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Neurosurgery Grand Rounds
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Erica Bisson, MD, MPH Date Recorded
November 03, 2021
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Neurosurgery Grand Rounds
Speaker
Erica F. Bisson, MD, MPH Date Recorded
March 03, 2021
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Neurosurgery Grand Rounds
Speaker
Erica F. Bisson, MD, MPH Date Recorded
September 04, 2019
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Neurosurgery Grand Rounds
Speaker
Erica Bisson, MD, MPH Date Recorded
April 11, 2018
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Neurosurgery Grand Rounds
Speaker
Erica Bisson, MD, MPH Date Recorded
January 17, 2018
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Neck and back pain are common, but if you have…
Date Recorded
September 15, 2015 Health Topics (The Scope Radio)
Brain and Spine Transcription
Dr. Miller: Is it time to see a spine surgeon for your back and neck pain? We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope
Dr. Miller: Hi, I'm Dr. Tom Miller and I am here with Dr. Erica Bisson and she is a neurosurgeon in the Department of Neurosurgery here at the University of Utah. Erica, tell me a little bit about when it might be the right time for a person with neck or back pain to see a spine surgeon?
First Steps: Treating Neck and Back Pain at Home
Dr. Bisson: What I tell most of my patients is that getting neck or back pain is a very common entity. A lot of people go out and do a lot of yard work or do excessive sporting activities wake up the next morning and feel like they have, what's considered a 'crick in the neck' or have a low backache.
Again, most of that is muscular in nature. It can be muscle spasm or some inflammation. Most of that is treated with what we consider conservative measures. This means things like anti-inflammatory, some Motrin, some Aleve, exercise or rest. Everybody is a little bit different which is better. We tend to tell people not to do strict bed rest because that's counterproductive in getting the muscles to move. Then also you can do things like heat and ice, which also help.
Relieving Pain Without Surgery
Dr. Miller: Now, what percent of patients actually get better with those conservative treatments?
Dr. Bisson: I would tell you about 90-plus percent patients get better with just those things alone.
Dr. Miller: In a week? Two weeks? A month?
Dr. Bisson: Most patients get better within a few days, but it's not unreasonable to think that it may take up to two to four weeks to see improvement with those conservative things.
Dr. Miller: So I would think that many of these patients would be best served by seeing their primary care physician or someone like a physical therapist who could help them work through some of the pain issues.
When to See a Doctor for Back and Neck Pain
Dr. Bisson: Absolutely. In fact, that's what we would recommend is first maybe try some of these things at home on your own and then if it's not getting better go see your primary care because they can often help with some of the advanced treatments, again, not surgical, like physical therapy.
Dr. Miller: So for our listeners, should they also have the time they present with their neck or back pain, a study like an MRI that actually looks at their neck? Or a CT scan? What's your thought on that?
Dr. Bisson: Actually, an MRI, a CT scan and even simple X-rays are not indicated in somebody who simply has neck or back pain that we think is muscular in nature. Now, it's very important that when somebody sees their primary care and talks about these issues, that they be asked questions about any neurologic dysfunction, which we think of as maybe some numbness and tingling in the arms or legs or pain going down the arms and legs, bowel and bladder dysfunction. These are things that we consider red or yellow flags, or reasons that we would want to get imaging studies.
Dr. Miller: So bladder dysfunction would be the inability to urinate, I'm assuming. Is that what you mean?
Dr. Bisson: It is what I mean. We can have also urinary retention, which means you can't empty your bladder properly.
Dr. Miller: That would indicate a fairly serious back problem.
Dr. Bisson: Yes, it would.
Neck and Back Surgery: A Last Resort Treatment
Dr. Miller: Of the patients that end up seeing you, what percentage of those patients actually has surgery?
Dr. Bisson: Believe it or not, even as a surgeon, only about 10-15% of the patients that I see in my office go and end up having surgery.
Dr. Miller: So a great take-home message is that much of back pain, neck pain, can be cured with conservative measures. That's what we should focus on.
Dr. Bisson: Absolutely. In fact, I tell my patients even if they come to me with a problem that can be fixed with surgery, I still always try the maximum medical management. Meaning, all of the things I talked about, anti-inflammatories, physical therapy, maybe even some injections because I know that a good deal of those will get better without surgery. Even if I could do surgery, I tell my patients, "I'd rather you take credit for it than me take credit for it."
Dr. Miller: That's perfect. So basically, the majority of people with back and neck pain will get better in time. There are some worrisome signs and symptoms that relate to muscle weakness or numbness. Those folks should be seen rather urgently and imaging is unnecessary unless you have some of those very specific findings.
Dr. Bisson: Absolutely.
Dr. Miller: Thanks very much, Erica.
Announcer: thescoperadio.com is University of Utah's Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com
MetaDescription
Neck and back pain are common, but chronic aches and pains could send you into a worrisome frenzy about your health. A University of Utah Health surgeon recommends these other pain relief options before resorting to the extremes of neck or back surgery.
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Are you noticing a combination of neck or upper…
Date Recorded
September 15, 2015 Health Topics (The Scope Radio)
Brain and Spine Transcription
Dr. Miller: CSM. What is that? We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.
Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. Erica Bisson. She's a neurosurgeon and also specializes in spine surgery. What is CSM?
Dr. Bisson: CSM actually stands for Cervical Spondylotic Myelopathy, which is a lot of words, but let me just break it down. What it means is that your spinal cord is being pinched in your neck. When I say pinched, the canal is being narrowed and that causes spinal cord dysfunction. Essentially, the messages that are coming from your brain and going out to your arms and legs aren't getting there in a timely fashion.
Dr. Miller: Now, who gets that?
Dr. Bisson: So the average age for patients who have CSM is in the 50s and 60s. We do see older individuals as well, but this is a degenerative process. This is something that happens as we age.
Dr. Miller: Now, do you go in surgically and open the space around the spinal column in order to create room for it to operate and function?
Dr. Bisson: That's exactly what we do. So when we approach this surgically, our main goal is to give the spinal cord room to move. If you look at an MRI or an image of an individual who has CSM, often you see bone spurs and other abnormalities that are causing the narrowing of the spinal canal so we have to either remove the bone spurs or open up the bone in some way, shape or fashion to enlarge that spinal canal so that the spinal cord itself gets completely surrounded by fluid and has a cushion enabling it to move properly.
Dr. Miller: If a patient has spinal cord dysfunction or CSM as you've called it, what are the symptoms that they might have? How would they know if they have this particular problem?
Dr. Bisson: Well, I'll tell you, the symptoms can be a little bit vague. Having said that, there are specific questions that I tend to ask patients to try to better understand if they're having symptoms from spinal cord dysfunction. Things that we talk about are problems with balance, so patients often have balance difficulty, their walking doesn't feel quite right. The other thing that patients mostly complain of is dropping things or loss of hand strength. They also complain of loss of dexterity. You know, it's funny, some of my patients tell me, "I feel like I'm telling my hands to do something, but they're not just quite doing it." Other patients tell me, "You know, I go to pick up my pen or I go to pick up my change of the counter and it slips out because I'm not quite able to tell what I'm picking up. I'm not feeling or sensing it."
Dr. Miller: Sensation in their fingertips. But isn't that also a problem of aging? Don't we get a little bit of that with aging? How do you tell it apart?
Dr. Bisson: Great question. You absolutely . . . so all those things, balance, loss of hand strength can be a problem with aging. What I'll comment is that I often have people who come in and have an MRI and I'm trying to differentiate them. You know, nationally and internationally, we're trying to find some kind of measure or test where we can say, "Ooh. That's CSM for sure." We don't have that yet. People are inventing all sorts of tests and new techniques to try to understand that, but it's the constellation of symptoms together.
They also, patients, find that they, if you examine them their reflexes are a little brisk. That's something we call Upper Motor Neuron Disease. Or that they're having spinal cord problems so we see this thing called hyperreflexia or abnormal reflexes where their knee jerks or their arm jerks a little bit too much, relative to normal.
Dr. Miller: If you do reparative surgery on these patients, what's the chance of recovery from the symptoms that they have?
Dr. Bisson: Tom, that is a fantastic question. And historically, if you review all the literature, which I have done time and time again on this topic, we have always told patients that the ultimate goal of the surgery is to halt the progression of the disease. The natural history of this disease process is that patients will get worse over time. So when we intervene, we open up that spinal canal and give room with a hope that we stopped them from getting worse, not that we're going to improve . . .
Dr. Miller: . . . what's happened already.
Dr. Bisson: Exactly.
Dr. Miller: But there's a good chance the progression would cease.
Dr. Bisson: Yes, absolutely. And what I will also tell you is anecdotally, after having seen many, many patients through this, over the last many years that I've focused my career around this, I do notice improvement. And I constantly am amazed at the recovery that I see. So while I tell every single patient going into surgery, "My goal is to stop the progression," anecdotally I see improvement. And I see vast improvement, which is so encouraging for me.
Dr. Miller: Now, there are different approaches as I understand, we talked about this a little bit before. I mean do you tell patients that there is a best way to perform the surgery? Is that something that you talked to them about? Or do we even know that?
Dr. Bisson: That's a great question. I would tell you that in some patients there is an optimal way. When we approach the neck for spinal surgery, we can either come in through the front of the neck or from the back of the neck and each has its pluses and minuses. There are some patients that only can have surgery from the front because different issues with their neck, the alignment or how the neck is curved and there are some patients who are most appropriate for the back. The vast majority or a good majority of patients can actually do either way, front or back. That happens to be a question that PCORI, which is the Patient-Centered Outcomes Research Institute set up by the government and through the ACA funded a large study that we here at the University of Utah are participating in, looking at the answer to that exact question.
Dr. Miller: So this may tell us in the end whether one approach or the other, back or front is best?
Dr. Bisson: Absolutely and we're very much looking forward to that.
Announcer: thescoperadio.com in University of Utah Health Sciences radio. If you like what you heard, make sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com
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Dr. Erica Bisson talks about her medical…
Date Recorded
September 02, 2015
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Dr. Erica Bisson discusses various aspects of her…
Speaker
Erica Bisson, MD Date Recorded
November 11, 2014 Science Topics
Medical Education
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