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 Most people think of neurosurgeons only as doctors that operate on the brain. In fact, the majority of “brain surgeons” spend most of their day taking care of patients with spine problems. Low back and neck pain are two of the most common complaints that prompt people to visit their doctors. Neurosurgeons spend a majority of their time in the office and the hospital evaluating patients with these problems. They try to come up with a diagnosis and treatment plan and only a relatively small percentage of people go on to need surgery.
Low back pain and neck pain are extremely common. They can have multiple causes and therefore can be somewhat difficult to treat. Pain can come from the muscles in the back and neck. It can also arise from the discs and the facet joints that connect the bones in the spine. All of these parts of the spine have their own nerve fibers which can become irritated or inflamed and contribute to pain. Episodes of low back and neck pain can often last for a few days to a few weeks and then get better.
Unfortunately, many people have chronic or recurring pain that affects their quality of life. Neurosurgeons see these patients and look for the many potential causes. Causes can range from degenerative or arthritic discs to more serious problems such as lumbar and cervical disc herniations or “stenosis”--narrowing of the canal where the spinal cord sits in the cervical spine (neck) and the nerves that supply the legs sit in the lumbar (lower) spine. Slippage of the bones in the neck and back can also occur from traumatic and degenerative causes. In the lumbar spine, these conditions can lead to compression of the large nerves that supply the legs which often causes not just back but severe leg pain or “sciatica.” In the cervical spine, they can lead to compression of the nerves that supply the arms, causing severe neck and arm pain, as well as more serious problems when pressure involves the spinal cord. Neurosurgeons are trained to surgically alleviate pressure on the nerves and relieve this pain.
Only a small percentage of patients with these problems ultimately go on to need surgery. Neurosurgeons can assist patients in starting appropriate physical therapy or chiropractic treatment programs. They can prescribe anti-inflammatory and anti-muscle spasm medications. Neurosurgeons can also help patients in deciding on their candidacy for pain management procedures. Pain management doctors are spinal trained anesthesiologists who offer injections of anti-inflammatories directly into the spine, usually under x-ray guidance. Neurosurgeons can follow patients through this process, and will often offer surgery when pain persists despite non-surgical attempts.
Patients with significant neck and low back pain want an understanding of what is causing their pain and they want to know their options, surgical and non-surgical, for treating it. That is the job of a neurosurgeon.
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