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Backaches May Be in Your Genes


But if unrelenting back pain is already part of your life, what can you do right now?

Tremendous progress has been made in the last 15 years in understanding "how the spine works from a mechanical standpoint, how the muscles and joints work -- as well as understanding the mechanisms of pain, what seems to cause back pain," Biscup tells WebMD.

The spine is complicated because the muscles, bones, ligaments, spinal cord, and nerves all are a very intimate part of the anatomy in that area, explains Biscup.

"Degenerative spine disease is responsible mostly for back pain, and that in itself can be quite incapacitating. But when the nerves become involved, then patients experience severe leg pain, leg numbness, severe weakness ... and there can be combined problems, ... tremendous back pain because of spinal degeneration and nerve pain because of pinched nerves."

The two most commonly treated conditions that cause back pain are herniated disk and spinal stenosis, which occurs when the lower end of the spinal column becomes narrowed and compressed, squeezing the spinal cord or spinal nerves.

In the past, these conditions were treated with aggressive, major surgeries, requiring large incisions to expose the back side of the spine and remove a considerable amount of the spine's bony covering as well as muscle ligaments -- a procedure called a laminectomy.

Although laminectomy takes pressure off the nerves and relieves the severe leg pain and symptoms, says Biscup, "the spinal degeneration that caused the condition in the first place is still there and continues to progress to some degree. [Surgery] doesn't solve the problem, but treats fairly severe symptoms of the underlying spinal degeneration problem."

Microsurgery is the best treatment to date and has been available for 12 or 13 years, says Biscup. "But not all surgeons do microsurgeries," he says.

Microdiscectomy treats herniated disk and microdecompression is for spinal stenosis. Both of these minimally invasive procedures, which involve a 1-inch incision and use a laser and special scope, are done as outpatient surgery under a local anesthetic -- so patients go home the same day.

In microdiscectomy, the soft tissues causing pressure on nerves are gently removed using lasers, and 90% to 95% of the time patients have complete relief, Biscup tells WebMD. Microdecompression involves lasers to remove painful bone as well as the very thick ligament that is pinching the nerves; 90% of the time patients are relatively pain-free afterward.

"These procedures are very, very effective," says Biscup. People return to "normal lifestyles in a relatively quick period of time."



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