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Scott Webb: Approximately 70% of neurosurgery deals with issues of the spine and this includes the treatment of back and neck pain due to a variety of causes. Neurosurgeons have the greatest amount of spinal surgery training of any other medical specialty and are the only specialty to treat the entire spine.

They are experts in diagnosing back and neck conditions and working with patients to create and administer a successful treatment plan. And when surgery is relevant for spinal conditions, today's neurosurgeons benefit from exceptional advances in surgical techniques, particularly minimally invasive surgery.

And joining me today is Dr. Samuel Borsellino. He's a neurosurgeon with Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Web. And doctor, estimates are that as many as 80% of the population will at one time in their lives experienced back pain. In fact, lower back pain represents the most common cause of disability worldwide. So doctor, let's start here. What are the common causes of back pain?

Dr. Samuel Borsellino: There's a lot of different causes of back pain as you said. The more common ones that we see are, for example, injuries related to overuse of the spine. They can be from traumatic injuries or even fractures of the spine. One of the very common things that we see is called spinal stenosis. That is a degenerative problem. We also see things like protruding or herniated disks, arthritis, and then there are the more rare causes of pain, such as things like infections or tumors or abnormal growths. Those are less common, but, uh, can be causing these types of problems.

The other thing I was going to mention is sometimes there can even be, uh, other medical, uh, causes of back pain that are not necessarily related to the spine, such as something like an aortic aneurysm or a kidney stone. Um, so those are also on the list, but probably lower down. The other thing I was going to say is that sometimes we don't really find a specific cause because many of these problems will go away on their own and we may not even find the cause by the time it resolves.

Scott Webb: Okay, doctor. Now let's talk about the common causes of neck pain.

Dr. Samuel Borsellino: The causes of neck pain, similar to the causes of low back pain, many of them can be related to muscle strain or soft tissue type of injuries. Those are common and those will usually resolve for the back and the neck on their own with usually things that can be done in the short term.

The most common ones that I see are things that are related to aging. In that category, I would say things like herniated discs or protruding discs, arthritis of the joints of the spine, bone spurs. Those are all related to and put under the category of degenerative spine disease. There can also be causes such as injuries to the bones, fractures, infections or tumors,

Scott Webb: And whether it's neck or back pain, when should we see someone like yourself?

Dr. Samuel Borsellino: My specialty is surgery on the brain and the spine. Many people when they think of a neurosurgeon and they think, "Well, he just does brain surgery," but a significant portion of what we do is spinal surgery and many neurosurgeons, a large portion of their practice consists of that. So we deal with problems involving the brain and the spine, and we certainly deal with the spine all the time.

So your primary care doctor can help guide you. They're the frontline, uh, healthcare providers that usually know the patient's history the best. And so they certainly are there to help and direct, you know, when you need to see a neurosurgeon.

You know, there are some more urgent things that would make me think that you would have to see someone such as a neurosurgeon more urgently maybe or more immediately. Things like having really severe low back pain or very severe neck pain that really is not decreasing at all with any kind of over-the-counter medications or rest. If you're having any kind of loss of bowel and bladder function that's associated with weakness in the legs, that would be a more urgent thing. If you're having weakness, numbness, tingling in the arms or legs, that would be something that would prompt you to see a neurosurgeon.

And then if it's associated with other things that are more concerning, such as fevers or having weight loss that you're not intending. So if you're having that associated with the back pain and the neck pain, those would be things that, to me, I consider red flags.

If you're having symptoms that sound like they're related to the nerves, that also would be something that would drive me to have that patient seek the care of a neurosurgeon. So what I mean by that is symptoms that are going down the arms or the legs, if you're having low back pain and you're having numbness or tingling that is going down the leg to can be above the knee or to below the knee, or if you're having oftentimes it can be sharp shooting pain that radiates down into the buttocks and down the back of the legs into the calf or into the feet, that's what people oftentimes refer to as sciatica.

Those would be nerve type symptoms. When it's related to the neck or cervical spine, it can be associated with numbness or tingling going down the arms, uh, even pain going into the shoulders or upper part of the arms. Those would be other symptoms that to me, uh, tell me that there's some irritation or inflammation of the nerves, and that would be something you'd want a neurosurgeon to evaluate.

Scott Webb: Let's talk about the treatment options. Uh, you and I were talking before we got started today, that there's just such a range of nonsurgical and surgical options. So let's take people through those.

Dr. Samuel Borsellino: As far as non-surgical options, you know, as I mentioned, when you have neck pain or back pain, a lot of the times this will be something that's self-limited that can go away on its own.

One way to look at it is that if you have an acute episode of something like this, just maybe doing some restriction of activity and over-the-counter medications, maybe reasonable to do, uh, initially. So in a sense, maybe taking it easy for a few days, that would be one option.

People will ask me about ice or heat and "When should I use ice" or "should I use ice? Should I use heat?" The general teaching for this is that generally in the first 48 hours or so, ice is probably more reasonable. What it does is it helps try to cut down swelling and inflammation. After 48 hours, some people feel that, you know, trying heat is also of benefit. The heat is thought to increase the blood flow, to try to heal.

Common things that we would try that are nonsurgical, uh, would the over-the-counter medications, anti-inflammatory type medicines, uh, what we call the NSAIDs, which would be ibuprofen, Motrin, Aleve, these types of medications. And I usually tell people maybe just trying it for at least a few days. If you try just one pill, it may not really do much. So I usually try to have people, uh, do this for at least a few days. One of the side effects you do have to watch for, the most common thing is GI upset. And so usually I'll have, uh, the patients try that with some food when they take that. Other medications common would be Tylenol, aspirin. The Tylenol has a little bit less chance of causing the GI upset-type of side effects.

Another option that we can do nonsurgically would be physical therapy. What I tell patients this is mostly we're working with a physical therapist and it's focusing on strengthening and stretching, and this can help the symptoms quite a bit.

One other thing I was going to mention was, uh, injections. And generally these injections are usually using some type of steroid medication that's injected by a needle. One of the common ones you might hear about is called epidural steroid injections. So this is an injection that is going down by the spine to try to help cut down inflammation. It's similar to taking a steroid pill by mouth, but it's putting it directly down by where the problem is. I always do tell patients that there's a small risk with something like that, because it is a needle going into the body, but it's small.

And then other things I wanted to talk about just that I think is important is, you know, weight loss, which is not something that happens right away. Uh, but this is something that can help in the long-term for pain by taking stress off the spine. The other thing that I think is very important to mention is if you're a smoker, smoking cessation is definitely something that can help. And I tell my patients that my belief is that smoking tends to make all pain worse. And so addressing that can definitely help the symptoms.

Scott Webb: Yeah. Good to know. There are lots of non-surgical options. So now let's talk about the surgical options.

Dr. Samuel Borsellino: Speaking generally, the surgeries that we do in neurosurgery are generally surgeries that are taking the pressure off of nerves. So what we call nerve compression and that's causing a lot of the symptoms. So our surgeries address, uh, taking the pressure off the nerves. The other thing that the surgery can sometimes do is help stabilize the spine.

From a general standpoint, those are options, but they really do vary and I always tell people, although many people have problems that are related, they are very individual for what the problem is for each patient.

And we do have minimally invasive options. That's been a trend in surgery, to make incisions smaller and with less injury to the soft tissues and muscles. I just wanted to mention one other technology that we have, which is a newer technology in the last 10 years or so, it's called spinal navigation. And before we had this technology, when uh, implants were placed into the spine, such as, for example, a screw going into the bone, we relied more on x-ray guidance, or even just the surgeon knowing the anatomy.

This technology is really great. And what it does is it allows us to place implants into the spine with a lot more accuracy. So I tell patients that it's kind of like a GPS for the spine. It allows us to go exactly into the place we want to be. And this is important because if you're placing a screw into the bone and it happens to be slightly off, it can break through the bone and be pushing on a nerve and that can be a problem. So I just wanted to mention that technology, which is one that I use all the time now and helps us to do these surgeries safer and with a better outcome.

Scott Webb: Doctor, as we get close to wrapping up here, let's talk just a little bit about virtual visits, telehealth during the pandemic. How has that gone for you? Is that working? Are you able to review MRI results and at least do initial consultations with people? How's that going for you?

Dr. Samuel Borsellino: Yeah, I think it's going very well. We are able to do telehealth visits and review imaging. I used to think before the COVID-19 pandemic that for most of what I did, we really needed to see the patient in person, we really couldn't do a lot over the phone. And I think it's actually the opposite, that we've learned that through this pandemic, that especially because of the nature of what I do, that it is very dependent on the imaging that we have, we can certainly evaluate patients by phone, uh, by telehealth visits, hear what their symptoms are, hear what's going on, review the imaging if there is imaging and then have a better idea of maybe one patient, you know, is someone who would benefit from a non-surgery options or sending for physical therapy even without seeing them in person. Another patient we may look at and talk to on the phone and see what the imaging looks like and say, "No, this is something kind of more urgent or it looks like something more where surgery is the road that we would go down probably."

So, I've even during the pandemic had patients who had more urgent issues that I was hearing about through telehealth through the phone. And when I did have concerns that something more urgent was going on, I would just actually direct them to go to the hospital because it really needed to get taken care of. So even though things can be urgent, we can even triage them, you know, through telehealth.

Scott Webb: Doctor, so great having you on today. Anything else we can tell listeners?

Dr. Samuel Borsellino: Uh, well, I want people to know that we have options and we have options today that we didn't even have in the past. We have very good imaging techniques now with MRI and CAT scan that give us, um, very detailed pictures of the anatomy. And we have very advanced technologies that allow us to do the surgeries with more safety and more efficacy than we did in the past. I want people to go away with the, uh, knowledge, uh, that neurosurgery has continued as medicine has to progress technologically and from a knowledge standpoint, and that we have solutions to people's problems and that we have a lot of options to help people.

Scott Webb: Yeah, it does sound like there are a lot of options. Doctor, thanks so much for your time today and you stay well.

Dr. Samuel Borsellino: Okay. Thank you very much, Scott. Appreciate you having me

Scott Webb: For more information on neurosurgery at Summa Health, call 330-576-3500 or go to SummaHealth.org/neuro. And if you found this podcast to be helpful and informative, please share it on your social channels and to check out the entire podcast library for additional topics.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

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