What’s the next step for osteoarthritis of the spine?
DEAR DR. ROACH: I’m 68 and have osteoarthritis all over -- neck, spine, hips, knees, shoulders, hands -- and all are getting worse. One hip was replaced two years ago, and my shoulder was replaced four months ago. Four years ago, X-rays showed arthritis in my spine and severe stenosis in lower lumbar (L4-L5). I’m at the point now where I can’t walk right, and it is affecting my relatively new hip.
I would like to see a back specialist, but I’m not sure who to see. A back surgeon will try to talk me into surgery and may not provide me with nonsurgical options. A chiropractor may cost me lots of money without solving any problems. Which is the most cost- and time-effective route to take? I’m really in pain. -- S.S.
ANSWER: The bad news first: We have no treatments that reverse, stop or even slow down the progression of osteoarthritis.
The good news is that there are some treatments, both surgical and nonsurgical, which may be able to provide you with relief. Before I go into those, let me assure you that there are many back surgeons, both orthopedic surgeons and neurosurgeons, who are very slow to operate and who only do so when other treatments have failed to provide adequate relief or when there is a clear indication for surgery, such as weakness that is progressing due to compression of the spinal cord or a nerve root. I know this because those are the surgeons I like to refer my patients to.
Let me also say that lower spine spinal manipulation, one type of treatment often used by chiropractic providers, osteopathic physicians and physical therapists, can improve pain levels and ability to function compared with several different types of treatments.
In my own practice, I will usually treat lumbar spinal stenosis pain initially with a combination of physical therapy and medication. Surgical consultation is indicated when a person’s pain is uncontrolled despite treatment, or when they are unable to do the things they need to do because of the pain, or the aforementioned weakness. My patients have also usually had a trial of epidural injections. These often fail, but some patients have a very good response.
Anyone considering surgery for lower back pain due to arthritis should know that the benefits of surgery will fade over time as the arthritis progresses. Also, approximately 20% of people will require a second operation within eight years of the first. Finally, there are no guarantees: A few people will have worse pain after surgery and rare catastrophes occur. Surgery should only be considered when a person’s quality of life is poor due to the condition.
DEAR DR. ROACH: I have claustrophobia and cannot tolerate an MRI scan. My doctor has recommended biplanar full-body imaging (EOS). I saw a picture and am worried it will feel closed in. -- D.D.
ANSWER: The biplanar full-body imaging scanner is a room-size device that uses very low dose X-rays to make images of the entire body standing, with the ability to make two-dimensional and three-dimensional images. It is often used to evaluate skeletal issues, such as scoliosis or limb-length discrepancies.
Although the device is indeed large, it does not close completely, and most people with claustrophobia do not have problems with this type of scan, which lasts only about 20 seconds.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.