following a good, general, healthy diet and activity level.

[00:18:47] Erin Spain, MS: So it's important to note that people don't have to go to Charleston to receive this type of care. Tell me about that.

[00:18:54] Dr. Adam Back: Fortunately, here in Lancaster and Indian Land and really South Charlotte, we're able to serve the community now locally, through MUSC. We are now providing neurosurgery and spine services here. We've worked very closely with our physical therapist community, pain providers to really be able to provide the comprehensive care that these patients need so that they don't have to travel far distances to go into Charleston. And a lot of patients don't want to travel into the city and to Charlotte, either. And so we now have the ability to take care of these patients right here locally in the community and ensure they get the high quality care that they need.

[00:19:31] Erin Spain, MS: As we wrap up today, this is a question we ask everyone that comes on the podcast. What do you do to optimize your health and live well?

[00:19:39] Dr. Adam Back: So, I spend a lot of time focusing on eating well, staying hydrated. I will tell you, growing up, I was terrible. I used to drink [a] 12-pack of Coke a day. So, over the past five years, I've really made an effort that I no longer drink but maybe one Coke a week. I try and drink as much water as I can. I think that's incredibly important. I can tell you, I feel such a difference just doing that. I also try and get out to the gym and work out probably three or four times a week, really finding that time, even if it's 20, 30 minutes to get out there, go for a walk, just get outside, get that sunlight in you, get that vitamin D, all those little things make a huge difference. But I'll tell you, there's one more thing that people don't talk about quite as much. I take about 15 minutes every morning and I sit quietly and I just think and relax. And I just take a moment to gather my thoughts. And I just let all those thoughts relax, get focused, and then I move on with my day. And I'll tell you that 15 minutes is probably the best 15 minutes I spend in my day.

[00:20:41] Erin Spain, MS: Thank you for all this detailed information. There's just a lot of opportunity for folks in the area to receive care. And I hope that they find this interesting and will come see you if they're experiencing any back or neck pain. So thank you for your time today.

[00:20:55] Dr. Adam Back: Thank you, Erin, for having me.

[00:20:56] Erin Spain, MS: For more information on this podcast, check out Advance.MUSCHealth.org.