LOWER BACK PAIN

When it comes to low back pain, understanding the right time to see your doctor is key. In most cases, starting with simple treatments like anti-inflammatory medicines, heat, ice, and changing your physical activity before seeing a physician is better and could help you find relief from the discomfort without going through expensive or invasive procedures.

Research has indicated that minor lower back pain often resolves on its own 80-90% of the time, regardless of professional medical treatment or at-home remedies. If your pain continues for more than 4-6 weeks, or if there are any signs of neurological issues, such as numbness or weakness radiating down the leg, patients should consult a medical professional immediately.

If a patient has experienced pain, numbness, or weakness in their lower back or, more commonly, their leg, a physician will recommend them to a neurological specialist like Dr. Johans. People who have experienced physical trauma, have cancer, or a weakened immune system should consider getting assessed by a neurosurgeon. Moreover, any issues with bowel or bladder control, loss of function in other areas, or progressive weakness or numbness warrant an assessment. Dr. Johans does not require a physician's referral, but some insurance companies do, so patients should call our office to verify that before scheduling a consultation.

However, it is important to understand that the evaluation does not necessarily mean a patient requires surgery; the final recommendation will be based on specific signs and symptoms in combination with a medical history and MRI scans.

Going to the emergency room for lower back pain is not a common occurrence, but there are certain circumstances in which it may be necessary. If a person experiences sharp and sudden pain in their back, or if they have any sudden loss of bowel or bladder function, then going to the ER should be considered. These symptoms could mean something more serious, such as a spinal injury, has occurred and needs immediate medical attention.

Another reason to go to the ER is if the person has progressive fever and chills accompanying back pain. Any sudden weakness or numbness in the legs should also indicate that you must go to the ER immediately. Additionally, if you have been involved in a car accident or physical trauma recently, getting checked out at the hospital just in case is important.

Before a neurological consultation, patients can do several at-home remedies and treatments independently to avoid or delay back surgery.

• Anti-inflammatory medicines
• Modifications to exercises and physical movements
• Losing and maintaining a healthy weight for your body type
• Stretches or physical therapy
• Yoga, Pilates, and core strength training
• Routine chiropractic adjustments
• Quitting smoking
• Steroid injections

If these conservative solutions are ineffective, it is time to consult with Dr. Johans about a surgery that could offer greater relief. In many cases, with the treatments listed above, many people will get better. But, if the pain in the lower back gets progressively worse over 4-6 weeks, surgical intervention could be necessary to prevent further neurological loss. He will work with every patient to explore all non-surgical options before suggesting they proceed with an operation.

If your back pain is persistent with the sensation of weakness or numbness that travels down the leg, it is time to consider surgery. Our first step will be to take an MRI scan to look for a disc herniation, bone spur, or smashed nerve root, indicating the necessity of surgery.

Once the MRI scan is ready to be examined, patients will discuss in-depth options with Dr. Johans to find the best treatment possible for their individual health goals.

The main goal of low back surgery is to alleviate the pressure on nerve roots that may be caused by a herniated disc or bone spur. The relief from this pressure can prevent further numbness, tingling, and weakness along the affected area and reduce any pain you might experience down in your leg.

Unfortunately, however, this type of surgery cannot guarantee that it will reduce all possibility of future back pain. The main goal of surgery is to alleviate the pain, numbness, and tingling felt in the leg caused by the back issue. However there are numerous causes of low back pain, and all require different types of treatment.

As with any surgery requiring general anesthesia, there is a risk of stroke or death. Dr. Johans and the attending medical professional will thoroughly consider a patient's heart and lung health to ensure a patient is fit to proceed with the surgery.

• A minor risk of low back surgery is bleeding, which can range from minimal to more serious depending on the patient's situation. Dr. Johans’ patients will lose, on average, one ounce of blood during surgery.
• Infections are another potential complication associated with such procedures. The national infection rate for this type of surgery is estimated at around 3%, with Dr. Johans having less than a 0.5% infection rate. Patients will be aware of infection typically within 8-10 days after surgery and will feel a sudden onset of fever, chills, and redness around the incision.
• There is a risk of inadvertently damaging a nerve during the procedure. This can lead to permanent numbness, tingling, or weakness in the affected area. Dr. Johans has extensive experience and knowledge of anatomy as well as sophisticated tools and techniques, allowing him to minimize significantly the risk of additional nerve damage.
• A cerebral spinal fluid (CSF) leak is another risk with lower back surgery. If a leak occurs, Dr. Johans will do everything possible to stop it. To this day, there has yet to be a CSF leak that he could not fix, thanks to his training in microsurgical techniques. It is recommended to ensure that your spine surgeon is trained in microsurgical techniques.
• Despite a perfectly performed discectomy, there is a 5% chance of suffering a second herniation in the same spot.

More often than not, the benefits of surgery for back pain outweigh the risks. Many patients report feeling a 90% decrease in their pain, numbness, and weakness as early as the night after the surgery or when they get home the next day. To mitigate these risks, Dr. Johans strives to provide patients with a clear understanding of what they should expect before their surgery so they can make an informed decision about their care.

MRI scans can be incredibly useful for uncovering the underlying cause of low back pain when a more serious condition is suspected. However, in many cases, they are unnecessary and only ordered as a precaution. An MRI scan may be recommended when there is weakness, numbness, severe leg pain, a suspicion of trauma, cancer, immunosuppression, a loss of bladder or bowel function, or if the pain persists despite treatment. However, an MRI scan may not be necessary if a patient only suffers from low back pain without any other issues mentioned above. Ultimately, an individual needs to consult their doctor about the best tests for them and how to manage their condition.

When diagnosing the cause of lower back pain, an x-ray is not always the best option. While it can provide valuable information about the anatomy and alignment of the spine, more is needed to pinpoint the exact source of discomfort accurately. Muscular or ligamentous problems cause most lower back pain; these soft tissues cannot be seen on plain x-rays.

To accurately determine the source of your back pain, Dr. Johans will take an x-ray of your spine in a neutral position and when flexed forward and backward. This imaging technique allows us to visualize any instability or abnormalities in the bones or joints of the spine that could be causing the discomfort. We can identify potential issues contributing to chronic back pain symptoms by assessing how the bones move within their structures.

Our office follows an evidence-based approach to treating low back pain. We use objective criteria that are measurable to ensure that we are providing the best possible care and avoiding unnecessary surgery whenever possible. To do this, we take a comprehensive approach involving various non-surgical treatments until the pain is gone or has progressed more than 4-6 weeks.

Dr. Johans assesses your condition in detail. He will review your medical history and perform a physical exam, looking for any signs of discomfort or pain. In addition, he will ask you to fill out the SF 36 form, an important assessment tool used to measure overall happiness and quality of life. It considers factors such as how your low back pain and leg pain affect your ability to function in day-to-day life. We will repeat this form in one month to track any improvements or declines in your condition. Lastly, Dr. Johans encourages all his patients to quit smoking as it could help decrease the cause of back pain and is generally better for their health.

No matter what, each patient will review every test, non-surgical, and surgical treatment option with Dr. Johans personally before they proceed. He will also educate them on the body's anatomy, physiology, and pathology so they can make the best, most informed decision possible.

After surgery, patients will be admitted to the hospital. For the comfort of his patients, Dr. Johans does not use a bladder catheter during surgery as it is quick enough that it does not require one. Specialized nurses will monitor your vital signs and check for potential neurological complications in the lower body. If anything concerning arises, they will alert Dr. Johans right away.

Patients will also be encouraged to start trying to eat and walk around as quickly as they feel comfortable, usually a few hours after surgery. Walking around helps to reduce the risk of dangerous blood clots forming in the legs and lungs. They should also take deep breaths every 15-20 minutes. To do this, take a big, slow breath in and then slowly exhale the air out. This will help get more oxygen into your lungs, improving your respiratory system and reducing the chance of developing a pulmonary disorder like pneumonia.

During evening rounds, Dr. Johans will explain discharge instructions, how to care for the incision wound, and what medications will be prescribed. He will then discuss the lumbar brace and how to use it properly. Patients won't need to wear the brace at all times, only while they are up walking around. After some time of doing simple activities, the patient can wean off the brace in four to six weeks.

Wound care typically involves two or three layers of stitches, sealed with a final plastic surgical closure. This is followed by a material that looks like super glue, which helps to glue the wound together. Finally, a very simple dressing is placed over the incision, which is mostly waterproof and can be worn for up to four or five days without needing to be changed. After showering or coming in contact with other water sources, it is important to check the dressing for signs of wetness, and if necessary, blot it dry and follow up with a blow dryer. While this may seem arduous, these precautions ensure the wound heals properly and quickly.

Generally, patients have a follow-up appointment one month later. If any issues arise in-between being discharged and the first follow-up appointment, patients can always call Dr. Johans. He will try to see any patient with concerns as quickly as possible, usually the same day as they called in. But his goal is to ensure all patients have all the information they need to understand what to expect during this recovery period.

After surgery on your lower back, knowing exactly what you can and cannot do can be hard. It is best to use common sense for what your body can handle, but Dr. Johans will suggest the following tips to help guide you:

• After surgery, Dr. Johans will suggest being active immediatly with NO prolonged bed rest. Patients can begin resuming their normal activities in moderation based on their back pain and lifting restrictions given to you.
• When bending down, stand up straight and bend your knees. This will help reduce the strain on your lower back and prevent further injury.
• Be aware of any activities that seem too strenuous or cause pain, as these should be avoided. Pay attention to how your body feels and take frequent breaks when needed during physical activity.
• For the first two weeks, do not lift any objects weighing more than 15 or 20 pounds, and keep the object close to your body. If an individual attempts to lift an object in front or to the side of them, this can cause torque in the back, resulting in pain and discomfort in the lower back area.
• If you take narcotics or muscle relaxant drugs, driving within 24 hours of the last dose is unsafe and illegal. However, if you are not on these medications, driving a car is legal, just with extra caution. Patients should be aware that they may need to stop more frequently than usual to get out and stretch their legs. Additionally, when getting into and out of a car, patients should move slowly and turn carefully to prevent further injury or discomfort.

The treatment plan prescribed by Dr. Johans will include medications like anti-inflammatory medicines, muscle relaxants, and narcotics. You will be on anti-inflammatory drugs for at least a few months, with a steady decrease in the dosage. Anti-inflammatory drugs are used to reduce the inflammation in your lower back that causes pain. Muscle relaxants and narcotics may also be prescribed to help ease the pain following the operation. Dr. Johans will not give most medications a refill prescription because his goal is to ensure they only help you regain your normal level of comfort and mobility.

At your follow-up appointment, we will work together to ensure you are feeling better. This appointment is very important as it allows us to ensure that your current treatment plan is working and helping you improve. We will take multiple measurements, review lab results, and discuss necessary changes to improve your health. This appointment typically occurs about a month after discharge from the hospital or clinic for optimal effectiveness.

Dr. Johans will examine the incision in detail to ensure it is healing properly and there are no signs of infection. After that, he will carefully assess your current physical ability, such as how strong you are and if you have any lingering numbness. All this information will help him determine the best course for getting you back to work or other activities.

If you have difficulty with your low back due to weakness, Dr. Johans may suggest you attend formal physical therapy sessions to regain mobility. Along with the recovery from surgery, we will look at how to get you back into work.

When you come back to the clinic, there will be some important forms for you to complete. These documents are part of the evaluation at your one-month follow-up appointment. Your insurance company wants an update on how you are feeling and what they can expect if you are doing well and your leg discomfort has significantly decreased or is no longer present. Usually, further imaging such as X-rays is not needed unless you experience a return of severe back pain, numbness, tingling, or weakness down your leg.

Patients are often delighted to report that their pain has decreased dramatically in their leg and back, and their functioning levels usually return to normal. The doctor and patient will discuss positive progress, such as being able to go back to work and returning to their daily activities. Patients are typically very enthusiastic about the improvements they have made, and Dr. Johans also enjoys this appointment as it gives him and the patient a chance to celebrate their progress.

We hope you are back to work at full capacity, and if not, we will still provide you with help and support until you reach this goal. Generally, it takes three months for a full recovery, but there is no fixed timeline. We are prepared to discuss any issues that may arise if recovery is going slower.