Frequently Asked Questions About the Spine

Orthopaedic spine surgeons and neurosurgeons are equally qualified to perform most types of spine surgery. Both perform cervical, thoracic, and lumbar surgery, including spinal cord and nerve decompression, spinal fusion, microsurgery and minimally-invasive spine surgery.

Both types of surgeons complete four years of medical school before entering aresidency in their specific field. Traditionally, orthopaedic surgeons complete five years of residency training in the diagnosis and treatment of all musculoskeletal (bone, joint, muscle and nerve) disorders including those of the spine, whereas neurosurgeons complete residency training in disorders of the brain and spine. Many spine surgeons will complete additional training in spine surgery after their residency called a fellowship. A fellowship involves more specialized training in advanced spinal surgery techniques including spinal fusion, minimally invasive spine surgery, and complex spinal reconstruction.

In some specific instances, either a neurosurgeon or an orthopaedic spine surgeon may be the more appropriate choice. For example, an orthopaedic spine surgeon may be more capable of doing spine deformity surgery (such as surgery for scoliosis and other large spinal deformities), whereas a neurosurgeon can better treat intradural tumors, i.e. tumors that are inside the central nervous system.

For the most part, the qualifications of the surgeon to do spine surgery are more driven by the amount of training in spine surgery and the amount of the surgeon's practice devoted to spine surgery rather than by whether or not the surgeon is a neurosurgeon or orthopaedic surgeon.

• Is the spine surgeon fellowship trained in spine surgery?
• Is the spine surgeon part of a multidisciplinary spine center?
• Is the spine surgeon trained in microsurgery and other minimally invasive techniques?
• Is spine surgery a big part of the surgeon's practice, or is he or she more of a general orthopaedic surgeon or neurosurgeon?

A physician who focuses on spinal surgery is likely to be far more adept and current in newer surgical techniques than one who only occasionally performs spine surgery.

• Did the surgeon fully explain the diagnosis and cause of your pain?
• Do you feel comfortable with the surgeon and feel that all of your questions have been satisfactorily addressed?
• Did the surgeon offer a full range of treatment choices or immediately discuss surgical treatment?

Often you may still have several non-surgical care alternatives available, which may help you avoid unnecessary surgery.

The term "chiropractic" combines the Greek words cheir (hand) and praxis (action) to describe a treatment done by hand. Hands-on therapy-especially adjustment of the spine-is central to chiropractic care. Spinal manipulation or manual therapy is also performed by many physical therapists, including those at Resurgens Spine Center. There appears to be firm literature support for spinal manipulation for lower back pain, and many of the published guidelines recommend spinal manipulation be included in the treatment plan in the care of lower back pain.

The modern profession of chiropractic was founded by Daniel David Palmer in 1895. Palmer, a self-taught healer, theorized that structural derangement of the spine can affect the nervous system. Palmer felt that identifying and restoring spinal structural integrity through chiropractic treatments improved the health of the individual by reducing pressure on sensitive neurological tissue.

When spinal injury occurs from accidents, falls, tension, over-exertion or other mechanisms, the inability of the spine to compensate can result in small changes in movement or position of one or more vertebrae. This causes irritation to the soft tissues and nerves directly by pressure or indirectly through reflexes. The treatment concept of manipulative therapy is to re-establish normal spinal mobility, which in turn alleviates the irritation to the tissues and nerves.

Chiropractors often use the word "subluxation" as a general term to describe the altered position of the vertebra and subsequent functional loss, which determines the location for the manipulative treatment. This differs from the medical use of the word subluxation, defined as an abnormal separation of the articular surfaces of a joint which can be quantified on radiographic imaging studies such as x-rays and CT scans. There are many different methods that a chiropractor may use for determining the spinal segments that require manipulation. Most commonly, the chiropractor will manually examine the spine with the patient both still and moving to identify spinal segments that are "subluxed". Chiropractors also use x-rays to locate subluxations. However, there is often disagreement between chiropractors and traditional medical physicians as to what constitutes a subluxation on x-ray.

The term "adjustment" refers to the specific manipulation chiropractors apply to vertebrae that have abnormal movement patterns or fail to function normally. A chiropractic adjustment involves using the hands or a device to apply a controlled, sudden force to a joint, moving it beyond its passive range of motion. This is often associated with an audible "pop" or "crack". This sound is due to a release of gas within the joints which relieves joint pressure. This phenomenon is known as joint "cavitation". The goal of the chiropractic adjustment is to increase the range and quality of motion in the area being treated.

Chiropractors and therapists utilize other forms of manual or manipulative therapy for spinal disorders such as stretching, traction, and massage. Spinal manipulation should be combined with active stretching and strengthening exercises for maximum benefit. Chiropractors and therapists may combine the use of spinal manipulation with several other treatments and approaches such as heat, ice, electrical stimulation, and counseling about diet and weight loss. Chiropractors do not utilize drugs or surgery in their practice. However, there are times when a chiropractor will recommend that the patient consult a medical doctor if these or other methods of treatment are indicated. Reasons for referral to a medical physician include suspicion of infection or tumor, unremitting pain that does not respond to six weeks of treatment, and neurologic symptoms such as radiating arm or leg pain, numbness or weakness.

Side effects and risks of spinal manipulation depend on the specific type of chiropractic treatment used. For example, side effects from chiropractic adjustments can include temporary headaches, tiredness, or discomfort in parts of the body that were treated. The likelihood of serious complications appears to be extremely low and related to the type of adjustment performed and the part of the body treated. Vascular accidents (stroke) have been reported with manipulations of the cervical spine (neck). However, documented reports of the incidence of this are very rare.

Studies have shown that when used alone, chiropractic adjustments typically provide only short-term relief of acute low back pain. However, when used in combination with active, patient-driven care (exercise, activity modification, improved body mechanics, ergonomic modifications) spinal manipulation can be effective in the treatment of low back pain. The Agency for Health Care Policy and Research (AHCPR) recommends treating lower back pain with spinal manipulation in the first four weeks of symptoms in conjunction with mild exercise such as walking or swimming, followed by conditioning exercises. They stress the importance of resuming normal daily activities as quickly as possible and found that more than four days of bed rest can be counterproductive.

In summary, chiropractic care and spinal manipulation techniques used by physical therapists have been shown to be safe and effective in the management of low back pain when combined with cardiovascular and strengthening exercise. Pain that is persistent beyond six weeks or that is associated with radiating leg or arm symptoms should be evaluated by a medical physician.

Learn more about the Spine Center at Resurgens Orthopaedics.