Back pain affects millions of people annually, and is the most prevalent cause of missed work, insurance claims and hospital visits today. In a healthy person, the back is strong, flexible and pain-free. Most back problems originate because degeneration or injury create conditions in the joints of the spine (discs) that put pressure, or impinge on nerves as they exit the spinal canal. This can irritate the nerve, creating persistent pain, weakness or numbness in other areas of the body.
In many cases, the symptoms can be relieved without surgery. A conservative treatment approach often involves rest, medication, support, physical and manual therapy, and conditioning. For a conservative approach to successfully relieve symptoms, the patient will have to adhere closely to the program set forth by the treatment team: Dr. Ross, the patient and the physical therapist.
In some cases, surgery is necessary to relieve symptoms and to prevent permanent spine or nerve damage. Dr. Ross may recommend surgery if the pain is causing severe limitations on the patient's lifestyle and is not responding to conservative treatment, or if the patient exhibits any of the following symptoms: Increasing numbness or weakness of the legs, loss of bladder or bowel control, or severe pain, especially in the legs.
Typical spinal problems include, but are not limited to the following:
* Stenosis - This refers to a narrowing of the passageways through which the nerves of the body exit the spinal cord. The size of the spinal canal and the foramen vary from person to person. Individuals with narrower passageways are at greater risk of irritating a nerve and developing pain, numbness or weakness.
* Torn Annulus - A sudden back movement can stretch the ligament of the back and cause tiny tears in the thick outer ring of the discs (called annulus). Both the ligaments and the annulus contain nerve endings to warn the body that the tissue in these areas has been injured.
* Bulging Disc - As we age and/or over stress our backs, the outer ring of the discs (the annulus) loses its resiliency. Eventually the center of the disc may push the wall of the disc outward, causing a hernia, or bulge. If the bulge presses a nerve, the patient may experience pain in the back and leg.
* Ruptured Disc - Pressure on a disc can rupture the outer wall of the disc, causing fluid to leak and pushing the nucleus of the disc through the opening. The pressure of the nucleus on the spinal nerves causes pain. If this pain radiates down the back of the buttock, thigh or leg, it is called sciatica. Continued pressure by the nucleus on a nerve can cause permanent nerve damage.
* Arthritis - The aging of our bodies can cause the bones to wear together and form bony spurs in the areas where the friction occurs. This osteoarthritis can cause or worsen stenosis, whereby the passageways of the spinal nerves become narrowed, possibly irritating the nerve fibers and resulting in pain.
* Spondylolisthesis - As time and stress degenerates our discs, they lose their resiliency and flatten, allowing the vertebrae to slip back and forth. This instability can irritate the vertebral joints (facets) or put pressure on the outer wall of the disc. In some cases, the vertebrae can even develop cracks, or stress fractures. All can irritate nerve endings or put pressure on nerve fibers, causing pain.
The brain is the most important and complex part of the human body. It defines our personality and intellect, gives us reason and memory, coordinates muscles and movement, and controls millions of autonomous functions that regulate our bodies. It is also one of the largest organs of the human body. Brain tissue is made up of special cells called neurons and neuroglia. Because neurons have little or no ability to regenerate themselves, injuries to the brain are particularly devastating and difficult to recover from.
The greatest dangers to the brain come from lack of oxygen, bleeding, and pressure. An injury to the head or body can present any combination of these dangers at once. Depending on the injury, the immediate goal of the neurosurgeon is to control bleeding, relieve pressure, and stabilize the area to fix the problem that caused the bleeding and swelling.
There are many types of head injuries and illnesses that Dr. Matthew Ross treats, including the following:
* Aneurysm - An aneurysm is a weakness in the wall of an artery that bulges outward from the pressure of the blood inside. The defect in the artery can leak blood, and possibly burst like a balloon, damaging brain tissue. To treat an aneurysm, the neurosurgeon tries to first control the bleeding, and then repair the defect to prevent future problems.
* Arteriovenous Malformation - (AVM) This condition is a defect in the blood vessels of the brain where the blood flows through a tangle of veins rather than flowing through a direct channel. Most AVM's are present as a defect from birth. The AVM restricts the blood flow through the affected area, and increases the risk of bleeding into the surrounding brain tissue. Neurosurgeons treat AVM's by clipping the tangled vessels to prevent bleeding, and to direct the flow of blood along its natural course.
* Brain Tumor - A brain tumor is a mass of abnormal cells inside the skull (cranium). The growth can be benign (non-cancerous), or malignant (cancerous). Damage is caused by the increase of cranial pressure resulting from the extra tissue. A primary tumor arises from the tissue of the brain itself. Tumors also arise from structures in the head, such as cranial nerve openings, meninges and the pituitary gland. A metastasizing tumor is a tumor caused by cancer in another part of the body that has spread to the brain.
The pressure on various parts of the brain causes the characteristic symptoms of a brain tumor. These include headache, altered states of consciousness, vomiting, seizures, vision problems, personality changes, dementia, and loss of sensory (feeling) or motor (movement) skills. Many advances in the treatment of brain tumors have been made in the last 20 years, and recovery is possible in many cases. Surgeons usually utilize a combination of surgery, radiation and chemotherapy to treat brain tumors.
* Concussion - A blow to the head, or suddenly stopping a moving head, can cause an abrupt, but temporary loss of consciousness called a concussion. With this condition, there is no obvious bruising of the brain, but loss of memory (amnesia) can occur following the injury.
* Contusion - A contusion is a visible bruising of the brain due to trauma and blood leaking from microscopic blood vessels. If the inner membrane is torn, blood can leak into an inner cavity of the brain. A victim of a contusion can lose consciousness for several minutes or hours.
* Hydrocephalus - The brain and spinal cord are nourished and protected by cerebrospinal fluid (CSF). This fluid constantly circulates around and within the brain and spinal cord, cushioning them from shock, and insulating them from inadvertent chemical attack by other parts of the body. Normally, the body absorbs the CSF as rapidly as it is formed. Sometimes, though, an obstruction, such as a brain tumor, congenital blockage, or inflammation in the brain, can interfere with this drainage. As the fluid accumulates inside the brain, pressure inside the head increases. In an infant, where the skull is not completely closed, the head bulges from the build-up of pressure. In an adult, the swelling displaces brain tissue, causing damage. To prevent damage, a neurosurgeon implants a special drain (a shunt) into the head to drain the CSF into a vein in the shoulder.
* Laceration - The most severe injury, laceration, usually results from skull fracture or a penetrating injury, like a gunshot wound. The brain tissue is torn, rupturing large blood vessels which bleed into the inner cavities of the brain and the spaces between the brain and skull. This causes pools of clotted blood that swell against brain tissue (cerebral hematoma) and pools of other fluids (edema), all of which increase the pressure inside the skull (intra-cranial pressure).
* Transient Ischemic Attack - (TIA) This condition is a temporary brain attack that usually causes no permanent damage. However, a TIA is serious because it is an advance warning of a much more serious condition called a stroke. In a TIA, blood flow to the brain is temporarily interrupted, then restored. The symptoms of a TIA are similar, but shorter than those of a stroke. A victim of a TIA may experience weakness, numbness or tingling in the face, arm or leg, have trouble seeing, talking, or understanding others, experience a sudden, severe headache, feel dizzy, or even lose consciousness. After a TIA, certain precautions and lifestyle changes can reduce the risk of having a full stroke.
Various peripheral nerves can cause problems if they become constricted as they travel through various passageways or tunnels. The most common are:
* Carpal Tunnel Syndrome - This condition is caused by compressing the median nerve at the wrist. This causes symptoms such as hand pain, numbness or tingling in the thumb and first two fingers. Weakness can also develop in the thumb.
* Cubital Tunnel Syndrome - This condition is caused by compression of the ulnar nerve at the elbow. It can lead to numbness in the ring finger and little finger. As the condition becomes more severe, it can cause difficulty with straightening or spreading the fingers.
Peripheral nerve problems are initially managed conservatively with anti-inflammatory, pain medicines, braces, physical therapy and/or cortisone injections. If these measures fail, an electromyogram and nerve conduction velocity test (EMG / NCV) is performed to pinpoint the source of the problem. Surgery can be helpful in alleviating the nerve compression, thus, reducing or eliminating pain, numbness and/or tingling. The longer the weakness and/or numbness is allowed to continue without treatment, the more likely permanent nerve damage may occur, and the less likely surgery will reverse these symptoms.
In medicine, we characterize pain as acute or chronic.
* Acute Pain - Often times, acute or new pain is how a person's body communicates there is a dangerous problem. Medically, we try to find the cause of the pain and fix it.
* Chronic Pain - If we cannot find the source of the pain, or if it persists despite our attempts to solve the problem, the pain is considered chronic. Chronic pain is not an indication of danger, but rather of irritation.
Dr. Matthew Ross's medical measures to address pain are designed to reduce, or minimize discomfort to improve the quality of a patient's life. The approaches are twofold:
* Non-Invasive, Conservative Pain Treatments - Initially, we try to lessen pain by using medication, topical rubs, physical therapy and/or electrical stimulation. Alternative approaches, such as chiropractic, acupuncture or physical therapy, are encouraged.
* Invasive, Conservative Pain Treatments - If non-invasive treatments do not provide sufficient relief, injection therapy by an anesthesia or physiatry pain specialist may be necessary.
* Surgery - Surgery is the last resort for intractable pain. Spinal cord stimulators can be implanted in the body to block pain messages from the arms, legs or back, reaching the brain at full intensity. Drug infusion pumps can be put in the body to help with severe cancer or other disabling pain. These measures rarely eliminate all pain. However, they can make the pain manageable so a person can lead a more normal, active life.