Biographical Sketch
Dr. Coran is an Orthopedic Spinal Surgeon. He is a graduate of the University of Michigan Medical School and the Harvard Combined Orthopedic Program. He has also had Fellowship training in the special fields of Pediatrics and Spinal Surgery. His practice is devoted to the care of patients of all ages with spinal problems. When not practicing medicine, Dr. Coran enjoys golf, skiing and running.
Introduction
Injuries of the back and neck are one of the most frequent reasons for doctor visits in the United States. Back and neck problems can occur in everyday life during work or recreational activities. Back and neck problems can be acute or chronic problems. Trauma including falls or twisting accidents can cause acute back and neck injuries, while chronic problems can recur without any precipitating event.
Understanding common back and neck problems is the first step for the prevention and treatment of these injuries but can occur during outdoor recreational activities.
People with chronic back and neck problems should be thoroughly evaluated and treated by a health care professional before participating in new outdoor recreational activities. Preexisting conditions of the spine may become aggravated during outdoor recreation, and symptoms of back pain and neck pain can return during participation in outdoor recreational activity.
When back and neck injuries occur for the first time with outdoor recreational activity, it is important to have a basic knowledge of the different types of injuries to the spine so that appropriate treatment can be initiated.
The most common types of neck and back injuries are:
- Sprains and strains.
- Disc herniations.
- Fractures.
Sprains and Strains are the most common types of injuries to the neck and back. A sprain or strain typically occurs with heavy lifting, twisting and repetitive bending activities. Bending at the waist level will commonly effect the lumbar (lower) back, while overhead lifting and repetitive bending of the neck are common causes of cervical (neck) sprains.
A sprain or strain injury usually involves a stretch or partial tear of a muscle, tendon and/or ligament, which support the lumbar or cervical spine.
Symptoms of sprains and strains of the neck and back include:
- Pain sensation, which is dull and aching.
- Pain localized to the neck or low back.
- There is no radiation of pain or numbness into the arms or legs.
- Severe pain with spasms of the muscles and difficulty walking may occur.
The treatment of a sprain or strain is:
- Ice locally for the first 24 hours.
- Nonsteroidal anti-inflammatory medications (such as aspirin or ibuprofen).
- Local heat after the first 24 hours.
- Maintain activity – avoid bed rest.
- No surgery.
Disc Herniations of the cervical or lumbar spine are less common than sprains and strains but can occur from the same types of activities. Repetitive bending, lifting, twisting and overhead activity can lead to disc herniations. The continuous jarring of the spine, which occurs with running or bouncing on outdoor recreational vehicles can also lead to disc injuries and herniations.
When a disc herniation occurs in the cervical or lumbar spine, the spinal cord or nerve roots can be effected. The disc structures are between the vertebrae (bones) of the spine and are in front of the nerve structures. When a disc herniates, it can apply pressure to the adjacent neural structures and lead to serious consequences.
Disc herniations in the cervical (neck) area can be the most serious due to the location of the spinal cord at this level. The spinal cord carries nerves to both the arms and legs, and an injury to the spinal cord can lead to paralysis. More typically, only a single nerve root is effected with a disc herniation and symptoms are limited to the neck and arms.
Disc herniations in the lumbar spine (lower back) typically affect the nerve roots, which supply the legs. The symptoms of numbness or weakness in either the arms or legs are signs of neurological problems that suggest a more serious injury than a simple sprain or strain.
The symptoms of disc herniations in the neck or lower back include:
- Severe pain, which can radiate from the neck or lower back into the arms or legs.
- The pain can be severe, and walking or even sitting can be very difficult.
- Numbness or tingling in the arms or legs can occur frequently.
- Less commonly, weakness or even paralysis (inability to move the arms or legs) can occur.
- Changes in bowel or bladder function can rarely occur and represent medical emergencies.
The treatment of disc herniations initially is identical to that for sprains and strains unless there are associated “red flags”.
The “red flag” warning signs of a serious problem include:
- Difficulty emptying the bladder or controlling bowel movements, which could represent severe neurological injury.
- Associated weakness of the arms or legs, which can progress to frank paralysis, also requires immediate medical attention.
SURGERY is done when disc herniations cause one of the red flag warning signs above. The warning signs lead to further investigations by a physician including plain x-rays and MRI studies of the injured area of the spine. The findings of large disc herniations pressing on the nerves or spinal cord would lead to a surgical procedure.
Surgery consists of removing the disc herniations, which then relieve the pressure on the neural structures. This is usually done by removing a small portion of bone from around the spine to gain access to the spinal canal where the disc herniation has occurred.
Microsurgical and minimally invasive techniques have lead to smaller incisions and faster recoveries for patients.
Even if there are no “red flags”, medical attention should be sought if the pain persists for more than seven (7) days despite simple treatment measures.
Fractures (Broken Bones) of the neck and back can occur with significant trauma such as falls from heights or high-speed outdoor recreational activities such as skiing. Whenever a fracture of the spine is suspected, immediate medical attention should be obtained to stabilize the injuries and prevent further damage to neurological structures. A person with a suspected fracture should not be moved until experienced medical personnel are available to evaluate the situation and stabilize the spine appropriately.
SURGERY is done when severe fractures occur. A patient with a fracture who is brought to medical attention requires extensive x-rays of the entire spine to look at the injured area as well as any associated injuries, which can occur in other regions of the spine when significant trauma occurs. Other medical problems can also occur with spine fractures including injuries to the internal organs of the chest and abdomen. These regions are also carefully evaluated with x-rays and CAT scans. A CAT scan provides a three-dimensional image of the internal structures and organs of the body.
When fractures are severe and become “unstable”, surgery is performed to fuse the unstable spine. Fusions often include the placement of metal screws and rods along the spine to support the fracture. If there is associated neurological injury from the fracture and associated bone or disc fragments, these are removed at the time of surgery as well. Recovery is variable and depends on the severity of the injury.
Summary
Injuries of the neck and back are common with many outdoor recreational activities. They can be preexisting chronic problems, which become aggravated by outdoor activity. They can also occur for the first time during outdoor activities. The types of injuries range from minor sprains and strains to severe disc herniations or fractures. Fortunately, most injuries are minor and self-limiting.
Understanding how these injuries occur and how to recognize them when they occur can provide a basic background for treatment.
Being aware of the “red flags” of spinal injuries can prevent serious consequences from occurring.
Being involved in outdoor recreational activities is beneficial for a person’s physical well-being.
