Neurosurgeons: Surgery May Not Be Necessary, But Don’t Ignore Back, Neck Symptoms

How do you know if your chronic back or neck pain — or that radiating pain that can be felt in the arms or legs — requires surgery? That is a very common question heard by neurosurgeons, who often provide non-surgical solutions to these conditions.

Michael Gomez, M.D., neurosurgeon and director of minimally invasive spinal surgery at Miami Neuroscience Institute.

“Back pain is common. I think by the age of 30 or 35, about 70 percent of people have missed work on account of back pain,” explains Michael Gomez, M.D., neurosurgeon and director of minimally invasive spinal surgery at Miami Neuroscience Institute, part of Baptist Health. “And we know that roughly 85 percent of people who have back and leg pain will get better on their own without surgery, somewhere within three months.

“So, typically when I counsel patients, if they’re able to live with it a little longer and see if it goes away, then we try to cool them off with some anti-inflammatory medicines. I typically have them wait six weeks to three months before we decide on having a surgery.”

Timothy Miller, M.D., neurosurgeon and director of functional neurosurgery at Marcus Neuroscience Institute, also part of Baptist Health, explains that often patients are referred by a primary care physician.

“I often tell patients, just start with your primary care physician,” says Dr. Miller. “They’re very good. In most cases, they can order the necessary imaging that would be required to see a neurosurgeon. And if you have these symptoms of back pain with radiation down into the lower extremity, there are very few other things that can mimic that. A neurosurgeon would be the next logical step.

“Again, that doesn’t necessarily mean that you’re going to be getting offered surgery right off the bat. And in fact, you probably won’t unless there’s something really concerning.”

Timothy Miller, M.D., neurosurgeon and director of functional neurosurgery at Marcus Neuroscience Institute.

Recently, Drs. Gomez and Miller took part in a Baptist Health Instagram Live — Neurosurgery: Beyond the Brain. The host of the program who relayed questions from the public to the neurosurgeons was Jeannette Kaplun, editor of Hispana Global.

Here are highlights of the question-and-answer session. (Watch the full Instagram Live here.)

Ms. Kaplun: One of our viewers is a little nervous because her mother was just told that she needs surgery above her tailbone. Should they be nervous about this type of surgery in general?

Dr. Gomez:
“It depends on the surgery. The most common surgery that we do is a lumbar laminectomy or discectomy. So, that’s probably what she’s having done. And patients tend to do really well. I mean, most of the common surgeries that we do are, in spite of using a microscope and these really fancy retractors, are very traditional surgeries that have been done for years.

“So, when you have a surgery that’s so common, that’s been done for years, the results tend to be predictable, and they’re predictably good … She should do just fine.

Ms. Kaplun: Have you seen an uptick in brain spine problems due to COVID or during COVID?

Dr. Miller:
“We have seen problems, neurological problems. But they’re not often surgical problems, right? We haven’t seen COVID causing brain tumors for instance, or advanced degenerative disease of the spine yet. It’s been around for a year now. So, I think the short answer is no. But what I have seen is, I think in the medical profession in general, we saw a large dip in elective surgeries during the initial stages of COVID between March and May or June of last year, when patients I think were reluctant to come into the hospital. And I, at least personally, have seen those backlogged patients coming in now and have gotten quite busy recently because I think people are starting to take care of themselves again on a general health front.”

Dr. Gomez:
“I’m seeing more back pain back … back and neck pain. I think it has to do with the poor ergonomics of working from home. Because when you work in an office, you got a real desk and your monitors up at the same level as your eyes. And you have a nice desk chair and your keyboard can be a little bit lower. And then early on when people were working from home, they were working at their kitchen island or at the dinner table or off a laptop where it’s less than ideal, as far as your body positioning. So, I didn’t see an uptick in issues, but I did see more people in the office coming in with just kind of generalized aches and pains in their neck and low back, just from working from home, being sedentary, gyms closed down — things like that.”

Ms. Kaplun: A viewer is recovering from a diskectomy. And one-month post-op, she’s dealing with odd residual numbness on her mid-thigh. She is asking if that is common and how long can residual issues last?

Dr. Miller:
“Residual numbness is actually very common. Nerves are the slowest healing tissue in the body, in fact. And so just because you take the pressure off of a nerve that’s been affected for a long period of time, it doesn’t mean it’s going to heal instantly and all your symptoms will resolve instantaneously. Typically, the first thing to get better will be the pain. When that nerve is not getting impacted and pressed on, on a day-to-day basis, that pain gets better usually fairly quickly, sometimes immediately. But numbness can actually take up to several years to fully get better as the nerve sort of heals over time. Unfortunately, in some patients, there is a little bit of residual numbness permanently, but that’s pretty rare.”

Ms. Kaplun: Can having difficulty buttoning a blouse or a shirt point to maybe a neurological or spinal problem or disorder?

Dr. Gomez:
“That’s actually one of the questions we ask patients. It’s pretty specific … So typically, when patients have cervical stenosis, so narrowing of the spinal canal in the neck with compression of the spinal cord, they’re going to have this weird numbness in their hands. So, it makes it difficult to button their shirts. Sometimes, they can’t hold onto their coffee cup. They have a hard time picking coins up off the table. So that typically concerns us about something going on in the cervical spine.”