Bone on bone

In this video, Dr. Castanet will show you the x-rays of a 60+-year-old, female, Asian patient who came to him stating that she wanted to avoid surgery which was scheduled in about 6 weeks. She wanted to know if he could help her avoid surgery, and she said that the surgeon said her vertebrae were “bone-on-bone”.

You will see in the video that she has disc collapse at L4-5 and L5-S1, i.e. two levels. If she gets surgical treatment, it will have to be a two-level fusion to restore the height of her spine at those two levels. This is done by pulling the vertebrae apart and placing a plastic spacer between the bones to restore the normal height of the discs and to get some pressure off of her joints, which are a source of severe pain. This is an example of the decompressive nature of most spinal surgical procedures. Whether a discectomy, laminectomy or fusion, spinal surgery usually involves the decompression of some tissues in the spine, hence relief of pain and improved function. This conceptual goal is also why non-surgical spinal decompression machines are the most effective non-surgical treatment for people with neck and back pain, as an alternative to surgical decompression.

The real question in non-surgical spine treatments is, can enough be done with non-surgical decompression to get this problem better, in this patient, at this time. The usual answer to that is, “yes”. But, in a specific person, it is not possible to say with certainty. We can only answer this question with some probability, given our population results.

Bone on bone

When I have a patient with this severe bone-on-bone, I will probably tell them what I told this lady. “I don’t know if I can help you, or if I can help you enough, but I can find out fast, within 2-6 treatments. Then she can decide if it is helping enough that she recovers to her satisfaction. Assuming that happens, we will still have to see if her improvement lasts long enough to be a reasonable alternative to surgical fusion.

My job is to inform her as best I can about her options, so she can make reasonable choices about which treatment she wants to pursue. There are some occasions when I will encourage a patient to get surgery. There are many variables to consider in making this recommendation, but I am not a biased physician, except to the patient’s best interest.

If I can help you with your back or neck problem, please call me at 404-558-4015.