Back Pain Identification
Dr. Walter Jacobsen practices Neurological Surgery in Milwaukee, WI. As a Spinal Neurological Surgeon, Dr. Jacobsen prevents, diagnoses, evaluates, and treats disorders of the autonomic, peripheral, and central nervous systems. Dr. Jacobsen specializes in Spinal deformity surgery, Scoliosis, Minimally invasive spine... more
Back pain is one of the most common conditions affecting Americans each year. It is estimated that 80-90 percent of our population will experience back pain significant enough to interfere with their daily life at least once in their life, and many of these patients will seek medical care for this pain. Many of these patients will recover from an acute episode of back pain with conservative care, such as oral anti-inflammatories, rest, massage, physical therapy, and chiropractic care, but some will develop chronic nagging pain that requires more aggressive treatment.
Back pain is defined as chronic if it lasts longer than 12 weeks, and can last much longer than that, at times interrupting patients’ lives for years, limiting their activity and ability to enjoy life. These are the patients in desperate need of thorough evaluation including obtaining a detailed patient history, physical exam, and diagnostic imaging including MRI, dynamic X-ray, and CT scan among others to identify the pain generator or generators. This initial evaluation can identify serious conditions of spinal instability, severe spinal stenosis, spinal deformity, and spondylolisthesis of the spine, all of which can lead to back pain. These conditions though represent the minority of patients with acute and chronic back pain, and we often need to more deeply investigate each patient’s condition.
When the diagnosis of a patient’s pain generator is not clear based on imaging and physical exam alone, further investigation requires a complete “spine team” approach for evaluation. In this scenario, we use physical exam and imaging findings to direct targeted physical therapy and very specific diagnostic injections to help elucidate the origin of each patient’s pain. Each patient’s condition is truly unique and needs to be evaluated as such. Our program utilizes each teammate's expertise to identify targets for treatment. I, the spine surgeon work with interventional pain specialists, chiropractors, physical therapists and physiatrists work together to identify damaged spinal segments and then determine the appropriate treatment for that pathology.
In my opinion, the most important job that we have as spine surgeons is correctly diagnosing a patient and identifying their pain generator using all of the above-listed techniques rather than just imaging alone. It is only after the correct diagnosis has been confirmed that treatment options are available. Treatment for these conditions can vary based on diagnosis and can be a combination of pain management with intervention, physical therapy, chiropractic care, massage, acupuncture, and in some cases surgical correction. Confirming the correct diagnosis is also essential to limit or prevent failure in treatment and surgical failures.
