Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Back pain can grow progressively worse and more disabling, depending on the cause. At some point, your doctor may suggest surgery. The lumbar laminectomy may be one
option. Despite medical breakthroughs, back pain has been a common problem through the centuries with no simple solutions.
Facts about back pain
Back pain results in more lost work productivity than any other medical condition. It is the second leading cause of missed workdays (behind the common cold).
In their lifetime, 70% of people in the United States will have some kind of back pain. Each year, one person in five will have it.
Back pain is more common in men than women.
Back pain is more common among whites than among other racial groups.
Most back pain occurs among people 45-64 years of age.
A common cause of acute back pain is muscle strain. A common cause of chronic back pain is degeneration of the lumbar spine and lumbar disk disease.
Each year, 13 million people go to the doctor for chronic back pain. It is estimated that the condition leaves 2.54 million Americans chronically disabled and another 2.54 million temporarily disabled.
Discussion of back pain has been found on Egyptian papyrus dating 3,500 years ago. As the centuries went by, thousands of physicians have discussed it and recommended treatments for it.
Back pain that can lead to surgery
The most common site of back pain is in the lower back. The National Center for Health Statistics states 14% of all new visits to doctors are for low back pain.
About 25% of people who have back pain have a herniated disk with nerve pain transmitted down a lower extremity. This pain is called sciatica, because the problem once was believed to stem from pressure on the sciatic nerve. Sciatica causes pain to radiate through your buttocks into one or both legs.
A disk acts as a shock absorber for your spine. It is made up of a tough outer ring of cartilage with an inner sac filled with a jellylike substance. When a disk herniates, the jellylike nucleus pushes through the harder outer ring (annulus), putting pressure on the
adjacent nerve root.
A herniated disk can cause varying degrees of pain. The most serious problem is cauda equina syndrome, compression at the point where roots of all the spinal nerves are located.
People may lose all nerve function below the area of compression, including loss of bowel and bladder control.
This condition is a true surgical emergency requiring immediate decompression if you are to preserve bowel and bladder function. The longer the delay, the less recovery can be expected.
Surgery for back pain
As with other back pain, doctors first attempt conservative medical treatment for a herniated disc. But surgery often produces gratifying relief.
Surgery may be considered for anyone with frequently recurring sciatica, usually if the pain interferes with your ability to work or do daily activities.
Doctors decide to perform surgery, however, only after they have tried a variety of treatments. Doctors usually reserve surgery for chronic sciatica. In general, most medical
experts do not recommend considering surgery in acute sciatica. The decision to have surgery should be a joint decision you make with your doctor.
Another indication for surgery is a progressive loss of nerve function. For example, you may lose a certain reflex and later begin to lose strength gradually.
Far more commonly, people go to a doctor with an acute lack of nerve function.
Usually these function losses are minor and may come and go. They respond well to medical treatment.
If the deficit is severe -- you cannot bend a knee or move a foot
-- surgery is an option.
Many people may not regain full nerve function after surgery, however.
In the U.S., some 450 cases of herniated disk per 100,000 require surgery.
The average age for surgery is 40-45 years.
Men are twice as likely to need surgery as women.
More than 95% of disk operations are performed on the fourth and fifth lumbar vertebrae.
Types of surgery: Doctors perform three common surgeries on the back to relieve nerve root compression. They often are done in combination with each other.
Laminotomy -- Removal of part of the bony lamina
above and below a nerve that is getting "pinched."
Laminectomy -- Removal of most of the bony arch, or lamina, of a vertebra (Laminectomy is most often done when back pain fails to improve with more conservative medical treatment.)
Discectomy -- Removal, or partial removal, of a spinal disk