MEDICAL SURFARI; HUMANS (LIKE DACHSUNDS) MUST BE CAREFUL OF SPINE INJURY

When it comes to neck and back pain and its referred pain into the arms and hands or the buttocks, legs and feet, I suspect that our savage ancestors of Sterkfontein are at least partly responsible for rising up on two feet 2-8 million years ago. Bipedal locomotion, and the associated weight bearing gravity effects have had an enormous impact on the human spine. Few other members of the animal kingdom, other than dachshunds, are plagued with so much spinal disease and degeneration. Believe it or not, in addition to the gravity effects on our upright spines, behavior choices are probably the biggest controllable factor in spine injury and degeneration. These behavior choices include tobacco abuse, overeating and lack of exercise resulting in obesity, improper lifting and risk taking behavior that may lead to trauma.

The human spine extends from the base of the skull to the tip of the tailbone and is made up of 33 vertebra separated by soft tissue discs designed as "shock absorbers" alleviating some of the mechanical stresses that would otherwise be placed upon the bone of the spine. In addition, the spine has more than 100 joints that are responsible for its proper motion allowing each vertebra some motion as it interacts with the rest of the skeletal system. It is the muscles and ligaments that define the degree of movement of the spine. Neck and back pain may result from disease, disorders, degeneration and injury to the muscles, ligaments, nerves, bones, joints and discs of the spine.

The most common causes of neck and back pain are due to stress and strain injury effects. In some people, neck pain may be associated with sharp pain and burning or aching discomfort between the shoulder blades, shoulders, upper arms or hands. Similarly, low back pain may also be associated with sharp aching or burning pain that radiates to the buttocks, thighs, calves and feet. These forms of radiating pain may also be associated with numbness and tingling or a "pins and needles" sensation that often follows a similar pattern as the pain. Most types of neck and back pain, even those with radiating pain, respond well to non-surgical care. Elective (non-emergency) surgery should be reserved only for those who have a finding that anatomically matches their symptoms and which has not responded to a thorough course of nonsurgical measures. Nonsurgical measures include therapies that are prescribed by your physician including anti-inflammatory medication, muscle relaxants and physical therapy. In some, but not most, injection therapy may be worthwhile.

As a neurosurgeon (even though most people think of neurosurgeons as brain surgeons), the majority of nervous system problems that I treat relate to the spine. I have taken care of more than 10,000 patients with neck and back problems and well less than ten percent have required surgery. Many of the conditions affecting the neck and back can be treated by your family physician or nurse practitioner.

Worldwide Web Resources

American Association of Neurological Surgeons

www,neurosurgery.org/pubpages/patres/herniatedbroch.html

This web page in the AANS web site discusses the anatomy and definition of a herniated disc as well as usual treatment options.

American Academy of Orthopaedic Surgeons

www.aaos.org/wordhtml/pateduc/lowback.htm

The AAOS has web pages on low back pain and neck pain, including information on herniated discs.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.