Conversations for Confidence: Expert Answers About Spine Care

If you have neck or back pain and need spine care – or are already receiving spine care – you probably have a lot of questions: How do I know when to see a spine specialist? Who do I meet with first? What treatment options are available? Will I need surgery? 

In a recent Q&A webinar, three spine physicians from The Christ Hospital Health Network talked through different aspects of our Comprehensive Spine Program and answered questions from patients. Travis McClain, DO, RMSK, a physical medicine and rehabilitation (PM&R) physician, explained the PM&R program; Ankit Patel, MD, an interventional spine physician, focused on interventional treatment options; and Jared Crasto, MD, an orthopedic spine surgeon, discussed when it’s time to consider spine surgery and common surgical procedures.  

Here’s what our experts want you to know if you’re living with neck, back, or related pain.  

What is a Comprehensive Spine Program? 

Spine care is complex and often requires care from multiple specialists. A comprehensive spine program has all the providers and treatment options in one place to manage your diagnosis. 

Typically, you’re introduced to a comprehensive spine program because you have some sort of spine-related pain. You can make your own appointment or your primary care provider, community chiropractor, physical therapist, or another specialist may refer you to our program. 

At The Christ Hospital Health Network, our Comprehensive Spine Program brings together experts from: 

• Chiropractic medicine 
• Neurology 
• Neuro-radiology 
• Neurosurgery 
• Pain medicine 
• Physical Medicine & Rehabilitation (PM&R) 
• Physical therapy 
• Psychology 

“When you have something going on with your body, you don’t want it addressed in isolation,” says Dr. McClain. “Within a comprehensive spine program, the goal is to establish a diagnosis and then coordinate care between all relevant teams.” 

 This orchestrated approach provides many benefits for patients, such as: 

• Faster diagnosis 
• Coordinated care 
• Seamless referrals 
• Better communication among providers
• Individualized treatment plans 
• Access to all treatment options 

Physical Medicine & Rehabilitation (PM&R) 

One of the specialties within The Christ Hospital Health Network’s Comprehensive Spine Program is Physical Medicine & Rehabilitation, or PM&R. Visits with a PM&R physician usually begin with a hospital-based evaluation.  

The goal of the initial evaluation is to find the source of pain and restore as much function and quality of life as possible with conservative approaches to care. The PM&R team looks at your spine, nerves, muscles, joints, and movement patterns, along with any imaging that may be available. They also talk to you about what you’re experiencing and your health goals.  

“In most cases, patients want to avoid surgery, so we’re trying to get them in a position where they feel like they can function and live their lives,” explains Dr. McClain. “Sometimes, their case does require surgery, but we try to take all the necessary steps before surgery to get people feeling like themselves again.” 

When Should You See a PM&R Physician? 

Common reasons people see a PM&R physician include: 

• Neck pain 
• Back pain  
• Sciatica (radiating pain from one area to another) 
• Herniated disc 
• Spinal stenosis 
• Numbness and tingling 
• Sports injuries 
• Joint pain 

Usually patients come to PM&R when their pain and other symptoms are ongoing, go away and come back, or interfere with daily life. Our physicians note that the most concerning symptoms are weakness or numbness in a foot or arm that happens suddenly or gets worse. For instance, if your shoulder feels numb one day and the next day your entire arm is numb, call your provider. Progressive symptoms can be a sign of worsening nerve compression and can be irreversible if not treated quickly.  

After an evaluation, your physician may start with conservative care methods, such as physical therapy, exercise, and medication. If needed, they’ll send you to the interventional spine team or for a surgical consultation, though most patients never require surgery.  

"90 to 95 percent of patients that have their epidurals continue doing very well,” says Dr. Crasto. “Typically, I'm only seeing those 5% who get [the epidural] and it's not doing well.” 

If they determine your pain isn’t spine-related, they might refer you to Orthopedics and Sports Medicine or the appropriate specialist.  

Interventional Spine Procedures 

Interventional spine procedures are non-surgical, targeted treatments to specific areas that cause pain. They’re designed to reduce pain, improve function, and facilitate rehabilitation if pain is getting in the way of progress. Usually, we consider these more interventional-based procedures after conservative therapies – such as medications or physical therapy – haven’t provided results. 

“Our role in this process is to target pain generators via minimally invasive procedures, mainly percutaneously through needles,” says Dr. Patel. “Generally, we’re using real-time guidance, so either ultrasound, most commonly X-ray (fluoroscopy), and occasionally a CT (Computed Tomography) scan.” 

Who is a Candidate for Interventional Spine Procedures? 

You may be a candidate for an interventional spine procedure if you have: 

• Failed conservative care, typically after six or more weeks 
• Supportive imaging that explains your symptoms 
• An identifiable pain source 
• No active infection or bleeding disorder 

Advanced imaging, preferably an MRI, is needed for most procedures. Procedures cannot be performed if a patient is on an antibiotic, and patients must stop taking blood thinners for a short time.  

What Are the Most Common Procedures? 

There are three main types of interventional spine procedures: 

• Injections and blocks: Steroid or anesthetic medication delivered directly to inflamed nerves, joints, or spinal spaces to reduce pain and swelling. 
• Nerve procedures: The use of heat (radiofrequency) or electrical signals to interrupt pain pathways for long-lasting relief without surgery.  
• Neurostimulation: Using small devices, gentle electrical pulses are delivered to “override” pain signals before they reach the brain.  

Almost every procedure is guided by fluoroscopy, which uses live X-ray imaging so the physician can confirm needle or device placement in real time.  

More specifically, these are some common procedures performed by our spine specialists: 

What Can I Expect During These Procedures? 

Each procedure is different but follows the same basic steps. Prior to your procedure, you’ll have a consultation where your team will review imaging, symptoms, and medications. If you’re taking blood thinners, you’ll need to stop taking them for up to a week. If you’re receiving sedation, you’ll also need to arrange for a driver. 

On the day of the procedure: 

1. You’re brought into the procedure suite at the Joint & Spine Center and our team gets you positioned, usually on your stomach.  
2. Your skin is cleaned and numbed with a local anesthetic.  
3. The physician starts to get pictures with the X-ray and begins to identify targets for treatment using fluoroscope, a special X-ray arm that sits close to your body but doesn’t touch you.  
4. Live X-ray images appear on the screen, so your team can see them in real time. Contrast dye helps confirm the correct placement before any medication is administered. 
5. Medication is delivered, which takes 15-45 minutes.  
6. You’re taken to the recovery area to rest for 20-30 minutes.  

You might have some soreness at the injection site for a few days, but most patients return to light activity the next day. The full effect of steroid injections can take up to five days. How long the effects of each procedure lasts is different, so you may need a procedure multiple times.  

Why Do Injections Stop Working, and What Comes Next?  

Interventional therapies can have diminishing effects, but they vary by person. You might have multiple pain generators, so treating one area doesn’t resolve all your pain. Your body also can adapt to repeated treatments.  

“When your body first sees the injection, it’s like, ‘This is great,’” says Dr. Patel. “But every subsequent time, it’s used to that relief, so it doesn’t seem as effective.” 

Because spine pain is so complex, it’s important to work with a multidisciplinary team who can help with any next steps. 

“If you get through a procedure and you’re not finding relief, it doesn’t necessarily mean you need surgery,” says Dr. McClain. “It might, but it also could mean you fall into the category where we need to try some outside the box options.”  

Even if an interventional procedure doesn’t provide lasting relief, it still gives insight into your pain. If you respond to an injection or anesthetic, it tells your providers more about the nerves causing your symptoms, which can help them arrive at a more accurate diagnosis.  

Spine Surgery 

When someone has back or neck pain, spine surgery is often the last consideration, after trying other treatment options. 

When is it Time to Consider Spine Surgery? 

We often consider spine surgery for patients who have: 

• Symptoms that have failed to respond to appropriate conservative measures, such as medications, physical therapy, and injections 
• A structural problem that can be addressed 
• Conditions at risk of progressing to cause nerve or spinal cord damage, such as spinal instability, deformity, trauma, cancer, or infection 
• Conditions with evidence of ongoing nerve or spinal cord damage such as progressive weakness or “foot drop” 

Two specific conditions often benefit from more immediate surgery: 

• Cauda equina syndrome, which is severe compression of the lumbar nerve roots causing lower extremity weakness, numbness, and loss of bladder and bowel control.  
• Myelopathy, which is severe compression of the spinal cord causing balance or gait dysfunction, loss of fine motor control, loss of hand dexterity, and loss of bladder and bowel control.  

What Spine Surgeries Are Performed at The Christ Hospital Health Network? 

There are three types of spine surgery: 

• Decompression surgery to stop compression of the nerve root (for example, herniated disc, lumbar stenosis, or facet joint cysts) 
• Stabilization or fusion surgery to help with cervical and lumbar stenosis, cervical herniated discs, spinal instability, or cervical and lumbar degenerative disc disease 
• Deformity correction surgery for anything that pulls the spine out of normal alignment (for example, spinal instability, adult and adolescent scoliosis, spinal trauma, infection, cancer, or metastatic disease) 

A single procedure might involve one or more surgery type. Examples include: 

• Lumbar discectomy or microdiscectomy: Removes a herniated disc fragment so it no longer compresses the nerve root.  
• Lumbar laminectomy: Removes bone or tissue narrowing the spinal canal. You can think of it like a “Roto-Rooter” procedure to open an area of the spine.   
• Lumbar stabilization or fusion surgery: Prepares bony surfaces to fuse together as one, usually with a clamp or screws and rods to hold the bone in place.   
• Lumbar deformity correction surgery: Realigns the spine and restores disc height, often with decompression surgery.    
• Neck surgeries: Anterior cervical fusion surgery, cervical disc arthroplasty, and posterior cervical laminectomy and fusion.  

What Can I Expect with Spine Surgery? 

Your surgery team will discuss all aspects of surgery with you, including recovery. 

Most spine surgeries are done under general anesthetic, meaning you’re asleep with a breathing tube. Smaller surgeries can take between an hour to 90 minutes, while larger surgeries can last as long as eight to 10 hours.  

Recovery time also varies widely. For example, downtime after a minimally invasive decompression surgery is often three to six weeks. A smaller infusion procedure might take three to six months to recover. And a more extensive deformity correction procedure might have a recovery period of six to 12 months.  

What Should I Consider Before Moving Forward with Spine Surgery? 

When considering spine surgery, it's important to find a surgeon that you trust and someone who can talk with you about all your other options first. Dr. Crasto says you want to make sure you’ve maximized the less invasive interventions first, such as medical treatment, therapy, and injections.  

Is it Bad to Delay Getting Spine Surgery?  

A common question Dr. Crasto gets from patients is, “Am I waiting too long to have surgery?” In other words, should I have surgery now while I’m healthy, but my symptoms aren’t bad? The short answer is no. Most surgeons don’t practice preventive spine surgery, so they wouldn’t treat something that isn’t causing a problem right now (with a few rare exceptions).  

“In general, waiting two to three years to have surgery won’t change much in terms of your risk,” says Dr. Crasto, “unless you pick up additional health problems in those years, but that’s hard to predict.” 

How Can I Prevent Spine Pain or Long-Term Issues? 

Two ways to help prevent spine issues in the future are to avoid smoking and to lose extra weight.   

Any nicotine use makes blood vessels narrow, preventing them from opening and diffusing nutrients. So when you have a minor injury, such as a disc herniation or inflammation, the blood vessels can’t open properly to heal it. Your risk of surgical complications or infection is much higher, too. 

“I will not do elective surgeries on patients using nicotine products because their risks of getting an infection is much higher,” says Dr. Crasto. “I think nicotine is one of our biggest reversible risk factors or modifiable risk factors in musculoskeletal care.” 

Additionally, extra weight in the belly or front of the spine can put pressure on the back. Dr. Crasto says to think of lifting a 20-pound weight straight in front of you. As you move the weight out from your center, it’s harder to hold and puts more stress on the spine. That kind of stress is the same with body weight – it can worsen conditions, such as disc herniation problems, stenosis, or spondylolisthesis.  

Where Do I Get Spine Imaging?  

The best place to start with imaging is your primary care provider. They can order X-rays and sometimes an MRI, which can help when the spine care team evaluates you for the first time.  

However, many patients see the spine care team without any imaging. When that happens, we start with an X-ray. There may be some limitations with the imaging a PM&R doctor can order, depending on your insurance.  

Schedule a Spine Care Consultation 

The Comprehensive Spine Care team at The Christ Hospital Health Network is ready to help find the source of your pain and relief. If you’re not sure where to start, our team can help. 

“We have a multidisciplinary spine team because there’s not one-size-fits-all treatment,” says Dr. Crasto. “Anywhere along the continuum, we have you covered.”     

To get started with a spine specialist, call 513-613-4075 or complete this form to request a call back.