You’re only as Young as Your Back

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Last week we looked at a recent JAMA article that showed an unnecessary, costlier, and riskier trend in spine surgery; namely a steep rise in the use of complex fusion surgeries for spinal stenosis. I brought up the point that nobody in our health care system really has the role of regulating this trend. It is really up to doctors and insurers to look at this type of information and choose to ignore it or incorporate it into what they do. In other words, we don’t have a health guardian guru to lead us.

I would like to follow that up with a few comments on the aging back. Spinal stenosis is a common problem associated with aging where the structures in the lower spine progressively degenerate over time as we grow older. As this process continues, the space down there for things like our nerve roots gets smaller and smaller, and this eventually starts to squeeze and irritate them, causing symptoms like pain and sciatica. Deterioration of the joints that support the spine causes aching backs, too.

I have had the opportunity of looking at live x-ray pictures of the lower backs of elderly patients in pain virtually every week of my thirteen year career. When you think about it, that is a lot of backs. Firsthand, I see what the deterioration of their many years of living actually looks like.

For those who have had some sort of surgery on their backs, the changes can be jaw-dropping. What I mean is their lower spines often show very advanced degrees of deterioration projecting images on the screen that look like collapsing buildings. It is painful to just look at it. These unfortunate folks come in to the office in need of epidural cortisone injections to relieve pain at a much higher frequency than elderly patients who never had surgery on their backs.

Most research done on pain relief and spine surgery usually follows patients for only a limited amount of time. Rarely are subjects followed for greater than two years because that is very difficult to do if you want to publish something. Research that has shown success with the more conservative decompression surgery for spinal stenosis followed patients for two years, with positive results found at the two year mark that were statistically significant. These studies don’t see these folks five, ten, or even fifteen years later, like I do on a routine basis, and I can tell you, it isn’t pretty to look at. The decisions we make today about how we manage our health can have huge consequences down the road.

Joseph Pilates, the sage founder of the exercise and rehabilitation practice now known as Pilates noted that true age lies in the “degree in natural and normal flexibility enjoyed by your spine throughout life.” In other words, you are only as young as your back.