Beating back pain

Greg Marshall didn’t think much of the tumble he took during a City League basketball game several years ago.

He assumed the back pain, which soon radiated down his leg, would go away on its own.

“But it didn’t,” says Marshall, 36, a Spokane father of two who is a trainer for the federal agency that regulates credit unions.

A buddy urged him to see a neurosurgeon. An MRI discovered a ruptured disc in his lower back, with some fragments of the disc in his spinal cord.

He never imaged having back surgery before his 30th birthday, but he had little choice.

“I really needed to have it done,” he says. “I couldn’t walk without pain or drugs.”

Marshall would eventually require three surgeries to relieve the pain and get back to his active lifestyle. Nevertheless, he considers himself a back-surgery success story.

“My back feels really great,” he says. “I don’t have any back pain. … I’m glad I went through all of the surgeries; I learned a lot.”

Despite the surgical horror stories of decades past, more and more people who go under the knife for back procedures end up happy with the results, experts say.

“What has changed No. 1, across the board, is the less-invasive nature of the surgery that’s used,” says Dr. Jeffrey Larson, a neurosurgeon with Coeur d’Alene Spine and Brain. “The whole process of evaluation and treatment has been refined.”

Doctors are now better at determining the small percentage of patients who would benefit from surgery, Larson says. And once they get those patients into the operating room, they are able to use better anesthesia, smaller incisions and improved instruments, he says.

Patients undergo back surgery to correct two basic problems – either to relieve pressure on a nerve or stabilize an area of the spine that’s moving when it shouldn’t be.

Often, physical therapy, injections or other treatments can be used to avoid surgery.

“The body’s good at healing these things,” Larson says. “But when that doesn’t happen, that’s when surgery is considered.”

Marshall went home to recover from that first surgery, but then he noticed pain creeping up in different spots. A steroid shot helped temporarily, but didn’t last long.

He learned that the disc just below the one fixed in the original surgery was now bulging and in need of repair. So, he had the second operation.

In an unfortunate déjÀ vu, he returned home to find he was still in pain. He was depressed to think he might need surgery again.

“”I didn’t think I was going to be able to do all the things I enjoy doing,” he says.

In May of 1999, not six months after the second surgery, he returned to the operating room to have part of his spine fused.

It’s not uncommon, doctors say, for people with back problems to need more than one surgery.

“I would still say back pain is still a very difficult thing to treat,” says Dr. Benjamin Ling, a neurosurgeon with Spokane’s Inland Neurosurgery and Spine Associates. “The primary take-home message is, despite improvements, back surgery for primary back pain is still a difficult undertaking.”

With something as serious as back surgery, it makes sense to seek a second opinion, Larson says.

“Be careful about gimmicks,” he says. “And don’t Internet shop for your back.”

Marshall had titanium rods filled with bone material implanted in his spine. As the bone grew, it fused his discs.

He’s back to playing basketball at least once a week and enjoys fly fishing when he has the time.

While he credits the surgeries with helping to relieve his pain, he’s taken responsibility for taking good care of himself in the years since.

“I learned I was very, very inflexible,” Marshall says. “I couldn’t bend and touch my knees. Now I stretch every day, and I can touch my toes.”

Doctors say it’s important for those who have undergone back surgery to maintain a healthy weight and work on strength and flexibility.

“You definitely have to maintain your core-muscle strength,” Ling says. “The spine is not a stand-alone structure.”