SpineUniverse spoke with Douglas Won, MD, a minimally invasive spine surgeon. Here Dr. Won answers our questions that many patients ask. And, if you think because he is a surgeon the only treatment he recommends is surgery, you’d be wrong.

What do you tell patients who experience back pain?

Dr. Won:
If the patient did not sustain a significant injury (eg, fall, automobile accident), but simply developed back pain—a common occurrence, such as a “weekend warrior”—most likely they will improve on their own. I may recommend an oral over-the-counter (OTC) anti-inflammatory drug combined with light stretching after a brief period of rest. Although rest may help relieve back pain, days of bed rest should be avoided. Rather, I want the patient to be as active as possible.

If back pain doesn't go away or worsens, the patient should see their healthcare provider, such as their primary care physician (PCP). The patient’s PCP may recommend an OTC or prescription anti-inflammatory medication, physical therapy, and/or chiropractic treatment. If symptoms do not improve, a referral to physical medicine rehabilitation (physiatrist) or pain management specialist is recommended before a surgical consultation.

Even the patients we evaluate in our spine center, over 95% are treated without surgery. Most patients get better with a short course of over-the-counter anti-inflammatory agents, ice, and a brief period of rest followed by stretching and moderate exercise.

When do you typically recommend spine surgery?

Dr. Won:
Keep in mind—of the approximately 5% of patients who need surgical treatment—very few require urgent spine surgery.

Most patients are treated with conservative treatments, such as spinal injections and organized physical therapy. If a course of conservative treatment does not improve the patient’s symptoms, and/or neurologic problems co-exist or develop with back pain, then a surgical recommendation may be considered. By “neurologic problems," I mean back pain that travels into a leg, numbness, tingling sensations, and/or weakness.

Can all spine surgical procedures be performed using minimally invasive techniques?

Dr. Won:
Most spine surgeries can be performed using minimally invasive techniques and different approaches to the spine (eg, approach the spine from the front, back, or side of the body).

Please explain how minimally invasive spine surgery can spare traumatic injury to muscles and soft tissues.

Dr. Won:
The most important benefit of the minimally invasive surgery is not necessarily the size of the incision, but rather how we approach the spine, and the ability to preserve the soft tissues and supporting structures. Among the important structures are the muscles, tendons, and ligaments—especially the multifidus muscles—strong muscles that support the spine.

Minimally invasive (MIS) surgical techniques allow surgeons to spare muscles instead cutting through muscles or stripping them away from the spine’s bones. During a MIS procedure, special small instruments separate soft tissues, such as the multifidus muscle(s), sparing injury to soft supporting tissue that maintains spinal stability.